Types of Brain Dysfunction in Critical Illness Robert D
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Tbi): Progress in Treating the Sig- Nature Wounds of the Current Conflicts
S. HRG. 111–866 OVERSIGHT HEARING ON TRAUMATIC BRAIN IN- JURY (TBI): PROGRESS IN TREATING THE SIG- NATURE WOUNDS OF THE CURRENT CONFLICTS HEARING BEFORE THE COMMITTEE ON VETERANS’ AFFAIRS UNITED STATES SENATE ONE HUNDRED ELEVENTH CONGRESS FIRST SESSION MAY 5, 2010 Printed for the use of the Committee on Veterans’ Affairs ( Available via the World Wide Web: http://www.access.gpo.gov/congress/senate U.S. GOVERNMENT PRINTING OFFICE 64–440 PDF WASHINGTON : 2011 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001 VerDate Nov 24 2008 12:21 Feb 28, 2011 Jkt 000000 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 H:\ACTIVE\050510.TXT SVETS PsN: PAULIN COMMITTEE ON VETERANS’ AFFAIRS DANIEL K. AKAKA, Hawaii, Chairman JOHN D. ROCKEFELLER IV, West Virginia RICHARD BURR, North Carolina, Ranking PATTY MURRAY, Washington Member BERNARD SANDERS, (I) Vermont LINDSEY O. GRAHAM, South Carolina SHERROD BROWN, Ohio JOHNNY ISAKSON, Georgia JIM WEBB, Virginia ROGER F. WICKER, Mississippi JON TESTER, Montana MIKE JOHANNS, Nebraska MARK BEGICH, Alaska SCOTT P. BROWN, Massachusetts ROLAND W. BURRIS, Illinois ARLEN SPECTER, Pennsylvania WILLIAM E. BREW, Staff Director LUPE WISSEL, Republican Staff Director (II) VerDate Nov 24 2008 12:21 Feb 28, 2011 Jkt 000000 PO 00000 Frm 00002 Fmt 5904 Sfmt 5904 H:\ACTIVE\050510.TXT SVETS PsN: PAULIN CONTENTS MAY 5, 2010 SENATORS Page Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii ........................... 1 Burr, Hon. -
A Protocol for a Scoping Review of Tools Used to Improve Care Delivery
Standardising Care in the ICU: A Protocol for a Scoping Review of Tools used to Improve Care Delivery laura Allum ( [email protected] ) Guy's and Saint Thomas' NHS Foundation Trust https://orcid.org/0000-0002-8083-419X Chloe Apps Guy's and Saint Thomas' NHS Foundation Trust Nicholas Hart Guy's and Saint Thomas' NHS Foundation Trust Natalie Pattison University of Hertfordshire Bronwen Connolly Queen's University Belfast Faculty of Medicine Health and Life Sciences Louise Rose King's College London Protocol Keywords: Critical care, Patient care planning, Checklist, Delivery of Healthcare, Prolonged critical illness Posted Date: December 4th, 2019 DOI: https://doi.org/10.21203/rs.2.18217/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Version of Record: A version of this preprint was published on July 19th, 2020. See the published version at https://doi.org/10.1186/s13643-020-01414-6. Page 1/11 Abstract Background: Increasing numbers of critically ill patients experience a prolonged intensive care unit stay contributing to greater physical and psychological morbidity, strain on families, and cost to health systems. Healthcare providers report dissatisfaction with provision of care for these longer stay patients due to competing demands from higher acuity patients. Quality improvement tools such as checklists concisely articulate best practices with the aim of improving quality and safety. However, these tools have not been designed for the specic needs of patients with prolonged ICU stay. The objective of this review is to generate data to inform development and implementation of quality improvement tools for patients with prolonged ICU stay, namely: the content, design and effect of multicomponent tools designed to standardise or improve ICU care. -
Proceedings of Réanimation 2019, the French Intensive Care Society International Congress
Ann. Intensive Care 2019, 9(Suppl 1):40 https://doi.org/10.1186/s13613-018-0474-7 MEETING ABSTRACTS Open Access Proceedings of Réanimation 2019, the French Intensive Care Society International Congress France. 