Pub Date : 2019-06-17DOI: 10.21037/JECCM.2019.06.02
Chunhui Xu, Shu Li, Yiming Wang, Min Zhang, Ming-Zhu Zhou
Antibiotic misuse is a crucial problem for critically ill patients. Biomarkers have emerged as tools to assist the clinician in antimicrobial therapy decisions among critically ill patients in intensive care units (ICU). They are useful for early identification of infection, timely initiation of antimicrobial therapy, and prompt evaluation of treatment course or duration. However, until now, an ideal biomarker has not yet been identified. The combination of procalcitonin (PCT), C-reactive protein (CPR) and other biomarkers may overcome their insufficiencies, with the high sensitivity of CRP compensating for the low sensitivity of PCT. Biomarkers could not predict antimicrobial resistance, and development of molecular diagnosis brings new challenges. The most important thing for the clinician is to understand the advantages and disadvantages of different methods so that to use them reasonably.
{"title":"Biomarkers in intensive care unit infections, friend or foe?","authors":"Chunhui Xu, Shu Li, Yiming Wang, Min Zhang, Ming-Zhu Zhou","doi":"10.21037/JECCM.2019.06.02","DOIUrl":"https://doi.org/10.21037/JECCM.2019.06.02","url":null,"abstract":"Antibiotic misuse is a crucial problem for critically ill patients. Biomarkers have emerged as tools to assist the clinician in antimicrobial therapy decisions among critically ill patients in intensive care units (ICU). They are useful for early identification of infection, timely initiation of antimicrobial therapy, and prompt evaluation of treatment course or duration. However, until now, an ideal biomarker has not yet been identified. The combination of procalcitonin (PCT), C-reactive protein (CPR) and other biomarkers may overcome their insufficiencies, with the high sensitivity of CRP compensating for the low sensitivity of PCT. Biomarkers could not predict antimicrobial resistance, and development of molecular diagnosis brings new challenges. The most important thing for the clinician is to understand the advantages and disadvantages of different methods so that to use them reasonably.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/JECCM.2019.06.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43200154","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}
Pub Date : 2019-06-13DOI: 10.21037/JECCM.2019.06.01
Judith Ruiz-Aguilar, Rodrigo Diaz-Ibañez, E. Sánchez-Rodríguez
Hyperbaric oxygen therapy (HBOT) for intensive care unit (ICU) patients places special technical and knowledge-based skills demands on nurses inside hyperbaric chambers. Probably the best clinical contributions of HBOT are in the acute cases, in the ischemia reperfusion injury. Nevertheless in the last years, hyperbaric units have focused more in chronic wounds. The first golden rule to treat an ICU patient in a hyperbaric chamber is that you can maintain the same quality of care inside the chamber as in the ICU. This means that the hyperbaric unit has to have the technology means as well as the proficiency and competency of its personnel to provide intensive care inside the chamber. These require competent nursing personnel. We present a case of a 5-year-old pediatric patient who suffered a deep second-degree thermal burn that compromised 32% of the total body surface; including the face, neck, thorax and both arms. The patient received medical support, HBOT and daily wound care. He received a total of 14 treatments and underwent complete healing of the burned areas. The hospital stay was of 17 days, which is lower than expected for a severe burned patient (average of 27.5±1.2 days). He experienced neither secondary effects nor complications. The management of ICU patients inside the chamber requires an experienced and competent team of physicians and nurses. When instituted early, HBOT in the management of thermal burns, makes great impact in the pathophysiology, reduction of surgical procedures and hospital stay.
