182 research outputs found
Contextualizing cardiac dysfunction in critically ill patients with COVID-19
No full textAcute cardiac injury incidence in COVID-19 is about 13 times higher in the Intensive Care Unit (ICU)/severely ill than in less critical patients. Patients with cardiovascular comorbidities seem to be more prone to develop higher acuity of the infection, and myocardial injury has been reported amongst them in up to 15% of those hospitalized and up to 30% of ICU-admitted ones. The symptoms of over ischemia/heart failure may be challenging to distinguish as dyspnea and chest discomfort overlap with those due to COVID-19. Therefore, beside close monitoring with electrocardiography, biomarkers and, in case of demonstrated cardiac involvement, echocardiography, strategies to improve myocardial oxygen delivery should be promptly applied. The cytokine release with complement and iNO dysregulation are established mechanisms potentially leading to sepsis-related cardiomyopathy, making sepsis per se one of the potential mechanism leading to acute cardiac injury in COVID-19 patients. Moreover, the hyper-inflammation with endothelial dysfunction is likely be responsible of both pulmonary in-situ platelet aggregation and deep thrombosis potentially leading to severe pulmonary embolism and right ventricular failure. Besides the customary antithrombotic prophylaxis for critical patients, D-dimer levels and tighter coagulation monitoring are recommended and should guide the choice for anticoagulation treatment. We summarize the current knowledge regarding cardiovascular involvement in patient with COVID-19
Lung ultrasound and B-lines quantification inaccuracy: B sure to have the right solution
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Reversing the Effect of Anticoagulants Safety in Patients Undergoing Emergency Surgery
No full textAnticoagulants are widely used, especially in the elderly, for the prevention and treatment of thromboembolic complications and in high-risk post myocardial infarction. Above all, Vitamin K antagonists (VKAs) are predominantly prescribed in the general population. Unfortunately, due to VKAs intrinsic pharmacodynamic and pharmacokinetic properties (high interindividual variability, food interaction, narrow therapeutic window), routine management of VKAs can be challenging both for the patients and for the clinicians, consequently, the number of patients taking non-vitamin K oral anticoagulants (i.e., direct oral anticoagulants) is increased in the last years. In fact, direct oral anticoagulants (DOACs) have progressively been used owing to their shorter half-lives, rapid onset, and predictable pharmacodynamics.
In the elderly, the incidence of pharmacologically induced coagulopathy, in trauma or emergency invasive procedure, is responsible for a huge increase of bleeding complications that can be life-threatening. Consequently, the perioperative management of patients taking anticoagulant agents and undergoing surgery is particularly challenging. A precise balance has to be reached between the risk of bleeding and the risk of thromboembolism. Then, when a decision of stopping anticoagulant has been made, it is vital to determine the time of anticoagulation interruption, resumption, and the necessity of bridging. Furthermore, in emergency scenario, the reversal of the anticoagulant should be mandatory, not only to prevent but also to treat perioperative bleeding. In this situation, a specific reversal strategy has to be chosen on the basis of the type of anticoagulants.
In this chapter, we aimed to provide an overview of the current knowledge regarding the perioperative management of patients receiving anticoagulants and undergoing surgery
Ultrasonographic Features of Muscular Weakness and Muscle Wasting in Critically Ill Patients
No full textMuscle wasting begins as soon as in the first week of one’s ICU stay and patients with multi-organ failure lose more muscle mass and suffer worse functional impairment as a consequence. Muscle wasting and weakness are mainly characterized by a generalized, bilateral lower limb weakness. However, the impairment of the respiratory and/or oropharyngeal muscles can also be observed with important consequences for one’s ability to swallow and cough. Muscle wasting represents the result of the disequilibrium between breakdown and synthesis, with increased protein degradation relative to protein synthesis. It is worth noting that the resulting functional disability can last up to 5 years after discharge, and it has been estimated that up to 50% of patients are not able to return to work during the first year after ICU discharge. In recent years, ultrasound has played an increasing role in the evaluation of muscle. Indeed, ultrasound allows an objective evaluation of the cross-sectional area, the thickness of the muscle, and the echogenicity of the muscle. Furthermore, ultrasound can also estimate the thickening fraction of muscle. The objective of this review is to analyze the current understanding of the pathophysiology of acute skeletal muscle wasting and to describe the ultrasonographic features of normal muscle and muscle weakness
Lung Ultrasonography as the First Confirmation Method for Central Venous Catheterization: How Far Are We?
No full textAssessment of the knowledge level and experience of healthcare personnel concerning CPR and early defibrillation: an internal survey
No full textBackground: In‐hospital cardiac arrest (IHCA) is a major public health problem with significant mortality. Rapid cardiopulmonary resuscitation and early defibrillation is extremely connected to patient outcome. In this study, we aimed to assess the effects of a basic life support and defibrillation course in improving knowledge in IHCA management. Methods: We performed a prospective observational study recruiting healthcare personnel working at Azienda Ospedaliero Universitaria Pisana, Pisa, Italy. Study consisted in the administration of two questionnaires before and after BLS-D course. The course was structured as an informative meeting and it was held according to European Resuscitation Council guidelines. Results: 78 participants completed pre- and post-course questionnaires. Only 31.9% of the participants had taken part in a BLS-D before our study. After the course, we found a significative increase in the percentage of participants that evaluated their skills adequate in IHCA management (17.9% vs 42.3%; p < 0.01) and in the correct use of defibrillator (38.8% vs 67.9% p < 0.001). However, 51.3% of respondents still consider their preparation not entirely appropriate after the course. Even more, we observed a significant increase in the number of corrected responses after the course, especially about sequence performed in case of absent vital sign, CPR maneuvers and use of defibrillator. Conclusions: The training course resulted in significant increase in the level of knowledge about the general management of IHCA in hospital staff. Therefore, a simple intervention such as an informative meetings improved significantly the knowledge about IHCA and, consequently, can lead to a reduction of morbidity and mortality
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