23–25 January 2019 Published: 29 March 2019 Oral communications Oral communications: Physiotherapists Conclusion: We found that peak expiratory was higher with than with- out collapsible tube. In vivo measurements in patients should be done COK‑1 to confrm this fnding. Bench assessment of the efect of a collapsible tube on the efcacy of a mechanical insufation‑exsufation device Romain Lachal (speaker) Réanimation médicale, Hôpital de la Croix‑Rousse, Hospices Civils de Lyon, Lyon, FRANCE Correspondence: Romain Lachal ‑ [email protected] Annals of Intensive Care 2019, 9(Suppl 1):COK-1 Introduction: Mechanical Insufation-Exsufation (MI-E) by using a specifc device is commonly used to increase weak cough, as in patients with chronic neuromuscular weakness or in intensive care unit (ICU) patients with ICU-acquired neuro-myopathy. The assess- ment of the efcacy of MI-E device is commonly done by measuring peak cough fow (PCF). Upper airways collapse is frequently associated with neuromuscular disease and may compromise MI-E efcacy. Tra- cheomalacia is another disease that may impede PCF to increase with MI-E device. The goal of present study was to carry out a bench study to assess the efect of MI-E on PCF with and without the presence of a collapsible tube. Our hypothesis was that PCF was lower with than without collapsible tube. COK‑2 Patients and methods: We used a lung simulator (TTL Michigan Early verticalization in neurologic intensive care units Instruments) with adjustable compliance (C) and resistance (R) to with a weight suspension system which a MI-E (CoughAssist E70, Philips-Respironics) was attached, Margrit Ascher (speaker), Francisco Miron Duran, Fanny Pradalier, Claire with or without a latex collapsible tube. -
Tactics of Family Doctors in Case of Syncopal States
MINISTRY OF PUBLIC HEALTH OF UKRAINE ZAPORIZHZHIA STATE MEDICAL UNIVERSITY DEPARTMENT OF GENERAL PRACTICE – FAMILY MEDICINE AND INTERNAL DISEASES DEPARTMENT OF GENERAL PRACTICE – FAMILY MEDICINE, THERAPY, CARDIOLOGY AND NEUROLOGY OF THE POSTGRADUATE FACULTY TACTICS OF FAMILY DOCTORS IN CASE OF SYNCOPAL STATES STUDY GUIDE for the students of the specialty "Medicine" in the program of the educational discipline "General Practice - Family Medicine" Zaporizhzhia 2020 2 UDC 616.8-009.832-08(072) М 99 Аpproved by Central Methodical Council of Zaporizhzhia State Medical University as а study guide (Protocol № 3 of 27.02.2020) and recommended for use in the educational process Authors: N. S. Mykhailovska - Doctor of Medical Sciences, Professor, head of the Department of General practice – family medicine and internal diseases, Zaporizhzhia State Medical University; A. V. Grytsay - PhD, associated professor of the Department of General practice – family medicine and internal diseases, Zaporizhzhia State Medical University; І. S. Kachan - associated professor of the Department of Family medicine, therapy, cardiology and neurology of the Postgraduate faculty, Zaporizhzhia State Medical University. Readers: S. Y. Dotsenko – Doctor of Medical Sciences, Professor, Head of the Internal Medicine №3 Department, Zaporozhye State Medical University; S. M. Kiselev – Doctor of Medical Sciences, Professor, Professor of the Department of Internal diseases 1, Zaporizhzhia State Medical University. Mykhailovska N. S. M99 Tactics of family doctors in case of syncopal states = Тактика сімейного лікаря при синкопальних станах: study guide for the practical classes and individual work for 6th-years students of international faculty (speciality «General medicine»), discipline «General practice – family medicine» / N. S. Mykhailovska, A. V. Grytsay, I.S. -
Intensive Care Medicine in 10 Years
BOOKS,FILMS,TAPES &SOFTWARE are difficult to read, the editing is inconsis- tory for critical care medicine. The book is initiate a planning process for leaders who tent, and the content that was omitted indi- divided into sections entitled “Setting the recognize the imperative for change and ad- cates that “efforts to bring this work from Stage,” “Diagnostic, Therapeutic, and In- aptation in critical care. Accordingly, I rec- conception to fruition in less than one year” formation Technologies 10 Years From ommend this book to individuals and groups (as stated in the book’s acknowledgments Now,” “How Might Critical Care Medicine engaged in all aspects of critical care man- section) prevented this book from being a Be Organized and Regulated?” “Training,” agement, now and in the future. “gold standard” text. and “The Critical Care Agenda.” Each sec- J Christopher Farmer MD tion consists of a series of essays/chapters Marie E Steiner MD MSc Department of Medicine that discuss various aspects of the topic, and Department of Pediatrics Mayo Clinic all the sections have solid scientific support Divisions of Pulmonary/ Rochester, Minnesota and bibliographies. The individual topics Critical Care and Hematology/ span the entire range of critical-care clinical Oncology/Blood and Marrow The author reports no conflict of interest related practice, administration, quality and safety, Transplantation to the content of this book review. and so forth. The contributors are acknowl- University Children’s Hospital, Fairview edged senior clinical and scientific leaders University of Minnesota Mechanical Ventilation: Physiological in critical care medicine from around the Minneapolis, Minnesota and Clinical Applications, 4th edition. -
