﻿FN Thomson Reuters Web of Science™
VR 1.0
PT J
AU Parry, Selina M
   Berney, Sue
   Granger, Catherine L
   Dunlop, Danielle L
   Murphy, Laura
   El-Ansary, Doa
   Koopman, Rene
   Denehy, Linda
TI A new two-tier strength assessment approach to the diagnosis of weakness
   in intensive care: an observational study.
SO Critical care (London, England)
VL 19
IS 1
BP 780
EP 780
DI 10.1186/s13054-015-0780-5
PD 2015-Dec
PY 2015
AB INTRODUCTION: Intensive care unit-acquired weakness (ICU-AW) is a
   significant problem. There is currently widespread variability in the
   methods used for manual muscle testing and handgrip dynamometry (HGD) to
   diagnose ICU-AW. This study was conducted in two parts. The aims of this
   study were: to determine the inter-rater reliability and agreement of
   manual muscle strength testing using both isometric and through-range
   techniques using the Medical Research Council sum score and a new
   four-point scale, and to examine the validity of HGD and determine a
   cutoff score for the diagnosis of ICU-AW for the new four-point scale.
   METHODS: Part one involved evaluation of muscle strength by two physical
   therapists in 29 patients ventilated >48 hours. Manual strength testing
   was performed by both physical therapists using two techniques:
   isometric and through range; and two scoring systems: traditional
   six-point Medical Research Council scale and a new collapsed four-point
   scale. Part two involved assessment of handgrip strength conducted on 60
   patients. A cutoff score for ICU-AW was identified for the new
   four-point scoring system.
   RESULTS: The incidence of ICU-AW was 42% (n=25/60) in this study (based
   on HGD). In part one the highest reliability and agreement was observed
   for the isometric technique using the four-point scale (intraclass
   correlation coefficient=0.90: kappa=0.72 respectively). Differences
   existed between isometric and through-range scores (mean difference=1.76
   points, P=0.005). In part two, HGD had a sensitivity of 0.88 and
   specificity of 0.80 for diagnosing ICU-AW. A cutoff score of 24 out of
   36 points was identified for the four-point scale.
   CONCLUSIONS: The isometric technique is recommended with reporting on a
   collapsed four-point scale. Because HGD is easy to perform and
   sensitive, we recommend a new two-tier approach to diagnosing ICU-AW
   that first tests handgrip strength with follow-up strength assessment
   using the isometric technique for muscle strength testing if handgrip
   strength falls below cutoff scores. Whilst our results for the
   four-point scale are encouraging, further research is required to
   confirm the findings of this study and determine the validity of the
   four-point scoring system and cutoff score developed of less than 24 out
   of 36 before recommending adoption into clinical practice.
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UT MEDLINE:25777875
PM 25777875
ER

PT J
AU Cameron, Saoirse
   Ball, Ian
   Cepinskas, Gediminas
   Choong, Karen
   Doherty, Timothy J.
   Ellis, Christopher G.
   Martin, Claudio M.
   Mele, Tina S.
   Sharpe, Michael
   Shoemaker, J. Kevin
   Fraser, Douglas D.
TI Early mobilization in the critical care unit: A review of adult and
   pediatric literature
SO JOURNAL OF CRITICAL CARE
VL 30
IS 4
BP 664
EP 672
DI 10.1016/j.jcrc.2015.03.032
PD AUG 2015
PY 2015
AB Early mobilization of critically ill patients is beneficial, suggesting
   that it should be incorporated into daily clinical practice. Early
   passive, active, and combined progressive mobilizations can be safely
   initiated in intensive care units (ICUs). Adult patients receiving early
   mobilization have fewer ventilator-dependent days, shorter ICU and
   hospital stays, and better functional outcomes. Pediatric ICU data are
   limited, but recent studies also suggest that early mobilization is
   achievable without increasing patient risk. In this review, we provide a
   current and comprehensive appraisal of ICU mobilization techniques in
   both adult and pediatric critically ill patients. Contra-indications and
   perceived barriers to early mobilization, including cost and health care
   provider views, are identified. Methods of overcoming barriers to early
   mobilization and enhancing sustainability of mobilization programs are
   discussed. Optimization of patient outcomes will require further studies
   on mobilization timing and intensity, particularly within specific ICU
   populations. (C) 2015 Elsevier Inc. All rights reserved.
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SN 0883-9441
UT WOS:000356066100003
ER

PT J
AU Wieske, Luuk
   van der Kooi, Anneke J.
   Witteveen, Esther
   Bouwes, Aline
   Schultz, Marcus J.
   van Schaik, Ivo N.
   Horn, Janneke
TI Intraepidermal nerve fiber density in intensive care unit-acquired
   weakness-an observational pilot study
SO JOURNAL OF CRITICAL CARE
VL 30
IS 4
BP 819
EP 821
DI 10.1016/j.jcrc.2015.03.024
PD AUG 2015
PY 2015
TC 0
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SN 0883-9441
UT WOS:000356066100029
ER

PT J
AU Friedrich, O
   Reid, M B
   Van den Berghe, G
   Vanhorebeek, I
   Hermans, G
   Rich, M M
   Larsson, L
TI The Sick and the Weak: Neuropathies/Myopathies in the Critically Ill.
SO Physiological reviews
VL 95
IS 3
BP 1025
EP 109
DI 10.1152/physrev.00028.2014
PD 2015-Jul
PY 2015
AB Critical illness polyneuropathies (CIP) and myopathies (CIM) are common
   complications of critical illness. Several weakness syndromes are
   summarized under the term intensive care unit-acquired weakness (ICUAW).
   We propose a classification of different ICUAW forms (CIM, CIP,
   sepsis-induced, steroid-denervation myopathy) and pathophysiological
   mechanisms from clinical and animal model data. Triggers include sepsis,
   mechanical ventilation, muscle unloading, steroid treatment, or
   denervation. Some ICUAW forms require stringent diagnostic features; CIM
   is marked by membrane hypoexcitability, severe atrophy, preferential
   myosin loss, ultrastructural alterations, and inadequate autophagy
   activation while myopathies in pure sepsis do not reproduce marked
   myosin loss. Reduced membrane excitability results from depolarization
   and ion channel dysfunction. Mitochondrial dysfunction contributes to
   energy-dependent processes. Ubiquitin proteasome and calpain activation
   trigger muscle proteolysis and atrophy while protein synthesis is
   impaired. Myosin loss is more pronounced than actin loss in CIM. Protein
   quality control is altered by inadequate autophagy. Ca(2+) dysregulation
   is present through altered Ca(2+) homeostasis. We highlight clinical
   hallmarks, trigger factors, and potential mechanisms from human studies
   and animal models that allow separation of risk factors that may trigger
   distinct mechanisms contributing to weakness. During critical illness,
   altered inflammatory (cytokines) and metabolic pathways deteriorate
   muscle function. ICUAW prevention/treatment is limited, e.g., tight
   glycemic control, delaying nutrition, and early mobilization. Future
   challenges include identification of primary/secondary events during the
   time course of critical illness, the interplay between membrane
   excitability, bioenergetic failure and differential proteolysis, and
   finding new therapeutic targets by help of tailored animal models. 
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UT MEDLINE:26133937
PM 26133937
ER

