tag:blogger.com,1999:blog-13038890651487810042024-03-18T22:53:38.276-05:00May 2007 ArchiveArchive of www.icuroom.netUnknownnoreply@blogger.comBlogger31125tag:blogger.com,1999:blog-1303889065148781004.post-18290717274670146212007-05-31T14:49:00.000-06:002007-06-01T11:34:22.435-06:00<strong><span style="color:#000000;"><span style="color:#000066;">Thursday May 31, 2007<br /></span><span style="color:#990000;">Intensive Intraoperative Insulin Therapy versus Conventional Glucose Management during Cardiac Surgery</span><br /><br />Since we are getting obsessive about tight control of blood glucose, concerns have been expressed about potential hypoglycemia. Many studies have shown that hypoglycemia during "tight" blood glucose control is a real danger with significant morbidity and mortality.<br /><br />One recent study from Mayo Clinic, Rochester, MN compared intensive intraoperative insulin therapy with conventional glucose management during cardiac surgery. Patients were randomly assigned to tight glucose control (80-100 mg/dL) with continuous insulin infusion) or conventional treatment (n = 201).<br /></span></strong><br /><ul><li><span style="color:#000000;">Patients in the conventional treatment group were given insulin during surgery if glucose levels were greater than 200 mg/dL. </span></li><li><span style="color:#000000;">Both groups were treated with insulin infusion to maintain normoglycemia after surgery.</span></li></ul><strong><span style="color:#000000;"><br /><span style="color:#003300;">Results:</span><br /><ul><li>Eighty two of 185 patients (44%) in the intensive treatment group and 86 of 186 patients (46%) in the conventional treatment group had an event. </li><li>More deaths (4 deaths vs. 0 deaths) and strokes (8 strokes vs. 1 strokes) occurred in the intensive treatment group.</li></ul><br /><em>Study concluded that Intensive insulin therapy during cardiac surgery does not reduce perioperative death or morbidity. The increased incidence of death and stroke in the intensive treatment group raises concern about routine implementation of this intervention.</em></span></strong><br /><br /><span style="color:#003300;"><br /><span style="font-size:78%;">Reference: click to get abstract/article</span></span><br /></span><br /><a href="http://www.annals.org/cgi/content/abstract/146/4/233" target="_blank"><span style="font-size:78%;color:#003300;">Intensive Intraoperative Insulin Therapy versus Conventional Glucose Management during Cardiac Surgery</span></a><span style="font-size:78%;color:#003300;">, A Randomized Trial, Annals of internal Medicine, 20 February 2007 Volume 146 Issue 4 Pages 233-243</span>Unknownnoreply@blogger.com7tag:blogger.com,1999:blog-1303889065148781004.post-58491086150472273132007-05-30T09:35:00.000-06:002007-05-30T09:36:17.183-06:00<strong><span style="color:#000066;">Wednesday May 30, 2007<br /></span><span style="color:#990000;">Digoxin Toxicity</span></strong><br /><br /><span style="color:#660000;"><strong>Q:</strong></span> <strong><em><span style="color:#003300;">Once patient receive Digoxin Fragmented Antibody (DIGIFAB or Digibind), how frequent digoxin level should be measured ?</span></em></strong><br /><br /><strong><span style="color:#660000;">A:</span></strong> <strong><span style="color:#000000;">Digoxin level after giving Digibind will rise and will remain distorted for about 7 days. This is due to ability of Digibind to pull all of the digoxin into blood stream. These are inactive fragments and not toxic. There is no need to follow Dig level after administration of Digibind as it will be erroneously high and misleading.</span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1303889065148781004.post-32971635946459743092007-05-29T07:46:00.000-06:002007-05-29T07:47:24.673-06:00<strong><span style="color:#000066;">Tuesday May 29, 2007 </span></strong><br /><strong><span style="color:#990000;">Mix for Norepinepherine</span><br /><br /><span style="color:#000000;"></span></strong><br /><strong><span style="color:#000000;">Do you know that.....<br /><br />NOREPINEPHRINE (LEVOPHED) is less stable in normal saline (loose its potency from oxidation). It is preferred to be mix in dextrose as the dextrose protects against oxidation of the norepinephrine and keep it active and stable.</span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1303889065148781004.post-3089792773759650382007-05-28T16:30:00.000-06:002007-05-28T16:32:03.209-06:00<span style="color:#000000;"><strong><span style="color:#000066;">Monday May 28, 2007</span><br /><span style="color:#990000;">Impact of delayed transfer of critically ill patients from emergency department to ICU</span><br /><br /><br />This is well known to Critical Care practitioners that critically ill patients does not desired treatment, if they continue to 'boarder' in emergency department. A very important study published this month in Criticare Care Medicine </strong><span style="font-size:78%;">1 </span><strong>regarding Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit.<br /><br />50,322 patients were divided into two groups: emergency department boarding more than/= 6 hrs (delayed n=1036) vs. emergency department boarding less than 6 hrs. (nondelayed n=49,286). Main outcomes were ICU and hospital survival and ICU and hospital length of stay. </strong></span><br /><span style="color:#000000;"><strong><br /><em>Results:</em><br /><ul><li>the median hospital length of stay was 7.0 (delayed) vs. 6.0 days (nondelayed). </li><li>ICU mortality was 10.7% (delayed) vs. 8.4% (nondelayed). </li><li>In-hospital mortality was 17.4% (delayed) vs. 12.9% (nondelayed). </li></ul><br /><br />Study concluded that, Critically ill emergency department patients with a more than/= 6-hr delay in intensive care unit transfer had increased hospital length of stay and higher intensive care unit and hospital mortality.<br /><br />As said in discussion, the various factors which led to relatively poor outcome in ED 'boarders' icludes busy nature of ED practice, which entails simultaneous responsibilities for numerous patients of varying severities of illness, ED physicians and nurses may not be able to provide the focused one-on-one care that a critically ill patient may require, ED overcrowding and high patient acuity relative to the clinical staffing of the ED. ICU is a clinical environment that, by definition, enables close attention to the critically ill and allows for expeditious recognition of physiologic change and sudden deterioration, the ED under most circumstances is neither designed nor staffed to provide extended longitudinal care for the critically ill patient. It is also possible that there may be a different level of critical care expertise among the physicians and nurses who care for the patients who await ICU transfer, compared with the critical care expertise of the practitioners in the ICU setting.</strong></span><br /><br /></span><br /><span style="color:#003333;"><br /></span><span style="font-size:78%;color:#003333;">Reference: click to get abstract<br /><br /></span><a href="http://www.ccmjournal.com/pt/re/ccm/abstract.00003246-200706000-00004.htm;jsessionid=GZwZHH2yMK9W12QmXmWlCl1G1FRyJz28WnzY1mvPx2xnT2hYQzH4!959335381!-949856145!8091!-1"><span style="font-size:78%;color:#003333;">Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit </span></a><span style="font-size:78%;color:#003333;">- Critical Care Medicine. 35(6):1477-1483, June 2007.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1303889065148781004.post-20224696993763158822007-05-26T22:53:00.000-06:002007-05-26T22:54:51.375-06:00<strong><span style="color:#000066;">Sunday May 27, 2007</span><br /><span style="color:#990000;">Little history of ICU</span><br /><br /><span style="color:#000000;">First designated area for critical care patients was established in 1958 by Peter Safar (1924 - 2003, also knows as Father of modern CPR), at Baltimore City Hospital USA, where he was Chief of Anesthesiology. Initially, the name was "Urgency & Emergency" room. First official Critical Care protocol was ABC (Airway, Breathing, and Circulation). The first Critical Care Residency was established in 1962 at the University of Pittsburgh.