Acute and Critical Care Echocardiography

2017 ◽  
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Organ Support ◽  
Critical Care Echocardiography ◽  
Frequent Use ◽  
Left And Right ◽  
Clinical Questions ◽  
Echocardiographic Images ◽  
And Function ◽  
Time Critical

This is a comprehensive practical guide to the practice of the new subspecialty of critical care echocardiography. The text covers all aspects of clinical practice and describes how to use transthoracic echocardiography to approach and manage common clinical questions. Specific emphasis is placed on the appropriate use of clinical echocardiographic data in the context of the patient’s critical illness; this is illustrated by the frequent use of case studies including both still and moving echocardiographic images. The text covers assessment of, and disorders affecting, the left and right heart, including shock and sepsis. It also looks at how to interpret diastolic information during critical illness and the effect of that illness on valve disease and function. The important subject of fluid responsiveness is explored in detail, as is the influence of organ support and illness on the diagnosis of cardiac tamponade. The information given in the text is summarized using algorithms in a field guide for the critical care echocardiographer, which also provides a rapid guide to assessing time-critical patient presentations.

scholarly journals Towards definitions of critical illness and critical care using concept analysis

2022 ◽  
Author(s):  
Raphael K Kayambankadzanja ◽  
Carl Otto Schell ◽  
Martin Gerdin Warnberg ◽  
Thomas Tamras ◽  
Hedi Mollazadegan ◽  
...  
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
High Risk ◽  
Organ Dysfunction ◽  
Concept Analysis ◽  
Practice Research ◽  
Organ Support ◽  
Vital Organ ◽  
Imminent Death ◽  
Definition Of

Objective As critical illness and critical care lack consensus definitions, this study aims to explore how the concepts are used, describe their defining attributes and propose potential definitions. Design We used the Walker and Avant stepwise approach to concept analysis. The uses and definitions of the concepts were identified through a scoping review of the literature and an online survey of 114 global clinical experts. Through content analysis of the data we extracted codes, categories and themes to determine the concepts defining attributes and we proposed potential definitions. To assist understanding, we present model, related and contrary cases concerning the concepts, we identified antecedents and consequences to the concepts, and defined empirical referents. Results The defining attributes of critical illness were a high risk of imminent death; vital organ dysfunction; requirement for care to avoid death; and potential reversibility. The defining attributes of critical care were the identification, monitoring and treatment of critical illness; vital organ support; initial and sustained care; any care of critical illness; and specialized human and physical resources. Our proposed definition of critical illness is, a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and the potential for reversibility. Our proposed definition of critical care is, the identification, monitoring and treatment of patients with critical illness through the initial and sustained support of vital organ functions. Conclusion The concepts critical illness and critical care lack consensus definitions and have varied uses. Through concept analysis of uses and definitions in the literature and among experts we have identified the defining attributes of the concepts and propose definitions that could aid clinical practice, research, and policy making.

Effectiveness of an Advanced Critical Care Echocardiography Course

2019 ◽  
Vol 35 (11) ◽  
pp. 1332-1337 ◽  
Author(s):  
Pralay Kumar Sarkar ◽  
Michel Boivin ◽  
Paul H. Mayo
Keyword(s):  
Critical Care ◽  
Image Acquisition ◽  
Image Interpretation ◽  
Left Ventricular ◽  
Structure And Function ◽  
Important Place ◽  
Critical Care Echocardiography ◽  
Ventricular Structure ◽  
Hands On ◽  
And Function

Background: Advanced critical care echocardiography (CCE) involves comprehensive assessment of cardiac structure and function for frontline critical care applications. This study reports the effectiveness of a 3-day course in advanced CCE. Methods: We studied the outcome of 5 consecutive advanced CCE courses delivered between 2013 and 2017. A total number of 239 learners were studied. The course included didactic lectures, image interpretation sessions, and hands-on training with normal individuals as models. Training domains included left ventricular structure and function, right ventricular structure and function, valve function using comprehensive 2-dimensional imaging, and Doppler-based measurements for cardiac pressures and flows. Measurements of course outcome included pre- and postcourse assessment of knowledge, image acquisition, and image interpretation skills. Learners rotated between hands-on training and interpretation sessions. The teacher-to-learner ratio was 1:3 during hands-on training. Interpretation sessions consisted of review of normal and abnormal echocardiographic videos with interactive small groups. Learners completed a video-based knowledge assessment examination before and after completion of the course. Hands-on image acquisition skills were tested at the completion of the course during all the years. For years 2016 and 2017, a precourse hands-on skill test was also performed. Results: There was a statistically significant improvement in knowledge and image interpretation skills in the cohort of 239 learners over 5 years of study period. There was improvement in image acquisition skills over the 2-year period when it was measured pre- and postcourse. Conclusions: A 3-day course on advanced CCE resulted in improvement knowledge/image interpretation and hands-on image acquisition skills. Clinical Implications: Advanced CCE has assumed an important place in hemodynamic monitoring of critically ill patients. A course of similar design may facilitate training of frontline clinicians in advanced CCE.

