scholarly journals Utility of transthoracic echocardiography (TTE) in assessing fluid responsiveness in critically ill patients – a challenge for the bedside sonographer.

2016 ◽  
Vol 18 (4) ◽  
pp. 508 ◽  
Author(s):  
Wojciech Mielnicki ◽  
Agnieszka Dyla ◽  
Tomasz Zawada
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Fluid Responsiveness ◽  
Critically Ill Patients ◽  
Transthoracic Echocardiography ◽  
Diagnostic Tools ◽  
Dynamic Parameters ◽  
Hemodynamic Assessment ◽  
Life Threatening

Transthoracic echocardiography (TTE) has become one of the most important diagnostic tools in the treatment of critically ill patients. It allows clinicians to recognise potentially reversible life-threatening situations and is also very effective in the monitoring of the fluid status of patients, slowly substituting invasive methods in the intensive care unit. Hemodynamic assessment is based on a few static and dynamic parameters. Dynamic parameters change during the respiratory cycle in mechanical ventilation and the level of this change directly corresponds to fluid responsiveness. Most of the parameters cannot be used in spontaneously breathing patients. For these patients the most important test is passive leg raising, which is a good substitute for fluid bolus. Although TTE is very useful in the critical care setting, we should not forget the important limitations, not only technical ones but also caused by the critical illness itself. Unfortunately, this method does not allow continuous monitoring and every change in the patient’s condition requires repeated examination.Keywords: hypovolaemia; non-invasive monitoring; intensive care unit; transthoracic echocardiography

scholarly journals Clinical Application of Ultrasound in Intensive Care Unit-Acquired Weakness

2020 ◽  
Vol 41 (03) ◽  
pp. 244-266
Author(s):  
Sunil Patel ◽  
Danielle Bear ◽  
Brijesh Patel ◽  
Zudin Puthucheary
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Early Recognition ◽  
Imaging Modality ◽  
Surrogate Marker ◽  
Diagnostic Tools ◽  
Muscle Groups

AbstractIntensive care unit-acquired weakness (ICUAW) is common and prolongs the duration of mechanical ventilation and ICU length of stay and is also a leading cause of physical restriction up to five years later. Developing diagnostic tools that allow early identification and risk stratification in all critically ill patients is vital. Ultrasound is a cheap, reproducible and noninvasive imaging modality that can be used to assess multiple muscle groups. It has advantages over other imaging techniques that entail risks of radiation as well as the logistical concerns of moving critically ill patients. Ultrasound muscle indices can be monitored over time and may serve as predictors for ventilatory weaning and long-term outcomes. The diaphragm is frequently perturbed during critical illness, specifically when mechanical ventilation is initiated. Diaphragm thickness and excursion have been shown to support extubation strategy with the former serving as a marker of inspiratory effort in the absence of more specialist tests. The techniques are reproducible with appropriate training and practice and have been applied in clinical trials. Peripheral skeletal muscle ultrasound has been the subject of intense research in ICU-acquired muscle weakness. The technique has also been found to be reproducible and can serve as a surrogate marker to current volitional and non-volitional tests in the assessment of muscle ICUAW. This article outlines the application of musculoskeletal ultrasound and its role in the early recognition of ICUAW in three distinct muscle groups: (1) diaphragm (2) rectus femoris and introduces the potential of (3) parasternal muscles.

scholarly journals Influenza Infections and Emergent Viral Infections in Intensive Care Unit

2019 ◽  
Vol 40 (04) ◽  
pp. 488-497 ◽  
Author(s):  
Ben Cantan ◽  
Charles-Edouard Luyt ◽  
Ignacio Martin-Loeches
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Viral Infections ◽  
Invasive Mechanical Ventilation ◽  
Current Evidence ◽  
Molecular Diagnostic ◽  
Diagnostic Tools ◽  
Medical Conditions

AbstractCritically ill patients are admitted to an intensive care unit (ICU) for multiple reasons. In this study, we aim to analyze the current evidence and findings associated with influenza and other emergent viral infections, namely, herpes simplex virus type 1 (HSV-1), Epstein-Barr virus (EBV), and cytomegalovirus (CMV).Among medical conditions, community-acquired respiratory infections are the most frequent reason for ventilatory support in ICUs. Community-acquired pneumonia in a severe form including the need of invasive mechanical ventilation and/or vasopressors is associated with high mortality rates. However, after the pandemic that occurred in 2009 by H1N1 influenza, the number of cases being admitted to ICUs with viral infections is on the rise. Patients in whom an etiology would not have been identified in the past are currently being tested with more sensitive viral molecular diagnostic tools, and patients being admitted to ICUs have more preexisting medical conditions that can predispose to viral infections. Viral infections can trigger the dysregulation of the immune system by inducing a massive cytokine response. This cytokine storm can cause endothelial damage and dysfunction, deregulation of coagulation, and, consequently, alteration of microvascular permeability, tissue edema, and shock. In severe influenza, this vascular hyperpermeability can lead to acute lung injury, multiorgan failure, and encephalopathy. In immunocompetent patients, the most common viral infections are respiratory, and influenza should be considered in patients with severe respiratory failure being admitted to ICU. Seasonality and coinfection are two important features when considering influenza as a pathogen in critically ill patients.Herpesviridae (HSV, CMV, and EBV) may reactivate in ICU patients, and their reactivation is associated with morbidity/mortality. However, whether a specific treatment may impact on outcome remains to be determined.