{"title":"Nursing in a critical care hyperbaric unit at Merida, Yucatan, Mexico: report of a case of an acute pediatric burn patient","authors":"Judith Ruiz-Aguilar, Rodrigo Diaz-Ibañez, E. Sánchez-Rodríguez","doi":"10.21037/JECCM.2019.06.01","DOIUrl":"https://doi.org/10.21037/JECCM.2019.06.01","url":null,"abstract":"Hyperbaric oxygen therapy (HBOT) for intensive care unit (ICU) patients places special technical and knowledge-based skills demands on nurses inside hyperbaric chambers. Probably the best clinical contributions of HBOT are in the acute cases, in the ischemia reperfusion injury. Nevertheless in the last years, hyperbaric units have focused more in chronic wounds. The first golden rule to treat an ICU patient in a hyperbaric chamber is that you can maintain the same quality of care inside the chamber as in the ICU. This means that the hyperbaric unit has to have the technology means as well as the proficiency and competency of its personnel to provide intensive care inside the chamber. These require competent nursing personnel. We present a case of a 5-year-old pediatric patient who suffered a deep second-degree thermal burn that compromised 32% of the total body surface; including the face, neck, thorax and both arms. The patient received medical support, HBOT and daily wound care. He received a total of 14 treatments and underwent complete healing of the burned areas. The hospital stay was of 17 days, which is lower than expected for a severe burned patient (average of 27.5±1.2 days). He experienced neither secondary effects nor complications. The management of ICU patients inside the chamber requires an experienced and competent team of physicians and nurses. When instituted early, HBOT in the management of thermal burns, makes great impact in the pathophysiology, reduction of surgical procedures and hospital stay.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/JECCM.2019.06.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43130901","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}
Pub Date : 2019-06-08DOI: 10.21037/JECCM.2019.06.04
R. Vlok, L. White, M. Binks, A. Hodge, T. Ryan, R. Baran, T. Melhuish
Background: Opioid analgesia is commonly employed in the postoperative period. Opioids have a well-documented side effect profile. Their administration is made difficult following major abdominal surgery in those patients intolerant of oral intake. Furthermore, efforts are required to reduce the contribution of prescription opioids to the global illicit drug epidemic. Buprenorphine is thought to have a lesser side effect profile than morphine, is available in sublingual form and has a reduced risk of addiction. This study aims to compare the effectiveness and side effect profile of buprenorphine against morphine in managing pain following major abdominal surgery. Methods: Five databases were searched up to May 2019. Randomized controlled trials comparing articles comparing buprenorphine with morphine post-major abdominal were included. Major abdominal surgery included operations on the abdominal wall, abdominal cavity or abdominal organs with an expected duration greater than 60 minutes. Postoperative pain and opioid-related adverse events, such as respiratory depression and sedation, were meta-analyzed. Results: Eleven studies with a combined pool of 764 patients were included. Buprenorphine provided improved analgesia from 6 to 12 hours postoperatively (P=0.0003). Pain and analgesia use were otherwise equivalent with buprenorphine and morphine use up to 48 hours postoperatively. There was no discrepancy in respiratory depression, sedation, nausea, vomiting, dizziness or hypotension. Conclusions: Buprenorphine is non-inferior to morphine in managing pain following major abdominal surgery. Opioid-related side effects were unaltered. Further study is required to analyse rates of addiction. The study was hindered by the number of relevant studies and the age of included data.
{"title":"Buprenorphine analgesia following major abdominal surgery: a systematic review and meta-analysis","authors":"R. Vlok, L. White, M. Binks, A. Hodge, T. Ryan, R. Baran, T. Melhuish","doi":"10.21037/JECCM.2019.06.04","DOIUrl":"https://doi.org/10.21037/JECCM.2019.06.04","url":null,"abstract":"Background: Opioid analgesia is commonly employed in the postoperative period. Opioids have a well-documented side effect profile. Their administration is made difficult following major abdominal surgery in those patients intolerant of oral intake. Furthermore, efforts are required to reduce the contribution of prescription opioids to the global illicit drug epidemic. Buprenorphine is thought to have a lesser side effect profile than morphine, is available in sublingual form and has a reduced risk of addiction. This study aims to compare the effectiveness and side effect profile of buprenorphine against morphine in managing pain following major abdominal surgery. Methods: Five databases were searched up to May 2019. Randomized controlled trials comparing articles comparing buprenorphine with morphine post-major abdominal were included. Major abdominal surgery included operations on the abdominal wall, abdominal cavity or abdominal organs with an expected duration greater than 60 minutes. Postoperative pain and opioid-related adverse events, such as respiratory depression and sedation, were meta-analyzed. Results: Eleven studies with a combined pool of 764 patients were included. Buprenorphine provided improved analgesia from 6 to 12 hours postoperatively (P=0.0003). Pain and analgesia use were otherwise equivalent with buprenorphine and morphine use up to 48 hours postoperatively. There was no discrepancy in respiratory depression, sedation, nausea, vomiting, dizziness or hypotension. \u0000 Conclusions: Buprenorphine is non-inferior to morphine in managing pain following major abdominal surgery. Opioid-related side effects were unaltered. Further study is required to analyse rates of addiction. The study was hindered by the number of relevant studies and the age of included data.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41854385","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}
