Thyroid Storm: An Updated Review
Thyroid storm, an endocrine emergency first described in 1926, remains a diagnostic and therapeutic challenge. No laboratory abnormalities are specific to thyroid storm, and the available scoring system is based on the clinical criteria. The exact mechanisms underlying the development of thyroid storm from uncomplicated hyperthyroidism are not well understood. A heightened response to thyroid hormone is often incriminated along with increased or abrupt availability of free hormones. Patients exhibit exaggerated signs and symptoms of hyperthyroidism and varying degrees of organ decompensation. Treatment should be initiated ...
Source: Journal of Intensive Care Medicine - January 30, 2015 Category: Intensive Care Authors: Chiha, M., Samarasinghe, S., Kabaker, A. S. Tags: Analytic Reviews Source Type: research
Transfusion-Associated Graft Versus Host Disease in the Immunocompetent Patient: An Ongoing Problem
Transfusion associated-graft versus host disease (TA-GVHD) is a rare complication of blood transfusion. It carries a very high mortality rate. Although the phenomenon has been well described in immunocompromised patients, this review focuses on the immunocompetent host. Cases of TA-GVHD continue to be reported following a variety of surgical procedures, especially cardiac procedures requiring cardiopulmonary bypass. Additional risk factors for TA-GVHD include blood component transfusion in populations with limited genetic diversity, the use of directed donations from family members, and the transfusion of fresh blood. As t...
Source: Journal of Intensive Care Medicine - January 30, 2015 Category: Intensive Care Authors: Jawa, R. S., Young, D. H., Stothert, J. C., Kulaylat, M. N., Landmark, J. D. Tags: Analytic Reviews Source Type: research
Successful Use of Extracorporeal Membrane Oxygenation in an Adult Patient With Toxic Shock-Induced Heart Failure
We report the case of a 51-year-old male who presented with profound cardiogenic shock and multiorgan failure that could not be managed by conventional therapy with intravenous fluids, vasopressors and inotropes. Venoarterial extracorporeal membrane oxygenation (VA ECMO) was instituted as a bridge to recovery. After administration of antibiotics and intravenous immunoglobulin, the patient’s condition improved and he was successfully weaned off ECMO after 6 days. The patient recovered from multiorgan failure, and left ventricular ejection fraction improved from <10% pre-ECMO to 65% 8 months after discharge. This ca...
Source: Journal of Intensive Care Medicine - January 9, 2015 Category: Intensive Care Authors: Gabel, E., Gudzenko, V., Cruz, D., Ardehali, A., Fink, M. P. Tags: Case Report Source Type: research
Brain Injury as a Risk Factor for Fever Upon Admission to the Intensive Care Unit and Association With In-Hospital Case Fatality: A Matched Cohort Study
Conclusion:
These data suggest that fever is a frequent occurrence after brain injury, and that it is independently associated with in-hospital case fatality. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - January 9, 2015 Category: Intensive Care Authors: Rincon, F., Patel, U., Schorr, C., Lee, E., Ross, S., Dellinger, R. P., Zanotti-Cavazzoni, S. Tags: Original Research Source Type: research
The Effect of Flow Trigger on Rapid Shallow Breathing Index Measured Through the Ventilator
Conclusions:
The RSBI measurement is significantly decreased by the base flow delivered through modern ventilators in the flow trigger mode. If RSBI is measured through the ventilator in the flow trigger mode, the difference should be considered when using RSBI to assess readiness for weaning from mechanical ventilation. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - January 9, 2015 Category: Intensive Care Authors: Kheir, F., Myers, L., Desai, N. R., Simeone, F. Tags: Original Research Source Type: research
Mortality Risk Prediction With an Updated Acute Physiology and Chronic Health Evaluation II Score in Critically Ill Obstetric Patients: A Cohort Study
Conclusions:
The APACHE II overestimates mortality in the sample population. The updated APACHE II model predicts mortality more accurately in the obstetric population. This formula may be useful in adapting the existing APACHE II to current mortality risk in obstetric critical care populations. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - January 9, 2015 Category: Intensive Care Authors: Paternina-Caicedo, A. J., Rojas-Suarez, J. A., Duenas-Castel, C., Miranda-Quintero, J. E., Bourjeily, G. Tags: Review of a Large Clinical Series Source Type: research
Do Clinical Parameters Predict First Planned Extubation Outcome in the Pediatric Intensive Care Unit?
Conclusions:
Physician judgment to determine extubation readiness led to a first planned extubation success rate of 91%. Age and the length of MV were primary risk factors for failed extubation. In patients with ≤1 day of MV, our findings suggest that confidence in extubation readiness following weaning to low ventilator rates may not be justified. Furthermore, reliance on preextubation ventilator settings and blood gas results to determine extubation readiness may lead to unnecessary prolongation of MV, thereby increasing the PICU LOS and excess cost. These findings are hypothesis generating and require further st...
