Respiratory Perioperative Management of Patients With Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) has become a major public health problem in the United State and Europe. However, perioperative strategies regarding diagnostic options and management of untreated OSA remain inadequate. Preoperative screening and identification of patients with undiagnosed OSA may lead to early perioperative interventions that may alter cardiopulmonary events associated with surgery and anesthesia.1 Hence, clinicians need to become familiar with the preoperative screening and diagnosis of OSA. Perioperative management of a patient with OSA should be modified and may include regional anesthesia and alternative...
Source: Journal of Intensive Care Medicine - May 1, 2014 Category: Intensive Care Authors: Porhomayon, J., Nader, N. D., Leissner, K. B., El-Solh, A. A. Tags: Analytic Reviews Source Type: research
Necrotizing Soft Tissue Infections
Necrotising soft tissue infection (NSTI) presents unique challenges in diagnosis and management. The key to a successful outcome is a high index of suspicion in appropriate clinical settings. Type II NSTI tends to occur on an extremity in younger, healthier patients with a history of known trauma, and to be monomicrobial. Type I NSTI tends to occur on the trunk of older, less healthy patients without an obvious history of trauma, and tends to be polymicrobial. Other, rarer types exist as well. The pathophysiology of both types involves superantigen acticivty, as well as a number of microbial byproducts which collectively d...
Source: Journal of Intensive Care Medicine - May 1, 2014 Category: Intensive Care Authors: Shiroff, A. M., Herlitz, G. N., Gracias, V. H. Tags: Analytic Reviews Source Type: research
Mechanical Ventilation After Injury
Injury is a major cause of critical illness worldwide. Severely injured patients often require mechanical ventilation not only to manage primary respiratory failure but also as adjunct to manage other conditions. Injury induces fundamental changes in multiple organ systems which directly impact ventilator management; these changes are not shared by patients without concomitant tissue injury. In this article, we review the physiologic changes after injury and discuss the impact of injury on ventilator strategies and management. We also explore the special considerations in patients with traumatic brain injury, thermal injur...
Source: Journal of Intensive Care Medicine - May 1, 2014 Category: Intensive Care Authors: Maung, A. A., Kaplan, L. J. Tags: Analytic Reviews Source Type: research
Diastolic Heart Failure: The Current Understanding and Approach for Management With Focus on Intensive Care Unit Patients
Multiple recent epidemiologic studies have highlighted the importance of diastolic heart failure (DHF) as a public health problem. Approximately half of patients presenting with symptomatic heart failure (HF) have DHF and they suffer from morbidity and mortality comparable to those with systolic HF. Our understanding of the pathophysiology of DHF has evolved rapidly over the last decade, and the associated echo-Doppler findings that assist with its diagnosis are greatly refined. Recently, there has been increased recognition of the role of diastolic dysfunction and DHF in the care of critically ill patients, including thos...
Source: Journal of Intensive Care Medicine - May 1, 2014 Category: Intensive Care Authors: Karrowni, W., Chatterjee, K. Tags: Analytic Reviews Source Type: research
Percutaneous Tracheostomy at the Bedside: 13 Tips for Improving Safety and Success
We have developed a set of routines and practices in the course of performing a large series (n = 70) of percutaneous dilational tracheostomy (PDT). The 13 tips discussed in this review fall into 4 categories. System factors that facilitate training, patient safety, and avoidance of crises including the use of appropriate personnel, importance of timing, use of premedication, and the utility and content of a preprocedure briefing. Suggestions to prevent loss of the airway include tips on airway assessment, preparation of airway equipment, and use of exchange catheter techniques. Strategies to avoid and manage both microvas...