<br /></span><br /><br /><br /><span style="color:#000000;"><span style="color:#003300;">Related site:</span> </span></strong><a href="http://www.safar.pitt.edu/" target="_blank"><strong><span style="color:#660000;">The Safar Center for Resuscitation Research</span></strong></a><br /><strong><span style="color:#000000;"><br /><span style="color:#003300;">Related previous pearl:</span> </span></strong><a href="http://february-2007-icuroom.blogspot.com/2007_02_20_archive.html" target="_blank"><strong><span style="color:#660000;">Beyond CPR - EPR</span></strong></a>Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-1303889065148781004.post-47404575652971160222007-05-26T02:57:00.000-06:002007-05-26T02:58:30.271-06:00<strong><span style="color:#000066;">Saturday May 26, 2007<br /></span><span style="color:#990000;">Bedside trick - suspecting tracheal aspiration !</span></strong><br /><br /><strong><span style="color:#000000;">One quick method of suspecting tracheal aspiration or atleast ruling out tracheal aspiration is checking glucose concentration by regular bedside glucose meters. A glucose concentration of more than <em>20 mg/dl</em> of bloodless tracheal aspirate doesn't confirm but atleast enhance the suspicion of tracheal aspiration .Though literature is full of conflicting data for this method but still it is a very quick, effective and easy way of suspecting or ruling out tracheal aspiration.</span></strong><br /><br /><span style="font-size:78%;color:#003300;">References: click to get abstracts / articles</span><br /><span style="font-size:78%;color:#003300;"></span><br /><span style="font-size:78%;color:#003300;">1. </span><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15687762&dopt=Abstract" target="_blank"><span style="font-size:78%;color:#003300;">Clinical implications of the glucose test strip method for early detection of pulmonary aspiration in nasogastric tube- fed patients</span></a><span style="font-size:78%;color:#003300;"> - Taehan Kanho Hakhoe Chi. 2004 Dec;34(7):1215-23<br />2. </span><a href="http://www.chestjournal.org/cgi/content/abstract/103/1/117" target="_blank"><span style="font-size:78%;color:#003300;">Comparison of blue dye visualization and glucose oxidase test strip methods for detecting pulmonary aspiration of enteral feedings in intubated adults</span></a><span style="font-size:78%;color:#003300;"> - Chest, Vol 103, 117-121<br />3. Glucose content of tracheal aspirates: Implications for the detection of tube feeding aspiration. Crit Care Med 1994; 22:1557-1562<br />4. Glucose Content of Tracheal Aspirates - Letter to the Editor - Critical Care Medicine: Volume 23(8) August 1995 pp 1451-1452</span>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-1303889065148781004.post-26724875515386808142007-05-25T13:44:00.000-06:002007-05-25T13:45:40.159-06:00<strong><span style="color:#000066;">Friday May 25, 2007</span></strong><br /><strong><span style="color:#990000;">One lung ventilation with Univent® Endotracheal Tube</span></strong><br /><br /><strong><span style="color:#000000;">There are many situations, where you may prefer only one lung to be ventilated like in pulmonary hemorrhage where you may like to block one lung to prevent the soiling of ther lung. In such instances, Univent® Endotracheal Tube could be of good value which can be quickly placed at bedside.</span></strong><br /><br /><br /><img id="BLOGGER_PHOTO_ID_5068586474332412370" style="DISPLAY: block; MARGIN: 0px auto 10px; CURSOR: hand; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijB84zI_8kth-IXRPeNNc8mvUze6b95IThmcAcdNGdbWDapkkQdKgAZ7ujjjnQH7D0cNftmiYdfsnUcbaiOBs46P69Bpez7CQxxFNzxPu2KbR1Y-VUQ9jESuONdLzv43LWWA4_EsgJM9k/s400/univent-fig1.jpg" border="0" /><br /><strong><span style="color:#000000;"><br />Tube is a regular endotracheal tube but has a extra lumen for bronchial blocker which can be advanced blindly (easily if right lung need to be blocked) or under bronchoscope guidance, and inflating the baloon cuff. For left side placement, rotating the blocker or preferably entire Univent® ETT with side of blocker towards left shown to have help in placement.<br /><br />Another advantage is to ventilate via blocker tube lumen, so it can also be used as a guide in difficult intubation (like bougie) or in expected difficult ETT changes.</span></strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1303889065148781004.post-86357346368709858002007-05-24T09:36:00.000-06:002007-05-25T13:43:57.789-06:00<strong><span style="color:#000000;"><span style="color:#000066;">Thursday May 24, 2007</span><br /></span><span style="color:#990000;"><span style="color:#990000;">Restless Legs syndrome</span> </span></strong><br /><strong><span style="color:#660000;"></span></strong><strong><span style="color:#000000;"></span></strong><br /><strong><span style="color:#000000;">Restless legs syndrome is a common condition in non-intubated patients which may get aggravated by ICU enviroment. Major factors associated with Restless Leg Syndrome in ICU are</span></strong><br /><strong><span style="color:#000000;"><ul><li>Iron-deficiency anemia</li><li>Peripheral neuropathy</li><li>Withdrawal from vasodilator drugs and sedatives</li><li>Cigarette smoking, alcohol and caffeine withdrawal</li><li>Various drugs including phenytoin, antidepressant drugs, H2 blockers, lithium, beta-blockers and antipsychotics</li><li>Hypomagnesemia </li><li>Renal insufficiency (uremia)</li></ul><br />Various pharmacological agents have been described and used with success including benzodiazepines, carbamazepine and clonidine. In ICU situation, one useful drug in this regard is Ropinirole which is a Dopamine agonist. One of the effect of Ropinirole is heavy sleepiness, which can be use as a bonus benefit in ICU. Dose can be initiated from .25 mg PO QHS upto 4 mg PO QHS.</span></strong><br /></span><br /><span style="color:#003300;"></span><br /><span style="font-size:78%;color:#003300;">References: (click to get abstract)</span><br /><span style="font-size:78%;color:#003300;"></span><br /><span style="font-size:78%;color:#003300;">1. </span><a href="http://www.aafp.org/afp/20000701/108.html" target="_blank"><span style="font-size:78%;color:#003300;">Restless Legs Syndrome: Detection and Management in Primary Care - NATIONAL HEART, LUNG, AND BLOOD INSTITUTE WORKING GROUP ON RESTLESS LEGS SYNDROME</span></a><span style="font-size:78%;color:#003300;"> - Vol. 62/No. 1 (July 1, 2000) - American Family Physician.</span><br /><span style="font-size:78%;color:#003300;"></span><br /><span style="font-size:78%;color:#003300;">2. </span><a href="http://www.ncbi.nlm.nih.gov//entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15390050" target="_blank"><span style="font-size:78%;color:#003300;">Ropinirole is effective in the treatment of restless legs syndrome. TREAT RLS 2: a 12-week, double-blind, randomized, parallel-group, placebo-controlled study</span></a><span style="font-size:78%;color:#003300;"> - Mov Disord. 2004 Dec;19(12):1414-23.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1303889065148781004.post-35408786814366421202007-05-23T15:46:00.000-06:002007-05-25T13:43:45.190-06:00<strong><span style="color:#000066;">Wednesday May 23, 2007<br /></span><span style="color:#990000;">Avandia's controversy</span><br /><br /><span style="color:#000000;">This week The New England Journal of Medicine has early published an online <span style="font-size:85%;">(for paper print due on June 14, 2007),</span> meta-analysis of 42 trials with more than 24 weeks of exposure with drug Rosiglitazone (</span></strong><a href="http://www.avandia.com/" target="_blank"><span style="color:#003300;"><strong>avandia</strong></span></a><span style="color:#000000;"><strong>). 15,560 patients were randomly assigned to treatment regimens that included rosiglitazone, and 12,283 were assigned to comparator groups with regimens that did not include Avandia</strong> <span style="font-size:78%;">1, 2.