Acute cardiac care最新文献_第8页

Mechanical ventilation with high tidal volume and associated mortality in the cardiac intensive care unit. 心脏重症监护病房高潮气量机械通气及其相关死亡率。

Acute cardiac care Pub Date : 2014-03-01 DOI: 10.3109/17482941.2013.869345

Matthew Shorofsky, Dev Jayaraman, Francois Lellouche, Regina Husa, Jed Lipes

{"title":"Mechanical ventilation with high tidal volume and associated mortality in the cardiac intensive care unit.","authors":"Matthew Shorofsky, Dev Jayaraman, Francois Lellouche, Regina Husa, Jed Lipes","doi":"10.3109/17482941.2013.869345","DOIUrl":"https://doi.org/10.3109/17482941.2013.869345","url":null,"abstract":"Background and objectives: Use of protective ventilation has been shown to decrease mortality in medical-surgical ICUs. There is limited data on tidal volume use in ventilated patients in the cardiac intensive care unit (CICU). We hypothesized that large tidal volumes are used in the CICU and that they could contribute to an increase in morbidity and mortality.Methods: We conducted a retrospective chart review of all mechanically ventilated patients with congestive heart failure or cardiac arrest in a single tertiary care CICU between April 2010 and February 2012. Ventilator settings were analyzed and tidal volume for predicted body weight (VT/PBW) was calculated for 51 patients.Results: The median initial tidal volume was 525 ml (IQR: 500-600) and median VT/PBW was 9.3 ml/kg (IQR: 8.3-10.1). Overall mortality was 29.4%. On univariate analysis, patients that received a VT/PBW below the median, mortality was 23.1% (95% CI: 7.9-39.3) compared to 36.0% (95% CI: 17.2-55.0) in patients that received a VT/PBW above themedian (P = 0.31). On multivariate analysis, the OR for death was 9.0 (95% CI: 1.3-62.0, P = 0.03) with VT/PBW above the median.Conclusion: Mechanical ventilation with high tidal volumes was associated with increased mortality in patients with congestive heart failure and post cardiac arrest in our CICU.","PeriodicalId":87385,"journal":{"name":"Acute cardiac care","volume":"16 1","pages":"9-14"},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3109/17482941.2013.869345","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32140387","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}

引用次数: 12

Strong ion gap in cardiogenic shock - the calculation seems wrong. 心源性休克中的强离子间隙——计算似乎是错误的。

Acute cardiac care Pub Date : 2014-03-01 Epub Date: 2014-01-10 DOI: 10.3109/17482941.2013.859270

Rainer Gatz

引用次数: 3

Classic Osborn waves and incessant ventricular fibrillation in severe hypothermia. 严重低温时的典型奥斯本波和不间断心室颤动。

Acute cardiac care Pub Date : 2013-12-01 Epub Date: 2013-11-05 DOI: 10.3109/17482941.2013.841948

Auras R Atreya, Sonali Arora

引用次数: 1

Flecainide toxicity--treatment with intravenous fat emulsion and extra corporeal life support. 氟氯胺毒性——静脉注射脂肪乳剂和额外的物质生命支持治疗。

Acute cardiac care Pub Date : 2013-12-01 Epub Date: 2013-11-07 DOI: 10.3109/17482941.2013.841949

Senthil K Sivalingam, Vijay T Gadiraju, Mini V Hariharan, Auras R Atreya, Joseph E Flack, Hany Aziz

{"title":"Flecainide toxicity--treatment with intravenous fat emulsion and extra corporeal life support.","authors":"Senthil K Sivalingam, Vijay T Gadiraju, Mini V Hariharan, Auras R Atreya, Joseph E Flack, Hany Aziz","doi":"10.3109/17482941.2013.841949","DOIUrl":"https://doi.org/10.3109/17482941.2013.841949","url":null,"abstract":"ventricular arrhythmias include phase two re-entry as well as triggered automaticity following intracellular calcium accumulation in epicardial cells (5). Cardiac arrhythmias seen with hypothermia usually resolve spontaneously with rewarming (6). It has been noted that hypothermic myocardium is less responsive to antiarrhythmic drugs and defi brillation at temperatures below 28 ° C/82.4 ° F (6), as noted in our patient. When cardiac instability with loss of circulation is noted, the best available care includes extra-corporeal membrane oxygenation (ECMO) or CPB (7). Th e neurologically intact survival rate in cardiac arrest patients treated with these modalities is approximately 50% (8). In patients with return of spontaneous circulation, the rates of multi-organ failure are high and pulmonary edema is encountered frequently (8). Th is is probably why ECMO has slightly better outcomes than traditional CPB as it is capable of providing pulmonary support (7). Remarkably, the patient walked home, neurologically intact aft er a prolonged hospital stay complicated by acute respiratory distress syndrome, prolonged delirium, clostridium diffi cile colitis and acute tubular necrosis due to rhabdomyolysis. In summary, it is important to anticipate life-threatening arrhythmias when managing a severely hypothermic patient and recognize that usual resuscitative measures may fail. Early activation of surgical/trauma protocols to institute appropriate re-warming including CPB/ECMO is vital. Declaration of interest: Th e authors report no confl icts of interest. Th e authors alone are responsible for the content and writing of the paper.","PeriodicalId":87385,"journal":{"name":"Acute cardiac care","volume":"15 4","pages":"90-2"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3109/17482941.2013.841949","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31840902","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}

