Circulation and circulatory support in the critically ill

2020 ◽  
pp. 3881-3891
Author(s):  
Michael R. Pinsky
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Rapid Assessment ◽  
Circulatory Support ◽  
Critically Ill Patient ◽  
Haemodynamic Monitoring ◽  
Vast Array ◽  
Bedside Echocardiography ◽  
Diagnostic Approaches

Cardiovascular dysfunction is common in critically ill patients and is the primary cause of death in a vast array of illnesses. The prompt identification and diagnosis of its probable cause, coupled to appropriate resuscitation and (when possible) specific treatments, are cornerstones of intensive care medicine. Cardiovascular performance can be assessed clinically at the bedside and through haemodynamic monitoring, and with therapeutic or other proactive interventions. Rapid assessment of shocked patients by bedside echocardiography is increasingly used in those institutions where equipment and expertise are available. Diagnostic approaches or therapies based on data derived from invasive haemodynamic monitoring in the critically ill patient assume that specific patterns of derangement reflect specific disease processes, which will respond to appropriate intervention.

Circulation and circulatory support in the critically ill

2010 ◽  
pp. 3122-3131
Author(s):  
Michael R. Pinsky
Keyword(s):  
Intensive Care ◽  
Intensive Care Medicine ◽  
Critically Ill ◽  
Cause Of Death ◽  
Circulatory Support ◽  
Critically Ill Patient ◽  
Cardiovascular Dysfunction ◽  
Vast Array

Cardiovascular dysfunction is common in the critically ill patient and is the primary cause of death in a vast array of illnesses. The prompt identification and diagnosis of its probable cause, coupled to appropriate resuscitation and (when possible) specific treatments, are cornerstones of intensive care medicine....

scholarly journals Impact of Renal Replacement Therapy on Mortality in Critically Ill Patients—The Nephrologist’s View within an Interdisciplinary Intensive Care Team

2021 ◽  
Vol 10 (15) ◽  
pp. 3379
Author(s):  
Matthias Klingele ◽  
Lea Baerens
Keyword(s):  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Positive Impact ◽  
Kidney Injury ◽  
Care Team ◽  
Critically Ill Patient ◽  
Late Start

Acute kidney injury (AKI) is a common complication in critically ill patients with an incidence of up to 50% in intensive care patients. The mortality of patients with AKI requiring dialysis in the intensive care unit is up to 50%, especially in the context of sepsis. Different approaches have been undertaken to reduce this high mortality by changing modalities and techniques of renal replacement therapy: an early versus a late start of dialysis, high versus low dialysate flows, intermittent versus continuous dialysis, anticoagulation with citrate or heparin, the use of adsorber or special filters in case of sepsis. Although in smaller studies some of these approaches seemed to have a positive impact on the reduction of mortality, in larger studies these effects could not been reproduced. This raises the question of whether there exists any impact of renal replacement therapy on mortality in critically ill patients—beyond an undeniable impact on uremia, hyperkalemia and/or hypervolemia. Indeed, this is one of the essential challenges of a nephrologist within an interdisciplinary intensive care team: according to the individual situation of a critically ill patient the main indication of dialysis has to be identified and all parameters of dialysis have to be individually chosen with respect to the patient’s situation and targeting the main dialysis indication. Such an interdisciplinary and individual approach would probably be able to reduce mortality in critically ill patients with dialysis requiring AKI.

The ART of Antiretroviral Therapy in Critically Ill Patients With HIV

2018 ◽  
Vol 34 (11-12) ◽  
pp. 897-909 ◽  
Author(s):  
Tyler Finocchio ◽  
William Coolidge ◽  
Thomas Johnson
Keyword(s):  
Intensive Care ◽  
Antiretroviral Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Critically Ill Patient ◽  
Intensive Care Setting ◽  
Antiretroviral Medications ◽  
Immunodeficiency Virus ◽  
Inflammatory Syndrome