</span><br /><strong><br /><em>Results showed that in the rosiglitazone group, as compared with the control group, the odds ratio for myocardial infarction was 1.43 (P=0.03), and the odds ratio for death from cardiovascular causes was 1.64 (P=0.06).</em><br /><br />But makers of Avandia GlaxoSmithKline promptly rejected the results of meta-analysis with strong references from other studies (like </strong></span><a href="http://care.diabetesjournals.org/cgi/content/abstract/25/10/1737" target="_blank"><span style="color:#000000;"><strong>ADOPT</strong></span></a><span style="color:#000000;"><strong> </strong><span style="font-size:78%;">4</span><strong> , </strong></span><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_AbstractPlus&term=%22DREAM+%28Diabetes+REduction+Assessment+with+ramipril+and+rosiglitazone+Medication%29+Trial+Investigators%22%5BCorporate+Author%5D" target="_blank"><span style="color:#000000;"><strong>DREAM</strong></span></a><span style="color:#000000;"><strong> <span style="font-size:78%;">5</span> and </strong></span><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&amp;db=PubMed&list_uids=16025252&dopt=Abstract" target="_blank"><span style="color:#000000;"><strong>RECORD</strong></span></a><span style="color:#000000;"><strong> 6 studies) showing no increase in cardivascular events <span style="font-size:78%;">3</span>.<br /><br />As controversy has created so much media attention that FDA issued a statement which can be read </strong></span><a href="http://www.fda.gov/bbs/topics/NEWS/2007/NEW01636.html" target="_blank"><strong><span style="color:#660000;">here</span></strong></a><br /><strong><span style="color:#000000;"><br /><br /><br /></span><span style="color:#003300;">Previous related pearl:</span><span style="color:#660000;"> </span></strong><a href="http://icuroompearls-september2006.blogspot.com/2006_09_04_archive.html" target="_blank"><strong><span style="color:#660000;">Avandia associated exacerbation of CHF</span></strong></a><br /><br /><br /><br /><span style="font-size:78%;color:#003300;">References: click to get abstract/article<br /><br />1. </span><a href="http://content.nejm.org/cgi/content/abstract/NEJMoa072761v1" target="_blank"><span style="font-size:78%;color:#003300;">Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes</span></a><span style="font-size:78%;color:#003300;"> - Article published at www.nejm.org May 21, 2007, due to print on june 14, 2007<br />2. </span><a href="http://content.nejm.org/cgi/content/full/NEJMe078099" target="_blank"><span style="font-size:78%;color:#003300;">Rosiglitazone and Cardiovascular Risk </span></a><span style="font-size:78%;color:#003300;">- editorial, published at www.nejm.org May 21, 2007, due to print on june 14, 2007<br />3. </span><a href="http://www.avandia.com/update.html" target="_blank"><span style="font-size:78%;color:#003300;">response from GlaxoSmithKline </span></a><span style="font-size:78%;color:#003300;">at avandia.com<br />4. </span><a href="http://care.diabetesjournals.org/cgi/content/abstract/25/10/1737" target="_blank"><span style="font-size:78%;color:#003300;">A Diabetes Outcome Progression Trial (ADOPT),</span></a><span style="font-size:78%;color:#003300;"> Diabetes Care 25:1737-1743, 2002<br />5. </span><a title="Click to search for citations by this author." href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_AbstractPlus&term=%22DREAM+%28Diabetes+REduction+Assessment+with+ramipril+and+rosiglitazone+Medication%29+Trial+Investigators%22%5BCorporate+Author%5D" target="_self"><span style="font-size:78%;color:#003300;">DREAM (Diabetes REduction Assessment with ramipril and rosiglitazone Medication) Trial Investigators</span></a><span style="font-size:78%;color:#003300;">; - Lancet. 2006 Sep 23;368(9541):1096-105<br />6. </span><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16025252&dopt=Abstract" target="_blank"><span style="font-size:78%;color:#003300;">Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycaemia in Diabetes (RECORD): </span></a><span style="font-size:78%;color:#003300;">study design and protocol. Diabetologia. 2005 Sep;48(9):1726-35.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1303889065148781004.post-67134353500970771832007-05-22T11:46:00.000-06:002007-05-22T14:56:10.494-06:00<strong><span style="color:#000066;">Tuesday May 22, 2007<br /></span></strong><br /><br /><span style="color:#000000;">Often intensivist receive calls regarding issues which are usually not expected from critical care unit. One such situation is cerumen (ear wax) ! - <span style="font-size:85%;">Scenario taken from true instance from one of our editors' call</span>.<br /></span><br /><br /><strong><span style="color:#660000;">Scenario:</span></strong> <em><strong><span style="color:#003300;">62 year old male admitted with community acquired pneumonia and responding well with treatment. Patient continue to complaint of right ear pain. On examination patient noted to have cerumen impaction. Patient is already on broad spectrum antibiotics. You ordered cerumenex (Triethanolamine polypeptide). You received call from nurse that pharmacy substituted cerumenex with Docusate sodium or colace (stool softener) and needs your approval. What you think?</span></strong></em><br /><br /><br /><strong><span style="color:#660000;">Answer:</span></strong> <strong><span style="color:#000000;">This is true that Docusate sodium is a very effective alternative to facilitate the removal of cerumen. Mechanism of action is same as for stool softener that it helps water or saline to mix with the hardened secretions and produce a softer cerumen which drained easily. Instill 1 ml and keep head to keep solution inside canal for 10 to 15 minutes and than let it drain.</span></strong><br /><br /><span style="color:#003300;"><br /><br /></span><span style="font-size:78%;color:#003300;">References: click to get abstract/article<br /><br />1. </span><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10969225&dopt=Abstract" target="_blank"><span style="font-size:78%;color:#003300;">Ceruminolytic effects of docusate sodium: a randomized, controlled trial.</span></a><span style="font-size:78%;color:#003300;"> Ann Emerg Med. 2000 Sep;36(3):228-32.<br /><br />2. Docusate Sodium for Use as a Ceruminolytic Agent. Amer Fam Phys. 2001 Mar;63(5):947.<br /><br />3. How does liquid docusate sodium (Colace) compare with triethanolamine polypeptide as a ceruminolytic for acute earwax removal? Journ of Fam Pract. 2000 Dec;49(12):1076. </span><br /><br /><span style="font-size:78%;color:#003300;">4. </span><a href="http://www.cochrane.org/reviews/en/ab004326.html" target="_blank"><span style="font-size:78%;color:#003300;">Ear drops for the removal of ear wax</span></a><span style="font-size:78%;color:#003300;"> - cochran reviews</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1303889065148781004.post-59257443406800816732007-05-21T11:04:00.000-06:002007-05-21T11:07:11.999-06:00<strong><span style="color:#000066;">Monday May 21, 2007</span></strong><br /><strong><span style="color:#000000;"><span style="color:#990000;"><span style="color:#990000;">Passive Leg Raising or Raising HOB to determine volume status</span><br /></span><br />As we are getting more and more tangled with technology, unfortunately we are losing simple bedside maneuvers which were once integral part of physical examination.<br /><br />CVP (central venous pressure) is a great way to determine volume status but even before central line get place, simple tricks at bedside may give assessment of volume status and may begin management even earlier. If blood pressure improves by just passively raising legs for 2-4 minutes or blood pressure drop by raising head of bed (HOB) to 45 degree, patient is probably hypovolumic.<br /><br />See references, where these tests have been validated in clinical trials.