Pub Date : 2019-06-03DOI: 10.21037/JECCM.2019.02.05
Kathleen D. Martin, W. Dorlac
Evaluation of trauma systems has matured over the last few decades. US trauma systems routinely undergo clinical and operational evaluation to ensure optimal care of the injured from the time of injury through reintegration with society. Assessments are carried out with the intent of defining optimal elements and rendering strategic recommendations for the trauma system. The framework for trauma system assessment was adopted from the Trauma Care Systems Planning and Development Act of 1990 which sought to create a consistent process and core functions to ensure a reproducible trauma system from prehospital through rehabilitation. Applying the core function of a public health model to trauma systems provided a process for enhancement of clinical care along the continuum through a framework that accentuates assessment, policy development and assurance while holding to the highest standards in trauma systems performance. A review of contemporary and evidence-based information regarding key strategies and processes related to the evaluation of trauma systems’ performance improvement was undertaken. The intent was to identify measurable metrics for trauma systems performance improvement and patient safety. There is a paucity of data related to specific metrics to evaluate the impact of trauma systems on performance and outcomes. The majority of publications focused on quality of trauma registry data, integration of prehospital data, and the core functions of a trauma system but lacked specific quantitative metrics to measure these core functions. The qualitative responses of “met or not met” can be subjective and equivocal. The American College of Surgeons Committee on Trauma (ACS COT) Trauma System Evaluation Committee has also developed qualitative minimal trauma system standards and implemented a comprehensive trauma system evaluation process. Trauma system-wide, risk adjusted, qualitative and quantitative metrics are recommended to address the full spectrum of injury which are essential to the advancement of the care of the injured patient.
{"title":"Trauma system performance improvement: a review of the literature and recommendations","authors":"Kathleen D. Martin, W. Dorlac","doi":"10.21037/JECCM.2019.02.05","DOIUrl":"https://doi.org/10.21037/JECCM.2019.02.05","url":null,"abstract":"Evaluation of trauma systems has matured over the last few decades. US trauma systems routinely undergo clinical and operational evaluation to ensure optimal care of the injured from the time of injury through reintegration with society. Assessments are carried out with the intent of defining optimal elements and rendering strategic recommendations for the trauma system. The framework for trauma system assessment was adopted from the Trauma Care Systems Planning and Development Act of 1990 which sought to create a consistent process and core functions to ensure a reproducible trauma system from prehospital through rehabilitation. Applying the core function of a public health model to trauma systems provided a process for enhancement of clinical care along the continuum through a framework that accentuates assessment, policy development and assurance while holding to the highest standards in trauma systems performance. A review of contemporary and evidence-based information regarding key strategies and processes related to the evaluation of trauma systems’ performance improvement was undertaken. The intent was to identify measurable metrics for trauma systems performance improvement and patient safety. There is a paucity of data related to specific metrics to evaluate the impact of trauma systems on performance and outcomes. The majority of publications focused on quality of trauma registry data, integration of prehospital data, and the core functions of a trauma system but lacked specific quantitative metrics to measure these core functions. The qualitative responses of “met or not met” can be subjective and equivocal. The American College of Surgeons Committee on Trauma (ACS COT) Trauma System Evaluation Committee has also developed qualitative minimal trauma system standards and implemented a comprehensive trauma system evaluation process. Trauma system-wide, risk adjusted, qualitative and quantitative metrics are recommended to address the full spectrum of injury which are essential to the advancement of the care of the injured patient.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/JECCM.2019.02.05","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45734192","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}
Pub Date : 2019-05-21DOI: 10.21037/JECCM.2019.05.01
A. Salmon, M. Metersky
Among the nosocomial infections, ventilator-associated pneumonia (VAP) has an attributable mortality rate of approximately 10% (1). VAP incidence rates and its trends through time are essential metrics for the monitoring of the effectiveness of preventive strategies. In a study recently published in Clinical Infectious Diseases , Xie et al ., have made a notable effort in reporting VAP epidemiological data from the China Critical Care Infection Surveillance (CRISIS) study (2).