Chronic Critical Illness: the Price of Survival
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Archivio istituzionale della ricerca - Università di Modena e Reggio Emilia DOI: 10.1111/eci.12547 REVIEW Chronic critical illness: the price of survival Alessandro Marchioni, Riccardo Fantini, Federico Antenora, Enrico Clini and Leonardo Fabbri Respiratory Disease Clinic Department of Oncology, Haematology and Respiratory Disease, University of Modena and Reggio Emilia, Modena, Italy ABSTRACT Background The evolution of the techniques used in the intensive care setting over the past decades has led on one side to better survival rates in patients with acute conditions and severely impaired vital functions. On the other side, it has resulted in a growing number of patients who survive an acute event, but who then become dependent on one or more life support techniques. Such patients are called chronically critically ill patients. Materials & Methods No absolute definition of the disease is currently available, although most patients are characterized by the need for prolonged mechanical ventilation. Mortality rates are still high even after dismissal from intensive care unit (ICU) and transfer to specialized rehabilitation care settings. Results In recent years, some studies have tried to clarify the pathophysiological characteristics underlying chronic critical illness (CCI), a disease that is also characterized by severe endocrine and inflammatory impair- ments, partly accounting for the almost constant set of symptoms. Discussion Currently, no specific treatment is available. However, a strategic early therapeutic approach on ICU admission might try to prevent the progress of the acute disease towards chronic critical illness. Keywords chronic critical illness, mechanical ventilation, systemic inflammation, wasting syndrome. -
Unarousable Unresponsiveness in Which the Patient Lies with the Eye Closed and Has No Awareness of Self and Surroundings (2)
Neurological Disease Deborah M Stein, MD, MPH 1. Coma a. Coma is defined as “a state of extreme unresponsiveness, in which an individual exhibits no voluntary movement or behavior” (1). i. Alternatively, coma is a state of unarousable unresponsiveness in which the patient lies with the eye closed and has no awareness of self and surroundings (2). b. Coma lies on a spectrum with other alterations in consciousness – from confusion to delirium to obtundation to stupor to coma and, ultimately, brain death (2). c. To be clearly distinguished from syncope, concussion, or other states of transient unconsciousness coma must persist for at least one hour (2). d. There are 2 important characteristics of the conscious state (3) i. The level of consciousness – “arousal or wakefulness” 1. Regulated by physiological functioning and consists of more primitive responsiveness to the world such as predictable involuntary reflex responses to stimuli. 2. Arousal is maintained by the reticular activating system (RAS) - a network of structures (including the brainstem, the medulla, and the thalamus) ii. The content of consciousness – “awareness” 1. Regulated by cortical areas within the cerebral hemispheres, e. There are two main causes for coma: i. Bihemispheric diffuse cortical or white matter damage or ii. Brainstem lesions bilaterally affecting the subcortical reticular activating systems. f. A huge number of conditions can result in coma. One way to categorize these conditions is to divide them into the anatomic and the metabolic causes of coma. i. Anatomic causes of coma are those conditions that disrupt the normal physical architecture and anatomy, either at the level of the cerebral cortex or the brainstem ii. -
Heat Illness & Hydration
