Thrombocytopenia in the Intensive Care Unit
Thrombocytopenia is a common laboratory finding in critically ill patients admitted to the intensive care unit. Potential etiologies of thrombocytopenia are myriad, ranging from acute disease processes and concomitant conditions to exposures and drugs. The mechanism of decreased platelet counts can also be varied: laboratory measurement may be spurious, platelet production may be decreased, or platelet destruction or sequestration may be increased. In addition to evaluation for the cause of thrombocytopenia, the clinician must also guard against spontaneous bleeding due to thrombocytopenia, prophylax against bleeding resul...
Source: Journal of Intensive Care Medicine - August 30, 2013 Category: Intensive Care Authors: Wang, H. L., Aguilera, C., Knopf, K. B., Chen, T.-M. B., Maslove, D. M., Kuschner, W. G. Tags: Analtyic Reviews Source Type: research
The Agony With Ecstasy: Lessons From a Recent Rave
(Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - July 14, 2013 Category: Intensive Care Authors: Hoo, G. W. S. Tags: Editorial Source Type: research
Multiple MDMA (Ecstasy) Overdoses at a Rave Event: A Case Series
Twelve patients with 3,4-methylenedioxymethamphetamine (MDMA) toxicity from a single rave event presented to multiple San Francisco Bay area hospitals with various life-threatening complications including seizures and hyperthermia. Eight required emergent endotracheal intubation and six had hypotension. Hyperkalemia, acute kidney injury, and rhabdomyolysis were present in most of the patients. In all, 2 patients died, 4 survived with permanent neurologic, musculoskeletal, and/or renal sequelae, and 6 survived without any apparent lasting deficits. Hyperthermia was present in 10 patients and was severe (40.9-43° C) in 7...
Source: Journal of Intensive Care Medicine - July 14, 2013 Category: Intensive Care Authors: Armenian, P., Mamantov, T. M., Tsutaoka, B. T., Gerona, R. R. L., Silman, E. F., Wu, A. H. B., Olson, K. R. Tags: Case Report Source Type: research
Effect of Lanz Pressure Regulating Valve on Self-sealing Mechanism and Air Leakage Across the Tracheal Tube Cuffs in a Benchtop Model
Conclusion:
Cuff pressure compensation with the Lanz system during cyclic respiratory pressure changes interferes with the self-sealing mechanism in HVLP tube cuffs at cuff pressures lower than PIP level. This results in larger air leak across tube cuffs particularly in tube cuffs made from PVC. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - July 14, 2013 Category: Intensive Care Authors: Dave, M. H., Spielmann, N., Mauch, J., Weiss, M. Tags: Techniques and Procedures Source Type: research
Clinical Evidence of Early Acute Lung Injury Often Precedes the Diagnosis of ALI
Conclusion:
The majority of hospitalized patients who are destined to develop ALI demonstrate tachypnea, increased oxygen requirements, and/or bilateral infiltrates on chest radiograph more than 12 hours prior to meeting criteria for diagnosis. Some patients with EALI may be identified prior to meeting diagnostic criteria during a potential therapeutic window. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - July 14, 2013 Category: Intensive Care Authors: Rackley, C. R., Levitt, J. E., Zhuo, H., Matthay, M. A., Calfee, C. S. Tags: Original Research Source Type: research
Outcomes of Patients on Multiple Vasoactive Drugs for Shock
Conclusion:
Patients requiring 3 or more vasoactive drugs rarely survive in the absence of an intervention aimed at correcting the underlying cause such as revascularization or source control surgery. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - July 14, 2013 Category: Intensive Care Authors: Prys-Picard, C. O., Shah, S. K., Williams, B. D., Cardenas, V., Sharma, G. Tags: Original Research Source Type: research
Incidence of Gastric Mucosal Injury as Measured by Reactance in Critically Ill Patients
This study shows that gastric ischemia as estimated by gastric reactance has a very high incidence in the critically ill, independently of the reason for admission. High reactance is related with higher morbidity in agreement with other reports using different methods of assessing splanchnic hypoperfusion in this patient population. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - July 14, 2013 Category: Intensive Care Authors: Beltran, N. E., Ceron, U., Sanchez-Miranda, G., Remolina, M., Godinez, M. M., Peralta, I. Y., Sacristan, E. Tags: Review of a Large Clinical Series Source Type: research
Nonsurgical Care of Intestinal and Multivisceral Transplant Recipients: A Review for the Intensivist
This article is intended for intensivists who provide care to critically ill recipients of intestinal and multivisceral transplants. As perioperative care of intestinal/multivisceral transplant recipients has been described elsewhere, this review focuses on common nonsurgical complications with which one should be familiar in order to provide optimal care. The article is both a review of the current literature on multivisceral and isolated intestinal transplantation as well as a reflection of our own experience at the University of Miami. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - July 14, 2013 Category: Intensive Care Authors: Hopfner, R., Tran, T. T., Island, E. R., McLaughlin, G. E. Tags: Analtyic Reviews Source Type: research
When the Heart Stops: A Review of Cardiac Arrest in Pregnancy
Cardiac arrest is a rare occurrence in pregnancy and may be related to obstetric or medical causes. Pregnancy is associated with profound physiologic changes that prepare the gravida for the challenges of labor and delivery, and resuscitation of the pregnant patient needs to take these changes into consideration. Cardiac output and plasma volume increase in pregnancy and distribute differently with the uterine circulation receiving approximately 17% of the total cardiac output. On the other hand, cardiac output is sensitive to positional changes in the second half of pregnancy but may improve with a lateral tilt of the gra...