PT J
AU Elkins, Mark
   Dentice, Ruth
TI Inspiratory muscle training facilitates weaning from mechanical
   ventilation among patients in the intensive care unit: a systematic
   review
SO JOURNAL OF PHYSIOTHERAPY
VL 61
IS 3
BP 125
EP 134
DI 10.1016/j.jphys.2015.05.016
PD JUL 2015
PY 2015
AB Question: Does inspiratory muscle training improve inspiratory muscle
   strength in adults receiving mechanical ventilation? Does it improve the
   duration or success of weaning? Does it affect length of stay,
   reintubation, tracheostomy, survival, or the need for post-extubation
   non-invasive ventilation? Is it tolerable and does it cause adverse
   events? Design: Systematic review of randomised trials. Participants:
   Adults receiving mechanical ventilation. Intervention: Inspiratory
   muscle training versus sham or no inspiratory muscle training. Outcome
   measures: Data were extracted regarding: inspiratory muscle strength and
   endurance; the rapid shallow breathing index; weaning success and
   duration; duration of mechanical ventilation; reintubation;
   tracheostomy; length of stay; use of non-invasive ventilation after
   extubation; survival; readmission; tolerability and adverse events.
   Results: Ten studies involving 394 participants were included.
   Heterogeneity within some meta-analyses was high. Random-effects
   meta-analyses showed that the training significantly improved maximal
   inspiratory pressure (MD 7 cmH(2)O, 95% CI 5 to 9), the rapid shallow
   breathing index (MD 15 breaths/min/l, 95% CI 8 to 23) and weaning
   success (RR 1.34, 95% CI 1.02 to 1.76). Although only assessed in
   individual studies, significant benefits were also reported for the time
   spent on non-invasive ventilation after weaning (MD 16 hours, 95% CI 13
   to 18), length of stay in the intensive care unit (MD 4.5 days, 95% CI
   3.6 to 5.4) and length of stay in hospital (MD 4.4 days, 95% CI 3.4 to
   5.5). Weaning duration decreased in the subgroup of patients with known
   weaning difficulty. The other outcomes weren't significantly affected or
   weren't measured. Conclusion: Inspiratory muscle training for selected
   patients in the intensive care unit facilitates weaning, with potential
   reductions in length of stay and the duration of non-invasive
   ventilatory support after extubation. The heterogeneity among the
   results suggests that the effects of inspiratory muscle training may
   vary; this perhaps depends on factors such as the components of usual
   care or the patient's characteristics. (C) 2015 Australian Physiotherapy
   Association. Published by Elsevier B.V.
TC 0
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SN 1836-9553
UT WOS:000357049100004
PM 26092389
ER

PT J
AU Goligher, Ewan C.
   Doufle, Ghislaine
   Fan, Eddy
TI Update in Mechanical Ventilation, Sedation, and Outcomes 2014
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 191
IS 12
BP 1367
EP 1373
DI 10.1164/rccm.201502-0346UP
PD JUN 15 2015
PY 2015
AB Novel approaches to the management of acute respiratory distress
   syndrome include strategies to enhance alveolar liquid clearance,
   promote epithelial cell growth and recovery after acute lung injury, and
   individualize ventilator care on the basis of physiological responses.
   The use of extracorporeal membrane oxygenation (ECMO) is growing
   rapidly, and centers providing ECMO must strive to meet stringent
   quality standards such as those set out by the ECMONet working group.
   Prognostic tools such as the RESP score can assist clinicians in
   predicting outcomes for patients with severe acute respiratory failure
   but do not predict whether ECMO will enhance survival. Evidence
   continues to grow that novel modes of mechanical ventilation such as
   neurally adjusted ventilatory assist are feasible and improve patient
   physiology and patient-ventilator interaction; data on clinical outcomes
   are limited but supportive. Critical illness causes long-term
   psychological and function sequelae: the risk of a new psychiatric
   diagnosis and severe physical impairment is significantly increased in
   the months after discharge from the intensive care unit. These long-term
   effects might be amenable to changes in sedation practice and increased
   early mobilization. Daily sedation discontinuation enhances the validity
   of routine delirium assessment. Many critically ill patients merit
   assessment by palliative care clinicians; the demand for palliative care
   services among critically ill patients is expected to grow. Future
   trials to test therapies for critical illness must ensure that study
   designs are adequately powered to detect benefit using realistic event
   rates. Integrating "big data" approaches into treatment decisions and
   trial designs offers a potential means of individualizing care to
   enhance outcomes for critically ill patients.
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SN 1073-449X
UT WOS:000356470000008
PM 26075422
ER

PT J
AU Brummel, Nathan E.
   Balas, Michele C.
   Morandi, Alessandro
   Ferrante, Lauren E.
   Gill, Thomas M.
   Ely, E. Wesley
TI Understanding and Reducing Disability in Older Adults Following Critical
   Illness
SO CRITICAL CARE MEDICINE
VL 43
IS 6
BP 1265
EP 1275
DI 10.1097/CCM.0000000000000924
PD JUN 2015
PY 2015
AB Objective: To review how disability can develop in older adults with
   critical illness and to explore ways to reduce long-term disability
   following critical illness.
   Data Sources: We searched PubMed, CINAHL, Web of Science and Google
   Scholar for studies reporting disability outcomes (i.e., activities of
   daily living, instrumental activities of daily living, and mobility
   activities) and/or cognitive outcomes among patients treated in an ICU
   who were 65 years or older. We also reviewed the bibliographies of
   relevant citations to identify additional citations. Study Selection: We
   identified 19 studies evaluating disability outcomes in critically ill
   patients who were 65 years and older.
   Data Extraction: Descriptive epidemiologic data on disability after
   critical illness.
   Data Synthesis: Newly acquired disability in activities of daily living,
   instrumental activities of daily living, and mobility activities was
   commonplace among older adults who survived a critical illness. Incident
   dementia and less severe cognitive impairment were also highly
   prevalent. Factors related to the acute critical illness, ICU practices,
   such as heavy sedation, physical restraints, and immobility, as well as
   aging physiology, and coexisting geriatric conditions can combine to
   result in these poor outcomes.
   Conclusions: Older adults who survive critical illness have physical and
   cognitive declines resulting in disability at greater rates than
   hospitalized, noncritically ill and community dwelling older adults.
   Interventions derived from widely available geriatric care models in use
   outside of the ICU, which address modifiable risk factors including
   immobility and delirium, are associated with improved functional and
   cognitive outcomes and can be used to complement ICU-focused models such
   as the ABCDEs.
TC 1
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SN 0090-3493
UT WOS:000354720300036
PM 25756418
ER