{"title":"The current epidemiological landscape of ventilator-associated pneumonia in the intensive care unit: a multicenter prospective observational study in China—study critique, ventilator-associated pneumonia incidence rates, and pathogen distribution","authors":"A. Salmon, M. Metersky","doi":"10.21037/JECCM.2019.05.01","DOIUrl":"https://doi.org/10.21037/JECCM.2019.05.01","url":null,"abstract":"Among the nosocomial infections, ventilator-associated pneumonia (VAP) has an attributable mortality rate of approximately 10% (1). VAP incidence rates and its trends through time are essential metrics for the monitoring of the effectiveness of preventive strategies. In a study recently published in Clinical Infectious Diseases , Xie et al ., have made a notable effort in reporting VAP epidemiological data from the China Critical Care Infection Surveillance (CRISIS) study (2).","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/JECCM.2019.05.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42061208","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}
Pub Date : 2019-05-15DOI: 10.21037/JECCM.2019.04.03
E. C. Sánchez
Here you will find the description of the pathophysiology of ischemia-reperfusion injury (IRI) and its treatment with hyperbaric oxygen therapy (HBOT). It includes a revision of peer-reviewed medical literature published in PubMed, regarding the pathophysiology of IRI and its management with hyperbaric oxygen (HBO). All the acute lesions, in the first 72 h, present a pathophysiology compatible with IRI. IRI has stages and involves ischemic and metabolic penumbras. Cellular hypoxia generates mitochondrial dysfunction, oxidative damage, activation of several inflammatory cascades, complement activation and eventually tissue death. HBOT restores oxygen tension maintaining cellular metabolism, restores ATP production, avoids or reduces mitochondrial dysfunction, prevents oxidative stress and apoptosis; and generates a secondary antioxidant production effect. All this, help to recover the marginal tissue, metabolic and ischemic penumbra, reduces cellular and tissue edema, promotes production of growth factors and enhances wound healing. The IRI requires a prompt response due to the short window of treatment. Adding HBOT to the early management could promote tissue survival by modifying ischemia, hypoxia, inflammation, immune response, and IRI injury. To determine the real use of HBOT in IRI; randomized and controlled studies are needed, within the window of treatment (<6 h).
{"title":"Pathophysiology of ischemia-reperfusion injury and its management with hyperbaric oxygen (HBO): a review","authors":"E. C. Sánchez","doi":"10.21037/JECCM.2019.04.03","DOIUrl":"https://doi.org/10.21037/JECCM.2019.04.03","url":null,"abstract":"Here you will find the description of the pathophysiology of ischemia-reperfusion injury (IRI) and its treatment with hyperbaric oxygen therapy (HBOT). It includes a revision of peer-reviewed medical literature published in PubMed, regarding the pathophysiology of IRI and its management with hyperbaric oxygen (HBO). All the acute lesions, in the first 72 h, present a pathophysiology compatible with IRI. IRI has stages and involves ischemic and metabolic penumbras. Cellular hypoxia generates mitochondrial dysfunction, oxidative damage, activation of several inflammatory cascades, complement activation and eventually tissue death. HBOT restores oxygen tension maintaining cellular metabolism, restores ATP production, avoids or reduces mitochondrial dysfunction, prevents oxidative stress and apoptosis; and generates a secondary antioxidant production effect. All this, help to recover the marginal tissue, metabolic and ischemic penumbra, reduces cellular and tissue edema, promotes production of growth factors and enhances wound healing. The IRI requires a prompt response due to the short window of treatment. Adding HBOT to the early management could promote tissue survival by modifying ischemia, hypoxia, inflammation, immune response, and IRI injury. To determine the real use of HBOT in IRI; randomized and controlled studies are needed, within the window of treatment (<6 h).","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/JECCM.2019.04.03","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42792208","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}
Pub Date : 2019-05-11DOI: 10.21037/jeccm.2019.10.08
G. Dimopoulos, Yuetian Yu, Wentao Bao
Emergence and spread of MDR pathogens have become a major leading cause of death worldwide and a major problem in ICU patients (1).
