共查询到20条相似文献，搜索用时 31 毫秒
1.
Alex Studemeister Lucy Studemeister Francisco Brun 《Heart & lung : the journal of critical care》2018,47(3):261-263
Background
Severe coccidioidal pneumonia with acute respiratory distress syndrome (ARDS) is associated with high mortality. Extracorporeal membrane oxygenation (ECMO) has been applied successfully to other severe fungal pneumonia associated with ARDS. We review our experience with the use of ECMO in severe coccidioidal ARDS.Objectives
To review indications and outcome of ECMO in severe pulmonary coccidioidomycosis.Methods
Three cases of severe ARDS caused by coccidioidomycosis are presented. All were managed with ECMO. Clinical course, complications, antifungal therapy and outcome are reviewed.Results
Three cases of severe coccidioidal ARDS survived after treatment with ECMO. Common complications included bacterial pneumonia, encephalopathy and critical illness myopathy. They received liposomal amphotericin during ECMO, and transitioned to azole therapy. All required prolonged hospitalization and rehabilitation.Conclusions
ECMO was life-saving in cases of coccidioidal ARDS. Common complications included pneumonia, encephalopathy and critical illness myopathy. All cases were successfully managed with liposomal amphotericin followed by azole therapy. They required prolonged hospitalization and rehabilitation. 相似文献2.
Background
The short-term outcomes of patients with cystic fibrosis (CF) surviving critical illness were not examined systematically.Objectives
To determine the factors associated with and variation in rates of routine home discharge among ICU-managed adult CF patients.Methods
Predictors of routine home discharge and its hospital-level variation were examined in ICU-managed adults with cystic fibrosis in Texas during 2004–2013.Results
Older age, rural residence, and severity of illness decreased odds of routine home discharge, while hospitalization in facilities accredited as part of the Cystic Fibrosis Foundation Care Center Network nearly doubled the odds of routine home discharge. The median (interquartile) adjusted rate of routine home discharge was 62.0% (31.5–82.5).Conclusions
The identified determinants of routine home discharge can inform clinical decision-making, while the demonstrated wide variation in adjusted across-hospital rates of routine home discharge of ICU-managed adults with CF can provide benchmark data for future quality improvement efforts. 相似文献3.
Benjamin Marchandot François Levy Nicola Santelmo Paul-Michel Mertes Olivier Morel 《Heart & lung : the journal of critical care》2018,47(3):248-249
Background
Adequate strategies using either transthoracic (TTE) or transesophageal (TEE) echocardiography in patients receiving cardiopulmonary resuscitation (CPR) is an ongoing area of research.Objectives
As transthoracic point-of-care ultrasound (POCUS) during cardiac arrest resuscitation might result in an increased duration of interruptions in the delivery of chest compressions; the use of TEE has been proposed as an alternative.Methods
No technical complications of either TTE nor TEE are so far being reported in the literature.Results
We report the case of a left intramural atrial hematoma complicating TEE procedure during cardiac arrest. This highlights a unique and to our knowledge, first-in-man, described complicating TEE procedure during CPR.Conclusions
Further research on the safety of transesophageal echo during CRP is mandatory and the question about any potential harm of particular interest. 相似文献4.
Mona A. Abed Nidal F. Eshah Debra K. Moser 《Heart & lung : the journal of critical care》2018,47(3):226-230
Background
In developing countries, the number of adults who develop myocardial infarction (MI) at a young age is high. The popularity of waterpipe smoking (WPS) has increased among the same age group. It is unknown if WPS contributes to the incidence of early-onset MI.Objective
To study the association of WPS with early-onset MI, which is defined as first MI occurring in individuals 18 ≥ age ≤ 45 years compared to those older than 45 years.Methods
This was a cross-sectional study. The association of WPS with first-time MI was compared between younger and older adults (N = 225).Results
Twenty-five percent of all participants developed an acute MI before the age of 46 years. Both cigarette and WPS were more common among younger first-time MI patients than older first-time MI patients.Conclusions
WPS is one risk factor that distinguishes the risk profile of young adults with early-onset MI. 相似文献5.