PT J
AU Wieske, Luuk
   Verhamme, Camiel
   Witteveen, Esther
   Bouwes, Aline
   Dettling-Ihnenfeldt, Daniela S.
   van der Schaaf, Marike
   Schultz, Marcus J.
   van Schaik, Ivo N.
   Horn, Janneke
TI Feasibility and Diagnostic Accuracy of Early Electrophysiological
   Recordings for ICU-Acquired Weakness: An Observational Cohort Study
SO NEUROCRITICAL CARE
VL 22
IS 3
BP 385
EP 394
DI 10.1007/s12028-014-0066-9
PD JUN 2015
PY 2015
AB An early diagnosis of ICU-acquired weakness (ICU-AW) is difficult
   because disorders of consciousness frequently preclude muscle strength
   assessment. In this study, we investigated feasibility and accuracy of
   electrophysiological recordings to diagnose ICU-AW early in non-awake
   critically ill patients.
   Newly admitted patients, mechanically ventilated a parts per thousand
   yen2 days and unreactive to verbal stimuli, were included in this study.
   Electrophysiological recordings comprised nerve conduction studies (NCS)
   of three nerves and, if coagulation was normal, myography in three
   muscles. Upon awakening, strength was assessed (ICU-AW: average Medical
   Research Council score < 4), blinded for electrophysiological
   recordings. Feasibility was expressed as the percentage of recordings
   that were both possible and had sufficient technical quality. Diagnostic
   accuracy of feasible (i.e., feasibility > 75 %) recordings was analyzed
   based on cut-off values from healthy controls and from critically ill
   patients with and without ICU-AW.
   Thirty-five patients were included (17 with ICU-AW). Recordings were
   obtained on day 4 (IQR: 3-6). Feasibility was acceptable for ulnar and
   peroneal nerve recordings, and low for sural recordings and myography.
   Diagnostic accuracy based on cut-off values from healthy controls was
   low. When using cut-off values from critically ill patients with and
   without ICU-AW, the peroneal compound muscle action potential amplitude
   and ulnar sensory nerve action potential amplitude had good diagnostic
   accuracy.
   Nerve conduction studies of the ulnar and peroneal nerve are feasible in
   critically ill patients. The diagnostic accuracy is low using cut-off
   values from healthy controls. Cut-off values validated specifically for
   discrimination between critically ill patients with and without ICU-AW
   may improve diagnostic accuracy.
TC 0
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SN 1541-6933
UT WOS:000354196300007
PM 25403763
ER

PT J
AU Connolly, Bronwen
   Thompson, April
   Douiri, Abdel
   Moxham, John
   Hart, Nicholas
TI Exercise-based rehabilitation after hospital discharge for survivors of
   critical illness with intensive care unit-acquired weakness: A pilot
   feasibility trial
SO JOURNAL OF CRITICAL CARE
VL 30
IS 3
BP 589
EP 598
DI 10.1016/j.jcrc.2015.02.002
PD JUN 2015
PY 2015
AB Purpose: The aim of this study was to investigate feasibility of
   exercise-based rehabilitation delivered after hospital discharge in
   patients with intensive care unit-acquired weakness (ICU-AW).
   Materials and methods: Twenty adult patients, mechanically ventilated
   for more than 48 hours, with ICU-AW diagnosis at ICU discharge were
   included in a pilot feasibility randomized controlled trial receiving a
   16-session exercise based rehabilitation program. Twenty-one patients
   without ICU-AW participated in a nested observational cohort study.
   Feasibility, clinical, and patient-centered outcomes were measured at
   hospital discharge and at 3 months.
   Results: Intervention feasibility was demonstrated by high adherence and
   patient acceptability, and absence of adverse events, but this must be
   offset by the low proportion of enrolment for those screened. The study
   was underpowered to detect effectiveness of the intervention. The use of
   manual muscle testing for the diagnosis of ICU-AW lacked robustness as
   an eligibility criterion and lacked discrimination for identifying
   rehabilitation requirements. Process evaluation of the trial identified
   methodological factors, categorized by "population," "intervention,"
   "control group," and "outcome."
   Conclusions: Important data detailing the design, conduct, and
   implementation of a multicenter randomized controlled trial of
   exercise-based rehabilitation for survivors of critical illness after
   hospital discharge have been reported. (C) 2015 The Authors. Published
   by Elsevier Inc. This is an open access article under the CC BY-NC-ND
   license.
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SN 0883-9441
UT WOS:000353400100029
PM 25703957
ER