Source: Journal of Intensive Care Medicine - January 9, 2015 Category: Intensive Care Authors: Laham, J. L., Breheny, P. J., Rush, A. Tags: Review of a Large Clinical Series Source Type: research
Granulocyte Transfusion Therapy
Bacterial and fungal infections continue to be a major cause of morbidity and mortality in severely neutropenic patients undergoing aggressive chemotherapy regimens or hematopoietic stem cell transplantation. Traditional granulocyte transfusion therapy, a logical approach in treating these infections, has been available for many years, and several controlled studies have shown this therapy to be useful. However, granulocyte transfusion therapy fell out of favor because the results were not clinically impressive, and adverse results were reported. These disappointing results were felt to be, in part, because of the low dose...
Source: Journal of Intensive Care Medicine - January 9, 2015 Category: Intensive Care Authors: Marfin, A. A., Price, T. H. Tags: Analytic Reviews Source Type: research
Intracerebral Hemorrhage in Patients Receiving Oral Anticoagulation Therapy
Intracerebral hemorrhage (ICH) in patients with oral anticoagulation therapy is an increasingly prevalent problem in large part due to the aging population and the increased use of anticoagulants for patients at high risk of thrombosis. Warfarin has been virtually the only outpatient anticoagulant choice until fairly recently. The development of subcutaneously injected heparinoids, and more recently, of direct thrombin inhibitors, has made the treatment and prognostication of ICH in anticoagulated patients more difficult. In this review, we will review the current state of diagnosis, prognostication, and treatment for pati...
Source: Journal of Intensive Care Medicine - January 9, 2015 Category: Intensive Care Authors: da Silva, I. R. F., Provencio, J. J. Tags: Analytic Reviews Source Type: research
Cocaine-Induced Agitated Delirium: A Case Report and Review
We report a case of cocaine-induced agitated delirium in a man who presented to our institution in a paradoxical form of circulatory shock. Rapid evaluation, recognition, and proper management enabled our patient not only to survive but also to leave the hospital without neurologic sequelae. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - December 9, 2014 Category: Intensive Care Authors: Plush, T., Shakespeare, W., Jacobs, D., Ladi, L., Sethi, S., Gasperino, J. Tags: Case Report Source Type: research
Video Laryngoscopy is Associated With Increased First Pass Success and Decreased Rate of Esophageal Intubations During Urgent Endotracheal Intubation in a Medical Intensive Care Unit When Compared to Direct Laryngoscopy
Conclusion:
The use of the VL for UEI performed by PCCM fellows is associated with a reduction in the rate of esophageal intubation and difficult endotracheal intubation when compared to the use of the DL. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - December 9, 2014 Category: Intensive Care Authors: Lakticova, V., Koenig, S. J., Narasimhan, M., Mayo, P. H. Tags: Original Research Source Type: research
Evaluation of a New Index of Mechanical Ventilation Weaning: The Timed Inspiratory Effort
Conclusion:
The TIE index performed better than the best weaning indices used in clinical practice. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - December 9, 2014 Category: Intensive Care Authors: de Souza, L. C., Guimaraes, F. S., Lugon, J. R. Tags: Original Research Source Type: research
Increasing Use of Less-Invasive Hemodynamic Monitoring in 3 Specialty Surgical Intensive Care Units: A 5-Year Experience at a Tertiary Medical Center
Conclusions:
In a 5-year period, the decreased insertions of PACs were replaced by increased utilization of less-invasive hemodynamic monitoring devices. This change in practice did not adversely impact mortality. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - December 9, 2014 Category: Intensive Care Authors: Kirton, O. C., Calabrese, R. C., Staff, I. Tags: Reviews of a Large Clinical Series Source Type: research
The Association of Serum Bilirubin Levels on the Outcomes of Severe Sepsis
Conclusion:
After multivariable adjustment for potential confounding factors, elevated serum bilirubin levels within 72 hours of admission are associated with an increased risk of mortality in patients with severe sepsis and septic shock. Prospective studies are warranted to further validate our findings. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - December 9, 2014 Category: Intensive Care Authors: Patel, J. J., Taneja, A., Niccum, D., Kumar, G., Jacobs, E., Nanchal, R. Tags: Reviews of a Large Clinical Series Source Type: research
Umbilical Cord Blood Transplantation: Review of Factors Affecting the Hospitalized Patient
The use of umbilical cord blood (UCB) as a stem cell donor source has dramatically increased over the last 2 decades. Patients undergoing UCB transplantation share medical management issues with patients receiving a hematopoietic stem cell transplantion using adult donor sources (peripheral blood stem cells or bone marrow stem cells) and may also have more complex medical issues that appear to be related to delayed immune recovery from UCB-derived stem cells. The interface with critical care providers is likely to occur in the transplant and posttransplant setting. Patients may experience UCB infusion reactions that range ...
Source: Journal of Intensive Care Medicine - December 9, 2014 Category: Intensive Care Authors: Delaney, M., Ballen, K. K. Tags: Analytic Reviews Source Type: research