Robyn Gallagher Sue Randall Stella H.M. Lin Janice Smith Alexander M. Clark Lis Neubeck 《Heart & lung : the journal of critical care》2018,47(5):471-476
Background
The mechanisms contributing to the success of cardiac rehabilitation (CR) are poorly understood and may include assessment, monitoring and review activities enabled by continuity of care and this is investigated in this study.Objectives
To identify active assessment components of CR.Methods
A qualitative study using focus groups and individual interviews. CR staff (n = 39) were recruited via professional association email and network contacts and organised into major themes.Results
CR staff assessment strategies and timely actions undertaken provided a sophisticated post-discharge safety net for patients. Continuity of care enabled detection of adverse health indicators, of which medication issues were prominent. Interventions were timely and personalised and therefore likely to impact outcomes, but seldom documented or reported and thus invisible to audit.Conclusion
CR staff assessment and intervention activities provide an unrecognised safety net of activities enabled by continuity of care, potentially contributing to the effectiveness of CR. 相似文献6.
Ubolrat Piamjariyakul Noreen C. Thompson Christy Russell Carol E. Smith 《Heart & lung : the journal of critical care》2018,47(3):211-215
Background
African Americans with heart failure (HF) have the highest rates of depression among all ethnicities in the USA.Objectives
To compare the effects by race on depressive symptoms and topics discussed in the first clinic appointment after HF hospitalization.Methods
This study is a secondary analysis of data from a randomized clinical trial testing a patient group discussion of HF self-management with 93 Caucasians and 77 African Americans.Results
Reduction in depressive symptoms was significantly greater among African American patients within the intervention group (F = 3.99, p = .047) than controls. There were significant differences by race in four topics (dietitian referral, appointment date, help preparing discussion questions, and advice on worsening HF symptoms) concerning patient-physician discussions.Conclusion
The intervention showed greater effect in reducing depressive symptoms among African Americans than Caucasians. Preparing patients for discussions at physician appointments on diet, depressive symptoms, and HF symptoms is recommended. 相似文献7.
Thomas E. MacMillan Rodrigo B. Cavalcanti 《The American journal of medicine》2018,131(3):317.e1-317.e10
Background
Overcorrection of plasma sodium in severe hyponatremia is associated with osmotic demyelination syndrome. Desmopressin (DDAVP) can prevent overcorrection of plasma sodium in hyponatremia. The objective of this study was to compare outcomes in hyponatremia according to DDAVP usage.Methods
This was a retrospective observational study including all admissions to internal medicine with hyponatremia (plasma sodium concentration <123 mEq/L) from 2004 to 2014 at 2 academic hospitals in Toronto, Canada. The primary outcome was safe sodium correction (≤12 mEq/L in any 24-hour and ≤18 mEq/L in any 48-hour period).Results
We identified 1450 admissions with severe hyponatremia; DDAVP was administered in 254 (17.5%). Although DDAVP reduced the rate of change of plasma sodium, fewer patients in the DDAVP group achieved safe correction (174 of 251 [69.3%] vs 970 of 1164 [83.3%]); this result was driven largely by overcorrection occurring before DDAVP administration in the rescue group. Among patients receiving DDAVP, most received it according to a reactive strategy, whereby DDAVP was given after a change in plasma sodium within correction limits (174 of 254 [68.5%]). Suspected osmotic demyelination syndrome was identified in 4 of 1450 admissions (0.28%). There was lower mortality in the DDAVP group (3.9% vs 9.4%), although this is likely affected by confounding. Length of stay in hospital was longer in those who received DDAVP according to a proactive strategy.Conclusions
Although observational, these data support a reactive strategy for using DDAVP in patients at average risk of osmotic demyelination syndrome, as well as a more stringent plasma sodium correction limit of 8 mEq/L in any 24-hour period for high-risk patients. Further studies are urgently needed on DDAVP use in treating hyponatremia. 相似文献8.
