MedWorm: Intensive Care Top 20

Guidelines for potential multiple organ donors (adult). Part III: organ-specific recommendations

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

A morte encefálica induz várias alterações fisiopatológicas que podem causar lesões em rins, pulmões, coração e fígado. Portanto, a atuação do intensivista durante a manutenção do potencial doador falecido exige cuidados específicos com estes órgãos visando sua maior viabilidade para transplantes. O manejo hemodinâmico cuidadoso, os cuidados ventilatórios e de higiene brônquica minimizam a perda de rins e pulmões para o transplante. A avaliação da condição morfológica e funcional do coração auxilia na avaliação do potencial transplantável deste órgão. Por fim, a avaliação da função hepática, assim como o controle metabólico e a realização de sorologias virais são fundamentais para a orientação das equipes transplantadoras na seleção do órgão ...

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Novel biomarkers in severe community-acquired pneumonia

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

A pneumonia adquirida na comunidade é a doença infecciosa que mais comumente exige internação em unidades de terapia intensiva e o diagnóstico precoce e preciso da pneumonia adquirida na comunidade ainda é um desafio. Os biomarcadores desempenham um importante papel auxiliando no julgamento clínico no Serviço de Emergência e são adjuvantes na avaliação da resposta terapêutica. Novos biomarcadores como cortisol, proadrenomedulina e endotelina-1 demonstraram estar associados a gravidade da doença e a evolução em curto prazo. Este artigo de revisão irá se basear no uso clínico de novos biomarcadores, na sua capacidade de predizer gravidade e de monitorar a resposta ao tratamento empregado.Community-acquired pneumonia (CAP) is the most common infectious disease requiring adm...

Guidelines for the management of accidental tetanus in adult patients

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

O tétano acidental, a despeito de ser uma doença prevenível por imunização, ainda é frequente nos países subdesenvolvidos e em desenvolvimento. Sua letalidade ainda é elevada e os estudos sobre a melhor forma de tratamento são escassos. Tendo em vista esta escassez e a importância clínica dessa doença, um grupo de especialistas reunidos pela Associação de Medicina Intensiva Brasileira (AMIB), desenvolveu recomendações baseadas na melhor evidencia disponível para o manejo do tétano no paciente necessitando cuidados intensivos. As recomendações incluem aspectos relativos à admissão do paciente tetânico na unidade de terapia intensiva, tratamento com imunoglobulinas, tratamento antibiótico, manejo da analgossedação e bloqueio neuromuscular, manejo da disautonomia e e...

Erratum to: Effects of expiratory tracheal gas insufflation in patients with severe head trauma and acute lung injury

Intensive Care Medicine — Tue, 08 Nov 2011 06:49:31 +0100

Content Type Journal ArticleCategory ErratumPages 1-1DOI 10.1007/s00134-011-2397-8Authors Melcior Martínez-Pérez, Critical Care Center, Hospital de Sabadell, Corporació Parc Taulí, Institut Universitari Fundació Parc Taulí, Universitat Autonoma de Barcelona, 08206 Sabadell, SpainFrancesca Bernabé, Critical Care Center, Hospital de Sabadell, Corporació Parc Taulí, Institut Universitari Fundació Parc Taulí, Universitat Autonoma de Barcelona, 08206 Sabadell, SpainRocío Peña, Critical Care Center, Hospital de Sabadell, Corporació Parc Taulí, Institut Universitari Fundació Parc Taulí, Universitat Autonoma de Barcelona, 08206 Sabadell, SpainRafael Fernández, Critical Care Center, Hospital de Sabadell, Corporació Parc Taulí, Institut Universitari Fundació Parc Taulí, Uni...

The neuroprotective role of therapeutic hypothermia after cardiac arrest

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

In this study, therapeutic hypothermia was applied to all post-cardiorespiratory arrest patients and demonstrated good neurological outcome in surviving patients. (Source: Revista Brasileira de Terapia Intensiva)

Posterior Reversible Encephalopathy Syndrome

Journal of Intensive Care Medicine — Mon, 23 Jan 2012 05:00:00 +0100

Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, altered mental status, visual disturbances, and seizures. Radiological features typically include edema of the posterior cerebral regions, especially of the parietooccipital lobes. Atypical imaging features, such as involvement of anterior cerebral regions, deep white matter, and the brain stem are also frequently seen. Vasoconstriction is common in vascular imaging. Different conditions have been associated with PRES, but toxemia of pregnancy, solid organ or bone marrow transplantation, immunosuppressive treatment, cancer chemotherapy, autoimmune diseases, and hypertension are most commonly described. The pathophysiology of PRES is unclear and different hypotheses are being discussed. Posterior reversible en...