PT J
AU Simonis, Fabienne D.
   Binnekade, Jan M.
   Braber, Annemarije
   Gelissen, Harry P.
   Heidt, Jeroen
   Horn, Janneke
   Innemee, Gerard
   de Jonge, Evert
   Juffermans, Nicole P.
   Spronk, Peter E.
   Steuten, Lotte M.
   Tuinman, Pieter Roel
   Vriends, Marijn
   de Vreede, Gwendolyn
   de Wilde, Rob B.
   Neto, Ary Serpa
   de Abreu, Marcelo Gama
   Pelosi, Paolo
   Schultz, Marcus J.
TI PReVENT - protective ventilation in patients without ARDS at start of
   ventilation: study protocol for a randomized controlled trial
SO TRIALS
VL 16
AR 226
DI 10.1186/s13063-015-0759-1
PD MAY 24 2015
PY 2015
AB Background: It is uncertain whether lung-protective mechanical
   ventilation using low tidal volumes should be used in all critically ill
   patients, irrespective of the presence of the acute respiratory distress
   syndrome (ARDS). A low tidal volume strategy includes use of higher
   respiratory rates, which could be associated with increased sedation
   needs, a higher incidence of delirium, and an increased risk of
   patient-ventilator asynchrony and ICU-acquired weakness. Another alleged
   side-effect of low tidal volume ventilation is the risk of atelectasis.
   All of these could offset the beneficial effects of low tidal volume
   ventilation as found in patients with ARDS.
   Methods/Design: PReVENT is a national multicenter randomized controlled
   trial in invasively ventilated ICU patients without ARDS with an
   anticipated duration of ventilation of longer than 24 hours in 5 ICUs in
   The Netherlands. Consecutive patients are randomly assigned to a low
   tidal volume strategy using tidal volumes from 4 to 6 ml/kg predicted
   body weight (PBW) or a high tidal volume ventilation strategy using
   tidal volumes from 8 to 10 ml/kg PBW. The primary endpoint is the number
   of ventilator-free days and alive at day 28. Secondary endpoints include
   ICU and hospital length of stay (LOS), ICU and hospital mortality, the
   incidence of pulmonary complications, including ARDS, pneumonia,
   atelectasis, and pneumothorax, the cumulative use and duration of
   sedatives and neuromuscular blocking agents, incidence of ICU delirium,
   and the need for decreasing of instrumental dead space.
   Discussion: PReVENT is the first randomized controlled trial comparing a
   low tidal volume strategy with a high tidal volume strategy, in patients
   without ARDS at onset of ventilation, that recruits a sufficient number
   of patients to test the hypothesis that a low tidal volume strategy
   benefits patients without ARDS with regard to a clinically relevant
   endpoint.
TC 0
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SN 1745-6215
UT WOS:000355405700001
PM 26003545
ER

PT J
AU Hooijman, Pleuni E.
   Beishuizen, Albertus
   Witt, Christian C.
   de Waard, Monique C.
   Girbes, Armand R. J.
   Spoelstra-de Man, Angelique M. E.
   Niessen, Hans W. M.
   Manders, Emmy
   van Hees, Hieronymus W. H.
   van den Brom, Charissa E.
   Silderhuis, Vera
   Lawlor, Michael W.
   Labeit, Siegfried
   Stienen, Ger J. M.
   Hartemink, Koen J.
   Paul, Marinus A.
   Heunks, Leo M. A.
   Ottenheijm, Coen A. C.
TI Diaphragm Muscle Fiber Weakness and Ubiquitin-Proteasome Activation in
   Critically Ill Patients
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 191
IS 10
BP 1126
EP 1138
DI 10.1164/rccm.201412-2214OC
PD MAY 15 2015
PY 2015
AB Rationale: The clinical significance of diaphragm weakness in critically
   ill patients is evident: it prolongs ventilator dependency, and
   increases morbidity and duration of hospital stay. To date, the nature
   of diaphragm weakness and its underlying pathophysiologic mechanisms are
   poorly understood.
   Objectives: We hypothesized that diaphragm muscle fibers of mechanically
   ventilated critically ill patients display atrophy and contractile
   weakness, and that the ubiquitin-proteasome pathway is activated in the
   diaphragm.
   Methods: We obtained diaphragm muscle biopsies from 22 critically ill
   patients who received mechanical ventilation before surgery and compared
   these with biopsies obtained from patients during thoracic surgery for
   resection of a suspected early lung malignancy (control subjects). In a
   proof-of-concept study in a muscle-specific ring finger protein-1
   (MuRF-1) knockout mouse model, we evaluated the role of the
   ubiquitin-proteasome pathway in the development of contractile weakness
   during mechanical ventilation.
   Measurements and Main Results: Both slow- and fast-twitch diaphragm
   muscle fibers of critically ill patients had approximately 25% smaller
   cross-sectional area, and had contractile force reduced by half or more.
   Markers of the ubiquitin-proteasome pathway were significantly
   up-regulated in the diaphragm of critically ill patients. Finally,
   MuRF-1 knockout mice were protected against the development of diaphragm
   contractile weakness during mechanical ventilation.
   Conclusions: These findings show that diaphragm muscle fibers of
   critically ill patients display atrophy and severe contractile weakness,
   and in the diaphragm of critically ill patients the ubiquitin-proteasome
   pathway is activated. This study provides rationale for the development
   of treatment strategies that target the contractility of diaphragm
   fibers to facilitate weaning.
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SN 1073-449X
UT WOS:000355021400011
PM 25760684
ER

PT J
AU Aboshaiqah, Ahmad E.
TI Nursing work environment in Saudi Arabia
SO JOURNAL OF NURSING MANAGEMENT
VL 23
IS 4
BP 510
EP 520
DI 10.1111/jonm.12164
PD MAY 2015
PY 2015
AB Aim The purpose of this study was to assess the work environment as
   perceived by nurses in a large tertiary hospital in Saudi Arabia.
   Background The quality of patient care services has been associated with
   the quality of work environment of nurses. It is therefore important to
   assess the work environment in order to acquire baseline data and enable
   the institution to benchmark their status from established quality
   standards.
   Method This study used a descriptive survey with 1007 staff nurses
   across service units of a 1000-bed government-operated hospital. The
   American Association of Critical-Care Nurses (AACN) Healthy Work
   Environment Assessment Questionnaire was used for data collection.
   Scores were aggregated and interpreted.
   Result Effective decision making, authentic leadership, appropriate
   staffing, true collaboration, skilled communication and meaningful
   recognition were rated as good (mean range 3.53-3.76).
   Conclusion Healthy work environments mutually benefit patients, nurses,
   nurse managers, health care providers, the health team, administration,
   the institution and the community at large.
   Implications for nursing management Valuable baseline data on the status
   of the work environment in this setting were generated. This should
   allow administrators and staff to work together in improving weaknesses
   and strengthening further whatever gains that are attained to ensure
   consistent provision of safe and quality patient care.
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SN 0966-0429
UT WOS:000355621900012
PM 24112380
ER

