International Journal of Critical Care and Emergency Medicine最新文献

{"title":"Emergency Airway Management due to Angioedema","authors":"Santos Cátia Ribeiro, Costa Simone, Araújo Ana","doi":"10.23937/2474-3674/1510156","DOIUrl":"https://doi.org/10.23937/2474-3674/1510156","url":null,"abstract":"","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"118 46","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139133315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methylene Blue in Management of Vasoplegic Shock Secondary to Primidone Overdose","authors":"DeMarco Elizabeth, Turnipseed Matthew, Qadeer Farhan","doi":"10.23937/2474-3674/1510155","DOIUrl":"https://doi.org/10.23937/2474-3674/1510155","url":null,"abstract":"Vasoplegic shock refractory to vasopressors is associated with significant morbidity and mortality. Catecholamine driven therapies are first-line in the management of vasoplegic shock. Research regarding the use of non-catecholamine agents in the setting of refractory vasoplegic shock is lacking. Methylene blue has multiple off-labelled indications for use, but recently has been suggested to have a role in treating vasoplegic shock. Vasoplegic shock is mediated by dysregulation of nitric oxide, which is generated via nitric oxide synthase. Methylene blue inhibits endothelial nitric oxide synthase and restores vascular tone through nitric oxide upregulation. Our case describes hemodynamic improvement following administration of a one-time dose of methylene blue in the management of refractory vasoplegic shock due to primidone overdose. Within 36 hours, he was titrated off all vasopressors with clinical improvement. This case report demonstrates the possible role of single-dose methylene blue in refractory vasoplegic shock.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"40 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139131229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of the Pulse Oximeter in Limb Ischemia: The Pulse Study","authors":"Joanna Skillman, Pratap Dutta","doi":"10.47363/jccem/2023(2)136","DOIUrl":"https://doi.org/10.47363/jccem/2023(2)136","url":null,"abstract":"Purpose: Does a non-invasive pulse oximeter probe accurately indicate limb ischemia with inflation of a tourniquet? How are the pulse waveform, perfusion index and oxygen saturations affected? Does pulse oximetry return to normal with restoration of blood flow? Are the findings similar, regardless of which probe is used? Methods: Single Centre, pilot, proof of concept study. Each volunteer staff member had two probes applied to both lower limbs and then to both upper limbs. One limb had a tourniquet applied (experimental limb). The pulse oximeter trace, perfusion index and oxygen saturations were recorded before tourniquet inflation (time point 0), at inflation (time point 1), just prior to deflation (time point 2) and after deflation when the waveform returned to a biphasic appearance (time point 3). Results: Changes in both pulse oximeter waveforms occurred within 45 seconds of tourniquet inflation, with flattening of the biphasic trace followed by complete loss of amplitude, which normalized on release of the tourniquet. Perfusion index values for the experimental arms and legs were statistically significantly smaller than the control sides during tourniquet inflation and exceeded baseline on deflation, due to reperfusion. Oxygen saturations were unreliable and did not reflect tourniquet inflation. Conclusion: Pulse Oximeter waveform and perfusion index provide a noninvasive, sensitive, responsive, available, repeatable, objective measure of vascular supply in the limbs in healthy volunteers, although oxygen saturation is not a reliable indicator of perfusion. Objective assessment using the pulse oximeter could aid clinical judgement in initiating early vascular intervention in limb injury.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136276639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An In-Depth Analysis of the Multi-Faceted Benefits of Cytosorb Filter Utilization during Cardiopulmonary Bypass","authors":"Salman Pervaiz Butt, Rashid Aziz, Simon Phillips","doi":"10.47363/jccem/2023(2)139","DOIUrl":"https://doi.org/10.47363/jccem/2023(2)139","url":null,"abstract":"Introduction: Cardiopulmonary bypass (CPB) is a vital component of many cardiac surgeries, but it can trigger systemic inflammatory responses, leading to post-operative complications. The CytoSorb filter, a cytokine adsorber, has emerged as a potential adjunctive therapy in CPB to mitigate inflammation. Method: A literature review was conducted to assess the impact of CytoSorb on inflammation and clinical outcomes during cardiac surgery with CPB. Various databases were searched including PubMed, MEDLINE, and Google Scholar using relevant keywords. Results: Studies have shown mixed results regarding CytoSorb’s efficacy in reducing pro-inflammatory cytokines and improving clinical outcomes. Some studies reported reduced cytokine levels, improved hemodynamics, and decreased need for vasopressors. However, others found no significant cytokine reduction or clinical improvement. CytoSorb was generally well-tolerated with no device-related serious adverse events reported. Additionally, CytoSorb demonstrated potential benefits in reducing bleeding complications