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Chrysostomou C.,Cardiac Intensive Care Unit | Morell V.O.,Childrens Hospital of Pittsburgh of UPMC | Wearden P.,Childrens Hospital of Pittsburgh of UPMC | Sanchez-de-Toledo J.,Autonomous University of Barcelona | And 2 more authors.
Congenital Heart Disease | Year: 2013

Objectives. The current drug of choice for reentrant supraventricular tachycardia (SVT) is adenosine followed by verapamil or diltiazem. Although limitations and significant adverse events have been encountered over the years, an alternative effective and safe agent has not been available. Dexmedetomidine has recently been shown to have potential antiarrhythmic effects, and here we describe our experience in the acute termination of reentrant SVT. Design. Retrospective case series. Setting: Quaternary University Children's Hospital, Cardiac Intensive Care Unit. Patients: Patients who received dexmedetomidine for SVT in the past 5 years. Interventions: None. Outcome Measures: SVT episodes terminated with dexmedetomidine were compared with episodes terminated with adenosine. Results. Fifteen patients, median age of 10 days (6-16), were given 27 doses of dexmedetomidine, mean dose 0.7 ± 0.3mcg/kg, for a total of 27 episodes of SVT. Successful termination occurred in 26 episodes (96%) at a median time of 30 seconds (20-35). Duration of sinus pause was 0.6 ± 0.2 seconds, there was one episode of hypotension and no bradycardia and sedation lasted for 34 ± 8 minutes. Five patients received 27 doses of adenosine, with an overall successful cardioversion in 17 patients (63%) (P= .0017). Transient bradycardia and hypotension was seen in three patients (11%), agitation in 16 patients (59%), and broncospasm in one patient. Median sinus pause was 2.5 seconds (2-9) (P < .001). Conclusions. Dexmedetomidine appears to have novel antiarrhythmic properties for the acute termination of reentrant SVT. Although adenosine is very effective, dexmedetomidine may prove to possess a more favorable therapeutic profile with increased effectiveness and fewer side effects. © 2013 Wiley Periodicals, Inc.

Zochios V.A.,Cardiac Intensive Care Unit | Wilkinson J.,Northampton General Hospital NHS Trust | Dasgupta K.,University of Nottingham
Journal of Vascular Access | Year: 2014

Objective: To review the evidence behind Ultrasound (US) guided placement of arterial cannulae and its use in the critically ill population. Data sources: We performed a computer-aided literature search using set search terms and electronic data bases of PubMed and EMBASE from their commencement date through the end of July 2013. Summary of review: Insertion of intra-arterial catheters is a commonly performed invasive procedure in the peri-operative and intensive care setting that facilitates invasive blood pressure and cardiac output monitoring as well as frequent blood sampling. Arterial catheterization can be particularly challenging in critically ill and high-risk surgical patients with circulatory collapse, low cardiac output state and peripheral edema, all of which can limit the ability to successfully palpate and cannulate the artery. There is a convincing body of evidence suggesting a decrease in complication rate and first-pass success rate in US guided central venous catheter (CVC) insertion compared with the landmark technique. While most intensivists and peri-operative physicians are familiar with US guided CVC placement, fewer use US to guide arterial access. Conclusions: Most studies have demonstrated a higher success rate when using US guidance for arterial cannulation. Moreover, the technique permits more rapid access and establishment compared with the conventional palpation technique. However, there is evidence opposing the routine use of US to guide arterial cannula insertion. Further studies are required to ascertain the benefits and cost effectiveness of US guided arterial catheterization in peri-operative and critical care. © 2013 Wichtig Editore.

Jaquiss R.D.B.,Duke University | Bronicki R.A.,Baylor College of Medicine | Bronicki R.A.,Cardiac Intensive Care Unit
Pediatric Critical Care Medicine | Year: 2013

OBJECTIVE:: For children with severe heart failure in whom medical management has failed, mechanical circulatory support in the form of either extracorporeal membrane oxygenation or ventricular assist device represents life-sustaining therapy. This review provides an overview of these two modalities, including a discussion of indications, contraindications, timing, and device selection, as part of the Pediatric Cardiac Intensive Care Society/Extracorporeal Life Support Organization Joint Statement on Mechanical Circulatory Support. DATA SOURCES, STUDY SELECTION, DATA EXTRACTION:: PubMed was searched using the following terms: ECMO, extracorporeal membrane oxygenation, ventricular assist device, VAD, and pediatric. Case reports, single-center series, multicenter studies, and registry reports were reviewed. CONCLUSIONS:: The two technologies have unique advantages and disadvantages and may be considered complementary devices, although they are frequently used in sequence. Either modality may be used as bridge-to-transplant or bridge-to-recovery, and the choice of device and device timing is influenced by the acuity of illness, comorbidities, potential for recovery, and anticipated duration of support. Copyright © 2013 by the Society of Critical Care Medicine and the World.

Thiagarajan R.R.,Cardiac Intensive Care Unit | Teele S.A.,Cardiac Intensive Care Unit | Beke D.M.,Cardiac Intensive Care Unit
Journal of Pediatric Rehabilitation Medicine | Year: 2012

Extracorporeal Membrane Oxygenation (ECMO) is widely used to support patients who have failed conventional therapies for cardio-respiratory failure. Patient immobility during management of critical illness and ECMO support can result in physical impairment that can lead to prolonged hospitalization and poor functional outcomes for ECMO survivors. Although little information regarding the role of physical therapy in improving functional outcomes for ECMO patients is available, early intervention with physical therapy may decrease duration of hospitalization and improve functional outcomes for patients supported with ECMO. © 2012 - IOS Press and the authors. All rights reserved.

Polito A.,University of Versailles | Eischwald F.,University of Versailles | Maho A.-L.L.,University of Versailles | Polito A.,Cardiac Intensive Care Unit | And 6 more authors.
Critical Care | Year: 2013

Background: Sepsis-associated brain dysfunction has been linked to white matter lesions (leukoencephalopathy) and ischemic stroke. Our objective was to assess the prevalence of brain lesions in septic shock patients requiring magnetic resonance imaging (MRI) for an acute neurologic change. Method: 71 septic shock patients were included in a prospective observational study. Patients underwent daily neurological examination. Brain MRI was obtained in patients who developed focal neurological deficit, seizure, coma, or delirium. Electroencephalogy was performed in case of coma, delirium, or seizure. Leukoencephalopathy was graded and considered present when white matter lesions were either confluent or diffuse. Patient outcome was evaluated at 6 months with the Glasgow Outcome Scale (GOS). Results: We included 71 patients with median age of 65 years (56 to 76) and SAPS II at admission of 49 (38 to 60). MRI was indicated on focal neurological sign in 13 (18%), seizure in 7 (10%), coma in 33 (46%), and delirium in 35 (49%). MRI was normal in 37 patients (52%) and showed cerebral infarcts in 21 (29%), leukoencephalopathy in 15 (21%), and mixed lesions in 6 (8%). EEG malignant pattern was more frequent in patients with ischemic stroke or leukoencephalopathy. Ischemic stroke was independently associated with disseminated intravascular coagulation (DIC), focal neurologic signs, increased mortality, and worse GOS at 6 months. Conclusions: Brain MRI in septic shock patients who developed acute brain dysfunction can reveal leukoencephalopathy and ischemic stroke, which is associated with DIC and increased mortality. © 2013 Polito et al.; licensee BioMed Central Ltd.

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