The management of patients with human immunodeficiency virus (HIV) can be a complicated specialty within itself, made even more complex when there are so many unanswered questions regarding the care of critically ill patients with HIV. The lack of consensus on the use of antiretroviral medications in the critically ill patient population has contributed to an ongoing clinical debate among intensivists. This review focuses on the pharmacological complications of antiretroviral therapy (ART) in the intensive care setting, specifically the initiation of ART in patients newly diagnosed with HIV, immune reconstitution inflammatory syndrome (IRIS), continuation of ART in those who were on a complete regimen prior to intensive care unit admission, barriers of drug delivery alternatives, and drug-drug interactions.

scholarly journals ABO Blood Group and RhD status Are Not Associated with Mortality and Morbidity in Critically Ill Patients; a Multicentre Observational Study of 29 512 Patients

2022 ◽  
Author(s):  
Thomas Kander ◽  
Martin F. Bjurström ◽  
Attila Frigyesi ◽  
Magnus Jöud ◽  
Caroline U. Nilsson
Keyword(s):  
Critically Ill ◽  
Blood Group ◽  
Critically Ill Patients ◽  
Blood Groups ◽  
Blood Type ◽  
Circulatory Support ◽  
Critically Ill Patient ◽  
Abo Blood Groups ◽  
Number Of Patients ◽  
Transfusion Requirements

Abstract Background. Previous studies have demonstrated an association between ABO blood groups and many types of disease. The present study primarily aimed to identify associations between ABO blood groups, RhD groups and mortality/morbidity outcomes in critically ill patients both in a main cohort and in six pre-defined subgroups. The secondary aim was to investigate any differences in transfusion requirement between the different ABO blood groups and RhD status.Methods. Adult patients admitted to any of the five intensive care units (ICUs) in Skåne, Sweden, between February 2007 and April 2021 were eligible for inclusion. The outcomes were mortality analysed at 28– and 90–days as well as at the end of observation and morbidity measured using days alive and free of (DAF) invasive ventilation (DAF ventilation) and DAF circulatory support, including vasopressors or inotropes (DAF circulation), maximum Sequential Organ Failure Assessment score (SOFAmax) the first 28 days after admission and length of stay. All outcomes were analysed in separate multivariable regression models (adjusted for age and sex), generating odds or hazard ratios for each blood group and RhD status using blood group O and RhD negative as reference. Transfusion requirements were also investigated.Results. In total, 29 512 unique patients were included in the analyses. There were no significant differences for any of the outcomes between non-O blood groups and blood group O, or between RhD groups. In five pre-defined subgroups (sepsis, septic shock, acute respiratory distress syndrome, cardiac arrest and trauma) there were no differences in mortality between non-O blood groups and blood group O or between the RhD groups. The Covid-19 cohort was not investigated given the low number of patients. Furthermore, we could not demonstrate any differences in the number of transfused patients between the ABO blood groups or between the RhD groups.Conclusions. ABO blood type and RhD status do not appear to influence mortality or morbidity in a general critically ill patient population. There were no differences in the number of transfused patients between the ABO blood groups or between the RhD status groups.

scholarly journals Chloride in intensive care units: a key electrolyte

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 1930 ◽  
Author(s):  
Ghassan Bandak ◽  
Kianoush B. Kashani
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Chloride Content ◽  
Patient Admission ◽  
Critically Ill Patient ◽  
The Past ◽  
Arterial Blood ◽  
Clinical Investigations

Over the past few years, chloride has joined the league of essential electrolytes for critically ill patients. Dyschloremia can occur secondary to various etiologic factors before and during patient admission in the intensive care unit. Some cases are disease-related; others, treatment-related. Chloride abnormalities were shown in animal models to have adverse effects on arterial blood pressure, renal blood flow, and inflammatory markers, which have led to several clinical investigations. Hyperchloremia was studied in several settings and correlated to different outcomes, including death and acute kidney injury. Baseline hypochloremia, to a much lesser extent, has been studied and associated with similar outcomes. The chloride content of resuscitation fluids was also a subject of clinical research. In this review, we describe the effect of dyschloremia on outcomes in critically ill patients. We review the major studies assessing the chloride content of resuscitation fluids in the critically ill patient.

scholarly journals ABO Blood Group and RhD status Are Not Associated with Mortality and Morbidity in Critically Ill Patients; a Multicentre Observational Study of 29 512 Patients

