Journal of emergency and critical care medicine (Hong Kong, China)最新文献

{"title":"Idiopathic intrahepatic arterioportal shunt rupture","authors":"S. Limchareon, Weravit Ruangsirinusorn","doi":"10.21037/jeccm.2019.08.12","DOIUrl":"https://doi.org/10.21037/jeccm.2019.08.12","url":null,"abstract":"A 70-year-old Thai female end-stage renal disease (ESRD) patient, with a 4 years history of peritoneal dialysis, was brought to the emergency department because of syncope after her regular peritoneal dialysis, and a mixture of fluid and blood was obtained from the peritoneal fluid. Blood loss was suspected from her physical examinations and labs. Her past medical history showed hypertension, dyslipidemia, ischemic stroke, causing right hemiparesis 10 years ago and aspirin (ASA) has been prescribed.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43290294","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":"A biomarker-based stratification tool for pediatric acute respiratory distress syndrome: a new approach to an old problem","authors":"J. Balcells, O. Roca","doi":"10.21037/JECCM.2019.01.01","DOIUrl":"https://doi.org/10.21037/JECCM.2019.01.01","url":null,"abstract":"Assessing the prognosis of a disease is an essential component of a high-quality healthcare process. In the clinical scenario, prognostic information is relevant to prioritizing patients, to selecting treatment modalities or level of care, and to informing patients and relatives about what is expected to happen. From the ethical standpoint, expected prognosis is a key element in the process of ascertaining the suitability of the treatment options being considered.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48996319","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":"Diagnosis of invasive pulmonary aspergillosis in the intensive care unit: what we should concern and how to do better","authors":"Hui Shen, Wentao Bao, Yuetian Yu","doi":"10.21037/jeccm.2019.10.02","DOIUrl":"https://doi.org/10.21037/jeccm.2019.10.02","url":null,"abstract":"Invasive pulmonary aspergillosis (IPA) is no longer a rare disease in the intensive care unit (ICU) on account of the increased number of immunocompromised hosts admitted, the application of invasive treatment procedures and the widespread use of broad-spectrum antibiotics. Different from those with agranulocytosis, symptoms and signs of IPA in ICU patients are subtle or non-specific which are unable to be distinguished from those with bacterial pneumonia or even with noninfectious diseases. Thus, accurately diagnosing of IPA is quite challenging. In this review, we will navigate through the IPA diagnostic tests currently available and how they apply to ICU population. Special attention is paid to the non-culture- based tests as well as have a look into what the future holds.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jeccm.2019.10.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45115080","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":"Consideration for thrombolysis for significant pulmonary embolism in haemodynamically stable patients—is it time for a rethink?","authors":"Debkumar Chowdhury","doi":"10.21037/jeccm.2019.09.07","DOIUrl":"https://doi.org/10.21037/jeccm.2019.09.07","url":null,"abstract":"Pulmonary embolism (PE) is a common diagnosis made in the emergency department with 60–70 cases per 100,000. The clinician needs to have up to-date knowledge and potential treatment strategies for management of this common condition. Thrombolysis for PE is one of the options that can be considered in the Emergency Department. The British Thoracic Society (BTS) has formed a set of recommendations for consideration of thrombolysis. We will discuss two clinical cases of differing severity and discuss the rationale behind the treatment strategies. Firstly, we present a lady in her late 40s with acute shortness of breath with pleuritic chest pain. She was brought in by ambulance and the resuscitation suite was pre-alerted that she was due to arrive. She had been recently treated for a lower limb deep venous thrombosis (DVT) and had presented to a local hospital 2/7 previously with some associated pleuritic chest pain. She was noted to be profoundly compromised from a cardiovascular perspective. She was treated with a systemic thrombolytic agent and she was subsequently discharged soon afterwards. The second case we present is that of a 50-year-old previously fit and well gentleman who presented with acute shortness of breath on minimal exertion for the previous 3 days. There was no background history of airway diseases with no smoking. He was noted to be marked hypoxic requiring 5 litres of oxygen to maintain an oxygen saturation of 95%. His blood pressure was noted to be stable throughout his time in the department. There was imaging and electrocardiographic evidence of right ventricular strain. It was also noted to be a marked rise in cardiac enzymes indicating cardiac involvement, based on the findings he subsequently underwent treatment with a systemic thrombolytic agent and made subsequently satisfactory recovery. The presence of raised troponin in the presence of an acute PE classifies as a massive PE. Systemic thrombolysis is the first line treatment for massive PE and should be started on clinical grounds alone if cardiac arrest in imminent with alteplase being the drug of choice. The decision to perform systemic thrombolysis in the haemodynamically stable patient is multifactorial and should be assessed in a case by case manner as highlighted by this article.