Management of Acute Myeloid Leukemia in the Intensive Care Setting
Patients with acute myeloid leukemia (AML) who are newly diagnosed or relapsed and those who are receiving cytotoxic chemotherapy are predisposed to conditions such as sepsis due to bacterial and fungal infections, coagulopathies, hemorrhage, metabolic abnormalities, and respiratory and renal failure. These conditions are common reasons for patients with AML to be managed in the intensive care unit (ICU). For patients with AML in the ICU, providers need to be aware of common problems and how to manage them. Understanding the pathophysiology of complications and the recent advances in risk stratification as well as newer th...
Source: Journal of Intensive Care Medicine - September 8, 2015 Category: Intensive Care Authors: Cowan, A. J., Altemeier, W. A., Johnston, C., Gernsheimer, T., Becker, P. S. Tags: Analytic Reviews Source Type: research
Pheochromocytoma-Induced Inverted Takotsubo-Like Cardiomyopathy Leading to Cardiogenic Shock Successfully Treated With Extracorporeal Membrane Oxygenation
We report a case of pheochromocytoma-induced inverted takotsubo-like cardiomyopathy leading to shock and cardiac arrest successfully treated with extracorporeal membrane oxygenation (ECMO) as a bridge to pharmacological therapy and curative adrenalectomy. A previously healthy 46-year-old woman presented to the emergency department with abdominal pain, dyspnea, nausea, and vomiting. Clinical evaluation revealed cardiorespiratory failure with hypoxia and severe metabolic acidosis. Computed tomography (CT) scan showed pulmonary edema and a left adrenal mass. Transthoracic echocardiography (TTE) displayed severe left ventricul...
Source: Journal of Intensive Care Medicine - August 17, 2015 Category: Intensive Care Authors: Flam, B., Broome, M., Frenckner, B., Branstrom, R., Bell, M. Tags: Case Report Source Type: research
Integrating Palliative Care into Critical Care: A Quality Improvement Study
Conclusions:
Patients who received PCC had higher disease acuity, longer ICU lengths of stay, and higher ICU mortality than controls. "Trigger" programs in the ICU may improve utilization of PCC services, improve patient comfort, and reduce invasive, often futile end-of-life care. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - August 17, 2015 Category: Intensive Care Authors: Hsu-Kim, C., Friedman, T., Gracely, E., Gasperino, J. Tags: Original Research Source Type: research
The Interhospital Medical Intensive Care Unit Transfer Instrument Facilitates Early Implementation of Critical Therapies and Is Associated With Fewer Emergent Procedures Upon Arrival
Conclusions:
The interhospital ICU transfer instrument is a tool that is effective in coordinating the transfer of medical ICU patients. Implementation leads to timely critical interventions and may reduce mortality. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - August 17, 2015 Category: Intensive Care Authors: Malpass, H. C., Enfield, K. B., Keim-Malpass, J., Verghese, G. M. Tags: Original Research Source Type: research
An Updated Therapeutic Intervention Scoring System for Critically Ill Children Enables Nursing Workload Assessment With Insight Into Potential Untoward Events
Conclusions:
Critically ill pediatric patients are more vulnerable to experience adverse events when their derived NW values are high. It is postulated that a critical NW exists, where adverse events are more likely to occur. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - August 17, 2015 Category: Intensive Care Authors: Trope, R., Vaz, S., Zinger, M., Sagy, M. Tags: Review of a Large Clinical Series Source Type: research
Comparison of Positive End-Expiratory Pressure of 8 versus 5 cm H2O on Outcome After Cardiac Operations
Conclusion:
Patients being mechanically ventilated after cardiac operations with an initial postoperative PEEP setting of 8 versus 5 cm H2O differed significantly only on hospital LOS but the difference was likely clinically unimportant. Thus, use of 8 cm H2O PEEP in these patients without a clinical indication, although likely not harmful, does not seem beneficial. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - August 17, 2015 Category: Intensive Care Authors: Hansen, J. K., Anthony, D. G., Li, L., Wheeler, D., Sessler, D. I., Bashour, C. A. Tags: Review of a Large Clinical Series Source Type: research
Brain Death Determination
In the United States, each year 1% to 2% of deaths are brain deaths. Considerable variation in the practice of determining brain death still remains, despite the publication of practice parameters in 1995 and an evidence-based guideline update in 2010. This review is intended to give bedside clinicians an overview of definition, the causes and pitfalls of misdiagnosing brain death, and a focus on the specifics of the brain death determination process. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - August 17, 2015 Category: Intensive Care Authors: Spinello, I. M. Tags: Analytic Reviews Source Type: research
Neurogenic Stunned Myocardium Following Acute Subarachnoid Hemorrhage: Pathophysiology and Practical Considerations
Neurogenic stunned myocardium (NSM) is a triad of transient left ventricular dysfunction, electrocardiogram changes, and elevation in cardiac enzymes, often mimicking a myocardial infarction. It has been described following acute brain injury. The purported mechanism is catecholamine excess resulting in cardiac dysfunction. From the clinical standpoint, the most frequently encountered electrocardiographic changes are QTc prolongation and ST-T changes, with modest elevations in troponin levels. Basal and mid-ventricular segments of the left ventricle are most commonly involved. NSM poses therapeutic challenges when it occur...
