463 research outputs found
Transpulmonary pressure monitoring in critically ill patients: pros and cons
No full textThe use of transpulmonary pressure monitoring based on measurement of esophageal pressure has contributed importantly to the personalization of mechanical ventilation based on respiratory pathophysiology in critically ill patients. However, esophageal pressure monitoring is still underused in the clinical practice. This technique allows partitioning of the respiratory mechanics between the lungs and the chest wall, provides information on lung recruitment and risk of barotrauma, and helps titrating mechanical ventilation settings in patients with respiratory failure. In assisted ventilation modes and during non-invasive respiratory support, esophageal pressure monitoring provides important information on the inspiratory effort and work of breathing. Nonetheless, several controversies persist on technical aspects, interpretation and clinical decision-making based on values derived from this monitoring technique. The aim of this review is to summarize the physiological bases of esophageal pressure monitoring, discussing the pros and cons of its clinical applications and different interpretations in critically ill patients undergoing invasive and non-invasive respiratory support
Supplemental Material, qSOFA_SuppTable2_2019-05-11_Final - Evaluation of qSOFA as a Predictor of Mortality Among ICU Patients With Positive Clinical Cultures—A Retrospective Cohort Study
No full textSupplemental Material, qSOFA_SuppTable2_2019-05-11_Final for Evaluation of qSOFA as a Predictor of Mortality Among ICU Patients With Positive Clinical Cultures—A Retrospective Cohort Study by Barry Kelly, Johann Patlak, Shahzad Shaefi, Dustin Boone, Ariel Mueller and Daniel Talmor in Journal of Intensive Care Medicine</p
Supplemental Material, DSC_qSOFA_Table3_2019-01-27 - Evaluation of qSOFA as a Predictor of Mortality Among ICU Patients With Positive Clinical Cultures—A Retrospective Cohort Study
No full textSupplemental Material, DSC_qSOFA_Table3_2019-01-27 for Evaluation of qSOFA as a Predictor of Mortality Among ICU Patients With Positive Clinical Cultures—A Retrospective Cohort Study by Barry Kelly, Johann Patlak, Shahzad Shaefi, Dustin Boone, Ariel Mueller and Daniel Talmor in Journal of Intensive Care Medicine</p
Supplemental Material, qSOFA_SuppTable1_2019-01-27 - Evaluation of qSOFA as a Predictor of Mortality Among ICU Patients With Positive Clinical Cultures—A Retrospective Cohort Study
No full textSupplemental Material, qSOFA_SuppTable1_2019-01-27 for Evaluation of qSOFA as a Predictor of Mortality Among ICU Patients With Positive Clinical Cultures—A Retrospective Cohort Study by Barry Kelly, Johann Patlak, Shahzad Shaefi, Dustin Boone, Ariel Mueller and Daniel Talmor in Journal of Intensive Care Medicine</p
Life-threatening hemorrhage following subcutaneous heparin therapy
No full textJana Hudcova, Daniel TalmorDepartment of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USAAbstract: Prophylactic administration of unfractionated heparin is a common practice in a perioperative period. Heparin monitoring with subcutaneous dosing is not recommended; however it becomes important in selected patients. We report a case of massive hemorrhage with subcutaneous heparin administration in an HIV-positive male patient with cachexia and mild liver dysfunction. Prolonged activated plasma thromboplastin time and thrombin time, but normal reptilase time well as response to protamine sulfate point towards the heparin effect. Inhibitor screen was negative and factor VIII activity was normal. All these rule out the possibility of acquired factor VIII inhibitor or any other inhibitor and confirm that this bleeding was due to heparin overdose. We believe that delayed clearance of UH secondary to possible involvement of reticuloendothelial system might have been be responsible for heparin overdose even though inadvertent administration of large dose of heparin intravenously can not be completely ruled out. Administration of unfractionated heparin to a patient with cachexia and abnormal liver function warrants close attention to heparin monitoring or switch to low molecular weight heparin since its mechanism of elimination differs.Keywords: unfractionated heparin, bleeding, prophylaxis, liver dysfunction, cachexia, HI
Postoperative pulmonary embolism in a three year old with Klippel&ndash;Trenaunay syndrome
No full textJana Hudcova1, Monica Kleinman2, Daniel Talmor11Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; 2Department of Anesthesia, Division of Critical Care Medicine, Children&rsquo;s Hospital Boston and Harvard Medical School, Boston, MA, USAAbstract: Massive pulmonary embolism (PE) in a small child is a rare event and unified guidelines for its treatment are missing. Timely diagnosis and management of massive pulmonary embolism is of crucial importance for a good outcome. We describe a unique management of PE causing oxygenation failure using a combination of catheter extraction technique, and regional thrombolysis on top of systemic heparin administration and inferior vena cava filter placement. Pulmonary hypertension was treated with inhaled nitric oxide. We believe that catheter extraction technique and regional thrombolysis is an option to consider provided that resources and expertise are available. Preoperative placement of an inferior vena cava filter should be contemplated in such high risk situations.Keywords: embolectomy, regional thrombolysis, inferior vena cava filter, inhaled nitric oxid
A fixed correction of absolute transpulmonary pressure may not be ideal for clinical use: Discussion on “Accuracy of esophageal pressure to assess transpulmonary pressure during mechanical ventilation”
No full textN/
Device for measuring bronchodilator delivery and response in resource-limited settings
No full textVersion of Recor
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