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43456268","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":"Defining the high-risk patient","authors":"Gemma Phillips, A. Cameron, T. Szakmany","doi":"10.21037/jeccm.2019.08.10","DOIUrl":"https://doi.org/10.21037/jeccm.2019.08.10","url":null,"abstract":"As the volume of surgery continues to grow worldwide, the identification of high-risk patients is an important goal to guide clinical decision making in the perioperative period. Risk stratification evolved over the last decade from simple risk stratification tools, still used widely in the clinical arena to more sophisticated risk prediction models based on machine learning and latent class analysis, which can be incorporated into a well-developed electronic patient record or critical care clinical information system. As the debate about which patients will benefit most from critical care admission and interventions is still ongoing, the identification of the high-risk patient is a continuing challenge. In this review we will summarise the latest developments in the use of these risk stratification tools and risk prediction models, which can be utilised to identify the high-risk surgical candidate.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jeccm.2019.08.10","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41924829","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":"Setting intraoperative fraction of inspired oxygen","authors":"R. M. Artigas, M. Soro, C. Ferrando","doi":"10.21037/jeccm.2019.08.04","DOIUrl":"https://doi.org/10.21037/jeccm.2019.08.04","url":null,"abstract":"Each year, millions of patients undergo surgery under general anaesthesia. Oxygen, the most ubiquitous drug used in the operative setting, is often titrated to the anaesthesiologist preference. The choice of a high inspired fraction of inspired oxygen (FiO2) is commonplace. Safety criteria along with a debatable effect on a decrease in surgical site infection (SSI) are the potential reasons to justify a high FiO2 usage. Based on the latter, several organizations such as the World Health Organization (WHO) or Centers for Disease Control (CDC) have issued recommendations to keep high FiO2 during surgery and the immediate postoperative period. In this article, we will review the evidence behind these beneficial effects and several potential side effects of a high FiO2 intraoperative strategy.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jeccm.2019.08.04","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46475053","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":"Fluid management in the perioperative setting: mind the kidney","authors":"Emanuele Favaron, J. Montomoli, M. Hilty, C. Ince","doi":"10.21037/jeccm.2019.08.09","DOIUrl":"https://doi.org/10.21037/jeccm.2019.08.09","url":null,"abstract":"Acute kidney injury (AKI) is one of the most frequent complications in critically ill patients and in the perioperative setting. The anatomical structure and the microvasculature of the kidney makes it highly vulnerable to hypoxia. Although fluid therapy is considered crucial in situations where improvement of cardiac output is needed, it can also contribute to AKI development when administered inappropriately. Hemodilution and anemia during cardio-pulmonary bypass have been demonstrated to be risk factors for AKI and they are likely to be a consequence of fluid administration. In order to assess the perfusion of the kidneys it is necessary to investigate the determinants of delivery of oxygen at the microcirculatory level. Indeed, fluids can decrease the capillary hematocrit and the functional capillary density, affecting the renal oxygenation and increasing the risk of AKI. Monitoring sublingual microcirculation can be a reliable tool to guide fluid administration, aiming to prevent or improve perioperative AKI.