The open critical care medicine journal最新文献

{"title":"Hemodynamic Comparison Between Right Heart Catheterization and Transthoracic Echocardiography in the Critically Ill Patients: A Prospective Study","authors":"H. Khouli","doi":"10.2174/1874828701005010001","DOIUrl":"https://doi.org/10.2174/1874828701005010001","url":null,"abstract":"Background: Tranthoracic echocardiography (TTE) is increasingly utilized in the management of critically ill patients in whom right heart catheterization (RHC) was frequently used in the past. We tested the hypothesis that bedside TTE can substitute for RHC for determining the etiology of cardiopulmonary compromise in critically ill patients when initial clinical assessment is limited. Methods: We prospectively enrolled 51 patients from medical and surgical Intensive Care Units with unknown etiology of cardiopulmonary compromise. Patients underwent assessment of their cardiopulmonary compromise by RHC and TTE. A final clinical assessment, considered the gold standard was adjudicated by the intensivist caring for the patient. Results: There was complete agreement between TTE data and RHC data in determining the etiology of cardiopulmonary compromise as cardiac or non-cardiac in 46 (90%) of the 51 patients. The kappa statistic for the agreement between TTE data and gold standard in determining the etiology of cardiopulmonary compromise as cardiac or non-cardiac was 0.90 (95% confidence interval (CI), 0.73 to 0.98; p<0.001). The kappa statistic for the agreement between RHC data and gold standard was 0.84 (95% confidence interval (CI), 0.63 to 0.95; p < 0.001). Based on the results of the gold standard assessment, the positive predictive value and negative predictive value for TTE data determining the etiology of cardiopulmonary compromise were 93% and 97% respectively. The positive predictive value and negative predictive value for RHC data determining the etiology of cardiopulmonary compromise were 100% and 92% respectively. TTE was highly suggestive of pulmonary embolism and cardiac tamponade in three patients where RHC was not. Conclusion: In this era where transthoracic echocardiography is increasingly utilized to manage critically ill patients with cardiopulmonary compromise, we found transthoracic echocardiography to be a useful diagnostic tool in determining the etiology of cardiopulmonary compromise when initial clinical assessment is limited. While both methods can be complementary to each other, bedside transthoracic echocardiography is an acceptable non-invasive alternative to right heart catheterization in determining the etiology of cardiopulmonary compromise in most critically ill patients when initial clinical assessment is limited.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"113 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2012-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80598414","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":"Subarachnoid Hemorrhage: A Neurological Emergency","authors":"M. Venti, Monica Acciarresi, G. Agnelli","doi":"10.2174/1874828701104010056","DOIUrl":"https://doi.org/10.2174/1874828701104010056","url":null,"abstract":"Subarachnoid hemorrhage (SAH) accounts for 5% of all strokes but its burden is relevant due to high mortality, high disability and remarkable incidence in the young. The rupture of an intracranial aneurysm is responsible for about 85% of SAHs; 10% are represented by non-aneurysmal conditions; 5% are represented by other medical conditions such as inflammatory or non-inflammatory lesions of cerebral artery, coagulopathy, neoplasms or drug abuse. The clinical presentation of a subarachnoid hemorrhage can be extremely variable ranging from nearly asymptomaticity to sudden death. Neuroimaging represent the first level instrumental investigation. In case of clinical suspect of SAH and negative neuroimaging, cerebrospinal fluid (CSF) examination is required. Following the diagnosis of SAH, determining cause and localization of bleeding is mandatory; digital catheter angiography is the gold standard. Rebleeding is the most frequent and severe complication of SAH. The aneurysm exclusion is the most effective treatment for preventing rebleeding. Endovascular occlusion of the aneurysm with coils has been shown to be associated with better short- and long-term outcomes than surgical clipping in select patients.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"37 1","pages":"56-60"},"PeriodicalIF":0.0,"publicationDate":"2011-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76466677","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":"Clinical Diagnostics, Therapy and Outcome After Basilar Artery Thrombosis","authors":"A. Lohse, C. Preul","doi":"10.2174/1874828701104010028","DOIUrl":"https://doi.org/10.2174/1874828701104010028","url":null,"abstract":"Acute basilar artery occlusion is a relatively rare but life threatening condition requiring rapid diagnosis and treatment. The circumstances and predictive value for outcome in these patients are not well documented. 88 patients with basilar artery occlusion treated in the Department of Neurology at Jena University Hospital from 1998 to 2007 were identified and studied. Of these, 45 were males and 43 females, aged between 20 and 92 years (median, 63 years). In 60.2%, MRI with MR angiography led to the diagnosis; 13.6% of all cases were diagnosed by cranial CT. 45 patients were treated with thrombolytic therapy with rt-PA (44/45) or urokinase (1/45; in 1999). Out of 45 patients, eight (17.7%) initially received systemic (i.v.) thrombolytic treatment. Recent research has suggested that for patients with unambiguous basilar artery thrombosis, the only promising treatment option is early thrombolytic treatment. The major clinical goal is to enable patients to live an independent life after the acute phase and, if required, rehabilitation. Consequently, this challenges the concept of a \"thrombolysis at all costs\" approach, especially in case of multi-morbidity, unidentifiable time frames, and comatose patients with regards to possible poor functional prognosis. An adequate therapy in the sense of an adaptable scheme, starting with immediate maximum therapy following diagnosis, and with defined decision points for possible therapeutic limitations at later stages of the disease course after ensuring poor prognosis may require further testing, depending on clinical conditions and the patients' documented, or presumable wishes.