1790: WARFARIN TRAUMA PATIENTS: COMPARING PROTHROMBIN COMPLEX CONCENTRATE TO VITAMIN K/FRESH FROZEN PLASMA.
WARFARIN; VITAMIN K; GLASGOW Coma Scale; INTERNATIONAL normalized ratio; PROTHROMBIN
B Learning Objectives: b There is scant data comparing Prothrombin Complex Concentrate (PCC) to Vitamin K/Fresh Frozen Plasma (FFP) in trauma patients. Patients that received PCC (PCC group) were compared to those who received Vitamin K/FFP (FFP group). [Extracted from the article]
Huang Gregory; Hileman Barbara; Chance Elisha; Gianetti Emily; Steiner Dena; Marchand Tiffany
Critical Care Medicine
2019
2019-01-02
Journal Article
<a href="http://doi.org/10.1097/01.ccm.0000552528.13105.55" target="_blank" rel="noreferrer noopener">10.1097/01.ccm.0000552528.13105.55</a>
Functional Recovery In A Patient With Postanoxic Myoclonus Secondary To Anaphylactic Shock
General & Internal Medicine
Kaphle U; Bailey R; Singh S
Critical Care Medicine
2014
2014-12
Journal Article or Conference Abstract Publication
n/a
Repeat Ct Is Not Necessary For Trauma Patients On Antithrombotics With An Initially Negative Head Ct
General & Internal Medicine
Huang G; Emerick E; Gianetti E; Chance E; Hileman B
Critical Care Medicine
2018
2018-01
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/01.ccm.0000529613.31218.8f" target="_blank" rel="noreferrer noopener">10.1097/01.ccm.0000529613.31218.8f</a>
Enteral Feeding Tube Placement Success With Intravenous Metoclopramide Administration In Icu Patients
critical care medicine; efficacy; enteral nutrition; gastrointestinal intubation; General & Internal Medicine; metoclopramide; Respiratory System
Objective: The purpose of this study was to determine if intravenous push metoclopramide would facilitate immediate transpyloric passage of a small-bore feeding tube without fluoroscopy or endoscopy. Design: Prospective, randomized trial. Patients: One hundred five medical and surgical ICU patients at a community teaching hospital. Interventions: Patients were randomized to receive 10 mg of metoclopramide 10 min before tube insertion or no medication. Measurement: Successful placement was stated as radiologically verified transduodenal tube location. Results: A 54% success rate was shown with administration of the drug with 46% success for the control. Chi square analysis of the success rate showed no significant relationship between administration of metoclopramide and successful tube placement (p=0.38). Increasing years of physician training was the only variable associated with successful placement (p=0.003). No association was found between successful tube placement and presence of endotracheal tube, tracheostomy, or cervical immobility, nor any interaction of metoclopramide with these variables. Conclusion: Intravenous metoclopramide, 10 mg, administered 10 min prior to intubation with a small-bore feeding tube (10F), was ineffective in facilitating transpyloric intubation.