2021 ◽  
Author(s):  
Thomas Kander ◽  
Martin F. Bjurström ◽  
Attila Frigyesi ◽  
Magnus Jöud ◽  
Caroline U. Nilsson
Keyword(s):  
Critically Ill ◽  
Blood Group ◽  
Critically Ill Patients ◽  
Blood Groups ◽  
Blood Type ◽  
Circulatory Support ◽  
Critically Ill Patient ◽  
Abo Blood Groups ◽  
Mortality And Morbidity ◽  
Transfusion Requirements

Abstract Background. Previous studies have demonstrated an association between ABO blood groups and many types of disease. The present study primarily aimed to identify associations between ABO blood groups, RhD groups and mortality/morbidity outcomes in critically ill patients both in a main cohort and in six pre-defined subgroups. The secondary aim was to investigate any differences in transfusion requirement between the different ABO blood groups and RhD status.Methods. Adult patients admitted to any of the five intensive care units (ICUs) in Skåne, Sweden, between February 2007 and April 2021 were eligible for inclusion. The outcomes were mortality analysed at 28– and 90–days as well as at the end of observation and morbidity measured using days alive and free of (DAF) invasive ventilation (DAF ventilation) and DAF circulatory support, including vasopressors or inotropes (DAF circulation), maximum Sequential Organ Failure Assessment score (SOFAmax) the first 28 days after admission and length of stay. All outcomes were analysed in separate multivariable regression models (adjusted for age and sex), generating odds or hazard ratios for each blood group and RhD status using blood group O and RhD negative as reference. Transfusion requirements were also investigated.Results. In total, 29 512 unique patients were included in the analyses. There were no significant differences for any of the outcomes between non-O blood groups and blood group O, or between RhD groups. In six pre-defined subgroups (sepsis, septic shock, acute respiratory distress syndrome, Covid-19, cardiac arrest and trauma) there were no differences in mortality between non-O blood groups and blood group O or between the RhD groups. Furthermore, we could not demonstrate any differences in the number of transfused patients between the ABO blood groups or between the RhD groups.Conclusions. ABO blood type and RhD status do not appear to influence mortality or morbidity in a general critically ill patient population. There were no differences in the number of transfused patients between the ABO blood groups or between the RhD status groups.

scholarly journals Bedside echocardiography in critically ill patients

2015 ◽  
Vol 13 (4) ◽  
pp. 644-646 ◽  
Author(s):  
Eduardo Casaroto ◽  
Tatiana Mohovic ◽  
Lilian Moreira Pinto ◽  
Tais Rodrigues de Lara
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Basic Training ◽  
Common Procedure ◽  
Left Ventricle Function ◽  
Non Invasive ◽  
Bedside Echocardiography ◽  
Cardiovascular Assessment ◽  
Ventricle Function

ABSTRACT The echocardiography has become a vital tool in the diagnosis of critically ill patients. The use of echocardiography by intensivists has been increasing since the 1990’s. This tool has become a common procedure for the cardiovascular assessment of critically ill patients, especially because it is non-invasive and can be applied in fast and guided manner at the bedside. Physicians with basic training in echocardiography, both from intensive care unit or emergency department, can assess the left ventricle function properly with good accuracy compared with assessment made by cardiologists. The change of treatment approach based on echocardiographic findings is commonly seen after examination of unstable patient. This brief review focuses on growing importance of echocardiography as an useful tool for management of critically ill patients in the intensive care setting along with the cardiac output assessment using this resource.

Intensive care medicine on military operations in the resource-limited environment: a case series

2020 ◽  
pp. jramc-2019-001344
Author(s):  
Jeyasankar Jeyanathan ◽  
D O'Brien ◽  
J E Smith
Keyword(s):  
Intensive Care ◽  
United Nations ◽  
Intensive Care Medicine ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Case Series ◽  
Critically Ill Patient ◽  
Military Operations ◽  
Field Hospital ◽  
Resource Limited

This paper describes a series of critically ill patients who were cared for at a UK military field hospital during Op TRENTON 4, in support of the United Nations Mission in South Sudan. These cases highlight the potential challenges in managing the critically ill patient during contingency operations that take place in an austere resource-limited environment.

