Critical care medicine
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Critical care medicine · Aug 2017
Multicenter StudyICU Patients Requiring Renal Replacement Therapy Initiation: Fewer Survivors and More Dialysis Dependents From 80 Years Old.
To assess the role of advanced age on survival and dialysis dependency after initiation of renal replacement therapy for acute kidney injury. ⋯ Patients with advanced age represent a substantial subgroup of patients requiring renal replacement therapy in the ICU. From 80 years, age should be considered as an additional risk of dying over the severity of organ failures. Patients 80 years old or older are likely to recover sufficient renal function allowing renal replacement therapy discontinuation when baseline estimated glomerular filtration rate is above 44 mL/min/1.73 m. At 3 months, only 6% were living at home, dialysis independent.
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Critical care medicine · Aug 2017
Randomized Controlled TrialThe Utility of High-Fidelity Simulation for Training Critical Care Fellows in the Management of Extracorporeal Membrane Oxygenation Emergencies: A Randomized Controlled Trial.
Although extracorporeal membrane oxygenation volume has increased, proficiency in the technology requires extensive training. We compared traditional water-drill-based extracorporeal membrane oxygenation training with simulation-based extracorporeal membrane oxygenation training with the hypothesis that simulation-based training is superior. ⋯ In novice critical care fellows, simulation-based extracorporeal membrane oxygenation training is superior to traditional training. Benefits transfer to novel scenarios and are maintained over the long term. Further studies evaluating the utility of simulation in other learner groups and for maintenance of proficiency are required.
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Critical care medicine · Aug 2017
Risk Factors for Pediatric Extubation Failure: The Importance of Respiratory Muscle Strength.
Respiratory muscle weakness frequently develops during mechanical ventilation, although in children there are limited data about its prevalence and whether it is associated with extubation outcomes. We sought to identify risk factors for pediatric extubation failure, with specific attention to respiratory muscle strength. ⋯ Neuromuscular weakness at the time of extubation was common in children and was independently associated with reintubation, particularly when postextubation effort was high.
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Critical care medicine · Aug 2017
Case ReportsLower Cranial Nerves Paralysis Following Prone-Position Mechanical Ventilation.
To communicate a complication of prone-position ventilation. ⋯ This is a very infrequent cause of dysphagia following prone-position ventilation.
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Critical care medicine · Aug 2017
Case ReportsAtriobronchial Fistula Complicated by Septic Cerebral Air Emboli After Pulmonary Vein Ablation.
To describe a case of an infected atriobronchial fistula as a late complication after pulmonary vein ablation, leading to septic air emboli and requiring urgent cardiac surgery. ⋯ Clinicians should be aware of the dramatic complications of invasive antiarrhythmic procedures and their atypical and late presentations. Better preprocedural appreciation of cardiac wall thickness, early echocardiographic diagnosis, and swift referral for cardiac surgery might impact outcome dramatically.