引用次数: 23

Heart-type fatty acid-binding protein may exclude acute myocardial infarction on admission to emergency department for chest pain. 心脏型脂肪酸结合蛋白可在因胸痛入院时排除急性心肌梗死。

Acute cardiac care Pub Date : 2013-12-01 Epub Date: 2013-11-06 DOI: 10.3109/17482941.2013.841947

Fabrizio Cappellini, Simona Da Molin, Stefano Signorini, Fausto Avanzini, Donata Saltafossi, Rosanna Falbo, Paolo Brambilla

{"title":"Heart-type fatty acid-binding protein may exclude acute myocardial infarction on admission to emergency department for chest pain.","authors":"Fabrizio Cappellini, Simona Da Molin, Stefano Signorini, Fausto Avanzini, Donata Saltafossi, Rosanna Falbo, Paolo Brambilla","doi":"10.3109/17482941.2013.841947","DOIUrl":"https://doi.org/10.3109/17482941.2013.841947","url":null,"abstract":"Chest pain is one of the most frequent reasons for presentation to the emergency department (ED), although the estimated prevalence of AMI (acute myocardial infarction) in the ED is about 4%. One criterion for diagnosis of AMI is the demonstration of a rise and/or fall in cardiac troponins, but time is needed for this to happen. Thus, the use of an additional 'early marker' of cardiac injury may aid to exclude AMI rapidly. The aim of the study was to evaluate the possibility of excluding AMI with the determination of heart-type fatty acid-binding protein (H-FABP) on baseline samples of patients referring to the ED for chest pain. 26 AMI patients and 41 non-AMI comparisons were included in the study. Both H-FABP and high sensitivity cardiac troponin T (hs-cTnT) were measured in baseline samples from these subjects. H-FABP had a negative predictive value of 100%, thus indicating the possibility of its usage in a rule-out strategy for AMI in ED for patients presenting with chest pain.","PeriodicalId":87385,"journal":{"name":"Acute cardiac care","volume":"15 4","pages":"83-7"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3109/17482941.2013.841947","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31832295","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}

引用次数: 16

Acute myocardial infarction due to coronary artery embolus associated with atrial fibrillation. 冠状动脉栓塞合并心房颤动所致急性心肌梗死。

Acute cardiac care Pub Date : 2013-12-01 Epub Date: 2013-10-25 DOI: 10.3109/17482941.2013.835828

Bo Xu, Paul Williams, Andrew T Burns

引用次数: 3

Percutaneous bail-out treatment of vein graft rupture with a polytetrafluoroethylene-covered stent. 经皮聚四氟乙烯覆盖支架治疗静脉移植破裂。

Acute cardiac care Pub Date : 2013-12-01 Epub Date: 2013-10-25 DOI: 10.3109/17482941.2013.835829

Antonios N Pavlidis, Grigorios V Karamasis, Brian R Clapp

引用次数: 3

Dynamic left ventricular outflow tract obstruction: hemodynamic pitfall ahead. 动态左心室流出道梗阻:前方血流动力学陷阱。

Acute cardiac care Pub Date : 2013-09-01 Epub Date: 2013-08-08 DOI: 10.3109/17482941.2013.822084

L Christian Napp, Udo Bavendiek, Joern Tongers, Johann Bauersachs, Philipp Roentgen

引用次数: 2

ECG-gated cardiac MDCT for detection of systolic anterior motion of mitral valve. 心电图门控心脏MDCT对二尖瓣收缩前运动的检测。