James M. Walter Chitaru Kurihara Thomas C. Corbridge Ankit Bharat 《Heart & lung : the journal of critical care》2018,47(4):398-400
Background
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is increasingly utilized in the management of severe acute respiratory distress syndrome (ARDS). Providers who care for patients on VV-ECMO should be familiar with common circuit complications.Objectives
To provide an example of a common complication, circuit “chugging,” and suggest a management algorithm which aims to avoid excessive fluid administration to patients with ARDS.Methods
We use a clinical case to illustrate chugging and discuss potential management strategies.Results
Our patient received frequent boluses of albumin for intermittent circuit chugging contributing to a net positive fluid balance of roughly 6 liters 4 days after cannulation.Conclusions
Chugging is a common complication for patients on VV ECMO. A thoughtful approach to management may help limit potentially harmful fluid administration for patients with ARDS. 相似文献9.
Celensia Tolson Lauren E. Richey Yujing Zhao Jeffrey E. Korte Kathleen Brady Louise Haynes Eric G. Meissner 《The American journal of the medical sciences》2018,355(6):553-558
Background
Persons with HIV infection who do not achieve virologic suppression contribute significantly to the ongoing HIV epidemic and have an increased risk of clinical sequelae related to immunosuppression. The extent to which substance use and mental health diagnoses affect HIV outcomes and the care continuum has not been previously assessed at the Medical University of South Carolina (MUSC), a large academic HIV clinic.Methods
To address this knowledge gap and identify targets for intervention, we performed a retrospective chart review to examine associations of substance use and mental health diagnoses with hospitalization and virologic suppression.Results
Patients with substance use or mental health diagnoses had increased rates of hospitalization and lower rates of sustained longitudinal HIV suppression. Prevalence of distinct substance-related disorders differed by race and sex. Although cocaine, alcohol and cannabis use were common, documented opiate use disorder was surprisingly infrequent given the ongoing opioid epidemic in South Carolina.Conclusions
These data suggest effective assessment and treatment of substance use disorders will help improve the HIV care continuum in South Carolina. 相似文献10.
Rajkumar Doshi Jay Shah Varun Jauhar Dean Decter Rajiv Jauhar Perwaiz Meraj 《Heart & lung : the journal of critical care》2018,47(3):231-236
Background
The aim of this study was to analyze the indications for using bare metal stents (BMSs) in hospitalizations with ST segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI).Methods
The study cohorts were identified from the National Inpatient Sample database from 2010–2014 using appropriate, International Classification of Diseases, 9th Revision, Clinical Modification, diagnostic and procedural codes.Results
A total of 123,487 hospitalizations were identified for this study. Drug eluting stent (DES) use demonstrated lower in-hospital mortality (5.8% vs. 3.3%, P = < 0.01) and other in-hospital outcomes, thus resulting in lower hospitalization stay. Higher age, black race, greater comorbidity burden, inferior wall myocardial infarction, and the use of mechanical circulatory devices were all associated with BMS use.Conclusion
DES was the preferred standard of care in the era of 2nd generation DES; however, BMSs were used in hospitalizations with high-risk procedures and multiple risk factors. 相似文献11.
Jemima Boyd Jenny Paratz Oystein Tronstad Lawrence Caruana Paul McCormack James Walsh 《Heart & lung : the journal of critical care》2018,47(2):81-86
Rationale
Consensus recommendations have been developed to guide exercise rehabilitation of mechanically ventilated patients in the intensive care unit.Objective
This study aimed to investigate the safety of exercise rehabilitation of mechanically ventilated patients and evaluate the consensus recommendations.Methods
This was a prospective, single-centre, cohort study conducted in a specialist cardiothoracic intensive care unit of a tertiary, university affiliated hospital in Australia.Results
91 mechanically ventilated participants; 54 (59.3%) male; mean age of 56.52 (16.3) years; were studied with 809 occasions of service recorded. Ten (0.0182%) minor adverse events were recorded, with only one adverse event occurring when a patient was receiving moderate level of vasoactive support.Conclusions
The consensus recommendations are a useful tool in guiding safe exercise rehabilitation of mechanically ventilated patients. Our findings suggest that there is further scope to safely commence exercise rehabilitation in patients receiving vasoactive support. 相似文献12.