Sideline Emergencies: Exertional Heat Illness- Prevention and Treatment Updates AOSSM: 2019 Sports Medicine & Football - Youth to the NFL Damion A. Martins, MD Medical Director of Sports Medicine Sports Medicine Fellowship Program Director, Atlantic Health Systems Director of Internal Medicine, New York Jets DISCLOSURE Neither I, (Damion Martins, MD), nor any family member(s), author(s), have any relevant financial relationships to be discussed, directly or indirectly, referred to or illustrated with or without recognition within the presentation. Learning Objectives Describe the pathophysiology of Exertional Heat Illness Identify signs and symptoms of Exertional Heat Stroke Understand urgent on the field management and treatment of Heat Illness Understand current evidence for prevention and treatment of Exertional Heat Stroke Overview Heat Illness – Diagnosis – Pathophysiology – Risk Factors – Evaluation / Treatment Hydration – NCAA / NFL data – IV vs PO data McNair video 6 Physiology Thermoregulation Production Dissipation – – basal metabolism conduction – – exercise radiation – convection – evaporation Sandor RP. Phys SportsMed. 1997;25(6):35-40. Heat Illness Spectrum Heat Illness Heat Injury Heat Stroke Definitions Exertional Heat Illness (EHI) Heat edema – initial days of heat exposure – self-limited, mild swelling of hands / feet Heat cramps or Exercise Associated Muscle Cramps (EAMCs) – skeletal muscle cramping during or after exercise – usually abdominal and extremities Heat syncope – orthostatic dizziness or sudden -
Neurologic Manifestations of Hypoglycemia
13 Neurologic Manifestations of Hypoglycemia William P. Neil and Thomas M. Hemmen University of California, San Diego United States of America (USA) 1. Introduction Unlike most other body tissues, the brain requires a continuous supply of glucose. It has very limited endogenous glycogen stores, and does not produce glucose intrinsically.1 Although it accounts for 2% of body weight, the brain utilizes 25% of the body’s glucose due to its high metabolic rate.2, 3 Evidence for the brains sole reliance on glucose came from obtaining a respiratory quotient of one after measuring differences between arterial and venous content of oxygen and carbon dioxide in blood traveling through the brain.4 In the past, neurons were thought to directly metabolize glucose, however, more recent studies suggest astrocytes may play an important role in glucose metabolism.5 Astrocytic foot processes surround brain capillaries, which deliver glucose to the brain. With this, they form the first cellular barrier for entering glucose.5 Astrocytes contain the non-insulin dependent GLUT1 transporter, as well as the insulin dependent GLUT4 transporter, suggesting a possible role for astrocytes in regulating and storing brain glucose in an insulin dependent and independent manner (see figure 1).6-8 In addition to glucose, the brain contains a very limited store of glycogen, (between 0.5 and 1.5 g, or about 0.1% of total brain weight). Unlike peripheral tissue, where glycogen is readily mobilized during hypoglycemia, the brain can only function normally for a limited duration. Glycogen content seems to fall in areas of highest brain metabolic rate, suggesting at least some, albeit limited role as fuel during hypoglycemia.7 Although the brain relies primarily on glucose during normal conditions, it can use ketone bodies during starvation. -
Goals of Care and End of Life in the ICU
Goals of Care and End of Life in the ICU Ana Berlin, MD, MPH, FACS KEYWORDS Goals of care Shared decision making ICU Functional and cognitive outcomes End-of-life care Palliative care Communication KEY POINTS The trauma and long-term sequelae of critical illness affect not only patients but also their families and caregivers. Unrealistic expectations and erroneous assumptions about the outcomes acceptable to patients are important drivers of misguided and goal-discordant medical treatment. Compassionately delivering accurate and honest prognostic information inclusive of func- tional, cognitive, and psychosocial outcomes is crucial for helping patients and families understand what to expect from an episode of surgical crticial illness. Skilled communication and shared decision-making strategies ensure that treatments provided in the ICU are aligned with realistic and attainable patient goals. Attentive management of physical and