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jeccm.2019.08.09","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46006695","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":"Perioperative goal directed therapy—current view","authors":"J. Zatloukal, J. Pouska, J. Beneš","doi":"10.21037/jeccm.2019.09.03","DOIUrl":"https://doi.org/10.21037/jeccm.2019.09.03","url":null,"abstract":"High-risk surgery is frequently associated with increased number of complications and higher mortality. Cardiovascular reserves of patients undergoing such procedures are frequently low, limiting their ability to sustain adequate organ perfusion. This puts the organs into the risk of hypoperfusion with loss of function and even failure. Perioperative goal directed therapy is can improve postoperative outcome of intermediate-to-high-risk surgical patients. Based on current evidence it seems to be associated with decreased postoperative length of stay, number of complications and possibly even mortality. In following narrative review, we discuss the contribution of perioperative goal directed therapy as well as its limits and possible future perspectives.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jeccm.2019.09.03","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46468460","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":"Monitoring the post surgery inflammatory host response","authors":"F. Paruk, J. Chausse","doi":"10.21037/jeccm.2019.08.06","DOIUrl":"https://doi.org/10.21037/jeccm.2019.08.06","url":null,"abstract":"The human response to surgery is meant to be protective and to promote healing. The cascade of events that ensue following tissue injury is highly complicated and involves an interplay of the metabolic, hemodynamic, hormonal and immunological systems. The release of biomolecules known as damage-associated molecular patterns (DAMPs) activates the pro-inflammatory innate and anti-inflammatory adaptive responses, which are designed to defend and contain the inflammatory process locally. The magnitude of tissue injury influences the scale of the inflammatory response. Further, patient factors as well as medical therapy influences this response. An imbalance between the pro-inflammatory and anti-inflammatory response or an exaggerated response may culminate with organ dysfunction, an increased susceptibility for infections or death. Cell mediated immunity (CMI) is often suppressed post surgery and patients are predisposed to the development of postoperative infections and complications. Mapping the immune response would be useful in terms of adjudging the patient’s response to surgery, alerting clinicians to the occurrence of complications thereby providing the opportunity to implement appropriate management timeously if necessary. There is a vast overlap in the surgical inflammatory response with that of the pathogen-associated molecular patterns (PAMPs) induced response that follows sepsis. This presents a challenge in the postoperative period in terms of distinguishing between infectious and non-infectious complications. Biomarkers have thus emerged as attractive contenders to map the immune response. Taking into account the complexity of the inflammatory response, it is unlikely that a single biomarker will ever be utilised to achieve this. In the era of personalised medicine, where our patient populations are quite heterogeneous, future directions point towards the use of multiple panels of novel biomarkers. Currently the procalcitonin (PCT) and C-reactive protein (CRP) are available for general use. This review explores the inflammatory response to surgery and the utility of CRP and PCT in the postoperative period. It highlights the importance of using biomarker kinetics coupled with the clinical response and the principle of individualised interpretation.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jeccm.2019.08.06","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49127610","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":"Peri-operative adverse respiratory events and post-operative non-invasive ventilation","authors":"S. Einav, M. Leone","doi":"10.21037/jeccm.2019.08.11","DOIUrl":"https://doi.org/10.21037/jeccm.2019.08.11","url":null,"abstract":"Postoperative respiratory adverse respiratory events (AREs) are a common phenomenon. Multiple causes contribute to peri-operative impairment of respiration and the development of post-operative AREs. AREs have been associated with poor patient outcomes and impose an unplanned burden on the medical system. The treatment of perioperative AREs should be tailored to treat the injurious processes that predominate in the case at hand. Specific characteristics of non-invasive ventilation techniques may make them particularly relevant to specific types of post-operative AREs. Future research needs to focus on identification of patients at risk for perioperative AREs and on matching of ventilation techniques to specific causes of ARE.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jeccm.2019.08.11","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46383392","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}