Acute Liver Failure: Diagnosis and Management
Acute liver failure is life threatening liver injury with coagulopathy and hepatic encephalopathy within 26 weeks and generally, in the absence of preexisting liver disease. Fulminant liver failure occurs when hepatic encephalopathy occurs within 8 weeks of jaundice. The majority of patients with ALF are women with the median age of 38 years. In the United States, drug induced liver injury including acetaminophen causes the majority of ALF cases. The etiology of ALF should be determined, if possible, because many causes have a specific treatment. The mainstay for ALF is supportive care and liver transplantation, if necessa...
Source: Journal of Intensive Care Medicine - October 24, 2016 Category: Intensive Care Authors: Punzalan, C. S., Barry, C. T. Tags: Analytic Reviews Source Type: research
Management of Acute Respiratory Failure in Patients With Hematological Malignancy
Acute respiratory failure (ARF) is the leading cause of intensive care unit admission in patients with hematologic malignancies and is associated with a high mortality. The main causes of ARF are bacterial and opportunistic pulmonary infections and noninfectious lung disorders. Management consists of a systematic clinical evaluation aimed at identifying the most likely cause, which in turn determines the best first-line empirical treatments. The need for mechanical ventilation is a major determinant of prognosis. Beneficial outcomes have been demonstrated with early use of noninvasive ventilation (NIV) in selected patients...
Source: Journal of Intensive Care Medicine - October 24, 2016 Category: Intensive Care Authors: Vadde, R., Pastores, S. M. Tags: Analytic Reviews Source Type: research
Spinal Decerebrate-Like Posturing After Brain Death: A Case Report and Review of the Literature
Conclusion:
Extension–pronation movements that mimic decerebrate posturing may be seen in a delayed fashion after BD. Verification of lack of any brain activity (by both examination and multiple ancillary tests) in this case and others prompts us to attribute these movements as spinal cord reflexes and propose they be recognized within the rubric of accepted post-BD automatisms that should not delay diagnosis or necessitate confirmatory testing. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - September 8, 2016 Category: Intensive Care Authors: Kumar, A., Tummala, P., Feen, E. S., Dhar, R. Tags: Case Reports Source Type: research
Resolution of a Mobile Right Atrial Thrombus Complicating Acute Pulmonary Embolism With Low-Dose Tissue Plasminogen Activator in a Patient With Recent Craniotomy
Right heart thrombus in transit (RHTT) is a rare, severe form of venous thromboembolism that carries a high mortality rate. The optimal treatment for RHTT has not been well established. Thrombolysis is a therapeutic modality for RHTT but carries the risk of bleeding complications including intracranial hemorrhage. Low-dose thrombolysis has been shown to be effective in treating submassive pulmonary emboli without an increased risk in bleeding complications, but it has not been studied in patients with RHTT. Here, we discuss the case of a 74-year-old male with lung cancer and recent craniotomy with metastasectomy 30 days pr...
Source: Journal of Intensive Care Medicine - September 8, 2016 Category: Intensive Care Authors: Patel, A. K., Kafi, A., Bonet, A., Shapiro, S. M., Oh, S. S., Zeidler, M. R., Betancourt, J. Tags: Case Reports Source Type: research
Factors Affecting Anxiety and Depression Symptoms in Relatives of Intensive Care Unit Patients
Conclusion:
Spouses and family members of relatively young patients had higher rates of anxiety and depression. In contrast to the literature, depression was more common than anxiety among the relatives of ICU patients. Further research is needed on the impact of cultural and regional differences on anxiety and depression rates in family members of ICU patients. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - September 8, 2016 Category: Intensive Care Authors: Köse, I., Zincircioglu, C., Öztürk, Y. K., Cakmak, M., Güldogan, E. A., Demir, H. F., Senoglu, N., Erbay, R. H., Gonullu, M. Tags: Original Research Source Type: research
The Outcome and Predictors of Mortality in Patients Therapeutically Cooled Postcardiac Arrest
Conclusion:
Patients admitted to ICU postcardiac arrest after therapeutic cooling have a high mortality. An initial rhythm of VT/VF confers a mortality benefit when compared to asystole and PEA. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - September 8, 2016 Category: Intensive Care Authors: Botha, J., OBrien, Y., Malouf, S., Cole, E., Ansari, E. S., Green, C., Tiruvoipati, R. Tags: Review of a Large Clinical Series Source Type: research
A 24-Hour Postintensive Care Unit Transition-of-Care Model Shortens Hospital Stay
Conclusion:
A new model for the post-MICU transition of care, with the MICU team continuing to manage all patients transferred to the medical ward for at least 24 hours, significantly decreased duration of hospital stay after MICU transfer without affecting MICU readmission and mortality rate. The implementation of this model may lower medical costs and make transition of care safer without adverse outcomes. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - September 8, 2016 Category: Intensive Care Authors: Kheir, F., Shawwa, K., Nguyen, D., Alraiyes, A. H., Simeone, F., Nielsen, N. D. Tags: Review of a Large Clinical Series Source Type: research
Decompressive Hemicraniectomy in Acute Neurological Diseases
Increased intracranial pressure (ICP) secondary to severe brain injury is common. Increased ICP is commonly encountered in malignant middle cerebral artery ischemic stroke, traumatic brain injury, subarachnoid hemorrhage, and intracerebral hemorrhage. Multiple interventions—both medical and surgical—exist to manage increased ICP. Medical management is used as first-line therapy; however, it is not always effective and is associated with significant risks. Decompressive hemicraniectomy is a surgical option to reduce ICP, increase cerebral compliance, and increase cerebral blood perfusion when medical management ...