</span></strong><br /><br /><br /><br /><span style="font-size:78%;color:#003300;">References: click to get abstract/article<br /><br />1. </span><a href="http://www.chestjournal.org/cgi/content/abstract/121/4/1245" target="_blank"><span style="font-size:78%;color:#003300;">Changes in BP Induced by Passive Leg Raising Predict Response to Fluid Loading in Critically Ill Patients</span></a><span style="font-size:78%;color:#003300;"> - Chest. 2002;121:1245-1252.)<br /><br />2. </span><a href="http://www.ccmjournal.org/pt/re/ccm/abstract.00003246-200605000-00016.htm;jsessionid=GQhL69076Bl8nGVPpNRBVJLpypMttddX6f7nrYBH5XWsJy8WL1Lk!741375937!-949856145!8091!-1" target="_blank"><span style="font-size:78%;color:#003300;">Passive leg raising predicts fluid responsiveness in the critically ill</span></a><span style="font-size:78%;color:#003300;"> - Critical Care Medicine. 34(5):1402-1407, May 2006<br /><br />3. </span><a href="http://ccforum.com/content/11/S2/P307" target="_blank"><span style="font-size:78%;color:#003300;">Passive leg raising-induced changes in mean radial artery pressure can be used to assess preload dependence</span></a><span style="font-size:78%;color:#003300;"> - poster from 27th International Symposium on Intensive Care and Emergency Medicine, Brussels, Belgium. 27–30 March 2007, Critical Care 2007, 11(Suppl 2):P307</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1303889065148781004.post-79527690873668314442007-05-20T01:48:00.000-06:002007-05-20T01:50:31.719-06:00<strong><span style="color:#000000;"><span style="color:#000066;">Sunday May 20, 2007</span><br /><span style="color:#990000;">Free International Cardiology Internet Congress<br /></span><br />Registration to participate in the the Fifth Virtual Congress of Cardiology - QCVC, organized by the Argentine Federation of Cardiology - is now open. The Congress will take place from September 1st to November 30th, 2007. The Argentine Federation of Cardiology - FAC organizes every two years, International Congresses of Cardiology by the Internet. They are characterized by a high scientific level and low cost for participants. </span></strong><br /><strong><span style="color:#000000;"><br />In last Virtual Congress of Cardiology (2005) 18,185 registrants from 128 countries participated. Access to the Fifth Virtual Congress of Cardiology will be made by a simple connection to the Internet. The lectures, reports, abstracts and brief communications will be published in Web pages. Opinions and questions will be sent by e-mail to discuss the respective forums and there will be on-line discussions in real time by scheduled chats. Everything that is treated in the Congress will remain permanently published on the Web. The Newsletter (Spanish, Portuguese, and English) will be edited weekly and sent to all the registrants throughout the three months of the Congress.<br /><br />Click </span></strong><a href="http://www.fac.org.ar/qcvc/graleng/insceng.php3" target="_blank"><strong><span style="color:#660000;">here</span></strong></a><strong><span style="color:#000000;"> to register or visit </span></strong><a href="http://www.fac.org.ar/qcvc"><strong><span style="color:#660000;">http://www.fac.org.ar/qcvc</span></strong></a><br /></span><br /><strong><span style="color:#000000;">Congress will have 21 thematic Units</span></strong><br /><ul><li><strong><span style="color:#000000;"> Arrhythmias and Electrophysiology </span></strong></li><li><strong><span style="color:#000000;">Basic Research </span></strong></li><li><strong><span style="color:#000000;">Bioengineering - Medical Informatics </span></strong></li><li><strong><span style="color:#000000;">Cardiomyopathy </span></strong></li><li><strong><span style="color:#000000;">Cardiovascular Interventionism </span></strong></li><li><strong><span style="color:#000000;">Cardiovascular Nursing </span></strong></li><li><strong><span style="color:#000000;">Cardiovascular Pharmacology </span></strong></li><li><strong><span style="color:#000000;">Cardiovascular Surgery </span></strong></li><li><strong><span style="color:#000000;">Cerebral and Peripheral Vascular Diseases </span></strong></li><li><strong><span style="color:#000000;">Chagas' Disease </span></strong></li><li><strong><span style="color:#000000;">Echocardiography </span></strong></li><li><strong><span style="color:#000000;">Epidemiology and Cardiovascular Prevention </span></strong></li><li><strong><span style="color:#000000;">Genetics </span></strong></li><li><strong><span style="color:#000000;">Heart Failure </span></strong></li><li><strong><span style="color:#000000;">Hypertension </span></strong></li><li><strong><span style="color:#000000;">Ischemic Heart Disease </span></strong></li><li><strong><span style="color:#000000;">Nuclear Cardiology </span></strong></li><li><strong><span style="color:#000000;">Pediatric Cardiology </span></strong></li><li><strong><span style="color:#000000;">Sports Cardiology </span></strong></li><li><strong><span style="color:#000000;">Technicians in Cardiology </span></strong></li><li><strong><span style="color:#000000;">Transdisciplinary Cardiology</span></strong> </li></ul>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1303889065148781004.post-75653084137956267062007-05-19T12:14:00.000-06:002007-05-19T12:27:31.160-06:00<span style="color:#000000;"><strong>Saturday May 19, 2007<br /><span style="color:#990000;">Blood substitutes</span></strong></span><br /><span style="color:#000000;"><strong></strong></span><br /><span style="color:#000000;"><strong>Though blood substitutes are not yet approved in USA but are now in use in other parts of the world. In this regard 2 products are worth mentioning.<br /><br />1. </strong></span><a href="http://www.biopure.com/shared/home.cfm?CDID=2&CPgID=53" target="_blank"><span style="color:#660000;"><strong>Hemopure</strong></span></a><span style="color:#000000;"><strong><span style="color:#660000;"> :</span> is a Bovine derived blood substitute and has already been approved for use in adult patients in South Africa.<br /><br />2. </strong></span><a href="http://www.northfieldlabs.com/polyheme.html" target="_blank"><span style="color:#660000;"><strong>Polyheme</strong></span></a><span style="color:#000000;"><strong><span style="color:#660000;">:</span> is a human derived blood substitute and Phase III trial in united states completed in July 2006</strong> <span style="font-size:78%;">1</span><strong> for its role in for hemorrhagic shock following traumatic injuries. But there are unconfirmed media reports of increase coronary events in study</strong> <span style="font-size:78%;">5.<br /></span><strong><br />Blood substitutes are solutions of chemically modified human or bovine hemoglobin which restores lost blood volume and can be given as rapid, massive infusion. One unit is equal to one unit of pRBC and can be given wide open.</strong></span><br /><span style="color:#000000;"><strong></strong></span><br /><span style="color:#000000;"><strong><span style="color:#003300;">Advantages:</span> Does not require typing or cross-matching before infusion and so far found not to cause transfusion reactions. Shelf life of over 12 months (ciruclation time is 1-2 days) and does not require refrigeration. Bovine based Hemopure has been said acceptable for use in Jehovah's Witnesses (?).</strong></span><br /><span style="color:#000000;"><strong></strong></span><br /><span style="color:#000000;"><strong><span style="color:#003300;">Disadvantages:</span> No evidence based data available yet. Concerns raised regarding mad cow disease in bovine based Hemopure !