Morgan Humphrey Sonia Everhart Desiree Kosmisky William E. Anderson 《Heart & lung : the journal of critical care》2018,47(4):387-391
Background
Sedation of mechanically ventilated patients should optimize comfort and safety while avoiding over-sedation and adverse outcomes. To our knowledge, characteristics associated with attaining target sedation are unknown.Objectives
Evaluate current sedation practice at a single center and explore which patient characteristics are associated with attaining target sedation.Methods
This is a single-center, retrospective chart review of sedated, ventilated patients in a medical/surgical ICU. Demographic and clinical data were collected. Univariate and multivariate logistic regression analyses were used with attaining target sedation as the dependent variable.Results
Of the 100 patients included (median 60.5 years), 50 attained target sedation. Univariate analyses (a = 0.10) revealed factors associated with target sedation were age (P = 0.08), history of alcohol abuse (P = 0.08), multiple comorbidities (P = 0.09), and delirium monitoring (P = 0.002). Multivariate analysis revealed an association between delirium monitoring/documentation and attaining target sedation (P = 0.005; OR 9.2; 95% CI 2.3–36.8).Conclusions
Patients without appropriate delirium monitoring/documentation had significantly reduced likelihood of achieving target sedation. 相似文献13.
Claire J. Tipping Anne E. Holland Meg Harrold Tom Crawford Nick Halliburton Carol L. Hodgson 《Heart & lung : the journal of critical care》2018,47(5):497-501
Background
The intensive care unit mobility scale (IMS) is reliable, valid and responsive. Establishing the minimal important difference (MID) of the IMS is important in order to detect clinically significant changes in mobilization.Objective
To calculate the MID of the IMS in intensive care unit patients.Methods
Prospective multi center observational study. The IMS was collected from admission and discharge physiotherapy assessments. To calculate the MID we used; anchor based methods (global rating of change) and two distribution-based methods (standard error of the mean and effect size).Results
We enrolled 184 adult patients; mean age 62.0 years, surgical, trauma, and medical. Anchor based methods gave a MID of 3 with area under the curve 0.94 (95% CI 0.89-0.97). The two distribution based methods gave a MID between 0.89 and 1.40.Conclusion
These data increase our understanding of the clinimetric properties of the IMS, improving its utility for clinical practice and research. 相似文献14.
15.
Rahman Shiri Ulla Euro Markku Heliövaara Mirja Hirvensalo Kirsti Husgafvel-Pursiainen Jaro Karppinen Jouni Lahti Ossi Rahkonen Olli T. Raitakari Svetlana Solovieva Xiaolin Yang Eira Viikari-Juntura Tea Lallukka 《The American journal of medicine》2017,130(12):1408-1414.e6
Background
The purpose of this study is to assess the effects of lifestyle risk factors on the risk of hospitalization for sciatica and to determine whether overweight or obesity modifies the effect of leisure-time physical activity on hospitalization for sciatica.Methods
We included 4 Finnish prospective cohort studies (Health 2000 Survey, Mobile Clinic Survey, Helsinki Health Study, and Young Finns Study) consisting of 34,589 participants and 1259 hospitalizations for sciatica during 12 to 30 years of follow-up. Sciatica was based on hospital discharge register data. We conducted a random-effects individual participant data meta-analysis.Results
After adjustment for confounding factors, current smoking at baseline increased the risk of subsequent hospitalization for sciatica by 33% (95% confidence interval [CI], 13%-56%), whereas past smokers were no longer at increased risk. Obesity defined by body mass index increased the risk of hospitalization for sciatica by 36% (95% CI 7%-74%), and abdominal obesity defined by waist circumference increased the risk by 41% (95% CI 3%-93%). Walking or cycling to work reduced the risk of hospitalization for sciatica by 33% (95% CI 4%-53%), and the effect was independent of body weight and other leisure activities, while other types of leisure activities did not have a statistically significant effect.Conclusions
Smoking and obesity increase the risk of hospitalization for sciatica, whereas walking or cycling to work protects against hospitalization for sciatica. Walking and cycling can be recommended for the prevention of sciatica in the general population. 相似文献16.