Source: Journal of Intensive Care Medicine - July 14, 2013 Category: Intensive Care Authors: Ramsay, G., Paglia, M., Bourjeily, G. Tags: Analtyic Reviews Source Type: research
The Emergent Malignant Obesity Hypoventilation Syndrome: A New Critical Care Syndrome
(Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - May 13, 2013 Category: Intensive Care Authors: Marik, P. E., Desai, H. Tags: The Authors ' Response Source Type: research
Development, Implementation, and Evaluation of an Institutional Daily Awakening and Spontaneous Breathing Trial Protocol: A Quality Improvement Project
Conclusion:
Despite the implementation of a DA-SBT protocol that was individualized to clinician preferences and institutional resources and accompanied by substantial education and reminders for use, compliance to the DA component of this protocol was low and duration of MV remained unchanged. Additional quality improvement strategies are needed to overcome barriers to DA-SBT protocol use that may not exist in controlled clinical trials. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - May 13, 2013 Category: Intensive Care Authors: Kher, S., Roberts, R. J., Garpestad, E., Kunkel, C., Howard, W., Didominico, D., Fergusson, A., Devlin, J. W. Tags: Original Research Source Type: research
A Novel Case of Transient Right Ventricular Failure in a Patient With Respiratory Distress
We report the case of a 61-year-old woman with no significant pulmonary or cardiac disease who presented with hypoxic respiratory failure in the setting of opioid overdose. She remained obtunded despite naloxone treatment and required endotracheal intubation as well as norepinephrine therapy for persistent hypotension. A transthoracic echocardiogram demonstrated isolated severe RV dysfunction without any LV abnormalities. Cardiac catheterization showed no obstructive coronary artery disease, pulmonary hypertension, or elevated left atrial pressures, and chest imaging only revealed signs of aspiration. Over the next 6 days,...
Source: Journal of Intensive Care Medicine - May 13, 2013 Category: Intensive Care Authors: Liu, S. S., Kovell, L. C., Horne, A., Chang, D., Petronis, J. D., Zakaria, S. Tags: Case Report Source Type: research
Aspergillus Infection and Extracorporeal Membrane Oxygenation Support
Conclusions:
Aspergillus infection/colonization is associated with a 70% overall mortality among patients supported on ECMO. The ELSO registry data confirms that Aspergillus infection among ECMO supported patients occurs often in hosts who do not have known immunodeficiencies. The case stresses the need for a high level of suspicion for Aspergillus infection in nonimproving lung disease in patients on ECMO support. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - May 13, 2013 Category: Intensive Care Authors: Garcia, X., Mian, A., Mendiratta, P., Gupta, P., Rycus, P., Prodhan, P. Tags: Case Report Source Type: research
Hypocalcemia in the Critically Ill patient
Hypocalcemia is common in the critically ill patient. In this population, however, the diagnosis of hypocalcemia is complicated by limitations in the interpretation of the total plasma calcium concentration. These limitations are principally the result of the effects of hypoalbuminemia and disorders of acid-base balance on the total calcium concentration. Thus, measurement of ionized calcium can be critical in determining an individual’s true serum calcium status. In this review, we first describe the regulation of normal calcium metabolism and then focus on the various etiologies of hypocalcemia, including congenita...
Source: Journal of Intensive Care Medicine - May 13, 2013 Category: Intensive Care Authors: Kelly, A., Levine, M. A. Tags: Analytic Review Source Type: research
