2012 Feb - The role of echocardiography in the management of patients supported by extracorporeal membrane oxygenation
Platts DG, Sedgwick JF, Burstow DJ, Mullany DV, Fraser JF.; J Am Soc Echocardiogr. 2012 Feb;25(2):131-41. Epub 2011 Dec 9.
Extracorporeal life support can be viewed as a spectrum of modalities based on modifications of a cardiopulmonary bypass circuit to provide cardiac and respiratory support, which can be used for extended periods, from hours to several weeks. Extracorporeal membrane oxygenation (ECMO) is among the most frequently used forms of extracorporeal life support. It can be configured for venovenous blood flow, to provide adequate oxygenation and carbon dioxide removal in isolated refractory respiratory failure, or in a venoarterial configuration, when support is required for cardiac and/or respiratory failure. Echocardiography plays a fundamental role throughout the entire journey of a patient supported on ECMO...
2012 Jan - Surgical decompression for cerebral oedema in acute ischaemic stroke
Cruz-Flores S, Berge E, Whittle IR.; Cochrane Database Syst Rev. 2012 Jan 18;1:CD003435.
BACKGROUND: Large cerebral infarction has a high case fatality. Despite the use of conventional medical treatments such as hyperventilation, mannitol, diuretics, corticosteroids and barbiturates, the outcome of this condition remains poor. Decompressive surgery to relieve intracranial pressure is performed in some cases, although evidence of any clinical benefits has not been available until recently. This is an update of a Cochrane review first published in 2002.
2012 Jan - Steroids for acute spinal cord injury
Bracken MB.; Cochrane Database Syst Rev. 2012 Jan 18;1:CD001046.
BACKGROUND: Acute spinal cord injury is a devastating condition typically affecting young people, mostly males. Steroid treatment in the early hours after the injury is aimed at reducing the extent of permanent paralysis during the rest of the patient's life.
2012 Jan - High-carbohydrate, high-protein, low-fat versus low-carbohydrate, high-protein, high-fat enteral feeds for burns
Masters B, Aarabi S, Sidhwa F, Wood F.; Cochrane Database Syst Rev. 2012 Jan 18;1:CD006122.
BACKGROUND: Severe burn injuries increase patients' metabolic needs. Aggressive high-protein enteral feeding is used in the post-burn period to improve recovery and healing.
2012 Jan - Tranexamic acid for upper gastrointestinal bleeding
Gluud LL, Klingenberg SL, Langholz E.; Cochrane Database Syst Rev. 2012 Jan 18;1:CD006640.
BACKGROUND: Tranexamic acid reduces haemorrhage through its antifibrinolytic effects. In a previous version of the present review, we found that tranexamic acid may reduce mortality. The present review includes updated searches of randomised trials on tranexamic acid versus placebo, cimetidine or lansoprazole.
2012 Jan - Antibiotic therapy for preventing infections in patients with acute stroke
Westendorp WF, Vermeij JD, Vermeij F, Den Hertog HM, Dippel DW, van de Beek D, Nederkoorn PJ.; Cochrane Database Syst Rev. 2012 Jan 18;1:CD008530.
BACKGROUND: Stroke is the main cause of disability in high income countries and ranks second as a cause of death worldwide. Infections occur frequently after stroke and may adversely affect outcome. Preventive antibiotic therapy in the acute phase of stroke may reduce infections and improve outcome.
2012 Jan - Quantitative versus qualitative cultures of respiratory secretions for clinical outcomes in patients with ventilator-associated pneumonia
Berton DC, Kalil AC, Teixeira PJ.; Cochrane Database Syst Rev. 2012 Jan 18;1:CD006482.
BACKGROUND: Ventilator-associated pneumonia (VAP) is a common infectious disease in intensive care units (ICUs). The best diagnostic approach to resolve this condition remains uncertain.
2012 Jan 17 - Virtual Autopsy as an Alternative to Traditional Medical Autopsy in the Intensive Care Unit: A Prospective Cohort Study
Background: Autopsy is an important educational and quality-control tool in the intensive care unit (ICU), but rates of traditional medical autopsies have declined worldwide. “Virtual” autopsy involving only advanced radiographic techniques might provide an alternative approach to postmortem examinations.
2012 Jan - Adrenocortical dysfunction in liver disease: A systematic review
Fede G, Spadaro L, Tomaselli T, Privitera G, Germani G, Tsochatzis E, Thomas M, Bouloux PM, Burroughs A, Purrello F.; Hepatology. 2012 Jan 11. doi: 10.1002/hep.25573. [Epub ahead of print]
In patients with cirrhosis adrenal insufficiency (AI) is reported during sepsis and septic shock, and is associated with increased mortality. Consequently, the term "hepato-adrenal syndrome" was proposed.
2012 Jan - Comparison of mortality associated with sepsis in the burn, trauma, and general intensive care unit patient: a systematic review of the literature
Mann EA, Baun MM, Meininger JC, Wade CE.; Shock. 2012 Jan;37(1):4-16.