Impact of Urgent Chemotherapy in Critically Ill Patients

2017 ◽  
Vol 35 (4) ◽  
pp. 347-353 ◽  
Author(s):  
Maria Cristina Franca de Oliveira ◽  
Juliana Carvalho Ferreira ◽  
Antonio Paulo Nassar Junior ◽  
Aldo Lourenço Abbade Dettino ◽  
Pedro Caruso
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Solid Tumor ◽  
Critically Ill Patients ◽  
Hematological Malignancies ◽  
Life Threatening ◽  
Life Threatening Complication

Objective: Compare the mortality between critically ill patients who received urgent chemotherapy for a cancer-related life-threatening complication with matched patients (controls) who did not received it. Design: Propensity score-matched retrospective study. Setting: Adult intensive care unit in an oncological hospital. Participants: All adults with solid tumor or hematological malignancies who received at least 1 day of urgent intravenous chemotherapy for a cancer-related life-threatening complication. Using the propensity score method adjusted for 10 variables, patients who received urgent chemotherapy were matched to patients who did not. Interventions: None. Main Outcomes Measures: Intensive care unit and hospital mortality. Results: Forty-seven patients (57% with solid tumors and 43% with hematological malignancies) who received urgent chemotherapy were matched to 94 controls. At intensive care unit admission, patients were similar except that those who received urgent chemotherapy were less likely to have received chemotherapy previously (36% vs 85%; P < .01). The intensive care unit (48.9% vs 23.4%; P < .01) and hospital (76.6% vs 46.8%; P < .01) mortality of the patients who received urgent chemotherapy was higher than the controls. The subgroup analysis showed that the higher mortality was limited to patients with solid tumor. Conclusion: The use of urgent chemotherapy is associated with an increase in the intensive care unit and hospital mortality of unselected critically ill patients with solid tumors but not in patients with hematological malignancies.

scholarly journals Treatment of a Critically Ill COVID-19 Patient with the Seraph 100 Microbind Affinity Filter

TH Open ◽  
2021 ◽  
Vol 05 (02) ◽  
pp. e134-e138
Author(s):  
Anke Pape ◽  
Jan T. Kielstein ◽  
Tillman Krüger ◽  
Thomas Fühner ◽  
Reinhard Brunkhorst
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Randomized Trials ◽  
Clinical Course ◽  
Pharmacological Therapy ◽  
The European Union ◽  
Positive Effects ◽  
Special Patient

AbstractThe coronavirus disease 2019 (COVID-19) pandemic has a serious impact on health and economics worldwide. Even though the majority of patients present with moderate and mild symptoms, yet a considerable portion of patients need to be treated in the intensive care unit. Aside from dexamethasone, there is no established pharmacological therapy. Moreover, some of the currently tested drugs are contraindicated for special patient populations like remdesivir for patients with severely impaired renal function. On this background, several extracorporeal treatments are currently explored concerning their potential to improve the clinical course and outcome of critically ill patients with COVID-19. Here, we report the use of the Seraph 100 Microbind Affinity filter, which is licensed in the European Union for the removal of pathogens. Authorization for emergency use in patients with COVID-19 admitted to the intensive care unit with confirmed or imminent respiratory failure was granted by the U.S. Food and Drug Administration on April 17, 2020.A 53-year-old Caucasian male with a severe COVID-19 infection was treated with a Seraph Microbind Affinity filter hemoperfusion after clinical deterioration and commencement of mechanical ventilation. The 70-minute treatment at a blood flow of 200 mL/minute was well tolerated, and the patient was hemodynamically stable. The hemoperfusion reduced D-dimers dramatically.This case report suggests that the use of Seraph 100 Microbind Affinity filter hemoperfusion might have positive effects on the clinical course of critically ill patients with COVID-19. However, future prospective collection of data ideally in randomized trials will have to confirm whether the use of Seraph 100 Microbind Affinity filter hemoperfusion is an option of the treatment for COVID-19.

scholarly journals Bereavement interventions to support informal caregivers in the intensive care unit: a systematic review

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Stephana J. Moss ◽  
Krista Wollny ◽  
Therese G. Poulin ◽  
Deborah J. Cook ◽  
Henry T. Stelfox ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Traumatic Stress ◽  
Critically Ill Patients ◽  
Informal Caregivers ◽  
Post Traumatic Stress ◽  
Bereavement Support ◽  
Complex Needs ◽  
Post Traumatic

Abstract Background Informal caregivers of critically ill patients in intensive care unit (ICUs) experience negative psychological sequelae that worsen after death. We synthesized outcomes reported from ICU bereavement interventions intended to improve informal caregivers’ ability to cope with grief. Data sources MEDLINE, EMBASE, CINAHL and PsycINFO from inception to October 2020. Study selection Randomized controlled trials (RCTs) of bereavement interventions to support informal caregivers of adult patients who died in ICU. Data extraction Two reviewers independently extracted data in duplicate. Narrative synthesis was conducted. Data synthesis Bereavement interventions were categorized according to the UK National Institute for Health and Clinical Excellence three-tiered model of bereavement support according to the level of need: (1) Universal information provided to all those bereaved; (2) Selected or targeted non-specialist support provided to those who are at-risk of developing complex needs; and/or (3) Professional specialist interventions provided to those with a high level of complex needs. Outcome measures were synthesized according to core outcomes established for evaluating bereavement support for adults who have lost other adults to illness. Results Three studies of ICU bereavement interventions from 31 ICUs across 26 hospitals were included. One trial examining the effect of family presence at brain death assessment integrated all three categories of support but did not report significant improvement in emotional or psychological distress. Two other trials assessed a condolence letter intervention, which did not decrease grief symptoms and may have increased symptoms of depression and post-traumatic stress disorder, and a storytelling intervention that found no significant improvements in anxiety, depression, post-traumatic stress, or complicated grief. Four of nine core bereavement outcomes were not assessed anytime in follow-up. Conclusions Currently available trial evidence is sparse and does not support the use of bereavement interventions for informal caregivers of critically ill patients who die in the ICU.

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