Source: Journal of Intensive Care Medicine - March 11, 2014 Category: Intensive Care Authors: Maxwell, B. G., Ganaway, T., Lighthall, G. K. Tags: Case Reports Source Type: research
Systemic Lupus-Induced Diffuse Alveolar Hemorrhage Treated With Extracorporeal Membrane Oxygenation: A Case Report and Review of the Literature
Conclusions:
Diffuse alveolar hemorrhage secondary to SLE is quite rare. The adult literature on the utilization of ECMO for DAH is limited mostly to antineutrophil cytoplasmic antibody (ANCA)-associated alveolar hemorrhage and a few reports of nonvasculitis DAH. Bleeding has been a contraindication to ECMO due to the need for systemic anticoagulation. Our case, along with a review of the literature, indicates that ECMO with anticoagulation can be safely utilized in patients with DAH. To our knowledge, this is the first reported adult case of DAH due to SLE successfully treated with ECMO. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - March 11, 2014 Category: Intensive Care Authors: Patel, J. J., Lipchik, R. J. Tags: Case Reports Source Type: research
Patterns of Use of Prophylaxis for Stress-Related Mucosal Disease in Patients Admitted to the Intensive Care Unit
Conclusions:
Stress ulcer prophylaxis administration in this ICU is inconsistent and includes both underutilization and overutilization. Educating physicians and implementing hospital protocols could improve use patterns. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - March 11, 2014 Category: Intensive Care Authors: Frandah, W., Colmer-Hamood, J., Nugent, K., Raj, R. Tags: Original Research Source Type: research
Subsequent Infections in Survivors of Sepsis: Epidemiology and Outcomes
Conclusions:
Critically ill patients who survive sepsis have an increased risk of recurrent infections in the year following their septic episode that is associated with increased mortality. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - March 11, 2014 Category: Intensive Care Authors: Wang, T., Derhovanessian, A., De Cruz, S., Belperio, J. A., Deng, J. C., Hoo, G. S. Tags: Review of a Large Clinical Series Source Type: research
Hemodynamic Consequences of Auto-PEEP
Auto–positive end-expiratory pressure (PEEP) is a common but frequently unrecognized problem in critically ill patients. It has important physiologic consequences and can cause shock and cardiac arrest. Treatment consists of relieving expiratory airflow obstruction and reducing minute ventilation delivered by positive pressure ventilation. Sedation and fluid management are important adjunctive therapies. This analytic review discusses the prevalence, pathophysiology, and hemodynamic consequences of auto-PEEP and an approach to its treatment. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - March 11, 2014 Category: Intensive Care Authors: Berlin, D. Tags: Analytic Reviews Source Type: research
The Effect of Statutory Limitations on the Authority of Substitute Decision Makers on the Care of Patients in the Intensive Care Unit: Case Examples and Review of State Laws Affecting Withdrawing or Withholding Life-Sustaining Treatment
While the ethics and critical care literature is replete with discussion of medical futility and the ethics of end-of-life care decisions in the intensive care unit, little attention is paid to the effect of statutory limitations on the authority of substitute decision makers during the course of treatment of patients in the critical care setting. In many jurisdictions, a clear distinction is made between the authority of a health care power of attorney, who is legally designated by a competent adult to make decisions regarding withholding or withdrawing life-sustaining treatment, and of next-of-kin, who are limited in thi...
Source: Journal of Intensive Care Medicine - March 11, 2014 Category: Intensive Care Authors: Venkat, A., Becker, J. Tags: Analytic Reviews Source Type: research
Intravenous Lipid Emulsion for the Treatment of Drug Toxicity
Intravenous lipid emulsion (ILE) has emerged as a powerful antidote for the treatment of drug toxicity in the past decade. Initial efficacy of ILE was shown in the setting of local anesthetic systemic toxicity (LAST), but recent case reports suggest its consideration in a variety of other drug toxicities. In this review, we will summarize the experimental evidence as well as the clinical experience in using ILE as an antidote. Specifically, we will look at the evidence for using ILE in LAST as well as toxicity due to beta-blockers, calcium-channel blockers, and tricyclic antidepressants. We will also review the current dos...
Source: Journal of Intensive Care Medicine - March 11, 2014 Category: Intensive Care Authors: Ozcan, M. S., Weinberg, G. Tags: Analytic Reviews Source Type: research
Response From the Authors
(Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - January 3, 2014 Category: Intensive Care Authors: Cannon, C. M., Holthaus, C. V., Rivers, E. P. Tags: Response from the Authors Source Type: research
Letter to the Editor
(Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - January 3, 2014 Category: Intensive Care Authors: Brown, S. G. A. Tags: Letter to the Editor Source Type: research
Management of Autism in the Adult Intensive Care Unit
We present the case of a 22-year-old male with severe autism and intellectual disorder who developed respiratory failure and required a prolonged ICU course. This patient exhibited severe distress, aggression, and self-injurious behavior. Management challenges included sedation, weaning from sedation, and liberation from mechanical ventilation. Success was achieved with a multispecialty team and by tailoring the environment and interactions to the patient’s known preferences. The use of dexmedetomidine to wean high-dose benzodiazepines and opiates also permitted successful liberation from mechanical ventilation. (Sou...
Source: Journal of Intensive Care Medicine - January 3, 2014 Category: Intensive Care Authors: Hsieh, E., Oh, S. S., Chellappa, P., Szeftel, R., Jones, H. D. Tags: The Proceedings of Critical Care Conferences from Cedars-Sinai Medical Center Source Type: research
The Intubated Patient With Mediastinal Disease--A Role for Esophageal Access Using the Endobronchial Ultrasound Bronchoscope
Ultrasound-guided transbronchial needle aspiration using the bronchoscope with a dedicated curvilinear probe has emerged as a primary tool for the investigation of mediastinal pathology. Recently, the utility of this scope has been expanded to include access via the esophagus. In this case series, we describe a role for esophageal ultrasound using the endobronchial ultrasound bronchoscope in the diagnostic evaluation of critically ill/intubated patients with mediastinal disease. Esophageal access with the ultrasound bronchoscope allows the pulmonologist to diagnose mediastinal disease in the intubated patient with minimal ...
Source: Journal of Intensive Care Medicine - January 3, 2014 Category: Intensive Care Authors: Bhaskar, N., Shweihat, Y. R., Bartter, T. Tags: Case Report Source Type: research