Perception of Nurses and Relatives on Family Needs of Critically Ill Patients: A Hospital Based Comparative Study

2020 ◽  
Vol 3 (2) ◽  
pp. 6-13
Author(s):  
Sabita Pandey ◽  
Roshanee Shrestha ◽  
Narayani Paudel
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Family Members ◽  
Holistic Health ◽  
Critically Ill Patient ◽  
Family Needs ◽  
Cross Sectional ◽  
Significant Difference

Background: Critical ill patients are not able to decide about their treatment and their relatives usually asked for the treatment decisions on behalf of the patient. At the time of critical illness, all family members or relatives experience crises and may be exhausted. Recognizing and addressing the relative’s needs is a very important aspect of holistic health care to critically ill patients. Methods: A descriptive cross-sectional study was conducted to make a comparison between the nurses’ and relatives’ perceptions regarding the needs of critically ill patients’ family members’ in the Nepalese context. A convenient sample of 50 nurses and 50 relatives who meet the inclusion criteria were selected and interviewed by using a structured questionnaire in the different intensive care units of Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal during the period of January to April 2018. The data were analyzed by using descriptive and inferential statistics in the statistical package for social sciences version 16. Results: The majority, (86%) of the relatives ranked “to know specific facts concerning the patient’s progress and treatment” as the topmost very important need, and 80% of the nurses’ ranked this need as a very important need. The majority of nurses (86%) ranked “to receive explanations about the environment of critical care unit for the first time” as a topmost very important need, whereas, only 54% of the relatives had ranked this need as very important to them. There was a statically significant positive correlation among some need statements between the two groups. Conclusion: There was a significant difference in the perception of some aspects of family needs by the nurses and relatives. Nurses’ mean score was lower than the relatives’ which can be a major source of disputes among nurses and relatives in the intensive care units. Keywords: Intensive Care Unit, critically ill patient, family needs, nurses’ perception and relatives, perception

Moral Distress in Clinicians Caring for Critically Ill Patients Who Require Mechanical Circulatory Support

2021 ◽  
Vol 30 (5) ◽  
pp. 356-362
Author(s):  
Artem Emple ◽  
Laura Fonseca ◽  
Shunichi Nakagawa ◽  
Gina Guevara ◽  
Cortessa Russell ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Mechanical Circulatory Support ◽  
Moral Distress ◽  
Circulatory Support ◽  
Advanced Practice ◽  
Chronic Critical Illness ◽  
Distress Scale

Background Although use of mechanical circulatory support is increasing, it is unclear how providing such care affects clinicians’ moral distress. Objective To measure moral distress among intensive care unit clinicians who commonly care for patients receiving mechanical circulatory support. Methods In this prospective study, the Moral Distress Scale-Revised was administered to physicians, nurses, and advanced practice providers from 2 intensive care units in an academic medical center. Linear regression was used to assess whether moral distress was associated with clinician type, burnout, or desire to leave one’s job. Clinicians’ likelihood of reporting frequent moral distress when caring for patients receiving mechanical circulatory support vs other critically ill patients also was assessed. Results The sample comprised 102 clinicians who had a mean (SD) score of 100.5 (51.6) on the Moral Distress Scale- Revised. After adjustment for clinician characteristics, moral distress was significantly higher in registered nurses than physicians/advanced practice providers (115.9 vs 71.0, P < .001), clinicians reporting burnout vs those who did not (114.7 vs 83.1, P = .003), and those considering leaving vs those who were not (121.1 vs 89.2, P = .001). Clinicians were more likely to report experiencing frequent moral distress when caring for patients receiving mechanical circulatory support (26.5%) than when caring for patients needing routine care (10.8%; P = .004), but less likely than when caring for patients with either chronic critical illness (57.8%) or multisystem organ failure (56.9%; both P < .001). Conclusion Moral distress was high among clinicians who commonly care for patients receiving mechanical circulatory support, suggesting that use of this therapy may affect well-being among intensive care unit clinicians.

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