Jungeun Lee Huong Q. Nguyen Monica E. Jarrett Pamela H. Mitchell Kenneth C. Pike Vincent S. Fan 《Heart & lung : the journal of critical care》2018,47(2):149-156
Background
Chronic obstructive pulmonary disease (COPD) patients experience multiple symptoms including dyspnea, anxiety, depression, and fatigue, which are highly correlated with each other. Together, those symptoms may contribute to impaired physical performance.Objectives
The purpose of this study was to examine interrelationships among dyspnea, anxiety, depressive symptoms, and fatigue as contributing factors to physical performance in COPD.Methods
This study used baseline data of 282 COPD patients from a longitudinal observational study to explore the relationship between depression, inflammation, and functional status. Data analyses included confirmatory factor analyses and structural equation modeling.Results
Dyspnea, anxiety and depression had direct effects on fatigue, and both dyspnea and anxiety had direct effects on physical performance. Higher levels of dyspnea were significantly associated with impaired physical performance whereas higher levels of anxiety were significantly associated with enhanced physical performance.Conclusion
Dyspnea was the strongest predictor of impaired physical performance in patients with COPD. 相似文献17.
Li Liu Xiuhua Wang Xi Cao Can Gu Chen Yang Yu OuYang 《Heart & lung : the journal of critical care》2018,47(3):216-221
Background
Existing theory and evidence suggest that self-care confidence may mediate the relationship between Type D personality and self-care adherence.Objectives
To assess the mediating role of self-care confidence between Type D personality and self-care adherence in Chinese HF patients.Methods
This is a secondary analysis of a cross-sectional study. Self-care confidence and self-care adherence (maintenance) were measured by the subscales of the Self-Care of Heart Failure Index (v6). The Type D Scale-14 was administered to assess negative affect (NA), social inhibition (SI), and Type D personality. Mediation analysis based on Baron and Kenny was performed.Results
A total of 127 HF patients were included. Self-care confidence partially mediated the relationship between Type D personality and self-care adherence but completely mediated the relationship between NA/SI and self-care adherence.Conclusions
Clinicians may effectively improve self-care adherence by enhancing self-care confidence in HF patients with Type D personality. 相似文献18.
Glenna Schluck Wei Wu James Whyte Laurie Abbott 《Heart & lung : the journal of critical care》2018,47(5):458-464
Background
Emergency room utilization and hospital readmission rates are disproportionately high for heart failure patients (HF). Emergency department (ED) utilization is intimately intertwined with hospital readmissions.Objective
Describe the arrival time distribution of HF patients presenting to the ED.Method
The study analyzed heart failure discharge data from the Florida State Emergency Department Database and the Florida State Inpatient Database from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. Data were treated as a Poisson process and analyzed using functional data analysis tools.Results
HF arrivals are multi-modal with the largest peak arrival time in the middle of the day as well as a smaller peak in the early morning hours, especially in rural areas.Conclusions
The arrival pattern has minor differences in rural and urban areas. HF clinic appointments should be established in the early morning hours when these patients utilize the ED. 相似文献19.
Kyoungrim Kang Leila Gholizadeh Hae-Ra Han Sally C. Inglis 《Heart & lung : the journal of critical care》2018,47(2):142-148
Background
Experience of myocardial infarction (MI) negatively affects different aspects of health-related quality of life (HRQoL).Objectives
This study aimed to examine trends in HRQoL of MI patients and to identify demographic, clinical and psychosocial predictors of HRQoL at three months.Methods
A total of 150 patients in South Korea were completed the study questionnaires at baseline. After three months from discharge, 136 participants completed follow-up questionnaires, including the Korean version of the MacNew Quality of Life after Myocardial Infarction Questionnaire (MacNew).Results
HRQoL significantly improved over three months. Younger age, ST-elevation MI, and higher LVEF, lower level of depression, better understanding of the illness and higher perceived social support at baseline were associated with better HRQoL at three months.Conclusion
Providing adequate information about the illness and social support as well as reducing negative psychological experiences in early days after MI may improve HRQoL of MI patients. 相似文献20.
Sim Leng Ooi Betsy Seah Vivien Xi Wu Karen Wei Ling Koh Nana Jiao Hong-Gu He Wenru Wang 《Heart & lung : the journal of critical care》2018,47(4):329-336