Heiselman D E; Hofer T; Vidovich R R
Chest
1995
1995-06
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1378/chest.107.6.1686" target="_blank" rel="noreferrer noopener">10.1378/chest.107.6.1686</a>
Comparison Of Dopamine To Dobutamine And Norepinephrine For Oxygen Delivery And Uptake In Septic Shock
agents; cardiac-output; catecholamines; consumption; dobutamine; dopamine; General & Internal Medicine; hemodynamics; infusion; inotropic; intra-pulmonary shunt; lactic-acidosis; norepinephrine; oxygen consumption; septic shock; severe sepsis; skeletal-muscle; therapy; transport
Objectives: To test whether dopamine infusion improves oxygen delivery (D over dot O-2) and oxygen uptake (V over dot O-2) in hyperdynamic septic shock patients stabilized by adequate volume and dobutamine alone, or by the combination of dobutamine and norepinephrine. Design: Prospective clinical trial of two patient groups. Group 1 (n = 15) was stabilized with dobutamine, and group 2 (n = 10) was stabilized with dobutamine and norepinephrine. Setting: Intensive care unit in a university hospital. Patients: Twenty-five postoperative, hyperdynamic septic shock patients. Interventions: The stabilizing catecholamine infusion was replaced in a stepwise manner by dopamine to achieve a similar mean arterial pressure (dopamine doses: group 1, mean 22 +/- 15 mu g/kg/min [range 6 to 52]; and group 2, mean 57 +/- 41 mu g/kg/min [range 15 to 130]). Measurements and Main Results: A complete hemodynamic profile was performed with oxygen transport-related variables at baseline, after replacement by dopamine and after resetting to the original catecholamine infusion. The change to dopamine resulted in increases in cardiac index (group 1: 20% [p < .01]; group 2: 33% [p < .01]), and D over dot O-2 (group 1: 19% [p < .01]; group 2: 27% [p < .01]). However, V over dot O-2, whether directly measured from the respiratory gases or calculated by the cardiovascular Fick principle, did not change in both groups with dopamine, while the oxygen extraction ratio decreased significantly in both groups with dopamine. Heart rate, pulmonary artery occlusion pressure, and pulmonary shunt fraction all increased with dopamine, Pao(2) decreased, but oxygen saturation remained stable in both groups with dopamine. Conclusions: Short-term dopamine infusion in hyperdynamic septic shock patients, de. spite producing higher global D over dot O-2, was not superior to dobutamine or the combination of dobutamine and norepinephrine infusion.
Hannemann L; Reinhart K; Grenzer O; Meierhellmann A; Bredle D L
Critical Care Medicine
1995
1995-12
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/00003246-199512000-00004" target="_blank" rel="noreferrer noopener">10.1097/00003246-199512000-00004</a>
Therapeutic Strategies To Hasten The Resolution Of Pulmonary Edema
acute respirator distress syndrome; adult; aldosterone; alveolar fluid clearance; catecholamines; clearance; dexamethasone; epithelial fluid clearance; General & Internal Medicine; guinea-pigs; liquid; lung; lung fluid balance; pulmonary edema; rats; respiratory-distress syndrome
Folkesson H G; Matthay M A
Critical Care Medicine
2003
2003-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/01.ccm.0000059641.03915.75" target="_blank" rel="noreferrer noopener">10.1097/01.ccm.0000059641.03915.75</a>
Epinephrine impairs splanchnic perfusion in septic shock
sepsis; oxygen consumption; General & Internal Medicine; epinephrine; agents; septic shock; norepinephrine; oxygen delivery; critically ill patients; intramural ph; tissue oxygenation; blood flow; oxygen consumption; gastric-mucosal ph; indocyanine green; splanchnic; splanchnic oxygen delivery; dobutamine; hepatic blood-flow; splanchnic oxygen consumption; vasoactive
Objective: To assess the effects of epinephrine on splanchnic perfusion and splanchnic oxygen uptake in patients with septic shock. Design: Prospective, controlled trial. Setting: University hospital intensive care unit (ICU). Patients: Eight patients with septic shock, according to the criteria of the 1992 American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference, requiring treatment with vasopressors. Interventions: We compared in crossover design a 2-hr infusion of epinephrine with dobutamine plus norepinephrine in eight ICU patients with septic shock, Systemic and splanchnic hemodynamics and oxygen transport were measured before and during treatment with epinephrine. Measurements and Main Results: There was essentially no effect of epinephrine on the global parameters, except for increased lactate concentrations, There were marked effects on the regional variables; epinephrine caused lower splanchnic flow and oxygen uptake, lower mucosal pH, and higher hepatic vein lactate. Conclusion: We conclude that undesirable splanchnic effects on patients in whom that region is particularly fragile should be considered when using epinephrine for septic shock treatment.