nonphysical symptoms, including the psychosocial and spiritual needs of families and caregivers, eases suffering in the ICU and beyond. INTRODUCTION There is little doubt that the past half-century has seen tremendous advances in surgical critical care. The advent of lung-protective ventilation in the management of acute respiratory distress syndrome (ARDS), the evolution of balanced resusci- tation strategies for the reduction of abdominal compartment syndrome, and the aggressive deployment of prevention and treatment strategies against the systemic inflammatory response syndrome and sepsis, along with many other technological innovations, have markedly reduced the morbidity and mortality associated with critical illness and multiorgan system failure. Nevertheless, at times even the Disclosure Statement: Support for Dr A. Berlin’s preparation of this article was provided by the New Jersey Medical School Hispanic Center of Excellence, Health Resources and Services Administration through Grant D34HP26020. -
The Relationships Among Emotion Regulation, Role Stress, And
THE RELATIONSHIPS AMONG EMOTION REGULATION, ROLE STRESS, AND PSYCHOLOGICAL DISTRESS IN SURROGATE DECISION MAKERS OF THE CHRONICALLY CRITICALLY ILL PATIENTS by MARY NJALIAN VARIATH Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Frances Payne Bolton School of Nursing CASE WESTERN RESERVE UNIVERSITY May, 2019 CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the thesis/dissertation of Mary Njalian Variath candidate for the degree of Doctor in Philosophy*. Committee Chair Ronald L. Hickman, Jr. PhD, RN, ACNP-BC, FNAP, FAAN Committee Member Jaclene A. Zauszniewski, PhD, RN-BC, FAAN Committee Member Mathew Plow, PhD Committee Member Arin Connell, PhD Date of Defense March 21, 2019 *We also certify that written approval has been obtained for any proprietary material contained therein. ii Dedication This dissertation is dedicated to my family. Behind this accomplishment stand the two strong pillars of my life, Variath Njalian (late) and Thressiamma Njalian, my parents. They taught me many important life lessons, instilled the values of hard work and sacrifice, showered unconditional love, and shared their passionate desire for education; all of which inspired me to accomplish this milestone. To Anice Sebastian, Lissy Jose, and Varghese Njalian, my siblings, whose encouragement, love, and support boosted my wavering confidence during this prolonged endeavor. And to my husband, whose love, constant support, and encouragement helped me to get through the obstacles of this journey. -
Developed by the Patient and Family Support Committee of the Society Of
'HYHORSHGE\WKH3DWLHQWDQG )DPLO\6XSSRUW&RPPLWWHHRIWKH 6RFLHW\RI&ULWLFDO&DUH0HGLFLQH +HDGTXDUWHUV 0LGZD\'ULYH 0RXQW3URVSHFW,/ ZZZVFFPRUJ , V V X H V $QVZHUV Chronic Critical Illness in Adults Requiring Prolonged Mechanical Ventilation :**4 Who Is This Brochure For? If an adult member of your family has been in the intensive care unit (ICU) on a breathing machine (mechanical ventilator or respirator) for many days, this brochure about chronic critical illness is for you. We hope that the brochure will help you understand chronic critical illness and feel more informed when you talk with the doctors and nurses about important decisions for your family member. What Is Chronic Critical Illness? Most patients who need care in the ICU get better quickly. After a few days in the ICU, they no longer need a breathing machine or other critical care treatments. But even with the best ICU care, some patients remain critically ill and have trouble breathing on their own, without a machine, for a much longer time. These patients have chronic critical illness. What Causes Chronic Critical Illness? We do not know why some ICU patients get better quickly, whereas others remain critically ill and need a breathing machine for a long time. But we are learning how to take better care of patients with chronic critical illness and their families. We are also learning more about what to expect from treatments that exist today. How Do Doctors and Nurses Know a Person Has Chronic Critical Illness? There is no test to diagnose chronic critical illness. Doctors and nurses know that adult patients have chronic critical illness when they still need a breathing machine even after weeks in the ICU.