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Clinical review: Idiopathic pulmonary fibrosis acute exacerbations - unravelling Ariadne's thread

Critical Care — Wed, 22 Dec 2010 00:00:00 +0100

Idiopathic pulmonary fibrosis (IPF) is a dreadful, chronic and irreversibly progressive fibrosing disease, leading to death all patients affected, and IPF acute exacerbations constitute the most devastating complication during its clinical course. IPF exacerbations are subacute/acute, clinically significant deteriorations of unidentifiable cause that usually transform the slow and more or less steady disease decline to the unexpected appearance of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), ending to death. The histological picture is that of diffuse alveolar damage (DAD), the tissue counterpart of ARDS, upon usual interstitial pneumonia (UIP) the tissue equivalent of IPF. ALI/ARDS and acute interstitial pneumonia share with IPF exacerbations the tissue damage patte...

The importance of diagnostic testing in the management of community-acquired respiratory infection during influenza season

Critical Care — Mon, 09 Jan 2012 05:00:00 +0100

Kuster and colleagues (Critical Care 15:R182) recently reported that during seasonal influenza febrile patients admitted to critical care with a diagnosis of pneumonia or respiratory infection are likely to have a diagnosis of influenza. Prompt identification of patients with influenza facilitates early empirical therapy and infection control. However, optimal management of patients requires confirmatory diagnostic microbiological testing and is exemplified by the case of a young male admitted at the peak of seasonal influenza. (Source: Critical Care)

January PCCM Supplement Offers Guidelines for Severe TBI

SCCM RSS News — Fri, 20 Jan 2012 14:21:51 +0100

The second edition of Guidelines for the Acute Medical Management of Severe Traumatic Brain Injury in Infants, Children, and Adolescents is now available as a supplement to the January issue of Pediatric Critical Care Medicine. In this update of the 2003 document, the guidelines committee maintained its commitment to produce evidence-based recommendations by applying rigorous inclusion and exclusion criteria. The guidelines have been endorsed by the American Academy of Pediatrics-Section on Neurological Surgery, American Association of Neurological Surgeons/Congress of Neurological Surgeons, Child Neurology Society, European Society of Pediatric and Neonatal Intensive Care, Neurocritical Care Society, Pediatric Neurocritical Care Research Group, Society of Critical Care Medicine, The Paedi...

Lethality and osteomuscular and cardiovascular complications in tetanus

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

CONCLUSION: The present study demonstrates the failure of primary medical care in vaccination and post-traumatic tetanus prophylaxis. Despite improvements in intensive care support, cardiovascular complications are still frequent in these patients. Individuals exhibiting high APACHE II scores and severe clinical forms of tetanus should be monitored closely due to a risk of death and cardiovascular complications. (Source: Revista Brasileira de Terapia Intensiva)

Influence of respiratory rate and end-expiratory pressure variation on cyclic alveolar recruitment in an experimental lung injury model

Critical Care — Mon, 16 Jan 2012 05:00:00 +0100

IntroductionCyclic alveolar recruitment (R/D) is an important mechanism of ventilator associated lung injury. In experimental models this process can be measured with high temporal resolution by detection of respiratory-dependent oscillations of the paO2 ([increment] paO2). A previous study showed that end-expiratory collapse can be prevented by an increased respiratory rate in saline-lavage rabbits. The current study compares the effects of increased PEEP versus an individually titrated respiratory rate (RRind) on intra-tidal amplitude of [increment] paO2 and on average paO2 in saline-lavaged pigs. Methods: Acute lung injury was induced by bronchoalveolar lavage in 16 anaesthetized pigs. R/D was induced and measured by a fast-responding intra-aortic probe measuring paO2.Ventilatory interv...

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Plasma neutrophil gelatinase-associated lipocalin for the prediction of acute kidney injury in acute heart failure

Critical Care — Sat, 07 Jan 2012 05:00:00 +0100

IntroductionThe accurate prediction of acute kidney injury (AKI) in patients with acute heart failure (AHF) is an unmet clinical need. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel sensitive and specific marker of AKI. Methods: A total of 207 consecutive patients presenting to the emergency department with AHF were enrolled. Plasma NGAL was measured in a blinded fashion at presentation and serially thereafter. The potential of plasma NGAL levels to predict AKI was assessed as the primary endpoint. We defined AKI according to the AKI Network classification. Results: Overall 60 patients (29%) experienced AKI. These patients were more likely to suffer from pre-existing chronic cardiac or kidney disease. At presentation, creatinine (median 140 [IQR, 91-203] umol/l vs. 97 [76-132...