耐多药病原体的出现和传播已成为世界范围内主要的死亡原因，也是ICU患者面临的主要问题(1)。
{"title":"Infections in the ICU—the big problem!","authors":"G. Dimopoulos, Yuetian Yu, Wentao Bao","doi":"10.21037/jeccm.2019.10.08","DOIUrl":"https://doi.org/10.21037/jeccm.2019.10.08","url":null,"abstract":"Emergence and spread of MDR pathogens have become a major leading cause of death worldwide and a major problem in ICU patients (1).","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jeccm.2019.10.08","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46055678","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}
Pub Date : 2019-05-08DOI: 10.21037/JECCM.2019.07.05
Y. Zerbib, J. Maizel, M. Slama
Bedside echocardiography is a cornerstone tool in the management of critically ill patients with hemodynamic compromise. This technique should be considered not only as an imaging technique but as well as a hemodynamical method. Both transthoracic and transesophageal approach are used in intensive care unit (ICU) patients. Left ventricular (LV) systolic function can be assessed in daily clinical practice by measuring ejection fraction (EF) and cardiac output. But these indices are dependent on load conditions. Mitral anterior plane systolic excursion and tissue Doppler imaging (TDI) and speckle tracking by measuring the systolic motion velocity of the mitral annulus and the LV strain may together assess the true contractility of the left ventricle. dP/dt measured on mitral regurgitation flow could help to assess LV contractility. Maximal elastance was described to be the best parameter to evaluate myocardial systolic function but not available in daily practice at the bedside in ICU patients. LV diastolic function and pressure are useful to have a comprehensive evaluation of LV function and could be assessed by recording the mitral flow using pulsed Doppler and the early diastolic velocity of mitral annulus recorded using TDI. Echocardiography should be done in patients with shock to assess the pathophysiology of the shock and in pulmonary oedema to distinguish patients with cardiogenic oedema or acute respiratory distress syndrome (ARDS). Only echocardiography may assess the hemodynamic of patient with shock and/or respiratory failure and the only tool which permits to diagnose the cause of this hemodynamical failure.
{"title":"Echocardiographic assessment of left ventricular function","authors":"Y. Zerbib, J. Maizel, M. Slama","doi":"10.21037/JECCM.2019.07.05","DOIUrl":"https://doi.org/10.21037/JECCM.2019.07.05","url":null,"abstract":"Bedside echocardiography is a cornerstone tool in the management of critically ill patients with hemodynamic compromise. This technique should be considered not only as an imaging technique but as well as a hemodynamical method. Both transthoracic and transesophageal approach are used in intensive care unit (ICU) patients. Left ventricular (LV) systolic function can be assessed in daily clinical practice by measuring ejection fraction (EF) and cardiac output. But these indices are dependent on load conditions. Mitral anterior plane systolic excursion and tissue Doppler imaging (TDI) and speckle tracking by measuring the systolic motion velocity of the mitral annulus and the LV strain may together assess the true contractility of the left ventricle. dP/dt measured on mitral regurgitation flow could help to assess LV contractility. Maximal elastance was described to be the best parameter to evaluate myocardial systolic function but not available in daily practice at the bedside in ICU patients. LV diastolic function and pressure are useful to have a comprehensive evaluation of LV function and could be assessed by recording the mitral flow using pulsed Doppler and the early diastolic velocity of mitral annulus recorded using TDI. Echocardiography should be done in patients with shock to assess the pathophysiology of the shock and in pulmonary oedema to distinguish patients with cardiogenic oedema or acute respiratory distress syndrome (ARDS). Only echocardiography may assess the hemodynamic of patient with shock and/or respiratory failure and the only tool which permits to diagnose the cause of this hemodynamical failure.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/JECCM.2019.07.05","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43664865","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}
Pub Date : 2019-05-06DOI: 10.21037/JECCM.2019.05.03
Clotilde Bailleul, N. Aissaoui
Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is a therapeutic option for patients with refractory cardiogenic shock (CS). It may also be used in other indications. Echocardiography remains the paramount bedside exam. In front of a refractory CS, an echocardiography should be run in order to get a good comprehension of the CS etiology and to settle the indication of ECMO (recovery expectation, contraindications such as aortic insufficiency…). At the implantation, echocardiography is the easiest way to control cannula position. After ECMO implantation, daily echocardiography helps understanding loading conditions, diagnosing complications and recovery. After several days of cardiopulmonary assistance, echocardiography guides the weaning strategy according to ECMO flow or helps deciding whether a new strategy is needed. Echocardiography is an essential tool to manage VA ECMO patients.