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"24 1","pages":"28-34"},"PeriodicalIF":0.0,"publicationDate":"2011-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85522768","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":"Dissections of Cervical Arteries - Clinical Presentation, Course, and Therapy in 71 Consecutive Patients of a Single University Centre","authors":"K. Neidhardt, O. Witte, S. Isenmann","doi":"10.2174/1874828701104010061","DOIUrl":"https://doi.org/10.2174/1874828701104010061","url":null,"abstract":"Dissections of the cervical arteries are among the most frequent causes of juvenile strokes. The etiology and pathogenesis of spontaneous dissections remain elusive. Best treatment remains to be defined. Here, we analyzed 71 consecutive patients from the Department of Neurology, University Hospital of Jena. We asked if immediate anticoagulation or alternative treatment with ASA would affect outcome. Patients treated initially with i.v. ASA tended to have a better outcome than patients who were anticoagulated (r=0.3; p<0.05). In heparin treated patients, an initial i.v. bolus shortened the interval before the target PTT was reached by 1.3 days (p<0.05), yet did not affect neurological outcome. Low NIHSS (National Institute of Health Stroke Scale) (r=-0.71; p<0.01) and high Barthel scores (r=0,77; p<0.01) at presentation predicted a good outcome. In 14 of 52 patients, low TSH (thyroid- stimulating hormone) indicated hyperthyreosis, while no patient was hypothyreotic. In 33 of 64 patients CRP (C-reactive protein) was elevated. These findings merit validation in larger trials.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"31 1","pages":"61-67"},"PeriodicalIF":0.0,"publicationDate":"2011-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78713685","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":"Neurological Sequelae of Sepsis: I) Septic Encephalopathy","authors":"T. Ringer, H. Axer, B. Romeike, J. Zinke, F. Brunkhorst, O. Witte, A. Günther","doi":"10.2174/1874828701104010002","DOIUrl":"https://doi.org/10.2174/1874828701104010002","url":null,"abstract":"Septic encephalopathy (SE) or sepsis-associated delirium is the most common encephalopathy in ICU patients. It is defined by brain dysfunction due to systemic inflammatory response syndrome and extracranial infection. Clinically, acute impairment in level of consciousness and confusion are primarily defining symptoms. Precise clinical evaluation of brain function is crucial, although the necessary diagnostic tools are limited and require further verification in clinical studies. Therefore, SE is often underestimated and not frequently diagnosed. This review gives an overview of clinical features, epidemiological data, pathophysiological processes, imaging and neuropathological findings as well as diagnostic and therapeutic approaches in SE patients to characterize this severe neurological complication of sepsis.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"53 1","pages":"2-7"},"PeriodicalIF":0.0,"publicationDate":"2011-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82749595","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":"16S rDNA-PCR and Sequencing Improves Diagnosis of Bacterial Infection of the Central Nervous System","authors":"K. Boden, S. Sachse, M. Baier, K. Schmidt, M. Brodhun, R. Husain, E. Straube, S. Isenmann","doi":"10.2174/1874828701104010044","DOIUrl":"https://doi.org/10.2174/1874828701104010044","url":null,"abstract":"Rapid initiation of antibiotic treatment and fast diagnosis are essential in bacterial infection of the central nervous system (CNS). Culture as common method for detecting bacteria is time consuming and unreliable once antibiotic treatment has been initiated. Eubacterial 16S rDNA-PCR with species differentiation by sequencing appears to be a promising tool. Our experiences with this method performed on specimens from patients with neurological disorders between 2004 and 2006 are presented. The follow-up of 26 patients revealed bacterial infection in 12 cases (ten on effective antibiotics). The pathogen was identified in seven cases (one by culture and PCR, six by PCR alone). Additionally, two positive PCR-results failed to be sequenced, yet suggest bacterial infection. Contamination was revealed in two cases without infection, one by PCR and one by PCR and culture. In conclusion, 16S rDNA-PCR may be useful for diagnosis bacterial infection of CNS, especially after onset of antibiotic therapy.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"2 1 1","pages":"44-46"},"PeriodicalIF":0.0,"publicationDate":"2011-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87649527","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":"Intracerebral Hemorrhage, Indication for Surgical Treatment and Surgical Techniques","authors":"R. Reichart, S. Frank","doi":"10.2174/1874828701104010068","DOIUrl":"https://doi.org/10.2174/1874828701104010068","url":null,"abstract":"Intracerebral hemorrhage is a common disease. We give a short review of primary haemorrhages under neurosurgical aspects. Neurological symptoms depend on localisation and size of the hematoma. Only a subgroup of intracerebral haemorrhages is treated surgically. The STICH-trial tried to differentiate, in which cases the hematoma should be removed surgically. Surgical treatment could be performed by open craniotomy, endoscopic evacuation of the hematoma or CT-guided stereotaxy.