Intensive care admissions and outcome at the University of Calabar Teaching Hospital, Nigeria

Journal of Critical Care — Wed, 01 Feb 2012 05:00:00 +0100

Abstract: An intensive care unit (ICU) is for critically ill patients who are likely to benefit from the expertise care provided. The outcome is dependent on the available human and material resources. The University of Calabar Teaching Hospital is a 410-bed hospital. It has a 3-bed general ICU consisting of 2 adult and 1 pediatric beds. A retrospective analysis of all ICU admissions as well as the mortality rate during a 12-month period that spans April 2009 and March 2010 was done. The data were collected from the ICU admissions and nurses' report books. The data extracted were the patients ages, stratified to pediatric (0-18 years) and adult (>18 years); the source of admission, primary diagnosis, the duration of admission, and the patients who were ventilated were also noted. The outco...

Year in review in Intensive Care Medicine 2011: I. Nephrology, epidemiology, nutrition and therapeutics, neurology, ethical and legal issues, experimentals

Intensive Care Medicine — Wed, 04 Jan 2012 07:01:13 +0100

Content Type Journal ArticleCategory Year in Review 2011Pages 1-18DOI 10.1007/s00134-011-2447-2Authors Massimo Antonelli, Department of Intensive Care and Anesthesiology, Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, ItalyMarc Bonten, Department of Medical Microbiology, Julius Center for Health Sciences and Primary Care University Medical Center Utrecht, Utrecht, The NetherlandsJean Chastre, Reanimation Medicale, Hopital Pitié Salpétrière, Paris, FranceGiuseppe Citerio, Neurointensive Care Unit, Ospedale S. Gerardo, Monza, ItalyGiorgio Conti, Department of Intensive Care and Anesthesiology, Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, ItalyJ. Randall Curti...

Respiratory syncytial virus (RSV) community-acquired pneumonia (CAP) in a hospitalized adult with human immunodeficiency virus (HIV) mimicking influenza A and Pneumocystis (carinii) jiroveci pneumonia (PCP)

Heart and Lung — Mon, 17 Oct 2011 04:00:00 +0100

Conclusion: We report on an adult patient with HIV with CAP that mimicked influenza and PCP, and was attributable to RSV. (Source: Heart and Lung)

Adrenal insufficiency in children with sepsis

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

CONCLUSION: This study determined the frequency of adrenal insufficiency in children with sepsis and its relationship to increased mortality within the first 28 post-admission days. No statistically significant association was found between adrenal insufficiency and mechanical ventilation time or the use of vasoactive drugs. (Source: Revista Brasileira de Terapia Intensiva)

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Bedside prediction rule for infections after pediatric cardiac surgery

Intensive Care Medicine — Thu, 19 Jan 2012 06:51:11 +0100

Conclusions A simple bedside prediction rule designed for use at 48 h post cardiac surgery can discriminate between children at high and low risk for a subsequent infection. Content Type Journal ArticleCategory Pediatric OriginalPages 1-8DOI 10.1007/s00134-011-2454-3Authors Selma O. Algra, Department of Pediatric Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The NetherlandsMieke M. P. Driessen, Department of Pediatric Intensive Care, University Medical Center Utrecht, Utrecht, The NetherlandsAlvin W. L. Schadenberg, Department of Pediatric Intensive Care, University Medical Center Utrecht, Utrecht, The NetherlandsAntonius N. J. Schouten, Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, ...

Rapid Sequence Intubation: A Safe and Effective Technique

Journal of Intensive Care Medicine — Mon, 23 Jan 2012 05:00:00 +0100

(Source: Journal of Intensive Care Medicine)

A 24-Year-Old Man With Cough, Rhabdomyolysis, and Pneumomediastinum

Journal of Intensive Care Medicine — Mon, 23 Jan 2012 05:00:00 +0100

Conclusion: Community-acquired MRSA pneumonia is a growing health threat that typically presents in young adults after, or in conjunction with, a flu-like illness. It is characterized by a rapidly progressive deteriorating clinical course. (Source: Journal of Intensive Care Medicine)

Influenza A 2009 (H1N1) Virus in Admitted and Critically Ill Patients

Journal of Intensive Care Medicine — Mon, 23 Jan 2012 05:00:00 +0100

Conclusion: A high percentage of patients with H1N1 presented with underlying comorbid conditions including asthma and pregnancy. Traditional markers of pneumonia severity including CURB-65 score, Pneumonia Severity Index (PSI), serum lactate, and AG did not correlate with ICU admission in patients with H1N1. Strong ion gap effectively identified significant acid–base disturbances not identified by lactate or AG, however the trend of greater ICU admission rates among patients with elevated SIG did not reach statistical significance. Further study is needed to identify clinical tools to aid in risk-stratifying H1N1 patients. (Source: Journal of Intensive Care Medicine)