Hypertonic Saline in Elevated Intracranial Pressure: Past, Present, and Future
Hypertonic Saline (HS) has been a proven and effective therapy and a safe alternative to mannitol in patients with increase intracranial pressure (ICP). We hereby present a case of 25-year-old women with intracranial bleed secondary to right parietal arteriovenous malformation. Patient underwent surgery for evacuation of hematoma and resection of arteriovenous malformation. Post- operative course was complicated by recurrent episodes of elevated ICP. She received total of 17 doses of 23.4% HS and 30 doses of mannitol with good outcome. Despite reluctance from some clinicians to use HS, hypertonic saline seems to be a safe ...
Source: Journal of Intensive Care Medicine - December 9, 2014 Category: Intensive Care Authors: Surani, S., Lockwood, G., Macias, M. Y., Guntupalli, B., Varon, J. Tags: Analytic Reviews Source Type: research
Reversing the Effects of Antiplatelet Agents in the Setting of Intracranial Hemorrhage: A Look at the Literature
Patients are increasingly being prescribed antiplatelet agents (APAs) for a growing number of medical and surgical conditions. These agents are associated with an increased risk of hemorrhage, including intracranial hemorrhage (ICH). In the setting of warfarin use and ICH, strategies to reverse the drug effects have improved outcomes. No such strategy exists for APAs, and these patients continue to have poor posthemorrhage outcomes. One strategy is the use of platelet transfusions to provide functional, circulating platelets. Studies have shown mixed results regarding the benefit of this practice. Other strategies include ...
Source: Journal of Intensive Care Medicine - December 9, 2014 Category: Intensive Care Authors: Jaben, E. A., Mulay, S. B., Stubbs, J. R. Tags: Analytic Reviews Source Type: research
Fever After Rewarming: Incidence of Pyrexia in Postcardiac Arrest Patients Who Have Undergone Mild Therapeutic Hypothermia
Conclusion:
Among a cohort of patients who underwent mild TH after OHCA, more than half of these patients developed pyrexia in the first 24 hours after rewarming. Although there were no significant differences in outcomes between febrile and nonfebrile patients identified in this study, these findings should be further evaluated in a larger cohort. Future investigations may be needed to determine whether postrewarming temperature management will improve the outcomes in this population. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - October 29, 2014 Category: Intensive Care Authors: Cocchi, M. N., Boone, M. D., Giberson, B., Giberson, T., Farrell, E., Salciccioli, J. D., Talmor, D., Williams, D., Donnino, M. W. Tags: Original Research Source Type: research
The Prevalence and Impact of Mortality of the Acute Respiratory Distress Syndrome on Admissions of Patients With Ischemic Stroke in the United States
Conclusion:
Our analysis demonstrates that ARDS is rare after AIS. Despite an overall significant reduction in mortality after AIS, ARDS carries a higher risk of death in this patient population. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - October 29, 2014 Category: Intensive Care Authors: Rincon, F., Maltenfort, M., Dey, S., Ghosh, S., Vibbert, M., Urtecho, J., Jallo, J., Ratliff, J. K., McBride, J. W., Bell, R. Tags: Original Research Source Type: research
The Effect of the Pressure-Volume Curve for Positive End-Expiratory Pressure Titration on Clinical Outcomes in Acute Respiratory Distress Syndrome: A Systematic Review
Conclusion
This analysis supports an association that ventilator management guided by the PVC for PEEP management may augment survival in ARDS. Nonetheless, only 3 randomized trials have addressed the question, and the total number of patients remains low. Further outcomes studies appear required for the validation of this methodology. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - October 29, 2014 Category: Intensive Care Authors: Hata, J. S., Togashi, K., Kumar, A. B., Hodges, L. D., Kaiser, E. F., Tessmann, P. B., Faust, C. A., Sessler, D. I. Tags: Review of a Large Clinical Series Source Type: research
Retrospective Computed Tomography Mapping of Intrapleural Air May Demonstrate Optimal Window for Ultrasound Diagnosis of Pneumothorax
Conclusion:
The CT scans demonstrate that intrapleural air most often collects along the mediastinum between ribs 3 and 6 on either side of the chest. Although no USs were performed in this retrospective study, one may infer that a parasternal approach along rib interspaces 3 to 6 is an easy and sensitive window to diagnose pneumothorax with US. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - October 29, 2014 Category: Intensive Care Authors: Kiley, S., Tighe, P., Hajibrahim, O., Deitte, L., Gravenstein, N., Robinson, A. Tags: Review of a Large Clinical Series Source Type: research
Common Anorectal Disorders for the Intensive Care Physician
This article will provide a brief review of anorectal anatomy, explain the proper anorectal examination, and discuss the current understanding and treatment concepts with regard to the most common anorectal disorders that the intensive care unit clinician is likely to face. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - October 29, 2014 Category: Intensive Care Authors: Bach, H. H., Wang, N., Eberhardt, J. M. Tags: Analytic Reviews Source Type: research
Massive Intravascular Hemolysis From Clostridium perfringens Septicemia: A Review
We describe the case of a patient with hemolysis-associated Clostridium perfringens septicemia and review all similar cases published in the literature since 1990, with specific focus on the relationship between treatment strategy and survival. We searched PubMed for all published cases of C. perfringens-associated hemolysis, using the medical subject terms "clostridia," "clostridial sepsis," and/or "hemolysis." All case reports, case series, review articles, and other relevant references published in the English literature since 1990 were included in this study. There were no exclusion criteria. Each case was examined wit...