MeierHellmann A; Reinhart K; Bredle D L; Specht M; Spies C D; Hannemann L
Critical Care Medicine
1997
1997-03
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/00003246-199703000-00005" target="_blank" rel="noreferrer noopener">10.1097/00003246-199703000-00005</a>
COMPARING THE CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH UNPLANNED EXTUBATION
General & Internal Medicine
Dasari C; Podugu A; Jihad D; Alasady J; Nemer O; Bolyard J; Boutros N
Critical Care Medicine
2014
2014-12
Journal Article or Conference Abstract Publication
n/a
Evidence-based stress ulcer prophylaxis guideline
General & Internal Medicine
Chow M P; Rogove H J; Swerlein A M
Critical Care Medicine
1999
1999-12
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/00003246-199912001-00064" target="_blank" rel="noreferrer noopener">10.1097/00003246-199912001-00064</a>
Use of routine blood cultures in protocols for therapeutic hypothermia for cardiac arrest
General & Internal Medicine
Castro J; Friedman N; Chen A; Heiselman D; Heiselman C
Critical Care Medicine
2006
2006-12
Journal Article or Conference Abstract Publication
n/a
Seizures in comatose cardiac arrest survivors receiving therapeutic hypothermia
General & Internal Medicine
Castro J; Friedman N; Chen A; Heiselman D; Heiselman C
Critical Care Medicine
2006
2006-12
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/00003246-200612002-00054" target="_blank" rel="noreferrer noopener">10.1097/00003246-200612002-00054</a>
Induced hypothermia therapy for survivors of in- and out-of-hospital cardiac arrest - A retrospective review
General & Internal Medicine
Castro J; Friedman N; Chen A; Heiselman D; Heiselman C
Critical Care Medicine
2006
2006-12
Journal Article or Conference Abstract Publication
n/a
SUCRALFATE VERSUS ANTACIDS AND CIMETIDINE IN PREVENTING ACUTE GASTROINTESTINAL-BLEEDING IN THE VENTILATOR PATIENT
General & Internal Medicine
Cannon L A; Heiselman D E; Gardner W G; Jones J L
Critical Care Medicine
1986
1986-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/00003246-198604000-00097" target="_blank" rel="noreferrer noopener">10.1097/00003246-198604000-00097</a>
MAGNESIUM LEVELS IN CARDIAC-ARREST VICTIMS - RELATION TO SUCCESSFUL RESUSCITATION
General & Internal Medicine
Cannon L A; Heiselman D E; Dougherty J M; Friedman N M
Critical Care Medicine
1986
1986-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/00003246-198604000-00236" target="_blank" rel="noreferrer noopener">10.1097/00003246-198604000-00236</a>
INFLUENCE OF N-ACETYLCYSTEINE ON INDIRECT INDICATORS OF TISSUE OXYGENATION IN SEPTIC SHOCK PATIENTS - RESULTS FROM A PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND-STUDY
blood gas analysis; critical illness; critically-ill patients; endotoxin; gastric mucosa; General & Internal Medicine; glutathione; intramural ph; l-arginine; multiple organ failure; n-acetylcysteine; nitric-oxide synthesis; organ failure; oxygen consumption; ph; relaxing factor; sepsis; septic; shock; skeletal-muscle; tissue oxygenation
Objectives: Deactivation of endothelium-derived relaxing factor due to an increased oxygen radical load during sepsis may contribute to an impairment in microcirculatory blood flow. We investigated whether treatment with the sulfhydryl donor and oxygen radical scavenger, N-acetylcysteine, would improve whole-body oxygen consumption (Vo(2)), gastric intramucosal pH, and veno-arterial CO2 gradient (veno-arterial PCO2) during septic shock. Design: Prospective, randomized, double-blind study conducted over 2 yrs. Setting: Septic shock patients admitted to the intensive care unit. Patients: Fifty-eight patients requiring hemodynamic monitoring (radial and pulmonary artery catheters) due to septic shock, were included in this study. All patients were examined within 72 hrs after the onset of sepsis. They were optimally resuscitated by conventional means with volume and inotropic agents, and exhibited