scholarly journals Electrical Stimulated Glut4 Signaling Attenuates Critical Illness-Associated Muscle Wasting

2021 ◽  
Author(s):  
Alex Bernard Addinsall ◽  
Nicola Cacciani ◽  
Anders Backeus ◽  
Yvette Hedstrom ◽  
Lars Larsson
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Protein Degradation ◽  
Soleus Muscle ◽  
Muscle Wasting ◽  
Muscle Protein ◽  
Cross Sectional ◽  
Controlled Mechanical Ventilation ◽  
Muscle Protein Degradation ◽  
And Function

Background: Critical illness myopathy (CIM) is a debilitating condition characterized by the preferential loss of the motor protein myosin. CIM is a byproduct of critical care, attributed to impaired recovery, longterm complications, and mortality. CIM pathophysiology is complex, heterogeneous and remains incompletely understood, however loss of mechanical stimuli contributes to critical illness associated muscle atrophy and weakness. Passive mechanical loading (ML) and electrical stimulation (ES) therapies augment muscle mass and function. While having beneficial outcomes, the mechanistic underpinning of these therapies is less known. Therefore, here we aimed to assess the mechanism by which chronic supramaximal ES ameliorates CIM in a unique experimental rat model of critical care. Methods: Rats were subjected to 8 days critical care conditions entailing deep sedation, controlled mechanical ventilation, and immobilization with and without direct soleus ES. Muscle size and function were assessed at the single cell level. RNAseq and Western blotting were employed to understand the mechanisms driving ES muscle outcomes in CIM. Results: Following 8 days of controlled mechanical ventilation and immobilization, soleus muscle mass, Myosin:Actin ratio and single muscle fiber maximum force normalized to cross-sectional area (specific force) were reduced by 40-50% (p< 0.0001). ES significantly reduced the loss of soleus muscle fiber cross-sectional area (CSA) and Myosin:Actin ratio by approximately 30% (p< 0.05) yet failed to effect specific force. RNAseq pathway analysis revealed downregulation of insulin signaling in the soleus muscle following critical care and GLUT4 trafficking was reduced by 55% leading to an 85% reduction of muscle glycogen content (p< 0.01). ES promoted phosphofructokinase and insulin signaling pathways to control levels (p< 0.05), consistent with the maintenance of GLUT4 translocation and glycogen levels. AMPK, but not AKT, signaling pathway was stimulated following ES, where the downstream target TBC1D4 increased 3 logFC (p= 0.029) and AMPK-specific P-TBC1D4 levels were increased approximately 2-fold (p= 0.06). Reduction of muscle protein degradation rather than protein synthesis promoted soleus CSA, as ES reduced E3 ubiquitin proteins, Atrogin-1 (p= 0.006) and MuRF1 (p= 0.08) by approximately 50%, downstream of AMPK-FoxO3. Conclusions: ES maintained GLUT4 translocation through increased AMPK-TBC1D4 signaling leading to improved muscle glucose homeostasis. Soleus CSA and myosin content was promoted through reduced protein degradation via AMPK-FoxO3 E3 ligases, Atrogin-1 and MuRF1. These results demonstrate chronic supramaximal ES reduces critical care associated muscle wasting, preserved glucose signaling and reduced muscle protein degradation in CIM.

scholarly journals Glutamine: An Obligatory Parenteral Nutrition Substrate in Critical Care Therapy

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Peter Stehle ◽  
Katharina S. Kuhn
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Parenteral Nutrition ◽  
Glutamine Supplementation ◽  
Metabolic Demand ◽  
Considerable Uncertainty ◽  
Intestinal Integrity ◽  
And Function ◽  
Large Multicentre Study

Critical illness is characterized by glutamine depletion owing to increased metabolic demand. Glutamine is essential to maintain intestinal integrity and function, sustain immunologic response, and maintain antioxidative balance. Insufficient endogenous availability of glutamine may impair outcome in critically ill patients. Consequently, glutamine has been considered to be a conditionally essential amino acid and a necessary component to complete any parenteral nutrition regimen. Recently, this scientifically sound recommendation has been questioned, primarily based on controversial findings from a large multicentre study published in 2013 that evoked considerable uncertainty among clinicians. The present review was conceived to clarify the most important questions surrounding glutamine supplementation in critical care. This was achieved by addressing the role of glutamine in the pathophysiology of critical illness, summarizing recent clinical studies in patients receiving parenteral nutrition with intravenous glutamine, and describing practical concepts for providing parenteral glutamine in critical care.