PT J
AU Nunnerley, Joanne
   Dunn, Jennifer
   McPherson, Kathryn
   Hooper, Gary
   Woodfield, Tim
TI PARTICIPATION AND QUALITY OF LIFE OUTCOMES AMONG INDIVIDUALS WITH
   EARTHQUAKE-RELATED PHYSICAL DISABILITY: A SYSTEMATIC REVIEW
SO JOURNAL OF REHABILITATION MEDICINE
VL 47
IS 5
BP 385
EP 393
DI 10.2340/16501977-1965
PD MAY 2015
PY 2015
AB Objective: A literature review to evaluate quality of life and
   participation outcomes of individuals with earthquake-related physical
   injury.
   Data sources: A systematic review was performed using National Health
   Service (NHS) Centre for Reviews and Dissemination (CRD) guidelines.
   MEDLINE, Embase, PsychINFO, CINAHL and AMED electronic databases were
   searched from 1966 to January 2014.
   Study selection: Studies that measured quality of life or participation
   outcomes among individuals who acquired a physical disability as a
   result of an earthquake injury were included, with no limits on research
   design.
   Data extraction: The search yielded 961 potentially relevant articles
   after removal of duplicates. Of these, only 8 articles met the inclusion
   criteria. Studies were rated for quality using the Critical Appraisal
   Skills Programme (CASP) guidelines.
   Data synthesis: A narrative synthesis was performed due to the
   heterogeneity of the included studies.
   Results: Injured earthquake survivors in developing countries experience
   diminished participation and reduced quality of life. Small sample sizes
   and lack of uniformity in outcome measurement limit generalizability. No
   studies from developed countries were identified.
   Conclusion: To maximize our understanding of quality of life and
   participation in injured earthquake survivors, future research should
   consider both the functional consequences of the injury and the
   environmental impact of the earthquake. The research should be based on
   representative samples of the injured earthquake survivors and use
   validated condition-specific outcome measures that are clearly defined
   within the publications. In addition, research should include all
   countries that are affected by earthquakes.
TC 0
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SN 1650-1977
UT WOS:000355371600001
PM 25886395
ER

PT J
AU Zolfaghari, Parjam S.
   Carre, Jane E.
   Parker, Nadeene
   Curtin, Nancy A.
   Duchen, Michael R.
   Singer, Mervyn
TI Skeletal muscle dysfunction is associated with derangements in
   mitochondrial bioenergetics (but not UCP3) in a rodent model of sepsis
SO AMERICAN JOURNAL OF PHYSIOLOGY-ENDOCRINOLOGY AND METABOLISM
VL 308
IS 9
BP E713
EP E725
DI 10.1152/ajpendo.00562.2014
PD MAY 1 2015
PY 2015
AB Muscle dysfunction is a common feature of severe sepsis and multiorgan
   failure. Recent evidence implicates bioenergetic dysfunction and
   oxidative damage as important underlying pathophysiological mechanisms.
   Increased abundance of uncoupling protein-3 (UCP3) in sepsis suggests
   increased mitochondrial proton leak, which may reduce mitochondrial
   coupling efficiency but limit reactive oxygen species (ROS) production.
   Using a murine model, we examined metabolic, cardiovascular, and
   skeletal muscle contractile changes following induction of peritoneal
   sepsis in wild-type and Ucp3(-/-) mice. Mitochondrial membrane potential
   (Delta psi m) was measured using two-photon microscopy in living
   diaphragm, and contractile function was measured in diaphragm muscle
   strips. The kinetic relationship between membrane potential and oxygen
   consumption was determined using a modular kinetic approach in isolated
   mitochondria. Sepsis was associated with significant whole body
   metabolic suppression, hypothermia, and cardiovascular dysfunction.
   Maximal force generation was reduced and fatigue accelerated in ex vivo
   diaphragm muscle strips from septic mice. Delta psi m was lower in the
   isolated diaphragm from septic mice despite normal substrate oxidation
   kinetics and proton leak in skeletal muscle mitochondria. Even though
   wild-type mice exhibited an absolute 26 +/- 6% higher UCP3 protein
   abundance at 24 h, no differences were seen in whole animal or diaphragm
   physiology, nor in survival rates, between wild-type and Ucp3(-/-) mice.
   In conclusion, this murine sepsis model shows a hypometabolic phenotype
   with evidence of significant cardiovascular and muscle dysfunction. This
   was associated with lower Delta psi m and alterations in mitochondrial
   ATP turnover and the phosphorylation pathway. However, UCP3 does not
   play an important functional role, despite its upregulation.
TC 0
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SN 0193-1849
UT WOS:000353951700002
PM 25714676
ER

PT J
AU Baldwin, Claire E.
   Bersten, Andrew D.
TI Myopathic characteristics in septic mechanically ventilated patients
SO CURRENT OPINION IN CLINICAL NUTRITION AND METABOLIC CARE
VL 18
IS 3
BP 240
EP 247
DI 10.1097/MCO.0000000000000165
PD MAY 2015
PY 2015
AB Purpose of reviewSurvivors of a critical illness may experience poor
   physical function and quality of life as a result of reduced skeletal
   muscle mass and strength during their acute illness. Patients diagnosed
   with sepsis are particularly at risk, and mechanical ventilation may
   result in diaphragm dysfunction. Interest in the interaction of these
   conditions is both growing and important to understand for
   individualized patient care.Recent findingsThis review describes
   developments in the presentation of both diaphragm and limb myopathy in
   critical illness, as measured from muscle biopsy and at the bedside with
   various imaging and strength-testing modalities. The influence of
   unloading of the diaphragm with mechanical ventilation and peripheral
   muscles with immobilization in septic patients has been recently
   questioned. Systemic inflammation appears to primarily accelerate and
   accentuate dysfunction, which may be remedied by early mobilization and
   augmented with developing muscle and/or nerve stimulation
   techniques.SummaryMany acute muscle changes in septic patients are
   likely to stem from pre-existing impairments, which should provide
   context for clinical evaluations of strength. During illness,
   sarcolemmal injury promotes a cascade of intra-cellular abnormalities.
   As unique characteristics of ICU-acquired weakness and differential
   effects on muscle groups are understood, early diagnosis and management
   should be facilitated.
TC 0
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SN 1363-1950
UT WOS:000353456700006
PM 25769059
ER

