Managing the Complications of Mild Therapeutic Hypothermia in the Cardiac Arrest Patient
Mild therapeutic hypothermia (MTH) is used to lower the core body temperature of cardiac arrest (CA) patients to 32°C from 34°C to provide improved survival and neurologic outcomes after resuscitation from in-hospital or out-of-hospital CA. Despite the improved benefits of MTH, there are potentially unforeseen complications associated during management. Although the adverse effects are transient, the clinician should be aware of the associated complications when managing the patient receiving MTH. We aim to provide the medical community comprehensive information related to the potential complications of survivors o...
Source: Journal of Intensive Care Medicine - June 4, 2015 Category: Intensive Care Authors: Noyes, A. M., Lundbye, J. B. Tags: Analytic Reviews Source Type: research
Exogenous Vasopressin-Induced Hyponatremia in Patients With Vasodilatory Shock: Two Case Reports and Literature Review
We present 2 patients who developed hyponatremia within hours of initiation of vasopressin infusion. Extensive diuresis followed its discontinuation with subsequent normalization of serum sodium. One of the patients required the use of hypertonic saline for more rapid normalization of serum sodium due to concerns for potential seizure activity. A review of the literature relevant to the incidence of vasopressin-induced hyponatremia is provided as well as discussion on additional factors relevant to septic shock that should be considered when determining the relative risk of hyponatremia in patients receiving vasopressin. (...
Source: Journal of Intensive Care Medicine - June 4, 2015 Category: Intensive Care Authors: Salazar, M., Hu, B. B., Vazquez, J., Wintz, R. L., Varon, J. Tags: Analytic Reviews Source Type: research
Hypercalcemia in the Intensive Care Unit: A Review of Pathophysiology, Diagnosis, and Modern Therapy
Hypercalcemia may be seen in a variety of clinical settings and often requires intensive management when serum calcium levels are dramatically elevated. All of the many etiologies of mild hypercalcemia can lead to severe hypercalcemia. Knowledge of the physiologic mechanisms involved in maintaining normocalcemia and basic pathophysiology is essential for making a timely diagnosis and hence prompt institution of etiology-specific therapy. The development of new medications and critical reviews of traditional therapies have changed the treatment paradigm for severe hypercalcemia, calling for a more limited role for aggressiv...
Source: Journal of Intensive Care Medicine - June 4, 2015 Category: Intensive Care Authors: Maier, J. D., Levine, S. N. Tags: Analytic Reviews Source Type: research
Incretins: Player or Stayer?
(Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - April 20, 2015 Category: Intensive Care Authors: Deane, A. M., Horowitz, M. Tags: Commentary Source Type: research
Isolated Shortness of Breath in a Woman With a History of Hodgkin Lymphoma
Conclusion:
When treating a patient with a history of malignancy who presents with dyspnea, it is important to consider the downstream effects related to cancer treatments, even decades later, to guide specific therapies and to assuage the patient’s fears. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - April 20, 2015 Category: Intensive Care Authors: Clapham, K. R., Bhimani, R. D., Cooper, J. P., Stern, T. A. Tags: Case Report Source Type: research
Off-Label Use of Gastrointestinal Medications in the Intensive Care Unit
Conclusion:
The PPIs are the most widely used off-label medications in the ICU. Stress ulcer prophylaxis is the most common indication. The level of evidence supporting off-label GI medication use is poor. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - April 20, 2015 Category: Intensive Care Authors: Barletta, J. F., Lat, I., Micek, S. T., Cohen, H., Olsen, K. M., Haas, C. E., Critical Care Pharmacotherapy Trials Network Tags: Review of a Large Clinical Series Source Type: research
SpO2/FiO2 Ratio on Hospital Admission Is an Indicator of Early Acute Respiratory Distress Syndrome Development Among Patients at Risk
Conclusions:
The SpO2/FiO2, measured within the first 6 hours after hospital admission, is an independent indicator of ARDS development among patients at risk. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - April 20, 2015 Category: Intensive Care Authors: Festic, E., Bansal, V., Kor, D. J., Gajic, O., US Critical Illness and Injury Trials Group: Lung Injury Prevention Study Investigators (USCIITG-LIPS) Tags: Review of a Large Clinical Series Source Type: research
Glucose Metabolism in Critically Ill Patients: Are Incretins an Important Player?
Critical illness afflicts millions of people worldwide and is associated with a high risk of organ failure and death or an adverse outcome with persistent physical or cognitive deficits. Spontaneous hyperglycemia is common in critically ill patients and is associated with an adverse outcome compared to normoglycemia. Insulin is used for treating hyperglycemia in the critically ill patients but may be complicated by hypoglycemia, which is difficult to detect in these patients and which may lead to serious neurological sequelae and death. The incretin hormone, glucagon-like peptide (GLP) 1, stimulates insulin secretion and i...