The purpose of this systematic review of the literature was to determine the association of sepsis with mortality in the severely injured adult patient by means of a comparative analysis of sepsis in burn and trauma injury with other critically ill populations.
2012 Jan - How to optimise antimicrobial prescriptions in the Intensive Care Unit: principles of individualised dosing using pharmacokinetics and pharmacodynamics
Roberts JA, Joynt GM, Choi GY, Gomersall CD, Lipman J; Int J Antimicrob Agents. 2012 Jan 6. [Epub ahead of print]
Optimising antimicrobial dosing for critically ill patients is highly challenging and when it is not achieved can lead to worse patient outcomes. To this end, use of dosing regimens recommended in package inserts from drug manufacturers is frequently insufficient to guide dosing in these patients appropriately. Whilst the effect of critical illness pathophysiology on the pharmacokinetic (PK) behaviour of antimicrobials can be profound, the variability of these changes between patients is still being quantified....
2011 Dec 20 - Comparative Effectiveness of Clostridium difficile Treatments - A Systematic Review
Background: Clostridium difficile infection is increasing in incidence and severity. The optimal treatment is unknown.
2011 Dec - Extracorporeal light chain elimination: high cut-off (HCO) hemodialysis parallel to chemotherapy allows for a high proportion of renal recovery in multiple myeloma patients with dialysis-dependent acute kidney injury
Heyne N, Denecke B, Guthoff M, Oehrlein K, Kanz L, Häring HU, Weisel KC.; Ann Hematol. 2011 Dec 15. [Epub ahead of print]
Acute kidney injury (AKI) is frequent in multiple myeloma (MM) patients and strongly affects prognosis, with particularly poor outcomes in patients requiring hemodialysis. Introduction of the novel therapeutic agents to MM therapy has improved myeloma response and renal outcome. This case series reviews the efficacy of combined systemic and extracorporeal therapy to further optimize time to light chain (serum-free light chain (sFLC)) reduction and renal recovery in MM patients with dialysis-dependent AKI (n = 19)....
2011 Dec - Pharmacological considerations for the proper clinical use of aminoglycosides
Pagkalis S, Mantadakis E, Mavros MN, Ammari C, Falagas ME.; Drugs. 2011 Dec 3;71(17):2277-94.
Aminoglycosides constitute one of the oldest classes of antimicrobials. Despite their toxicity, mainly nephrotoxicity and ototoxicity, aminoglycosides are valuable in current clinical practice, since they retain good activity against multidrug-resistant Gram-negative pathogens, such as Pseudomonas aeruginosa and Acinetobacter spp.
2011 Nov - Cost-Effectiveness Analysis of Polymyxin-B Immobilized Fiber Column and Conventional Medical Therapy in the Management of Abdominal Septic Shock in Italy
Berto P, Ronco C, Cruz D, Melotti RM, Antonelli M.; Blood Purif. 2011 Nov 11;32(4):331-340. [Epub ahead of print]
Introduction: Severe abdominal sepsis and septic shock are common problems in intensive care units (ICUs), and carry high mortality. The purpose of this economic analysis was to determine the cost-effectiveness of polymyxin B immobilized fiber column (PMX-F) plus conventional therapy (CT) (PMX-F-CT) versus CT alone for patients with severe sepsis/septic shock of abdominal origin, in the perspective of the Italian hospital.
2011 Nov - Hypertonic Fluid Administration in Patients With Septic Shock: A Prospective Randomized Controlled Pilot Study
van Haren FM, Sleigh J, Boerma EC, La Pine M, Bahr M, Pickkers P, van der Hoeven JG.; Shock. 2011 Nov 15. [Epub ahead of print]
INTRODUCTION.: We assessed the short-term effects of hypertonic fluid versus isotonic fluid administration in patients with septic shock.
2011 Oct - Regional Citrate Anticoagulation in Predilution Continuous Venovenous Hemofiltration Using Prismocitrate 10/2 Solution
Regional citrate anticoagulation (RCA) for continuous renal replacement therapy (CRRT) is associated with a longer filter life and fewer bleeding events. Complexity of the regimen is the major hurdle preventing widespread application. This study describes a simple predilution continuous venovenous hemofiltration (CVVH) protocol utilizing a commercially prepared replacement solution containing citrate (Prismocitrate 10/2).
2011 Oct - Intervention in acute cerebral ischaemic stroke: a review of the role of pharmacological therapies and intra-arterial mechanical thrombectomy devices [Review]
Acute ischaemic stroke (AIS) is the leading cause of death and disability in developed nations. In the past decade pharmacologic and endovascular therapy has been approved for use in treatment of patients presenting with AIS. The time window from symptom onset to be eligible for treatment is narrow, allowing for only a small proportion of these patients to be treated. Currently the established method of treatment is intravenous thrombolytic therapy for patients without contraindication, presenting within the time window of 4.5 h from the onset of symptoms. The improvement in patient outcome with this therapy is poor. This has led to exploration of intra-arterial mechanical thrombectomy devices to both increase the time window and also attempt to improve patient outcome with and without intravenous thrombolytic therapy.