{"title":"Role of echocardiography in the management of veno-arterial extra-corporeal membrane oxygenation patients","authors":"Clotilde Bailleul, N. Aissaoui","doi":"10.21037/JECCM.2019.05.03","DOIUrl":"https://doi.org/10.21037/JECCM.2019.05.03","url":null,"abstract":"Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is a therapeutic option for patients with refractory cardiogenic shock (CS). It may also be used in other indications. Echocardiography remains the paramount bedside exam. In front of a refractory CS, an echocardiography should be run in order to get a good comprehension of the CS etiology and to settle the indication of ECMO (recovery expectation, contraindications such as aortic insufficiency…). At the implantation, echocardiography is the easiest way to control cannula position. After ECMO implantation, daily echocardiography helps understanding loading conditions, diagnosing complications and recovery. After several days of cardiopulmonary assistance, echocardiography guides the weaning strategy according to ECMO flow or helps deciding whether a new strategy is needed. Echocardiography is an essential tool to manage VA ECMO patients.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/JECCM.2019.05.03","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47385961","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}
Pub Date : 2019-05-03DOI: 10.21037/JECCM.2019.02.02
A. Santini, F. Collino, E. Votta, A. Protti
Soon after physicians began to artificially ventilate patients with respiratory insufficiency due to poliomyelitis (1) and intensive care units developed, risks of mechanical ventilation—namely ventilator-induced lung injury (VILI)—became evident (2). The recognition of this iatrogenic, and potentially lethal, syndrome led to a slow change in the goal of mechanical ventilation for respiratory failure: from maintaining near-normal gas exchange, with use of large tidal volumes and high airway pressures (3), to avoiding additional lung damage—the so-called “lung protective” ventilation (4). The last 60 years of preclinical and clinical research in the field focused on identifying the single ventilator variable most responsible for VILI, with no conclusive answer.
{"title":"Risk factors of ventilator-induced lung injury: mechanical power as surrogate of energy dissipation","authors":"A. Santini, F. Collino, E. Votta, A. Protti","doi":"10.21037/JECCM.2019.02.02","DOIUrl":"https://doi.org/10.21037/JECCM.2019.02.02","url":null,"abstract":"Soon after physicians began to artificially ventilate patients with respiratory insufficiency due to poliomyelitis (1) and intensive care units developed, risks of mechanical ventilation—namely ventilator-induced lung injury (VILI)—became evident (2). The recognition of this iatrogenic, and potentially lethal, syndrome led to a slow change in the goal of mechanical ventilation for respiratory failure: from maintaining near-normal gas exchange, with use of large tidal volumes and high airway pressures (3), to avoiding additional lung damage—the so-called “lung protective” ventilation (4). The last 60 years of preclinical and clinical research in the field focused on identifying the single ventilator variable most responsible for VILI, with no conclusive answer.","PeriodicalId":73727,"journal":{"name":"Journal of emergency and critical care medicine (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/JECCM.2019.02.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42915024","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}
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