stable clinical conditions (hemodynamic values, body temperature, hemoglobin, FIO2). Interventions: A gastric tonometer was inserted to measure the gastric intramucosal pH. Subjects randomly received either 150 mg/kg of intravenous N-acetylcysteine or placebo over a 15-min period, then a continuous infusion of 12.5 mg/hr of N-acetylcysteine or placebo over similar to 90 mins. Measurements: Infusion measurements were begun 60 mins after the beginning of infusion and lasted similar to 30 mins. The infusion was then discontinued and 2 hrs later the final measurements were taken. Main Results: Basic patient characteristics (age, sex, Acute Physiology and Chronic Health Evaluation [APACHE] II scores, Multiple Organ Failure scores) did not differ significantly, nor did pre- and 2-hr postinfusion measurements differ between any of the groups. Thirteen (45%) patients responded (i.e., showed an increase in Vo(2) >10%, reaching a mean of 19%) to the N-acetylcysteine infusion. The N-acetylcysteine responders also showed an increase in gastric intramucosal pH, a decrease in veno-arterial PCO2, an increase in oxygen delivery, cardiac index, stroke index, and left ventricular stroke work index, as well as a significant decrease in systemic vascular resistance in comparison to baseline. The N-acetylcysteine nonresponders, as well as the patients in the placebo group, did not show any significant changes in any of these variables. The N-acetylcysteine responders had a higher survival rate (69%) than the nonresponders (19%) and were studied earlier after onset of sepsis (37 hrs) than the nonresponders (61 hrs). The only significant difference between the entire N-acetylcysteine group (which included responders plus nonresponders) and the placebo group was an increased 30, in the entire N-acetylcysteine group during infusion measurements. Conclusions: N-acetylcysteine provided a transient improvement in tissue oxygenation in about half of the septic shock patients, as indicated by an increase in Vo(2) and gastric intramucosal pH and a decrease in veno-arterial PCO2. The higher survival rate in the N-acetylcysteine responders and the fact that half of the patients receiving N-acetylcysteine did not respond, suggests that, in some patients, sepsis irreversibly damages the microvasculature to the extent that N-acetylcysteine has no effect. If analyzed by intention to treat, the N-acetylcysteine did not produce effects that were significantly different from the placebo. Whether the N-acetylcysteine challenge was merely diagnostic or whether N-acetylcysteine can be effective in the treatment of sepsis deserves further investigation.
Spies C D; Reinhart K; Witt I; Meierhellmann A; Hannemann L; Bredle D L; Schaffartzik W
Critical Care Medicine
1994
1994-11
Journal Article
n/a
THC IS MORE PREDICTIVE OF A GREATER INJURY SEVERITY SCORE THAN ALCOHOL FOR TRAUMA PATIENTS OVER 30
General & Internal Medicine
Muakkassa F F; Marley R; Billue K; Yetmar Z; Salvator A
Critical Care Medicine
2014
2014-12
Journal Article
n/a
FAILURE TO WEDGE AND PULMONARY-HYPERTENSION DURING PULMONARY-ARTERY CATHETERIZATION - A SIGN OF TOTALLY OCCLUSIVE PULMONARY-EMBOLISM
General & Internal Medicine
Traeger S M
Critical Care Medicine
1985
1985
Journal Article
<a href="http://doi.org/10.1097/00003246-198507000-00007" target="_blank" rel="noreferrer noopener">10.1097/00003246-198507000-00007</a>
CASTING A WIDER NET: ADDING A SQID TO DELIRIUM ASSESSMENT
General & Internal Medicine
Thandra K; Ogunmuyiwa J; Yohannes-Tomicich J; Alici Y; Root J; Yang G; Zhang H; Kostelecky N; Pastores S; Halpern N; Chawla S; Voigt L
Critical Care Medicine
2018
2018-01
Journal Article
<a href="http://doi.org/10.1097/01.ccm.0000528768.45411.cb" target="_blank" rel="noreferrer noopener">10.1097/01.ccm.0000528768.45411.cb</a>
CONTINUOUS-INFUSION OF PYRIDOSTIGMINE IN THE MANAGEMENT OF MYASTHENIC CRISIS