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"29 1","pages":"68-71"},"PeriodicalIF":0.0,"publicationDate":"2011-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82706012","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":"Disease Management in Patients with Delirium","authors":"T. Jochum, K. Bär","doi":"10.2174/1874828701104010047","DOIUrl":"https://doi.org/10.2174/1874828701104010047","url":null,"abstract":"Delirium occurs as a pathophysiological state in connection with various diseases, particularly among patients in critical care. Since it may be a life-threatening condition, any physician should be able to initiate correct assessment and treatment of delirium. This review summarizes current knowledge on care of patients with delirium. The symptoms of delirium contain primarily disturbance of consciousness, attention, cognition, and perception and may comprise disturbance of psychomotor activity, emotions, and sleep. High prevalence of delirium is observed in critically ill patients in intensive care units. It is thus necessary to monitor the comorbid conditions when patients are diagnosed with delirium, especially since delirium is a prognostic factor for rise in morbidity and mortality. The identification of underlying aetiology of delirium and immediate intervention and treatment for urgent general medical conditions should be in the focus, and should be paralleled by measures ensuring patient's safety and continuous monitoring. Somatic interventions depend on underlying aetiology, and patient's clinical as well as comorbid conditions, but they mainly consist of treatment with high-potency neuroleptic drugs such as haloperidol. Interventions which reduce or eliminate environmental factors contributing to an exacerbation and maintenance of delirium are strongly recommended. Eventually, it is important to establish and maintain psychological support to the patient and his family regarding illness, including post-delirium management.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"12 1","pages":"47-55"},"PeriodicalIF":0.0,"publicationDate":"2011-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72915329","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":"Motor Neuron Diseases and Myopathies: Implications for Perioperative Management and Intensive Care","authors":"T. Prell, J. Grosskreutz","doi":"10.2174/1874828701104010024","DOIUrl":"https://doi.org/10.2174/1874828701104010024","url":null,"abstract":"Motor neuron diseases like amyotrophic lateral sclerosis and myopathies are associated with a higher risk of cardiac and respiratory complications, especially during operative procedures. This review gives an overview of the various complications from which patients with motor neurone diseases and muscular dystrophies may suffer during operations and anaesthesia. The main focus is on the pathophysiological aspects as well as the diagnoses of typical cardiac and respiratory complications, their prevention, and their management.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"4 1","pages":"24-27"},"PeriodicalIF":0.0,"publicationDate":"2011-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78649895","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":"Editorial: Neurological Intensive Care","authors":"H. Axer, A. Günther","doi":"10.2174/1874828701104010001","DOIUrl":"https://doi.org/10.2174/1874828701104010001","url":null,"abstract":"Critical care medicine has seen tremendous advances over recent years. The specialty now accounts for improved patient survival in greater numbers and with ever increasing complexities of care requirements. These are patients commonly present with associated neurological problems [1]. The multicenter pan-European SOAP study [2] prospectively collated demographic, co-morbidity, clinical and laboratory data on new ICU admissions over a two-week period. In 16% of admissions, neurological dysfunction represented the third most common indication for admission after cardiovascular and respiratory aetiologies (32% and 19% respectively). Another observational study of 1850 critically ill patients admitted to a medical intensive care unit revealed 92 patients to be primarily admitted with neurological compromise (5%), and a further 216 went on to develop neurological complications (12.3%) [3]. The most common of these included seizures, metabolic or hypoxic-ischemic encephalopathy and cerebral vascular events (CVE). Evidence suggests that these patients have 2.5 fold increased ICU admission and a twofold longer overall hospital stay [3]. Needless to say the ICU physician requires a high degree of expertise in neurology. Routine ICU consultations include assessments of failure to regain or impaired consciousness, seizures, confusion, involuntary or weak muscle function, post CVE deficits, inability to ventilator wean, prognosis and declaration of brain death. Specialized neurological intensive care units (neuro-ICU's) originally evolved from the respiratory support facilities in the epidemic era of polio myelitis. Today, they are able to offer focused, appropriate and rapid treatment modalities to their patients. Their spectrum comprises neurological, respiratory, cardiovascular, and disease-specific therapies such as plasma exchange, immunoabsorption, intracranial pressure monitoring and treatment, hypothermia and many more [5]. Development continues with interventional neuro-radiology as a contemporaneous new frontier in the treatment of patients with intracranial stenosis, vessel occlusion or vascular malformation [7]. The care of the critically ill neurological patient is not simply a combination of critical care and neurological assessment [8], but an integrated treatment plan specific for neurological disease. Neuro-ICU remains a domain of neurology whereby the challenge is the application of neurological pathophysiology theory in the modern critical care setting. This special issue of 'Neurological Intensive Care' is a comprehensive scientific and evidence based overview of the relevant topics. It presents a selection of articles dealing with a variety of neurological complications encountered within the general ICU environment. It also highlights specific neurological diseases and their management strategies relevant to neuro-ICU. It should prove of interest to intensivists of all specialties. which permits …","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"6 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2011-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85835761","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}