PT J
AU Smuder, Ashley J.
   Sollanek, Kurt J.
   Min, Kisuk
   Nelson, W. Bradley
   Powers, Scott K.
TI Inhibition of Forkhead BoxO-Specific Transcription Prevents Mechanical
   Ventilation-Induced Diaphragm Dysfunction
SO CRITICAL CARE MEDICINE
VL 43
IS 5
BP E133
EP E142
DI 10.1097/CCM.0000000000000928
PD MAY 2015
PY 2015
AB Objectives: Mechanical ventilation is a lifesaving measure for patients
   with respiratory failure. However, prolonged mechanical ventilation
   results in diaphragm weakness, which contributes to problems in weaning
   from the ventilator. Therefore, identifying the signaling pathways
   responsible for mechanical ventilation-induced diaphragm weakness is
   essential to developing effective countermeasures to combat this
   important problem. In this regard, the forkhead boxO family of
   transcription factors is activated in the diaphragm during mechanical
   ventilation, and forkhead boxO-specific transcription can lead to
   enhanced proteolysis and muscle protein breakdown. Currently, the role
   that forkhead boxO activation plays in the development of mechanical
   ventilation-induced diaphragm weakness remains unknown.
   Design: This study tested the hypothesis that mechanical
   ventilation-induced increases in forkhead boxO signaling contribute to
   ventilator-induced diaphragm weakness.
   Setting: University research laboratory.
   Subjects: Young adult female Sprague-Dawley rats.
   Interventions: Cause and effect was determined by inhibiting the
   activation of forkhead boxO in the rat diaphragm through the use of a
   dominant-negative forkhead boxO adeno-associated virus vector delivered
   directly to the diaphragm.
   Measurements and Main Results: Our results demonstrate that prolonged
   (12 hr) mechanical ventilation results in a significant decrease in both
   diaphragm muscle fiber size and diaphragm-specific force production.
   However, mechanically ventilated animals treated with dominant-negative
   forkhead boxO showed a significant attenuation of both diaphragm atrophy
   and contractile dysfunction. In addition, inhibiting forkhead boxO
   transcription attenuated the mechanical ventilation-induced activation
   of the ubiquitin-proteasome system, the autophagy/lysosomal system, and
   caspase-3.
   Conclusions: Forkhead boxO is necessary for the activation of key
   proteolytic systems essential for mechanical ventilation-induced
   diaphragm atrophy and contractile dysfunction. Collectively, these
   results suggest that targeting forkhead boxO transcription could be a
   key therapeutic target to combat ventilator-induced diaphragm
   dysfunction.
TC 0
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Z8 0
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SN 0090-3493
UT WOS:000353061000002
PM 25746508
ER

PT J
AU Pene, Frederic
   Ait-Oufella, Hafid
   Taccone, Fabio Silvio
   Monneret, Guillaume
   Sharshar, Tarek
   Tamion, Fabienne
   Mira, Jean-Paul
CA Commission Rech Translationnelle S
TI Insights and limits of translational research in critical care medicine
SO ANNALS OF INTENSIVE CARE
VL 5
AR 8
DI 10.1186/s13613-015-0050-3
PD APR 30 2015
PY 2015
AB Experimental research has always been the cornerstone of
   pathophysiological and therapeutic advances in critical care medicine,
   where clinical observations and basic research mutually fed each other
   in a so-called translational approach. The objective of this review is
   to address the different aspects of translational research in the field
   of critical care medicine. We herein highlighted some demonstrative
   examples including the animal-to-human approach to study host-pathogen
   interactions, the human-to-animal approach for sepsis-induced
   immunosuppression, the still restrictive human approach to study
   critical illness-related neuromyopathy, and the technological
   developments to assess the microcirculatory changes in critically ill
   patients. These examples not only emphasize how translational research
   resulted in major improvements in the comprehension of the
   pathophysiology of severe clinical conditions and offered promising
   perspectives in critical care medicine but also point out the obstacles
   to translate such achievements into clinical practice.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 2110-5820
UT WOS:000355916400001
PM 25977834
ER

PT J
AU Wieske, Luuk
   Dettling-Ihnenfeldt, Daniela S.
   Verhamme, Camiel
   Nollet, Frans
   van Schaik, Ivo N.
   Schultz, Marcus J.
   Horn, Janneke
   van der Schaaf, Marike
TI Impact of ICU-acquired weakness on post-ICU physical functioning: a
   follow-up study
SO CRITICAL CARE
VL 19
AR 196
DI 10.1186/s13054-015-0937-2
PD APR 27 2015
PY 2015
AB Introduction: ICU-acquired weakness is thought to mediate physical
   impairments in survivors of critical illness, but few studies have
   investigated this thoroughly. The purpose was to investigate differences
   in post-ICU mortality and physical functioning between patients with and
   without ICU-acquired weakness at 6 months after ICU discharge.
   Method: ICU patients, mechanically ventilated >= 2 days, were included
   in a single-center prospective observational cohort study. ICU-acquired
   weakness was diagnosed when the average Medical Research Council score
   was < 4 in awake and attentive patients. Post-ICU mortality was recorded
   until 6 months after ICU discharge; in surviving patients, physical
   functioning was assessed using the Short-Form Health Survey physical
   functioning domain. The independent effect of ICU-acquired weakness on
   post-ICU mortality was analyzed using a multivariable Cox proportional
   hazards model. The independent effect of ICU-acquired weakness on the
   physical functioning domain score was analyzed using a multivariable
   linear regression model.
   Results: Of the 156 patients included, 80 had ICU-acquired weakness.
   Twenty-three patients died in the ICU (20 with ICU-acquired weakness);
   during 6 months follow-up after ICU discharge another 25 patients died
   (17 with ICU-acquired weakness). Physical functioning domain scores were
   available for 96 survivors (39 patients with ICU-acquired weakness).
   ICU-acquired weakness was independently associated with an increase in
   post-ICU mortality (hazard ratio 3.6, 95% confidence interval, 1.3 to
   9.8; P = 0.01) and with a decrease in physical functioning (beta: -16.7
   points; 95% confidence interval, -30.2 to -3.1; P = 0.02).
   Conclusion: ICU-acquired weakness is independently associated with
   higher post-ICU mortality and with clinically relevant lower physical
   functioning in survivors at 6 months after ICU discharge.
TC 0
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Z8 0
ZS 0
Z9 0
SN 1466-609X
UT WOS:000354244200001
PM 25928709
ER

PT J
AU Lugg, Sebastian T.
   Howells, Phillip A.
   Thickett, David R.
TI The increasing need for biomarkers in intensive care unit-acquired
   weakness - are microRNAs the solution?
SO CRITICAL CARE
VL 19
AR 189
DI 10.1186/s13054-015-0901-1
PD APR 22 2015
PY 2015
AB There is an increasing focus on intensive care unit-acquired weakness,
   its underlying mechanisms and therapeutic options. In this article we
   offer a commentary on the paper by Bloch and colleagues entitled
   'MiR-181a: a potential biomarker of acute muscle wasting following
   cardiac surgery'. There is a need for biomarkers for intensive care
   unit-acquired weakness, not only in clinical practice but also in order
   to streamline future therapeutic trials. MicroRNAs are attractive
   biomarkers, and may have an important role in this disease. We highlight
   the significance of the authors' finding of miR-181a, a novel plasma
   biomarker for the development of acute muscle wasting in post-operative
   cardiac surgery patients and discuss future research that is needed in
   this field following on from the study findings.
TC 0
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Z9 0
SN 1466-609X
UT WOS:000353266000001
PM 25902802
ER