</strong></span><br /><br /><br /><span style="font-size:78%;color:#003300;">References: Click to get abstract/article </span><br /><span style="font-size:78%;"><br /><span style="color:#003300;">1. </span></span><a href="http://www.clinicaltrials.gov/ct/show/NCT00076648?order=1" target="_blank"><span style="font-size:78%;color:#003300;">Safety and Efficacy of PolyHeme(R) in Hemorrhagic Shock Following Traumatic Injuries Beginning in the Pre-Hospital Setting</span></a><span style="font-size:78%;color:#003300;"> - clinicaltrials.gov<br />2. </span><a href="http://www.ajwrb.org/basics/hemopure.shtml" target="_blank"><span style="font-size:78%;color:#003300;">Watchtower Approves HemoPure for Jehovah's Witnesses</span></a><span style="font-size:78%;color:#003300;"> - ajwrb.org<br />3. </span><a href="http://www.clinchem.org/cgi/content/full/43/9/1792" target="_self"><span style="font-size:78%;color:#003300;">Effect of Hemopure® on Prothrombin Time and Activated Partial Thromboplastin Time on Seven Coagulation Analyzers,</span></a><span style="font-size:78%;color:#003300;"> - Clinical Chemistry. 1997;43:1792<br />4. </span><a href="http://www.facs.org/education/gs2003/gs14moore.pdf" target="_blank"><span style="font-size:78%;color:#003300;">PolyHeme</span></a><span style="font-size:78%;color:#003300;"> - American College of Surgeons at facs.org<br />5. </span><a href="http://polyhemelawsuit.com/" target="_blank"><span style="font-size:78%;color:#003300;">PolyHeme Lawsuit</span></a><span style="font-size:78%;color:#003300;"> - polyhemelawsuit.com</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1303889065148781004.post-14782687619891390102007-05-18T15:58:00.001-06:002007-05-18T16:00:12.692-06:00<strong><span style="color:#000066;">Friday May 18, 2007</span></strong><br /><br /><br /><strong><span style="color:#660000;">Q:</span></strong> <strong><em><span style="color:#003333;">What these 2 consecutive CXR tells you?</span></em></strong><br /><br /><br /><img id="BLOGGER_PHOTO_ID_5066023611512314306" style="DISPLAY: block; MARGIN: 0px auto 10px; CURSOR: hand; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHVnpHzm0n_GVLNJ8Y052luhgtAA43yiRcbJMWkyTvlpu6hLFL05RRpZxt-4WRSYBu00TVVdys65k6KCXZkhQTz_Etp5ycLESHwVikYJXrIE_rGCiAaMg-pXPybG6_WYCCUUH_f7o94TA/s400/hh1.JPG" border="0" />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1303889065148781004.post-75650407426337502782007-05-17T13:36:00.000-06:002007-05-17T13:37:58.851-06:00<strong><span style="color:#000066;">Thursday May 17, 2007</span></strong><br /><strong><span style="color:#990000;">FFP and platelet transfusion may be associated more with ALI/ARDS than pRBC transfusion<br /></span></strong><br /><br /><span style="color:#000000;"><strong>This is a well known fact that transfusion cause acute lung injury (ALI) / ARDS. but this is probably the first study which has formally evaluated the transfusion of specific blood products as a risk factor for ALI/ARDS in critically ill medical patients. Study is published in this month issue of chest</strong> <span style="font-size:85%;">1.</span><br /><strong><br />Dr. Hasrat Khan and coll. from Mayo Clinic College of Medicine, Rochester, MN has looked into 841 consecutive critically ill patients and compared 298 patients who received blood product transfusions with those who did not. ALI/ARDS developed more commonly (25% vs 18%) in patients exposed to any transfusion.<br /><br />Seventeen patients received massive RBC transfusions (ie, more than 10 units of blood transfused within 24 hours), of whom 13 also received fresh-frozen plasma (FFP) and 11 received platelet transfusions.<br /></strong><strong><em><br />Among those patients receiving individual blood products, ALI/ARDS was more likely to develop in patients who received FFP transfusions (OR, 2.48) and platelet transfusions (OR, 3.89) than in those who received only RBC transfusions (OR, 1.39).</em><br /></strong></span><br /><strong><span style="color:#000000;">Study Concluded that transfusion is associated with an increased risk of the development of ALI/ARDS in critically ill medical patients. The risk is higher with transfusions of plasma-rich blood products, FFP, and platelets, than with RBCs.<br /><br /><br /></span></strong><strong><span style="color:#000000;"></span></strong><span style="font-size:78%;color:#000000;">Reference: click to get abstract<br />1. </span><a href="http://www.chestjournal.org/cgi/content/abstract/131/5/1308" target="_blank"><span style="font-size:78%;color:#000000;">Fresh-Frozen Plasma and Platelet Transfusions Are Associated With Development of Acute Lung Injury in Critically Ill Medical Patients</span></a><span style="font-size:78%;color:#000000;"> - Chest. 2007; 131:1308-1314</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1303889065148781004.post-11608008303335801472007-05-16T12:37:00.000-06:002007-05-16T12:39:55.029-06:00<strong><span style="color:#000066;">Wednesday May 16, 2007</span></strong><br /><strong><span style="color:#990000;">Right or biventricular ventricular assist device (RVAD or BiVAD)</span></strong><br /><br /><img id="BLOGGER_PHOTO_ID_5065229618088171954" style="DISPLAY: block; MARGIN: 0px auto 10px; CURSOR: hand; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsFaZWNUsxSClqzebkXK2J84X_j7QtJWgi_QmDwz9-yG27Ud6xg-iPxIb_GuXfdQhD_DFdgp6Dancm8CtqcXhaqiN_oD7nQ2T1a-e0gIT6D08F-7wjf2wvntT2wGr7uncN46_dTdIs1X0/s400/bivad.jpg" border="0" /><br /><strong><span style="color:#000000;">Continuing our theme from yesterday on </span></strong><a href="http://may-2007-icuroom.blogspot.com/2007_05_15_archive.html" target="_blank"><strong><span style="color:#660000;">LVAD</span></strong></a><strong><span style="color:#000000;"> , Right Ventricular assist device (RVAD) provide support for failed right ventricle and connects it to pulmonary artery. Another extreme is to provide support to both ventricles simultaneously and its called BiVAD or Biventricular assist device.<br /></span></strong><br /><span style="color:#000000;"><strong><span style="color:#003333;"></span></strong></span><br /><span style="color:#000000;"><strong><span style="color:#003333;">Related:</span> See Video </strong></span><a href="http://video.google.com/videoplay?docid=-5805461003408681548&q=ventricular+assist+device&hl=en" target="_blank"><span style="color:#660000;"><strong>Dr. Dow's pump </strong></span></a><span style="color:#000000;"><strong>from Dr. Cohen at Texas Heart Institute, Houston - also describing mechanism of presently used pulsatile and centrifugal (continuous) VADs.</strong></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1303889065148781004.post-7357866231723974572007-05-15T11:29:00.000-06:002007-05-15T11:33:55.348-06:00<strong><span style="color:#000066;">Tuesday May 15, 2007</span></strong><br /><strong><span style="color:#990000;">What is Implantable left ventricular assist device (LVAD)</span></strong><br /><br /><br /><strong><span style="color:#000000;">A ventricular assist device (VAD) is a mechanical pump that helps failed heart pump blood throughout the body. It was destined to used as a "bridge-to-transplant" but it is also a destined therapy for many patients who are not eligible for transplant. Actually, recently it has been reported that LVAD may reverse the heart failure by prolonged unloading of the myocardium causing myocardial recovery ! <span style="font-size:78%;">1</span> There are many commercially type pumps available in market but basic idea is the same to help weak ventricle in pumping blood. There are 2 basic kinds available though - Pusatile and continuous (or debakey which is totally implanted inside the body). Parts consist of<br /><br />1. A pump unit, implanted in the abdomen (very thin patients becomes ineligible)</span></strong><br /><strong><span style="color:#000000;"><br />2. An inflow tube (or conduit), attached to the bottom of the apex of left ventricle<br /><br />3. An outflow tube, attached to the aorta Internal valves that allow for one-way blood flow through the system<br /><br />4. Power leads, that pass from the internal device through the skin.<br /><br />5. External controller and power base unit or battery pack that attaches to the power leads/cables. </span></strong><br /></span><span style="color:#000000;"><br /><br />The controller is programmed to maintain a specific pump spread. It displays the status of the system and sounds alarms if any. The controller and batteries can be worn in a belted waist pack or a holster under the arm. Or, it may be connected to a power base unit and plugged into a wall outlet.