Source: Journal of Intensive Care Medicine - September 8, 2016 Category: Intensive Care Authors: Crudele, A., Shah, S. O., Bar, B. Tags: Analytic Reviews Source Type: research
Fecal Microbiota Transplant: Treatment Options for Clostridium difficile Infection in the Intensive Care Unit
Clostridium difficile infection (CDI) has steadily increased in incidence since the 1990s, with an associated increase in recurrence and severity, which has in turn lead to more intensive care unit (ICU) admissions. The development of recurrent CDI, in particular, has been associated with increasing patient morbidity and mortality as well as an immense financial burden on the health care system. Recently, fecal microbiota transplantation (FMT) has received much publicity as an effective means of treatment for recurrent CDI. The goal of this review is to provide evidence-based recommendations for the diagnosis and managemen...
Source: Journal of Intensive Care Medicine - September 8, 2016 Category: Intensive Care Authors: Han, S., Shannahan, S., Pellish, R. Tags: Analytic Reviews Source Type: research
Damage Control and the Open Abdomen: Challenges for the Nonsurgical Intensivist
Conclusions:
Temporary abdominal closure improves outcomes in patients with abdominal compartment syndrome, hemorrhagic shock, and intra-abdominal sepsis but creates new challenges with electrolyte derangement, hypovolemia, malnutrition, enteric fistulas, and loss of abdominal wall domain. Intensive care of such patients mandates attention to resuscitation, sepsis control, and expedient abdominal closure. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - September 8, 2016 Category: Intensive Care Authors: Griggs, C., Butler, K. Tags: Analytic Reviews Source Type: research
Acute Parotitis as a Complication of Noninvasive Ventilation
We describe herein the case of an 82-year-old man who developed unilateral parotitis during prolonged NIV for acute heart failure. Intravenous antibiotics, corticosteroids, and adjusting the mask laces’ position allowed rapid resolution of clinical symptoms. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - August 7, 2016 Category: Intensive Care Authors: Alaya, S., Mofredj, A., Tassaioust, K., Bahloul, H., Mrabet, A. Tags: Case Report Source Type: research
Low Blood Arterial Oxygenation During Venovenous Extracorporeal Membrane Oxygenation: Proposal for a Rational Algorithm-Based Management
Conclusion:
If hypoxemia occurs during VV-ECMO, collecting oxygenation parameters and a clear step-by-step algorithm could guide specific intervention to improve oxygenation. This flow diagram is in accordance with current recommendations recapitulated in guidelines or troubleshooting chart but more accurate and complete. Although rational and appealing, it remains to be tested together with a number of still unsolved issues. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - August 7, 2016 Category: Intensive Care Authors: Messai, E., Bouguerra, A., Guarracino, F., Bonacchi, M. Tags: Techniques and Procedures Source Type: research
Evaluation of Serum Lactate, Central Venous Saturation, and Venous-Arterial Carbon Dioxide Difference in the Prediction of Mortality in Postcardiac Arrest Syndrome
Conclusion:
In post-CA syndrome, serum lactate and Clac were consistently able to predict mortality. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - August 7, 2016 Category: Intensive Care Authors: Riveiro, D. F. M., Oliveira, V. M. d., Braunner, J. S., Vieira, S. R. R. Tags: Original Research Source Type: research
When to Stop CPR and When to Perform Rhythm Analysis: Potential Confusion Among ACLS Providers
Conclusion:
Confusion exists regarding whether or not CPR and cardiac medications should be continued in the presence of a pulse. Education may be warranted to emphasize avoiding compressions and medications when a palpable pulse is detected. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - August 7, 2016 Category: Intensive Care Authors: Giberson, B., Uber, A., F. Gaieski, D., Miller, J. B., Wira, C., Berg, K., Giberson, T., Cocchi, M. N., S. Abella, B., Donnino, M. W. Tags: Review of a Large Clinical Series Source Type: research
Hypothermia in Adult ICUs: Changing Incidence But Persistent Risk Factor for Mortality
Conclusion:
The incidence of hypothermia at ICU admission was dependent on medical versus surgical status, and the method of non-invasive temperature measurement, but was persistently associated with ICU mortality. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - August 7, 2016 Category: Intensive Care Authors: Niven, D. J., Stelfox, H. T., Laupland, K. B. Tags: Review of a Large Clinical Series Source Type: research