when used in patients taking antiplatelet or anticoagulant medications during cardiac surgery. Discussion: The use of CytoSorb in cardiac surgery with CPB holds promise but requires further research. Future directions include evaluating long-term benefits and safety, refining patient selection criteria, conducting comparative studies, standardizing guidelines for CytoSorb integration, and exploring its utility in other cardiac surgery scenarios. Conclusion: CytoSorb offers potential benefits in attenuating systemic inflammation during cardiac surgery with CPB. While evidence suggests positive outcomes in specific contexts, more research is needed to establish its regular use and optimize patient care. Collaborative decision-making and individualized patient management are essential when considering CytoSorb therapy. Continued investigation will provide valuable insights into its precise role in managing inflammation during CPB, enhancing patient outcomes, and refining clinical protocols.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136277744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful ECMO Decannulation after (103 Days) Due to COVID-19 Infection: A Case Report","authors":"Hossam Elshekhali","doi":"10.47363/jccem/2023(2)135","DOIUrl":"https://doi.org/10.47363/jccem/2023(2)135","url":null,"abstract":"We present a case of a 41-year-old COVID-19 positive male; he was intubated for severe acute respiratory distress syndrome (ARDS). He continued to have refractory hypoxemia despite positive pressure ventilation, prone positioning, and the use of neuromuscular blockade. Considering ECMO support, a multidisciplinary team evaluated the case and he was initiated on venovenous ECMO (V-V ECMO). His prolonged ECMO course was complicated with many different challenges but eventually, he showed a remarkable improvement in his lung functions. ECMO was successfully decannulated after 103 days of initiation. He was then weaned from mechanical ventilator (MV) with closure of tracheostomy and later on discharged home on low dose supplemental oxygen.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136272564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum Hemorrhage","authors":"S Felis, V Tirloni, M Bertoni","doi":"10.47363/jccem/2023(2)134","DOIUrl":"https://doi.org/10.47363/jccem/2023(2)134","url":null,"abstract":"Postpartum hemorrhage (PPH) is the primary cause of maternal mortality and morbidity worldwide: in fact, about a quarter of deaths that occur during pregnancy, childbirth or the puerperium are caused by postpartum hemorrhage. There are many causes of postpartum hemorrhage, the most important are: uterine atony, lacerations of the cervix and/or perineum, retention of placental material, coagulation problems, uterine inversion, uterine rupture. This causes of PPH are represented by the ‘4Ts’ formula: tone, tissue, trauma, thrombin. An important role is played by prevention: identification of risk factors, prophylaxis with oxytocin at the time of delivery, early treatment. The first important thing is the quantification of blood loss because the clinical signs are often blurred and due to frank anemia resulting in tachycardia, small and frequent pulse, hypotension, sweating, paleness. As previously mentioned, it is important to act early in the case of PPH through maintenance of velamina and targeted therapies that differ according to the cause of PPH (the 4T algorithm is useful). Early intervention reduces the need for blood transfusions and reduces the incidence of serious complications such as DIC. However, the management of postpartum hemorrhage is not limited to the postpartum phase, but the patient must be monitored in the puerperium, a phase in which the thromboembolic risk is increased. The couple must also be informed of the risk of PPH in future pregnancies. PPH represents a serious risk for the patient and requires multidisciplinary input and proper preparation of the team working in the delivery room.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135783239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of a “Do Not Resuscitate” (DNR) Status on Patient Care: A Descriptive Survey on the Perceptions of ICU and Medical/Surgical Nurses","authors":"Joria Rainbolt Clemente, P. Hess, Cyr-Geraurd Oca, M. Raphael, Regina M. Valdez, F. Cohn, June Rondinelli","doi":"10.29173/ijcc62","DOIUrl":"https://doi.org/10.29173/ijcc62","url":null,"abstract":"Background: Nursing research literature demonstrates a persistent concern regarding how nurses interpret “Do Not Resuscitate” (DNR) code status.\u0000Aim: The aim of this study was to assess nurses’ perceptions of the effect of a DNR code status on patient care.\u0000Methods: This study was a cross-sectional, descriptive survey offered to all clinical nurses in the Medical, Surgical, Telemetry, Critical Care, and Emergency Departments within one urban community hospital in Southern California, USA.  Descriptive statistics were used for demographic data and individual question analysis, which included frequency and percentages for categorical variables in addition to means with standard deviation for continuous data. Open- ended questions received content analysis.\u0000Results: This study resulted in a convenience sample of 120 registered nurses (RNs). Greater than 95% of nurses who completed the survey agreed that nursing care should continue until patient death.  