1,721,152 research outputs found
Esmolol in septic shock. old pathophysiological concepts, an old drug, perhaps a new hemodynamic strategy in the right patient
No full textComment on Beta-blockers in septic shock: a magnifying glass on the relation heart vessel. [J Thorac Dis. 2016]
Heart rate reduction may be a major determinant of vascular tone in esmolol-treated septic shock patients-although still remains to be confirmed! [J Thorac Dis. 2016]
Ventriculo-arterial coupling: the comeback? [J Thorac Dis. 2016]
Beta-blockers in patients with septic shock: plenty of promise, but no hard evidence yet. [J Thorac Dis. 2016
Artificial Intelligence and Left Ventricular Diastolic Function Assessment: A New Tool for Improved Practice?
No full textPredatory open-access publishing in critical care medicine
No full textPurpose: To evaluate the characteristics and practice of predatory journals in critical care medicine (CCM). Methods: We checked a freely accessible online and constantly updated version of the Beall lists of potential predatory publishers/journals in the field of CCM. We checked the journals’ websites to retrieve the following data such as: 1) Country and address (checked by Google maps); 2) Article processing charges (APC); 3) Indexing; 4) Editor-in-chief and the Editorial Board (EB) members; 5) Number of published articles; 6) Review time (lapse submission-acceptance); 7) English form. Results: We identified 86 CCM journals from 48 publishers. Most journals’ reported address was in the US (52%). The address was unreliable in 43%. English form was low/very-low in 72% of cases. Three journals were indexed in PubMed. Several journals reported false indexing in the Committee on publication ethics (COPE), International Committee of Medical Journal Editors (ICMJE), Directory of Open Access Journals (DOAJ) and Google Scholar. Median APCs for research article was 909.5 USD. Name of the Editor-in-chief and EB lists were reported by 29% and 81%, respectively. Median lapse submission-acceptance for published articles was 32 days. Conclusions: We found a relevant number of probable predatory CCM journals. Scientists should carefully check journal's characteristics to avoid selecting predatory journals as editorial target
Artificial intelligence: a new editor limiting self-citation malpractice
Full text linkLetter to the editor
Beta-blocker use in severe sepsis and septic shock. a systematic review
No full textObjective: Recent growing evidence suggests that beta-blocker treatment could improve cardiovascular dynamics and possibly the outcome of patients admitted to intensive care with severe sepsis or septic shock.
Design: Systematic review.
Data sources: MEDLINE and EMBASE healthcare databases. Review methods: To investigate this topic, we conducted a systematic review of the above databases up to 31 May 2015. Due to the clinical novelty of the subject, we also included non-randomized clinical studies. We focused on the impact of beta-blocker treatment on mortality, also investigating its effects on cardiovascular, immune and metabolic function. Evidence from experimental studies was reviewed as well.
Results: From the initial search we selected 10 relevant clinical studies. Five prospective studies (two randomized) assessed the hemodynamic effects of the beta(1)-blocker esmolol. Heart rate decreased significantly in all, but the impact on other parameters differed. The imbalance between prospective studies' size (10 to 144 patients) and the differences in their design disfavor a meta-analysis. One retrospective study showed improved hemodynamics combining metoprolol and milrinone in septic patients, and another retrospective study found no association between beta-blocker administration and mortality. We also found three case series. Twenty-one experimental studies evaluated the hemodynamic, immune and/or metabolic effects of selective and/or non-selective beta-blockers in animal models of sepsis (dogs, mice, pigs, rats, sheep), yielding conflicting results.
Conclusions: Whilst there is not enough prospective data to conduct a meta-analysis, the available clinical data are promising. We discuss the ability of beta blockade to modulate sepsis-induced alterations at cardiovascular, metabolic, immunologic and coagulation levels
Understanding left ventricular diastolic dysfunction in anesthesia and intensive care patients: a glass with progressive shape change
No full textLeft ventricular (LV) diastolic dysfunction is a commonly encountered condition and its impact on the anesthesia and the intensive care population is often underestimated. The study of the diastole is known as "diastology" and comprises four phases: isovolumetric relaxation, early filling phase, diastasis, and late filling phase. Diastolic function needs at least the same attention as systolic function, since its alteration has been associated with worse prognosis. Notwithstanding, many physicians consider the assessment of diastolic function too much complex. In this context, the latest 2016 guideline have simplified the assessment of diastolic function. In this educational review, we approach diastolic dysfunction with didactic purposes. First, we use a metaphor to consider the LV as a glass that progressively changes its shape and height along the disease course, resembling variable end-diastolic pressures and volumes at different stages while progressing with diastolic dysfunction. We guide readers in the process of diagnosis and grading of LV diastolic dysfunction, with description of pathophysiological changes in LV relaxation and consequently in the pressure gradient between the left-sided heart chambers. In the second part, starting from physiology we move towards suggestions for the clinical management of anesthesia and intensive care patients with diastolic dysfunction under different scenarios (hypo- and hypervolemia, weaning, sepsis, tachycardia and arrhythmias, right ventricular dysfunction)
Exposure to severe hyperoxemia worsens survival and neurological outcome in patients supported by veno-arterial extracorporeal membrane oxygenation: A meta-analysis
No full textBackground: Veno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a rescue treatment in refractory cardiogenic shock (CS) or refractory cardiac arrest (CA). Exposure to hyperoxemia is common during VA-ECMO, and its impact on patient's outcome remains unclear. Methods: We conducted a systematic review (PubMed and Scopus) and meta-analysis investigating the effects of exposure to severe hyperoxemia on mortality and poor neurological outcome in patients supported by VA-ECMO. When both adjusted and unadjusted Odds Ratio (OR) were provided, we used the adjusted one. Results are reported as OR and 95% confidence interval (CI). Subgroup analyses were conducted according to VA-ECMO indication and hyperoxemia thresholds. Results: Data from 10 observational studies were included. Nine studies reported data on mortality (n = 5 refractory CA, n = 4 CS), and 4 on neurological outcome. As compared to normal oxygenation levels, exposure to severe hyperoxemia was associated with higher mortality (nine studies; OR: 1.80 [1.16–2.78]; p = 0.009; I2 = 83%; low certainty of evidence) and worse neurological outcome (four studies; OR: 1.97 [1.30–2.96]; p = 0.001; I2 = 0%; low certainty of evidence). Magnitude and effect of these findings remained valid in subgroup analyses conducted according to different hyperoxemia thresholds (>200 or >300 mmHg) and VA-ECMO indication, although the association with mortality remained uncertain in the refractory CA population (p = 0.13). Analysis restricted to studies providing adjusted OR data confirmed an increased likelihood of poorer neurological outcome (three studies; OR: 2.11 [1.32–3.38]; p = 0.002) in patients exposed to severe hyperoxemia but did not suggest higher mortality (five studies; OR: 1.68 [0.89–3.18]; p = 0.11). Conclusions: Severe hyperoxemia exposure after initiation of VA-ECMO may be associated with an almost doubled increased probability of poor neurological outcome and mortality. Clinical efforts should be made to avoid severe hyperoxemia during VA-ECMO support
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