cholinergic; cholinesterase inhibitors; compounds; edrophonium; General & Internal Medicine; gravis; injections; intravenous; kinetics; myasthenia gravis; neostigmine; neuromuscular diseases; ocular motility disorders; pyridinium; pyridostigmine bromide; receptors; ventilatory weaning
Saltis L M; Martin B R; Traeger S M; Bonfiglio M F
Critical Care Medicine
1993
1993-06
Journal Article
<a href="http://doi.org/10.1097/00003246-199306000-00025" target="_blank" rel="noreferrer noopener">10.1097/00003246-199306000-00025</a>
Stimulation of alveolar epithelial fluid clearance in human lungs by exogenous epinephrine
activation; alveolar epithelium; catecholamine; cells; cftr; cystic fibrosis transmembrane conductance regulator; General & Internal Medicine; glibenclamide; injury; liquid clearance; na+ transport; Norepinephrine; pulmonary edema; pulmonary edema; rat; resected human lung; resolution
Objectives. Because several experimental studies have demonstrated that cyclic adenosine monophosphate generation following beta-adrenoceptor activation can markedly stimulate alveolar fluid clearance, we determined whether the endogenous levels of catecholamines that occur in the pulmonary edema fluid and plasma of patients with acute lung injury are high enough to stimulate alveolar fluid clearance in the human lung. Design: Observational clinical Study. Setting. Academic university hospital and laboratory. Patients: Twenty-one patients with acute pulmonary edema plus ex vivo human lungs. Interventions. Measurements of catecholamine levels in patient samples and controlled laboratory studies of the effects of these catecholamine levels on the rates of alveolar fluid clearance in ex vivo human lungs. Measurements and Main Results. The concentrations of both epinephrine and norepinephrine in the pulmonary edema fluid and plasma were similar to 10(-9) M (range of 1-8 x 10(-9) M) in hydrostatic pulmonary edema (n = 6) and acute lung injury patients (n = 15). We therefore tested whether 10(-9) M epinephrine or norepinephrine stimulated alveolar fluid clearance in isolated human lungs and found that these epinephrine or norepinephrine concentrations did not stimulate alveolar fluid clearance. However, higher concentrations of epinephrine (10(-7) M), but not norepinephrine (10(-7) M), significantly stimulated alveolar fluid clearance by 84% above control. Glibenclamide (10(-5) M) and CFTR(inh)-172 (10(-5) M), cystic fibrosis transmembrane conductance regulator inhibitors, completely inhibited the epinephrine-induced stimulation of alveolar fluid clearance. Conclusions. These results indicate that endogenous catecholamine concentrations in pulmonary edema fluid are probably not sufficient to stimulate alveolar fluid clearance. In contrast, administration of exogenous catecholamines into the distal airspaces can stimulate alveolar fluid clearance in the human lung, an effect that is mediated in part by cystic fibrosis transmembrane conductance regulator. Therefore, exogenous cyclic adenosine monophosphate-dependent stimulation will probably be required to accelerate the resolution of alveolar edema in the lungs of patients with pulmonary edema.
Sakuma T; Gu X; Wang Z; Maeda S; Sugita M; Sagawa M; Osanai K; Toga H; Ware L B; Folkesson G; Matthay M A
Critical Care Medicine
2006
2006-03
Journal Article
<a href="http://doi.org/10.1097/01.ccm.0000201403.70636.0f" target="_blank" rel="noreferrer noopener">10.1097/01.ccm.0000201403.70636.0f</a>
Lean Six Sigma: Trimming the fat! Effectively managing precious resources*.
Female; Male; Intensive Care Units; Critical Care; Human; Outcome Assessment; Pediatric; Systems Analysis; Patient Rounds – Administration
Besunder JB; Super DM
Critical care medicine
2012
2012-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/ccm.0b013e3182372bd4" target="_blank" rel="noreferrer noopener">10.1097/ccm.0b013e3182372bd4</a>
A Gap, and Opportunity, in the ICU Admission, Discharge, and Triage Guidelines.