Basic Critical Care Echocardiography by Pulmonary Fellows

2014 ◽  
Vol 42 (10) ◽  
pp. 2169-2177 ◽  
Author(s):  
Kay Choong See ◽  
Venetia Ong ◽  
Jeffrey Ng ◽  
Rou An Tan ◽  
Jason Phua
Keyword(s):  
Critical Care ◽  
Critical Care Echocardiography

Advances in critical care for the older patient

2013 ◽  
Vol 23 (2) ◽  
pp. 118-130 ◽  
Author(s):  
Diane Monkhouse
Keyword(s):  
Quality Of Life ◽  
Critical Care ◽  
Critical Illness ◽  
General Population ◽  
Acute Illness ◽  
Limited Resources ◽  
Care Practice ◽  
Older Patient ◽  
Life Sustaining Treatment

SummaryAs the proportion of elderly people in the general population increases, so does the number admitted to critical care. In caring for an older patient, the intensivist has to balance the complexities of an acute illness, pre-existing co-morbidities and patient preference for life-sustaining treatment with the chances of survival, quality of life after critical illness and rationing of expensive, limited resources. This remains one of the most challenging areas of critical care practice.

scholarly journals Residents and Medical Students Correctly Answer Clinical Questions More Often with Google and UpToDate than With PubMed or Ovid MEDLINE

2011 ◽  
Vol 6 (2) ◽  
pp. 39
Author(s):  
Theresa Arndt
Keyword(s):  
Critical Care ◽  
Medical Students ◽  
Correct Answer ◽  
Care Practice ◽  
Control Group ◽  
Ovid Medline ◽  
Significant Difference ◽  
Search Tool ◽  
Clinical Questions ◽  
Attending Physicians

Objective – To determine which search tool (Google, UpToDate, PubMed or Ovid-MEDLINE) produces more accurate answers for residents, medical students, and attending physicians searching on clinical questions in anesthesiology and critical care. Searcher confidence in the answers and speed with which answers were found were also examined. Design – Randomized study without a control group. Setting – Large university medical center. Subjects –Subjects included 15 fourth year medical students (third and fourth year), 35 residents, and 4 attending physicians volunteered and completed the study. One additional attending withdrew halfway through the study. The authors were unsuccessful in recruiting an equal number of subjects from each group. Methods – A set of eight anesthesia and critical care questions was developed, based on their commonality and importance in clinical practice and their answerability. Four search tools were employed: Google, UpToDate, PubMed, and Ovid MEDLINE. In part I, subjects were given a random set of four of the questions to answer with the search tool(s) of their choice, but could use only one search tool per question. In part II, several weeks later, the same subjects were randomly assigned a search tool with which to answer all 8 questions. The authors state that “for data analysis, PubMed was arbitrarily chosen to be the “reference standard.”” Statistical analysis was used to identify significant differences between PubMed and the other search tools. Main Results – Part I: Subjects choosing a search tool were more likely to find a correct answer with Google or UpToDate. There were no statistically significant differences in confidence with answers between any of the search tools and PubMed. Part II: Though subjects were assigned a search tool, some questions were repeated from part I. For repeated questions, Ovid users (compared to PubMed users) were significantly less likely to find the correct answer for repeated questions. Otherwise, there was no statistically significant difference in questions answered correctly. Confidence did not differ. When asked to answer new questions, subjects using Google and UpToDate were significantly more likely to find a correct answer than PubMed users. UpToDate users were more confident. There was no statistical difference in primary outcome (correct answer with high confidence) between Google, Ovid, and PubMed. Pooled data from parts I and II, removing repeated questions: Subjects using Google and UpToDate were more likely to find correct answers. Confidence was highest among UpToDate users. Average search time per question (limited to 5 minutes per question) in ascending order of time spent was: UpToDate, Google, PubMed, and Ovid. Conclusion – While the number of participants is small, the results suggest that the popular search engine Google and the commercially produced secondary online source UpToDate are more useful and efficient for finding answers to questions arising in anesthesiology and critical care practice than tools focused exclusively on indexing the primary literature.

Sign in / Sign up

Export Citation Format

Share Document