PT J
AU Bloch, Susannah A. A.
   Donaldson, Anna V. J.
   Lewis, Amy
   Banya, Winston A. S.
   Polkey, Michael I.
   Griffiths, Mark J. D.
   Kemp, Paul R.
TI MiR-181a: a potential biomarker of acute muscle wasting following
   elective high-risk cardiothoracic surgery
SO CRITICAL CARE
VL 19
AR 147
DI 10.1186/s13054-015-0853-5
PD APR 7 2015
PY 2015
AB Introduction: Acute muscle wasting in the critically ill is common and
   associated with significant morbidity and mortality. Although some
   aetiological factors are recognised and muscle wasting can be detected
   early with ultrasound, it not possible currently to predict in advance
   of muscle loss those who will develop muscle wasting. The ability to
   stratify the risk of muscle wasting associated with critical illness
   prior to it becoming clinically apparent would provide the opportunity
   to predict prognosis more accurately and to intervene at an early stage.
   MicroRNAs are small non-coding RNAs that modulate post-transcriptional
   regulation of translation, some are tissue specific and can be detected
   and quantified in plasma. We hypothesised that certain plasma microRNAs
   could be biomarkers of ICU acquired muscle weakness.
   Methods: Plasma levels of selected microRNAs were measured in pre- and
   post-operative samples from a previously reported prospective
   observational study of 42 patients undergoing elective high-risk
   cardiothoracic surgery, 55% of whom developed muscle wasting.
   Results: The rise in miR-181a was significantly higher on the second
   post-operative day in those who developed muscle wasting at 1 week
   compared to those who did not (p = 0.03). A rise in miR-181a of greater
   than 1.7 times baseline had 91% specificity and 56% sensitivity for
   subsequent muscle wasting. Other microRNAs did not show significant
   differences between the groups.
   Conclusion: Plasma miR-181a deserves further investigation as a
   potential biomarker of muscle wasting. Additionally, since mir-181a is
   involved in both regulation of inflammation and muscle regeneration and
   differentiation; our observation therefore also suggests directions for
   future research.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1466-609X
UT WOS:000353199900001
ER

PT J
AU Lorenzo, Theresa
   van Pletzen, Ermien
   Booyens, Margaret
TI Determining the competences of community based workers for
   disability-inclusive development in rural areas of South Africa,
   Botswana and Malawi.
SO Rural and remote health
VL 15
IS 2
BP 2919
EP 2919
PD 2015 Apr-Jun
PY 2015
AB INTRODUCTION: Persons with disabilities and their families still live
   with stigma and a high degree of social exclusion especially in rural
   areas, which are often poorly resourced and serviced. Community-based
   workers in health and social development are in an ideal position to
   assist in providing critical support for some of those most at risk of
   neglect in these areas. This article analyses the work of community
   disability workers (CDWs) in three southern African countries to
   demonstrate the competencies that these workers acquired to make a
   contribution to social justice for persons with disabilities and their
   families. It points to some gaps and then argues that these competencies
   should be consolidated and strengthened in curricula, training and
   policy. The article explores local experiences and practices of CDWs so
   as to understand and demonstrate their professional competencies and
   capacity to deliver disability-inclusive services in rural areas, ways
   that make all information, activities and programs offered accessible
   and available to persons with disabilities.
   METHODS: A qualitative interpretive approach was adopted, informed by a
   life history approach. Purposive sampling was used to select 16 CDWs who
   had at least 5 years experience of disability-related work in a rural
   area. In-depth interviews with CDWs were conducted by postgraduate
   students in Disability Studies. An inductive and interpretative
   phenomenological approach was used to analyse data.
   RESULTS: Three main themes with sub-categories emerged demonstrating the
   competencies of CDWs. First, integrated management of health conditions
   and impairments within a family focus comprised 'focus on the functional
   abilities' and 'communication, information gathering and sharing'.
   Second, negotiating for disability-inclusive community development
   included four sub-categories, namely 'mobilising families and community
   leaders', 'finding local solutions with local resources', 'negotiating
   retention and transitions through the education system' and 'promoting
   participation in economic activities'. Third, coordinated and efficient
   intersectoral management systems involved 'gaining community and
   professional recognition' and<i> </i>the ability to coordinate efforts
   ('it's not a one-man show'). The CDWs spoke of their commitment to
   fighting the inequities and social injustices that persons with
   disabilities experienced. They facilitate change and manage the multiple
   transitions experienced by the families at different stages of the
   disabled person's development.
   CONCLUSIONS: Disability-inclusive development embraces a philosophy of
   social inclusion and a set of values that seeks to protect the human
   dignity and rights of persons with disabilities. It requires a workforce
   equipped with skills to work intersectorally and in a cross-disciplinary
   manner in order to operationalise the community-based rehabilitation
   guidelines that are designed to promote delivery of services in remote
   and rural areas. CDWs potentially have a unique set of competencies that
   enables them to facilitate disability-inclusive community development in
   rural areas. The themes reveal how the CDWs contribute to building
   relationships that restore the humanity and dignity of persons with
   disabilities in their family and community. These competencies draw from
   different disciplines which necessitates recognition of the CDWs as a
   cross-disciplinary profession.
TC 0
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UT MEDLINE:26048267
PM 26048267
ER

