Heart & lung : the journal of critical care
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Takotsubo cardiomyopathy can occur at the early phase of severe acute brain injuries. In the case of cardiac output decrease or shock, the optimal treatment is still a matter of debate. Due to massive stress hormone release, the infusion of catecholamines may have limited effects and may even aggravate cardiac failure. Other inotropic agents may be an option. Levosimendan has been shown to have potential beneficial effects in this setting, although milrinone has not been studied. ⋯ Milrinone could be a good alternative when inotropes are required in Takotsubo cardiomyopathy and when dobutamine infusion is associated with tachyarrhythmia.
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Mechanical circulatory support is increasingly used in acute cardiogenic shock. ⋯ Right heart assessment prior to ECMO implantation may be beneficial to provide tailored therapy if ECMO weaning fails. Survival after cardiogenic shock requiring ECMO seems to be associated with impaired long-term quality of life.
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Review Meta Analysis
De-escalation of empiric antibiotics in patients with severe sepsis or septic shock: A meta-analysis.
To evaluate the impact of de-escalation therapy on clinical outcomes in patients with severe sepsis and/or septic shock. ⋯ Antibiotic de-escalation therapy has no detrimental impact on mortality in patients with severe sepsis and/or septic shock, as compared to the continuation of broad-spectrum antibiotics. Since de-escalation affords an opportunity to limit overuse of broad-spectrum antibiotics, it should be considered as an option in clinical practice.
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Explore (1) the characteristics of the Maine population with delayed geographic access to interventional cardiology (IC) services and (2) the effect of delayed geographic IC access on coronary mortality. ⋯ Delayed geographic IC access was associated with disparity but not with increased age-adjusted coronary mortality.
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Review Meta Analysis
The effect of reintubation on ventilator-associated pneumonia and mortality among mechanically ventilated patients with intubation: A systematic review and meta-analysis.
This meta-analysis summarized the risks that reintubation impose on ventilator-associated pneumonia (VAP) and mortality. ⋯ Reintubation can represent a threat to survival and increase the risk of VAP. The risk of mortality after reintubation differs between planned and unplanned extubation. Extubation failure is associated with a higher risk of VAP in the cardiac surgery population than in the general population.