</span><br /><br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgK-TigTGLX5M_AltVHua4fzLXLse-tPpPeW7EiwP4JSn9hhaT-1jYmrZ8I4ulwi1JfFERNn_GNIHFE4xEcZ7QZfeTN4PrIl5ifexE6iqRZx3cxfk6pSPs05V39USgvWT8Oay_FRlBcy9U/s1600-h/lvad.jpg"><img id="BLOGGER_PHOTO_ID_5064841183103952658" style="DISPLAY: block; MARGIN: 0px auto 10px; CURSOR: hand; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgK-TigTGLX5M_AltVHua4fzLXLse-tPpPeW7EiwP4JSn9hhaT-1jYmrZ8I4ulwi1JfFERNn_GNIHFE4xEcZ7QZfeTN4PrIl5ifexE6iqRZx3cxfk6pSPs05V39USgvWT8Oay_FRlBcy9U/s400/lvad.jpg" border="0" /></a><br /><br /><span style="font-size:78%;color:#003333;">References: click to get article / abstract</span><br /><br /><span style="font-size:78%;color:#003333;">1. </span><a href="http://content.nejm.org/cgi/content/short/355/18/1873" target="_blank"><span style="font-size:78%;color:#003333;">Left Ventricular Assist Device and Drug Therapy for the Reversal of Heart Failure</span></a><span style="font-size:78%;"><span style="color:#003333;"> - NEJM, Volume 355:1873-1884, November 2, 2006</span><br /></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1303889065148781004.post-4831542272155453852007-05-14T07:42:00.000-06:002007-05-14T07:44:38.831-06:00<strong><span style="color:#000066;">Monday May 14, 2007</span><br /></strong><strong><span style="color:#990000;">Role of continuous renal replacement therapy (CRRT) in critical care setting still not clear<br /></span><br /><span style="color:#000000;">Acute Kidney Injury (AKI) in critically ill patients is sometimes associated with multi organ dysfunction syndrome (MODS). Patients who require dialysis have mortality rate over 50%. CRRT instead of intermittent hemodialysis (IHD) is being used in several institutions in this setting. The critical care physicians and nursing staff now often manage CRRT, rather than the nephrologists and dialysis nurses. However there is no data to show that CRRT is superior to IHD in critically ill patients probably because these patients are sicker and are difficult to study</span></strong> <span style="color:#000000;"><span style="font-size:78%;">2, 3.<br /></span><strong><br /></strong></span><strong><br /><span style="color:#003300;">Previous related pearl:</span> </strong><a href="http://icuroom-pearls.blogspot.com/2005/12/saturday-december-24-2005-is-sledd.html" target="_blank"><strong><span style="color:#660000;">Is SLEDD better than CVVHD in ICU patients ?</span></strong></a><br /><span style="color:#003300;"><span style="color:#660000;"><br /></span><br /><span style="font-size:78%;">References: click to get article / abstract</span></span><br /><br /><span style="font-size:78%;color:#003300;">1. </span><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17464141&query_hl=6&itool=pubmed_docsum" target="_blank"><span style="font-size:78%;color:#003300;">Continuous renal replacement in critical illness</span></a><span style="font-size:78%;color:#003300;"> - Contrib Nephrol. 2007;156:309-19<br />2. </span><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=17021268" target="_blank"><span style="font-size:78%;color:#003300;">Survival by dialysis modality in critically ill patients with acute kidney injury</span></a><span style="font-size:78%;color:#003300;"> - J Am Soc Nephrol. 2006 Nov;17(11):3132-8. Epub 2006 Oct 4.<br />3. </span><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17377902&query_hl=6&itool=pubmed_docsum" target="_blank"><span style="font-size:78%;color:#003300;">Renal replacement therapy for acute kidney injury: let's follow the evidence</span></a><span style="font-size:78%;color:#003300;"> - Int J Artif Organs. 2007 Feb;30(2):89-94</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1303889065148781004.post-22183654071257600052007-05-13T08:44:00.001-06:002007-05-13T08:48:52.911-06:00<strong><span style="color:#000000;"><span style="color:#000066;">Sunday May 13, 2007<br /></span></span><span style="color:#990000;">Great Critical Care Video lectures - and they are free !!</span></strong><br /><span style="color:#000000;"><br /><strong>David Crippen, MD, FCCM, Associate Professor at University of Pittsburgh Medical Center, Department of Critical Care Medicine has done a great service to the education of Critical Care Medicine. He has started free video lecture series and five videos have been loaded (and more are coming so bookmark it):</strong><br /><br /><strong><span style="color:#003300;">First:</span> Introducion.<br /><br /><span style="color:#003300;">Second:</span> Crippen: Sedation and Anxiolysis: ICU Case Studies, Part 1- Introduction to ICU stress delirium.</strong><br /><br /><strong><span style="color:#003300;">Third:</span> Crippen: Sedation and Anxiolysis: ICU Case Studies, Part 2- Case studies of delirium, pain, anxiety and discomfort in the ICU.</strong><br /><br /><strong><span style="color:#003333;">Fourth:</span> Crippen: Sedation and Anxiolysis: ICU Case Studies, Part 3- Severe, life threatening delirium using ethanol withdrawal as a model.</strong><br /><br /><strong><span style="color:#003300;">Fifth:</span> Crippen: Sedation and Anxiolysis: ICU Case Studies, Part 4- Cerebral function monitoring using compressed spectral array (CSA) for therapeutically paralyzed patients.</strong><br /><br /><span style="font-size:85%;">You must have "Flash" loaded. (upload free if needed </span></span><a href="http://www.adobe.com/shockwave/download/download.cgi?P1_Prod_Version=ShockwaveFlash&promoid=BIOW" target="_blank"><span style="font-size:85%;color:#660000;">here</span></a><span style="color:#000000;"><span style="font-size:85%;">)</span><br /><strong><br />Click at: </strong></span><a href="http://ccm-l.org/CMEcrippen/videos.html" target="_blank"><strong><span style="color:#660000;">http://ccm-l.org/CMEcrippen/videos.html</span></strong></a><br /></span>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-1303889065148781004.post-7653985996728600302007-05-12T16:50:00.000-06:002007-05-12T16:51:46.642-06:00<strong><span style="color:#000000;"><span style="color:#000066;">Saturday May 12, 2007</span><br /></span><span style="color:#990000;">Xifaxan (Rifaximin)</span></strong><br /><strong><span style="color:#000000;"></span></strong><br /><strong><span style="color:#000000;">Rifaximin is in use in other countries since last 2 decades but has been approved by FDA in USA just couple of years ago. Rifaximin was invented initially in Italy for the treatment of travelers' diarrhea but quickly found its way for improvement in hepatic encephalopathy beside lactulose and neomycin 1, 2,5,6,7. Some new studies showed that it may be more effective than lactulose 3 or neomycin 4.Atleast one multi-center trial is underway 8, as well as other trials looking at Rifaximin's efficacy in Irritable Bowel Syndrome, Clostridium Difficile-Associated Diarrhea and Ulcerative Colitis 8.Rifaximin is an oral, semi-synthetic, nonsystemic antibiotic. The recommended dosage in hepatic encephalopathy is 1200 mg a day in divided doses.</span></strong><br /><br /><span style="font-size:78%;color:#003300;"></span><br /><span style="font-size:78%;color:#003300;"></span><br /><span style="font-size:78%;color:#003300;">References: click to get abstract/article</span><br /><span style="font-size:78%;color:#003300;"></span><br /><span style="font-size:78%;color:#003300;"> 1. </span><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7555036&dopt=Abstract" target="_blank"><span style="font-size:78%;color:#003300;">Rifaximin in the treatment of chronic hepatic encephalopathy </span></a><span style="font-size:78%;color:#003300;">- Curr Med Res Opin. 1995;13(5):274-81.<br /><br />2. </span><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9327194&dopt=Citation" target="_blank"><span style="font-size:78%;color:#003300;">Rifaximin, a non-absorbable rifamycin, for the treatment of hepatic encephalopathy. A double-blind, randomised trial.