*Patient Discharge; *Triage; Hospitalization; Humans; Intensive Care Units; Patient Admission; Patient Discharge; Scales; Triage
Frakes Michael A; Wilcox Susan R; Bigham Michael T; Angelotti Timothy; Marcolini Evie G; Cohen Jason
Critical care medicine
2017
2017-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/CCM.0000000000002202" target="_blank" rel="noreferrer noopener">10.1097/CCM.0000000000002202</a>
Exploring the scope of post-intensive care syndrome therapy and care: engagement of non-critical care providers and survivors in a second stakeholders meeting.
*Health Status; *Intensive Care Units; Awareness; Continuity of Patient Care/*organization & administration; Critical Illness/*psychology; Health Education; Humans; Mental Health; Survivors/*psychology; Syndrome; United States
BACKGROUND: Increasing numbers of survivors of critical illness are at risk for physical, cognitive, and/or mental health impairments that may persist for months or years after hospital discharge. The post-intensive care syndrome framework encompassing these multidimensional morbidities was developed at the 2010 Society of Critical Care Medicine conference on improving long-term outcomes after critical illness for survivors and their families. OBJECTIVES: To report on engagement with non-critical care providers and survivors during the 2012 Society of Critical Care Medicine post-intensive care syndrome stakeholder conference. Task groups developed strategies and resources required for raising awareness and education, understanding and addressing barriers to clinical practice, and identifying research gaps and resources, aimed at improving patient and family outcomes. PARTICIPANTS: Representatives from 21 professional associations or health systems involved in the provision of both critical care and rehabilitation of ICU survivors in the United States and ICU survivors and family members. DESIGN: Stakeholder consensus meeting. Researchers presented summaries on morbidities for survivors and their families, whereas survivors presented their own experiences. MEETING OUTCOMES: Future steps were planned regarding 1) recognizing, preventing, and treating post-intensive care syndrome, 2) building strategies for institutional capacity to support and partner with survivors and families, and 3) understanding and addressing barriers to practice. There was recognition of the need for systematic and frequent assessment for post-intensive care syndrome across the continuum of care, including explicit "functional reconciliation" (assessing gaps between a patient's pre-ICU and current functional ability at all intra- and interinstitutional transitions of care). Future post-intensive care syndrome research topic areas were identified across the continuum of recovery: characterization of at-risk patients (including recognizing risk factors, mechanisms of injury, and optimal screening instruments), prevention and treatment interventions, and outcomes research for patients and families. CONCLUSIONS: Raising awareness of post-intensive care syndrome for the public and both critical care and non-critical care clinicians will inform a more coordinated approach to treatment and support during recovery after critical illness. Continued conceptual development and engagement with additional stakeholders is required.
Elliott Doug; Davidson Judy E; Harvey Maurene A; Bemis-Dougherty Anita; Hopkins Ramona O; Iwashyna Theodore J; Wagner Jason; Weinert Craig; Wunsch Hannah; Bienvenu O Joseph; Black Gary; Brady Susan; Brodsky Martin B; Deutschman Cliff; Doepp Diana; Flatley Carl; Fosnight Sue; Gittler Michelle; Gomez Belkys Teresa; Hyzy Robert; Louis Deborah; Mandel Ruth; Maxwell Carol; Muldoon Sean R; Perme Christiane S; Reilly Cynthia; Robinson Marla R; Rubin Eileen; Schmidt David M; Schuller Jessica; Scruth Elizabeth; Siegal Eric; Spill Gayle R; Sprenger Sharon; Straumanis John P; Sutton Pat; Swoboda Sandy M; Twaddle Martha L; Needham Dale M
Critical care medicine
2014
2014-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/CCM.0000000000000525" target="_blank" rel="noreferrer noopener">10.1097/CCM.0000000000000525</a>