Yet when asked about physiologic, demographic, chronic, or cognitive status, participants answered with varying degrees of certainty about the care that should be provided.\u0000Conclusions: Further research is needed to explore the inconsistency in nurses’ understanding of the care provided to a patient with DNR status. There may be opportunities to improve consistency in practice with education or protocols to outline optimal care of a patient with DNR orders.  \u0000 ","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74723644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives of Intensive Care patients and family members on competencies for Advanced Intensive Care nurses in Europe","authors":"Christina Jones, M. Peskett, P. Ramsay, R. Endacott, A. Xyrichis, K. Iliopoulou","doi":"10.29173/ijcc49","DOIUrl":"https://doi.org/10.29173/ijcc49","url":null,"abstract":"Background \u0000One output from the International Nursing Advanced Competency-based Training for Intensive Care (INACTIC) collaboration is a set of core competencies for advanced practice Intensive Care Unit (ICU) nurses across Europe. Some European countries, such as the UK, have identified such competencies, however, these advanced practice roles are rarely practiced across the rest of Europe. The INACTIC competencies were developed with an expert panel of 184 ICU nurses from 20 countries. It is also important to examine what patients and relatives with experience of intensive care felt about these competencies.   \u0000Aim \u0000To examine the views of recovered ICU patients and relatives regarding the INACTIC competencies. \u0000Methods \u0000Three patient and relative focus groups were conducted in England (n=5), Scotland (n=4) and Greece (n=4) to discuss a lay version of the INACTIC competencies. Discussions were open ended, followed a topic guide, recorded and transcribed verbatim. Analysis followed a conventional thematic approach, with the findings discussed iteratively among the authors. \u0000Results \u0000The feedback from across the focus groups resulted in three themes: 1) the importance of nurses being empowered to advocate for the patient; 2) the centrality of communication; and, 3) the impact of variability in ICU practices. There was a notable difference with the Greek focus group; because of restricted family visiting policies, relatives did not feel encouraged to participate in patient care. \u0000Conclusions \u0000The perspectives of patients and relatives largely aligned with the consensus of the INACTIC expert panel. Local differences in ICU experience highlight the changes that some ICUs would need to make for the INACTIC competencies to be embedded.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80840691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Staffing in the ICU with New Graduate Nurses: A Novel Critical Care Fellowship Program","authors":"PhD RN Ccrn Emma Blackmon, RN Cnrn Scrn Haley Floriano MSN, PhD RN Sarina Fazio, PhD RN NEA-BC Amy Doroy, PhD MSc RN Elizabeth Papathanassoglou","doi":"10.29173/ijcc65","DOIUrl":"https://doi.org/10.29173/ijcc65","url":null,"abstract":"Background: There is a growing shortage of critical care nurses. New graduate nurses (NGN) are increasingly hired into critical care settings, though NGN job turnover is estimated between 18-60% in the first year of practice. The COVID-19 pandemic exacerbated nurse turnover and the need to rapidly train new ICU nurses while also employing effective retention management strategies. \u0000Aim: To highlight the success of a NGN Critical Care Fellowship Program (CCFP) within the existing health system’s NGN Residency Program prior to and during the COVID-19 pandemic. \u0000Methods: The CCFP was launched in 2016 with 7 participating ICUs. The NGNs participate in the medical center’s existing 1-year NGN Residency Program and spend a total of 24 weeks orienting in 3 different ICUs. Orientation concludes based on a performance evaluation and readiness to work independently. NGNs are mentored and supported throughout their first year in practice through monthly debriefing of clinical and preceptor experiences. \u0000Results/Findings: Between 2016-2022, a total of 65 NGNs have participated in the CCFP. Sixty fellows completed orientation and were hired into an adult ICU during their orientation period. Retention of CCFP NGNs after 1 year was 96% (n=48/50), 2 years was 97% (n=33/34) and 3 years was 96% (n=23/24). \u0000Conclusions: Results demonstrate the development of an educationally robust, emotionally compassionate program, concentrated on the development, training and focused support of the NGN can be successfully implemented and sustained over time.","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80425912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ged Williams Awarded Officer of the Order of Australia","authors":"P. Zrelak","doi":"10.29173/ijcc75","DOIUrl":"https://doi.org/10.29173/ijcc75","url":null,"abstract":"<jats:p>N/A</jats:p>","PeriodicalId":13937,"journal":{"name":"International Journal of Critical Care and Emergency Medicine","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90360369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}