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Miscellaneous

Increased sound levels in the cardiac ICU are associated with an increase in heart rate, blood pressure, and sedation

Abstract   Background: Several organizations including the Environmental Protection Agency, World Health Organization and American Academy of Pediatrics recommend that hospital sound levels not exceed 45 decibels. Yet, several studies across multiple age groups have observed higher than recommended levels in the intensive care setting. Elevated sound levels in hospitals have been associated with disturbances […]

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Uncategorized

Complexities, Benefits, Risks, and Clinical Implications of Sodium Bicarbonate Administration in Critically Ill Patients: A State-of-the-Art Review

Abstract Sodium bicarbonate has been used in the treatment of different pathologies, such as hyperkalemia, cardiac arrest, tricyclic antidepressant toxicity, aspirin toxicity, acute acidosis, lactic acidosis, diabetic ketoacidosis, rhabdomyolysis, and adrenergic receptors’ resistance to catecholamine in patients with shock. An ongoing debate about bicarbonate’s efficacy and potential harm has been raised for decades because of

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Complexities, Benefits, Risks, and Clinical Implications of Sodium Bicarbonate Administration in Critically Ill Patients: A State-of-the-Art Review Read Post »

Circulatory, Miscellaneous

Exercise and cardiac rehabilitation after LVAD implantation

Abstract Left ventricular assist devices (LVAD) have improved mortality and quality of life for patients with end-stage heart failure by providing an alternative to cardiac transplant or as a bridge to transplantation. The improvement in functional capacity however is minimal to modest depending on the right ventricular function, optimal hemodynamics on LVAD therapy, and comorbidities.

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Miscellaneous

How I perform diaphragmatic ultrasound in the intensive care unit

The diaphragm is a thin, dome-shaped muscle, compris-ing a costal and crural part, and a non-contracting central tendon. Muscle fiber activation shortens and thickens the diaphragm in the zone of apposition, moving the dome caudally. Diaphragm function, defined as the ability to contract and generate pressure, has substantial reserve capacity. However, clinically significant diaphragm weak-ness,

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Miscellaneous

Left diaphragmatic ultrasound in the intensive care unit: practical considerations and alternative approaches

We read with great interest the recent article by Her-mans et al. on diaphragmatic ultrasound, which provides a detailed guide on both methodology and clinical appli-cations [1]. This article has significantly enhanced our understanding of diaphragmatic ultrasound, especially for its application in intensive care unit (ICU) [2]. We would like to offer some additional considerations

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Left diaphragmatic ultrasound in the intensive care unit: practical considerations and alternative approaches Read Post »

Respiratory

Gattinoni’s Legacy: Personalizing ARDS Management Through Physiology

While writing this editorial, we learned that Professor Luciano Gattinoni—a giant in our field—had passed away. “Giant” seems an inadequate descriptor for a physician-scientist whose profound insights have fundamentally reshaped our understanding of critical care in general, and of acute respiratory distress syndrome (ARDS) in particular. His enduring legacy will continue to impact researchers, clinicians,

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Circulatory

Fever following extracorporeal membrane oxygenation decannulation: Infection, thrombosis or just physiology?

Abstract   Purpose Fever is frequent after extracorporeal membrane oxygenation (ECMO) decannulation. We aimed to evaluate the incidence of post-decannulation fever and describe its causes. Methods Adult ECMO patients who were successfully weaned from ECMO were retrospectively included. Minimal and maximal core temperatures were collected daily for each patient from 48 h before decannulation up to

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Fever following extracorporeal membrane oxygenation decannulation: Infection, thrombosis or just physiology? Read Post »

Sepsis

Microcirculation: Current Perspective in Diagnostics, Imaging, and Clinical Applications

Abstract This review discusses the pivotal role of microcirculation in maintaining tissue oxygenation and waste removal and highlights its significance in various pathological conditions. It delves into the cellular mechanisms underlying hemodynamic coherence, elucidating the roles of the endothelium, glycocalyx, and erythrocytes in sustaining microcirculatory integrity. Furthermore, the review gives comprehensive information about microcirculatory changes

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Circulatory, Sepsis

Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort study

Summary   Background Patients with sepsis-induced cardiomyopathy with cardiogenic shock have a high mortality. This study assessed venoarterial extracorporeal membrane oxygenation (VA-ECMO) support for sepsis-induced cardiogenic shock refractory to conventional treatments. Methods In this retrospective, multicentre, international cohort study, we compared outcomes of 82 patients (aged ≥18 years) with septic shock who received VA-ECMO at

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Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort study Read Post »

Mechanical Ventilation

What every paediatrician needs to know about mechanical ventilation

Abstract Mechanical ventilation (MV) is a lifesaving intervention for children with acute respiratory failure (ARF). However, improper application can lead to adverse outcomes, such as ventilation-induced lung injury (VILI), patient self-inflicted lung injury (P-SILI), and ventilation-induced diaphragmatic dysfunction (VIDD). This review discusses the fundamentals of MV, challenges in minimizing its side effects, and strategies to

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