</span></a><span style="font-size:78%;color:#003300;"> - Curr Med Res Opin. 1997;13(10):593-601.<br /><br />3. </span><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12480560&dopt=Abstract" target="_blank"><span style="font-size:78%;color:#003300;">Comparison of rifaximin and lactitol in the treatment of acute hepatic encephalopathy: results of a randomized, double-blind, double-dummy, controlled clinical trial</span></a><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12480560&dopt=Abstract"><span style="font-size:78%;color:#003300;"> </span></a><span style="font-size:78%;color:#003300;">- J Hepatol. 2003 Jan;38(1):51-8<br /><br />4. </span><a href="http://bmj.bmjjournals.com/cgi/content/full/323/7306/233" target="_blank"><span style="font-size:78%;color:#003300;">Neomycin should not be used to treat hepatic encephalopathy</span></a><span style="font-size:78%;color:#003300;"> - BMJ 2001;323:233 ( 28 July )<br /><br />5. Management of Hepatic Encephalopathy: Role of Rifaximin - Chemotherapy 2005;51 (Suppl. 1):90-95<br /><br />6. Evaluation of the efficacy and safety of rifaximin in the treatment of hepatic encephalopathy: a double-blind, randomized, dose-finding multi-centre study. Eur J Gastroenterol Hepatol 2000; 12: 203-208<br /><br />7. </span><a href="http://eprints.ucl.ac.uk/archive/00000625/" target="_blank"><span style="font-size:78%;color:#003300;">Rifaximin, a nonabsorbed oral antibiotic, in the treatment of hepatic encephalopathy: antimicrobial activity, efficacy and safety.</span></a><span style="font-size:78%;color:#003300;"> Reviews in Gastroenterological Disorders, 5 (Supplement 1). S10-S18.<br /><br />8. </span><a href="http://www.clinicaltrials.gov/ct/search;jsessionid=6C3B84602A44276B27E2CBFBA2E27FFD?term=rifaximin&submit=Search" target="_blank"><span style="font-size:78%;color:#003300;">Rifaximin trials</span></a><span style="font-size:78%;color:#003300;"> - clinicaltrials.gov </span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1303889065148781004.post-18148484856953978702007-05-11T16:58:00.000-06:002007-05-11T17:00:19.719-06:00<strong><span style="color:#000066;">Friday May 11, 2007<br /></span><span style="color:#990000;">Hypokalemia and Hypertension !</span><br /><br /><span style="color:#000000;">Interesting article published this week in The New England Journal of Medicine: Sodium and Potassium in the Pathogenesis of Hypertension. Just to quote few lines from article:</span></strong><br /><br /><em><strong><span style="color:#003300;">"........Numerous studies show an adverse effect of a surfeit of sodium on arterial pressure. By contrast, potassium, the main intracellular cation, has usually been viewed as a minor factor in the pathogenesis of hypertension.<span style="color:#660000;"> However, abundant evidence indicates that a potassium deficit has a critical role in hypertension and its cardiovascular sequelae.......Population studies have shown an inverse relation of potassium intake to blood pressure, the prevalence of hypertension, or the risk of stroke</span>.... After adjusting for potentially confounding variables, the INTERSALT (The International Study of Salt and Blood Pressure) researchers estimated that a decrease in potassium excretion by 50 mmol per day was associated with an increase in systolic pressure of 3.4 mm Hg and an increase in diastolic pressure of 1.9 mm Hg............ <span style="color:#660000;">A high-potassium diet and increases in serum potassium, even within the physiologic range, cause endothelium-dependent vasodilatation by hyperpolarizing the endothelial cell through stimulation of the sodium pump and opening potassium channels</span>....The central actions of changes in the concentrations of sodium and potassium in the cerebrospinal fluid and of an excess of sodium and a deficit of potassium in the body are probably mediated by changes in the activity of the neuronal sodium pump and the renin–angiotensin system in the brain.<span style="color:#660000;"> These changes alter sympathetic outflow, which then causes directional changes in blood pressure. Baroreceptor sensitivity is depressed by potassium depletion and restored by potassium supplementation</span>.......In its 2002 advisory, the coordinating committee of the National High Blood Pressure Education Program identified both a reduction in dietary sodium and potassium supplementation as proven approaches for preventing and treating hypertension. The Institute of Medicine...also advises adults to consume at least 120 mmol of potassium per day (approximately 4.7 g of potassium per day, which is about twice the current U.S. average)......"</span></strong></em><br /><br /><span style="font-size:78%;color:#003300;"><br />Reference: click to get abstract<br /><br /></span><a href="http://content.nejm.org/cgi/content/extract/356/19/1966" target="_blank"><span style="font-size:78%;color:#003300;">Sodium and Potassium in the Pathogenesis of Hypertension</span></a><span style="font-size:78%;color:#003300;"> - Volume 356:1966-1978 , May 10 2007</span>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-1303889065148781004.post-34482742269120332072007-05-10T10:58:00.000-06:002007-05-10T11:00:29.771-06:00<strong><span style="color:#000066;">Thursday May 10, 2007</span></strong><br /><strong><span style="color:#990000;">What is Tandem Heart®</span></strong><img id="BLOGGER_PHOTO_ID_5062977463650232066" style="DISPLAY: block; MARGIN: 0px auto 10px; CURSOR: hand; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGeJUur4JlWAOZuQ7TGbvx53_VaeUs-XpVIHCkpejzmG0Es_BF2pzgIt5hWSsOvzYF2K8RNizEw1vmNZzv5cS-nbXLrKXYTfNJzVIyCSAl37Yfpnzeg2pfwRURvTieEBYYwjY2DJyRViI/s400/tandem+heart.jpg" border="0" /><strong><span style="color:#000000;"><br />To support cardiac failure or to bridge the time till permanent solution found (cardiac surgery, heart transplant etc) various mechanical circulatory support systems have been used. Intraaortic balloon pump (IABP) is the most widely used measure but it is limited in its funtion due to support it provides and in its relatively shorter duration of use desired.<br /><br />The Tandem Heart® Percutaneous Ventricular Assist Device (pVAD)™ system uses a <em>transseptal cannula that allows direct unloading of the left heart at blood flow rates sufficient to sustain patients.</em><br /><br />In TandemHeart a percutaneous catheter inserted at the right femoral vein, advanced upto right atrium, and under flouroscopy literally a hole is made in the interatrial septum (in the fossa ovalis). Next an arterial catheter inserted percutaneously into the right femoral artery (or two arterial catheters into both femoral arteries) and then advanced into the lower abdominal aorta. Catheters made connected to a centrifugal pump. Heparin is used continuously through the lubrication system of the device, adjusting the activated clotting time (maintained at 200 seconds). </span></strong><br /><strong><span style="color:#000000;"></span></strong><br /><strong><span style="color:#000000;">The Tandem Heart has a low blood surface contact area, resulting in reduced potential for hemolysis and thromboemboli.<br /><br />Data suggests it to be a promising technology and may become a regular feature in coronary care units. In references below, we are providing results from well done studies and bedside work.<br /></span></strong><br /><strong><span style="color:#000000;"></span></strong><br /><span style="font-size:78%;color:#003333;">References: click to get abstracts/articles<br /><br />1. </span><a href="http://circ.ahajournals.org/cgi/content/abstract/104/24/2917" target="_blank"><span style="font-size:78%;color:#003333;">Reversal of Cardiogenic Shock by Percutaneous Left Atrial-to-Femoral Arterial Bypass Assistance</span></a><span style="font-size:78%;color:#003333;"> - (Circulation. 2001;104:2917.)<br /><br />2. </span><a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1524679" target="_blank"><span style="font-size:78%;color:#003333;">Clinical Experience with the TandemHeart® Percutaneous Ventricular Assist Device</span></a><span style="font-size:78%;color:#003333;"> - Tex Heart Inst J. 2006; 33(2): 111–115.