Source: Journal of Intensive Care Medicine - April 20, 2015 Category: Intensive Care Authors: Nielsen, S. T., Krogh-Madsen, R., Moller, K. Tags: Analytic Reviews Source Type: research
Acute Coronary Syndrome
Acute coronary syndrome (ACS) is a major health care and economic burden in the United States and accounts for more than 1 million hospitalizations annually. The morbidity and mortality due to ACS are substantial—nearly half of all deaths due to coronary heart disease occur following an ACS. This review provides an up-to-date summary of the pathophysiology, diagnosis, and treatment of ACS. We also provide an overview of the management of common hemodynamic disturbances and myocardial infarction complications that physicians often encounter in an intensive care setting. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - April 20, 2015 Category: Intensive Care Authors: Makki, N., Brennan, T. M., Girotra, S. Tags: Analytic Reviews Source Type: research
Amiodarone-Induced Thyroid Dysfunction
Amiodarone is an effective medication for the treatment of cardiac arrhythmias. Originally developed for the treatment of angina, it is now the most frequently prescribed antiarrhythmia drug despite the fact that its use is limited because of potential serious side effects including adverse effects on the thyroid gland and thyroid hormones. Although the mechanisms of action of amiodarone on the thyroid gland and thyroid hormone metabolism are poorly understood, the structural similarity of amiodarone to thyroid hormones, including the presence of iodine moieties on the inner benzene ring, may play a role in causing thyroid...
Source: Journal of Intensive Care Medicine - April 20, 2015 Category: Intensive Care Authors: Danzi, S., Klein, I. Tags: Analytic Reviews Source Type: research
A Randomized, Double-Blind Pilot Study of Dexmedetomidine Versus Midazolam for Intensive Care Unit Sedation: Patient Recall of Their Experiences and Short-Term Psychological Outcomes
Conclusions:
Transitioning benzodiazepine sedation to dexmedetomidine when patients qualify for daily awakenings may reduce the development of delirium and facilitate remembrance of ICU experiences but may lead to manifestations of ASD. Monitoring hypotension is required for both the sedatives. Additional comparative studies focusing on the long-term impact of ICU recall and psychological outcomes are needed. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - January 30, 2015 Category: Intensive Care Authors: MacLaren, R., Preslaski, C. R., Mueller, S. W., Kiser, T. H., Fish, D. N., Lavelle, J. C., Malkoski, S. P. Tags: Original Research Source Type: research
Bronchoscopic Intubation During Continuous Nasal Positive Pressure Ventilation in the Treatment of Hypoxemic Respiratory Failure
We report a case series of 10 nonconsecutive patients with NIPPV failure who were intubated via a flexible bronchoscope during nasal mask positive pressure ventilation. All 10 patients were intubated in the first attempt. Hypotension was the most frequent complication (33%). Mean decrease in oxyhemoglobin saturation during the procedure was 4.7 ± 3.1. This method of intubation may extend the benefits of preoxygenation throughout the whole process of endotracheal intubation. It requires an experienced operator and partially cooperative patients. A prospective trial is necessary to determine the best intubation method...
Source: Journal of Intensive Care Medicine - January 30, 2015 Category: Intensive Care Authors: Barjaktarevic, I., Berlin, D. Tags: Original Research Source Type: research
The Effect of a Hypoglycemia Treatment Protocol on Glycemic Variability in Critically Ill Patients
Conclusions:
Implementation of the hypoglycemia treatment protocol described led to a reduction in glucose variability, while still providing a safe and effective way to manage hypoglycemia in critically ill patients. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - January 30, 2015 Category: Intensive Care Authors: Arnold, P., Paxton, R. A., McNorton, K., Szpunar, S., Edwin, S. B. Tags: Reviews of a Large Clinical Series Source Type: research
Mature Trauma Intensivist Model Improves Intensive Care Unit Efficiency But Not Mortality
Conclusions:
Our mature intensivists staffing model shows improvement in ICU throughput (ventilator days, ICU days, decreased consultant use, and increased bedside procedures) but no survival benefit. Further improvements in overall trauma mortality may lie in the resuscitative and operative phase of patient care. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - January 30, 2015 Category: Intensive Care Authors: Lee, J., Rogers, F., Rogers, A., Horst, M., Chandler, R., Miller, J. A. Tags: Reviews of a Large Clinical Series Source Type: research
Ethical Considerations in Consenting Critically Ill Patients for Bedside Clinical Care and Research
Care of critically ill patients, as in any other field, demands the exercise of ethical principles related to respect of patient’s autonomy, beneficence, nonmaleficence, and distributive justice. Professional duty and the common law require doctors to obtain consent before giving treatment or for requesting participation in clinical research. A procedure or research study must be adequately explained, and the patient must have the capacity to consent. If a patient does not have decision-making capacity, treatment must be given using alternative forms of consent or using principles of implied consent in emergency or l...
Source: Journal of Intensive Care Medicine - January 30, 2015 Category: Intensive Care Authors: Rincon, F., Lee, K. Tags: Analytic Reviews Source Type: research