Source: Journal of Intensive Care Medicine - August 17, 2015 Category: Intensive Care Authors: Murthy, S. B., Shah, S., Rao, C. P. V., Bershad, E. M., Suarez, J. I. Tags: Analytic Reviews Source Type: research
Making a Difference in Eye Care of the Critically Ill Patients
Ocular surface disorders are frequently encountered in patients under sedation and paralyzed patients in intensive care units (ICUs). In the ICUs, treatment is usually focused on the management of organ failures, and eye care becomes a side issue. As a result, ophthalmological complications do occur (incidence ranges from 3.6% to 60%) and are frequently overlooked in this setting. To identify the best available evidence in providing the best eye care to prevent exposure keratopathy, a literature review was performed. The databases of PUBMED, COCHRAN, and EMBASE library were searched. We only looked at higher quality articl...
Source: Journal of Intensive Care Medicine - August 17, 2015 Category: Intensive Care Authors: Alansari, M. A., Hijazi, M. H., Maghrabi, K. A. Tags: Analytic Reviews Source Type: research
Hypertriglyceridemic Pancreatitis Caused by the Oral Contraceptive Agent Estrostep
We report a case of severe hypertriglyceridemia-induced acute pancreatitis in a 24-year-old woman caused by Estrostep, occurring nearly 10 years after she began using the drug. The patient was admitted to the medical intensive care unit (ICU) for aggressive volume resuscitation and management of severe electrolyte abnormalities. Laboratory studies obtained on admission indicated severe hypertriglyceridemia (2,200 mg/dL), hyponatremia (120 mEq/L), and hypocalcemia (0.78 mmol/L). Amylase and lipase levels were also elevated (193 and 200 U/L, respectively). Ranson score calculated after 48 hours of admission was 4, and her Ac...
Source: Journal of Intensive Care Medicine - June 4, 2015 Category: Intensive Care Authors: Abraham, M., Mitchell, J., Simsovits, D., Gasperino, J. Tags: Case Report Source Type: research
Diagnostic Laparoscopy in the Intensive Care Unit
Primary and acquired abdominal pathology accounts for a significant proportion of sepsis and SIRS in the ICU population. Abdominal processes often present a difficult diagnostic dilemma in the truly critically ill patient who, due to hemodynamic instability or severe acute respiratory distress syndrome (ARDS) requiring high-level ventilatory support, is at significant risk during transport to radiology department. Furthermore, the accuracy of radiologic studies in the ICU setting is often limited. Laparoscopy provides a "minimally invasive" definitive modality to diagnose intra-abdominal problems. It may quickly provide th...
Source: Journal of Intensive Care Medicine - June 4, 2015 Category: Intensive Care Authors: Zemlyak, A., Heniford, B. T., Sing, R. F. Tags: Techniques and Procedures Source Type: research
Continuous Electroencephalogram in Comatose Postcardiac Arrest Syndrome Patients Treated With Therapeutic Hypothermia: Outcome Prediction Study
Conclusions:
In comatose postcardiac arrest patients treated with hypothermia, EEG during the maintenance and rewarming phase of hypothermia can contribute to prediction of neurologic outcome. Pending large multicenter prospective studies evaluating the role of cEEG in prognostication, our study adds to the existing evidence that cEEG can play a potential role in prediction of outcome in postcardiac arrest patients treated with hypothermia. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - June 4, 2015 Category: Intensive Care Authors: Sadaka, F., Doerr, D., Hindia, J., Lee, K. P., Logan, W. Tags: Original Research Source Type: research
Ventilator Settings Can Substantially Impact Patients' Comfort
Conclusion:
Ventilator parameters may impact patients’ comfort substantially. Future studies may help identify evidence-based methodology for gauging comfort following changes in ventilator settings and the settings that are most likely to positively impact various groups of patients. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - June 4, 2015 Category: Intensive Care Authors: Fortis, S., Florindez, J., Balasingham, S., Aguirre, M. D., Amoateng-Adjepong, Y., Manthous, C. A. Tags: Original Research Source Type: research
The Influence of Surrogate Decision Makers on Clinical Decision Making for Critically Ill Adults
Conclusion:
Some surrogate characteristics may modify clinicians’ beliefs and practices regarding end-of-life care, suggesting the nuances of the surrogate–physician relationship and clinical decision making for critically ill patients. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - June 4, 2015 Category: Intensive Care Authors: Shah, R. D., Rasinski, K. A., Alexander, G. C. Tags: Review of a Large Clinical Series Source Type: research
Predictors of Death and Prolonged Renal Insufficiency in Ethylene Glycol Poisoning
Conclusion:
Compared to survivors with an uncomplicated recovery, patients poisoned with ethylene glycol who died or had prolonged RI were more likely to exhibit clinical signs such as coma, seizures, and acidosis. Antidote administration within 6 hours is associated with better outcomes, unlike earlier time to dialysis. (Source: Journal of Intensive Care Medicine)
Source: Journal of Intensive Care Medicine - June 4, 2015 Category: Intensive Care Authors: Lung, D. D., Kearney, T. E., Brasiel, J. A., Olson, K. R. Tags: Review of a Large Clinical Series Source Type: research