Acute cardiac care Pub Date : 2013-09-01 DOI: 10.3109/17482941.2013.822085

Eduard Ghersin, Ivan Castellon, Jennifer E Runco Therrien, Tanyanan Tanawuttiwat, Jonathan Lessick, Adam Checkver, Victor Soto

{"title":"ECG-gated cardiac MDCT for detection of systolic anterior motion of mitral valve.","authors":"Eduard Ghersin, Ivan Castellon, Jennifer E Runco Therrien, Tanyanan Tanawuttiwat, Jonathan Lessick, Adam Checkver, Victor Soto","doi":"10.3109/17482941.2013.822085","DOIUrl":"https://doi.org/10.3109/17482941.2013.822085","url":null,"abstract":"Objectives: Evaluating ECG-gated cardiac MDCT detection of systolic anterior motion of the mitral valve, in comparison to trans-thoracic echocardiography as a gold standard.Materials and methods: Study group included 83 consecutive patients (57 men; average age 56.1 years) evaluated with both retrospective ECG-gated cardiac MDCT and trans-thoracic echocardiography within an interval of 30 days. ECG-gated cardiac MDCT imaging was performed with retrospective ECG- gating using 64-slice and 128-slice CT scanners with an inherent temporal resolution range of 75-165 ms. MDCT's and trans- thoracic echocardiograms were retrospectively and independently evaluated by experienced radiologist and cardiologist respectively, for presence of systolic anterior motion of the mitral valve.Results: 7 patients (8.4%) were found to have systolic anterior motion by trans-thoracic echocardiography, from which 6 were found to have systolic anterior motion by ECG-gated cardiac MDCT. Of the 76 patients without systolic anterior motion on trans-thoracic echocardiography, all were correctly identified using ECG-gated cardiac MDCT. The sensitivity, specificity, positive and negative predictive values and accuracy of ECG-gated cardiac MDCT in identifying systolic anterior motion of the mitral valve were 85.7% (6/7), 100% (76/76), 100% (6/6), 98.7% (76/77) and 98.8% (82/83), respectively.Conclusion: ECG-gated cardiac MDCT is comparable to trans-thoracic echocardiography in detecting systolic anterior motion of the mitral valve.","PeriodicalId":87385,"journal":{"name":"Acute cardiac care","volume":"15 3","pages":"69-75"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3109/17482941.2013.822085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31667557","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}

引用次数: 0

Strong-ion gap approach in patients with cardiogenic shock following ST-elevation myocardial infarction. st段抬高型心肌梗死后心源性休克患者的强离子间隙入路。

Acute cardiac care Pub Date : 2013-09-01 Epub Date: 2013-06-27 DOI: 10.3109/17482941.2013.776691

Paola Attanà, Chiara Lazzeri, Marco Chiostri, Claudio Picariello, Gian Franco Gensini, Serafina Valente

{"title":"Strong-ion gap approach in patients with cardiogenic shock following ST-elevation myocardial infarction.","authors":"Paola Attanà, Chiara Lazzeri, Marco Chiostri, Claudio Picariello, Gian Franco Gensini, Serafina Valente","doi":"10.3109/17482941.2013.776691","DOIUrl":"https://doi.org/10.3109/17482941.2013.776691","url":null,"abstract":"Objective: Assess if acid-base evaluation by Stewart's approach had a clinical role in cardiogenic shock (CS) following ST-elevation myocardial infarction (STEMI).Setting: There are three widely used approaches to investigate metabolic acidosis: base excess (BE), anion gap (AG) and the Stewart's approach or strong ion gap (SIG). Available studies suggest the usefulness of SIG in sepsis and trauma. No data are so far available in CS.Measurements and results: We enrolled 63 consecutive patients with CS following STEMI submitted to Percutaneous Coronary Intervention (PCI). On admission, the APACHE II (Acute physiology and chronic health evaluation II) score and HOMA (Homeostasis model assessment) index were assessed together with glomerular filtration rate (eGFR), quantitative BE, AG, lactate values and 12 h lactate clearance. Non-survivors showed a higher incidence of PCI failure, higher APACHE II score, lower LVEF, lower eGFR, lower 12 h lactate clearance; a higher admission lactate and more negative BE. No difference was detectable in AG and SIG. Only 3 patients exhibited pathological values of SIG (≥ 2) and only 1 of these patients died.Conclusions: According to our data the SIG approach does not seem to add further information to usual parameters in acid-base evaluation or early risk stratification in CS patients.","PeriodicalId":87385,"journal":{"name":"Acute cardiac care","volume":"15 3","pages":"58-62"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3109/17482941.2013.776691","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31538735","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}

引用次数: 19