Source: Journal of Intensive Care Medicine - October 29, 2014 Category: Intensive Care Authors: Simon, T. G., Bradley, J., Jones, A., Carino, G. Tags: Analytic Reviews Source Type: research
Modern Trends in Infection Control Practices in Intensive Care Units
This article reviews the modern trends in infection control practices to prevent HAIs in ICUs with a focus on methods for monitoring hand hygiene, updates in isolation precautions, new methods for environmental cleaning, antimicrobial bathing, prevention of ventilator-associated pneumonia, central line-associated bloodstream infections, catheter-associated urinary tract infections, and Clostridium difficile infection. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - October 29, 2014 Category: Intensive Care Authors: Gandra, S., Ellison, R. T. Tags: Analytic Reviews Source Type: research
A Patient With Trauma Having Cavitary Pulmonary Nodules: Should Further Workup be Pursued?
Conclusion:
The TPPs may be discovered on imaging shortly after blunt chest trauma and, in asymptomatic individuals, can often be monitored with observation and serial imaging. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - September 5, 2014 Category: Intensive Care Authors: Patel, D., Kamangar, N. Tags: Case Reports Source Type: research
Fatal Case of Tension Pneumothorax and Subcutaneous Emphysema After Open Surgical Tracheostomy
We report a case of a surgical tracheostomy complicated with fatal tension pneumothorax and subcutaneous emphysema secondary to an iatrogenic posterior tracheal wall laceration. This complication is barely seen in usual practice, and its recognition and aggressive therapy may avoid fatal outcomes. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - September 5, 2014 Category: Intensive Care Authors: Gupta, P., Modrykamien, A. Tags: Case Reports Source Type: research
Mutual Agreement Between Providers in Intensive Care Medicine on Patient Care After Interdisciplinary Rounds
Conclusions:
The recommendation of IDRs without mutual agreement in important aspects of patient care hampers safety in daily practice. This study demonstrates that a survey to determine this agreement between the intensivists, junior physicians, and ICU nurses has low agreement, as measured directly after the IDRs. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - September 5, 2014 Category: Intensive Care Authors: Have, E. C. M. T., Nap, R. E. Tags: Original Research Source Type: research
Impact of Nurse Integrated Rounds on Self-Reported Comprehension, Attitudes, and Practices of Nurses and Resident Physicians in a Pediatric Intensive Care Unit
Conclusions:
The NIRs are well accepted by nurses and physicians and are accompanied by self-reported improvements in comprehension, attitudes, and practices of nurses and RPs in the PICU. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - September 5, 2014 Category: Intensive Care Authors: Kalyanaraman, M., McQueen, D., Sykes, J. A., Mikkilineni, S., Aizley, C., Kelly, M. J., Wiggins, M. Tags: Original Research Source Type: research
Critical Care in Patients Undergoing Lumbar Spine Fusion: A Population-Based Study
Conclusions:
Approximately, 10% of the patients undergoing lumbar spine surgery require CCS. Utilizing the present data, critical care physicians and administrators can identify patients at risk, educate clinical staff, identify targets for intervention, and allocate resources to meet the needs of this particular patient population. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - September 5, 2014 Category: Intensive Care Authors: Memtsoudis, S. G., Stundner, O., Sun, X., Chiu, Y.-L., Ma, Y., Fleischut, P., Kerr, G. E., Girardi, F. P., Walz, J. M. Tags: Review of a Large Clinical Series Source Type: research
Potassium Abnormalities in a Pediatric Intensive Care Unit: Frequency and Severity
Conclusions:
Mild potassium abnormalities are common in the PICU. Repeating hemolyzed hyperkalemic samples may be beneficial. Guidance in monitoring frequencies of potassium abnormalities in pediatric critical care is needed. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - September 5, 2014 Category: Intensive Care Authors: Cummings, B. M., Macklin, E. A., Yager, P. H., Sharma, A., Noviski, N. Tags: Review of a Large Clinical Series Source Type: research