<br /><br />3. </span><a href="http://ats.ctsnetjournals.org/cgi/content/abstract/77/4/1431" target="_blank"><span style="font-size:78%;color:#003333;">Temporary assist device for postcardiotomy cardiac failure</span></a><span style="font-size:78%;color:#003333;"> - Ann Thorac Surg 2004;77:1431-1433<br /><br />4. </span><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&list_uids=14530729" target="_blank"><span style="font-size:78%;color:#003333;">Left ventricular assist devices as permanent heart failure therapy: the price of progress</span></a><span style="font-size:78%;color:#003333;">.- Ann Surg. 2003 Oct;238(4):577-83; discussion 583-5<br /><br />5. </span><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&list_uids=15945107" target="_blank"><span style="font-size:78%;color:#003333;">Percutaneous left ventricular assist device: "TandemHeart" for high-risk coronary intervention</span></a><span style="font-size:78%;"><span style="color:#003333;">. - Catheter Cardiovasc Interv. 2005 Jul;65(3):346-52.</span><br /></span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1303889065148781004.post-66379107862388818062007-05-09T07:35:00.001-06:002007-05-09T07:35:58.096-06:00<strong><span style="color:#000066;">Wednesday May 09, 2007</span><br /><br /><br /><span style="color:#660000;"> Q;</span> <em><span style="color:#003333;">Patients with which poisoning present with garlic odor?</span></em><br /><br /><span style="color:#660000;">A:</span> Organophosphate poisoning.</strong>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1303889065148781004.post-24998318467502907472007-05-08T22:29:00.000-06:002007-05-07T22:36:13.112-06:00<span style="color:#000000;"><span style="color:#000066;"><strong>Tuesday May 08, 2007<br /></strong></span><strong><span style="color:#990000;">PPI (Proton pump inhibitor) drip !<br /></span><br /></strong></span><span style="color:#000000;"><strong>One notable study recently published in The New England Journal of Medicine regarding use of preemptive Omeprazole (PPI) infusion - 80 mg IV bolus followed by an 8 mg per hour drip - before Endoscopy in Patients with Gastrointestinal Bleeding. <em>The basic concept is a neutral gastric PH is critical for the stability of clots over bleeding arteries.</em><br /><br />638 patients were enrolled and randomly assigned to omeprazole or placebo (319 in each group).<br /><br /></strong><span style="font-size:85%;">Patients with hypotensive shock had been first stabilized. Patients requiring urgent endoscopy or surgery were excluded. Long term aspirin users were excluded. For nonsteroidal antiinflammatory drugs users, the drugs were discontinued. Patients who had bleeding from coumadin were given vitamin K or FFP. - See full article for inclusion or exclusion criteria.<br /></span><strong><br /><span style="color:#003300;">Results:</span></strong></span><br /><span style="color:#000000;"><strong><ul><li>The need for endoscopic treatment was lower in the omeprazole group than in the placebo group ( 19.1% vs. 28.4%). </li><li>The hospital stay was less than 3 days in 60.5% of patients in the omeprazole group, as compared with 49.2% in the placebo group.</li><li>On endoscopy, fewer patients in the omeprazole group had actively bleeding ulcers (12 of 187, vs. 28 of 190 in the placebo group) and </li><li>more omeprazole-treated patients had ulcers with clean bases (120 vs. 90). </li></ul><br />But there were no significant differences in the mean amount of blood transfused, the number of patients who had recurrent bleeding, who underwent emergency surgery or who died within 30 days.<br /><br />Authors concluded that Infusion of high-dose omeprazole before endoscopy accelerated the resolution of signs of bleeding in ulcers and reduced the need for endoscopic therapy.</strong></span><br /></span><br /><br /><br /><span style="font-size:78%;color:#003300;">Reference: click to get article/abstract</span><br /><br /><span style="font-size:78%;color:#003300;">1. </span><a href="http://content.nejm.org/cgi/content/abstract/356/16/1631" target="_blank"><span style="font-size:78%;color:#003300;">Omeprazole before Endoscopy in Patients with Gastrointestinal Bleeding</span></a><span style="font-size:78%;color:#003300;"> -, NEJM, April 19, 2007, Volume 356:1631-1640</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-1303889065148781004.post-37783157946370927952007-05-07T13:45:00.000-06:002007-05-07T22:38:57.136-06:00<strong><span style="color:#000066;">Monday May 07, 2007</span></strong><br /><div align="left"><strong><span style="color:#990000;">Re</span></strong><span style="color:#990000;"><strong>visting Intra-Abdominal Hypertension (IAH)<br /></strong><br /></span><br /><span style="color:#000000;"><strong>Intra-Abdominal Hypertension (IAH) and Abdominal Compartment Syndrome (ACS) are encountered in critical care setting, which requires prompt identification and management.<br /><br /><br /><span style="color:#003333;">DEFINITIONS</span><br /><br /><span style="color:#660000;">1. Intraabdominal pressure (IAP):</span> The steady-state pressure concealed within the abdominal cavity.</strong></span></div><div align="left"> </div><div align="left"> </div><div align="left"><strong><span style="color:#660000;">2. Abdominal perfusion pressure (APP):</span></strong></div><span style="color:#000000;"><strong><div align="center"><br /><br /></strong><em><span style="color:#003300;"><strong>APP = MAP - IAP<br /></strong>* Mean arterial pressure (MAP)</span></em> </div><div align="left"><br /><br /><strong><span style="color:#660000;">3. Intra-abdominal Hypertension (IAH):</span> IAH is defined by a sustained or repeated pathologic elevation of IAP >12 mmHg. Normal IAP is approximately 5-7 mmHg in critically ill adults.<br /><br /><span style="color:#660000;">4. Abdominal Compartment Syndrome (ACS):</span> ACS defined as a sustained IAP > 20 mmHg (with or withou an APP less than 60 mmHg) that is associated with new organ dysfunction / failure.</strong></div><strong><div align="left"><br /></div><div align="left"><span style="color:#003300;">HOW TO MEASURE</span><br /><br />IAP should be expressed in mmHg (1 mmHg = 1.36 cmH2O) and measured at end-expiration in the complete supine position after ensuring that abdominal muscle contractions are absent and with the transducer zeroed at the level of the mid-axillary line. The reference standard for intermittent IAP measurement is via the bladder with a maximal instillation volume of 25 mL of sterile saline. Normal IAP is approximately 5-7 mmHg in critically ill adults.<br /></strong></span></div><br /><div align="left"><strong><span style="color:#003300;">GRADES of IAH:<br /></span></strong></div><div align="left"><strong><span style="color:#000000;">Grade I , 12-15 mmHg<br /></span></strong></div><div align="left"><strong><span style="color:#000000;">Grade II, 16-20 mmHg<br /></span></strong></div><div align="left"><strong><span style="color:#000000;">Grade III, 21- 25 mm Hg<br /></span></strong></div><div align="left"><strong><span style="color:#000000;">Grade IV, more than 25 mm Hg<br /></span></strong></div><br /><strong><span style="color:#003300;">Related web site:</span></strong> <a href="http://www.wsacs.org/" target="_blank" rel="nofollow"><strong><span style="color:#660000;">The World Society of the Abdominal Compartment Syndrome (WSACS)</span></strong></a><br /><br /><em><span style="color:#003333;">See following diagram from commercially available product - AbViser® AutoValve™ - click on pic to get bigger image </span></em><br /><br /><img id="BLOGGER_PHOTO_ID_5061907359663531762" style="DISPLAY: block; MARGIN: 0px auto 10px; CURSOR: hand; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfz3wocWlPkUpUprEbehgcx1y7QaGCzephV_jbhUJlFpsizvA1bLd-AzzkEkW6OmbeJNI6G2p_sEHmzDgzSxTWtox3YGjigF4wZXa-YZa1VoBb-xmmt4ffOdj9JcGBHeGsx37n_AN_8TQ/s400/autovalve_diagram.jpg" border="0" />Unknownnoreply@blogger.com0