PT J
AU Goligher, Ewan C.
   Laghi, Franco
   Detsky, Michael E.
   Farias, Paulina
   Murray, Alistair
   Brace, Deborah
   Brochard, Laurent J.
   Sebastien-Bolz, Steffen
   Rubenfeld, Gordon D.
   Kavanagh, Brian P.
   Ferguson, Niall D.
TI Measuring diaphragm thickness with ultrasound in mechanically ventilated
   patients: feasibility, reproducibility and validity
SO INTENSIVE CARE MEDICINE
VL 41
IS 4
BP 642
EP 649
DI 10.1007/s00134-015-3687-3
PD APR 2015
PY 2015
AB Ultrasound measurements of diaphragm thickness (T (di)) and thickening
   (TFdi) may be useful to monitor diaphragm activity and detect diaphragm
   atrophy in mechanically ventilated patients. We aimed to establish the
   reproducibility of measurements in ventilated patients and determine
   whether passive inflation by the ventilator might cause thickening apart
   from inspiratory effort.
   Five observers measured T (di) and TFdi in 96 mechanically ventilated
   patients. The probe site was marked in 66 of the 96 patients. TFdi was
   measured at peak and end-inspiration (airway occluded and diaphragm
   relaxed) in nine healthy volunteers inhaling to varying lung volumes.
   The association with diaphragm electrical activity was quantified.
   Right hemidiaphragm thickness was obtained on 95 % of attempts; left
   hemidiaphragm measurements could not be obtained consistently. Right
   hemidiaphragm thickness measurements were highly reproducible (mean +/-
   A SD 2.4 +/- A 0.8 mm, repeatability coefficient 0.2 mm, reproducibility
   coefficient 0.4 mm), particularly after marking the location of the
   probe. TFdi measurements were only moderately reproducible (median 11 %,
   IQR 3-17 %, repeatability coefficient 17 %, reproducibility coefficient
   16 %). TFdi and diaphragm electrical activity were positively
   correlated, r (2) = 0.32, p < 0.01). At inspiratory volumes below 50 %
   of inspiratory capacity, passive inflation did not cause diaphragm
   thickening. TFdi was considerably lower in patients on either partially
   assisted or controlled ventilation compared to healthy subjects (median
   11 vs. 35 %, p < 0.001).
   Ultrasound measurements of right hemidiaphragm thickness are feasible
   and highly reproducible in ventilated patients. At clinically relevant
   inspiratory volumes, diaphragm thickening reflects muscular contraction
   and not passive inflation. This technique can be reliably employed to
   monitor diaphragm thickness, activity, and function during mechanical
   ventilation.
TC 0
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ZS 0
Z9 0
SN 0342-4642
UT WOS:000352653200008
PM 25693448
ER

PT J
AU Howe, Matthew D
   McCullough, Louise D
TI Prevention and management of stroke in women.
SO Expert review of cardiovascular therapy
VL 13
IS 4
BP 403
EP 15
DI 10.1586/14779072.2015.1020300
PD 2015-Apr
PY 2015
AB Stroke is the leading cause of acquired disability and the third leading
   cause of death in women worldwide. Sex differences in risk factors,
   treatment response and quality of life after stroke complicate stroke
   management in women. Women have an increased lifetime incidence of
   stroke compared to men, largely due to a sharp increase in stroke risk
   in older postmenopausal women. Women also have an increased lifetime
   prevalence of stroke risk factors, including hypertension and atrial
   fibrillation in postmenopausal women, as well as abdominal obesity and
   metabolic syndrome in middle-aged women. Controversy continues over the
   risks of oral contraceptives, hormone therapy and surgical intervention
   for carotid stenosis in women. Pregnancy and the postpartum period
   represent a time of increased risk, presenting challenges to stroke
   management. Recognition of these issues is critical to improving acute
   care and functional recovery after stroke in women.
TC 0
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Z8 0
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Z9 0
UT MEDLINE:25747877
PM 25747877
ER

PT J
AU Connolly, Bronwen
   MacBean, Victoria
   Crowley, Clare
   Lunt, Alan
   Moxham, John
   Rafferty, Gerrard F.
   Hart, Nicholas
TI Ultrasound for the Assessment of Peripheral Skeletal Muscle Architecture
   in Critical Illness: A Systematic Review
SO CRITICAL CARE MEDICINE
VL 43
IS 4
BP 897
EP 905
DI 10.1097/CCM.0000000000000821
PD APR 2015
PY 2015
AB Objectives: To critically evaluate and summarize identified evidence for
   the use of ultrasound to measure peripheral skeletal muscle architecture
   during critical illness.
   Data Sources: Seven electronic databases (Medline, Cumulative Index to
   Nursing and Allied Health Literature, Cochrane Library, Physiotherapy
   Evidence Database, Scopus, Excerpta Medica Database, and Web of Science
   [including Science Citations and Conference Proceedings]) and personal
   libraries were searched for relevant articles. Cross-referencing further
   identified references.
   Study Selection: Quantitative study designs excluding abstracts,
   published in English, including adult critically ill patients in the
   ICU, evaluating peripheral skeletal muscle architecture during critical
   illness with ultrasound were included. Studies using ultrasonographic
   muscle data as outcome measures in interventional trials were excluded.
   Data Extraction: Performed by one reviewer using a standardized data
   extraction form and cross-checked by a second reviewer. Quality
   appraisal was undertaken by two independent reviewers-studies were
   classified, graded, and appraised according to standardized algorithms
   and checklists. Preferred Reporting Items for Systematic Reviews and
   Meta-Analyses guidelines were adhered to.
   Data Synthesis: Seven studies with independent patient cohorts totaling
   300 participants were included. One study adopted a case-control design,
   and the remainder were case series. Ultrasound data demonstrated
   deficits in a variety of peripheral skeletal muscle architecture
   variables across a range of muscle groups associated with critical
   illness. Ultrasound offered more accurate data compared to limb
   circumference measurement and has excellent reported reliability, but
   underestimated data acquired via more invasive muscle biopsy.
   Conclusion: Ultrasound provides clinical utility for assessing the
   trajectory of change in peripheral skeletal muscle architecture during
   critical illness, supplementing more detailed characterization, albeit
   rarely used, from muscle biopsy analysis. Adoption of standardized
   operating protocols for measurement will facilitate future meta-analysis
   of data.
TC 0
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Z8 0
ZS 0
Z9 0
SN 0090-3493
UT WOS:000351004100029
PM 25559437
ER

PT J
AU Creutzfeldt, Claire J.
   Hough, Catherine L.
TI Get Out of Bed: Immobility in the Neurologic ICU
SO CRITICAL CARE MEDICINE
VL 43
IS 4
BP 926
EP 927
DI 10.1097/CCM.0000000000000836
PD APR 2015
PY 2015
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0090-3493
UT WOS:000351004100042
PM 25768363
ER

PT J
AU Barreiro, Esther
   Sznajder, Jacob I.
   Nader, Gustavo A.
   Budinger, G. R. Scott
TI Muscle Dysfunction in Patients with Lung Diseases A Growing Epidemic
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 191
IS 6
BP 616
EP 619
DI 10.1164/rccm.201412-2189OE
PD MAR 15 2015
PY 2015
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1073-449X
UT WOS:000351257200007
PM 25767924
ER

PT J
AU Segers, Johan
   Hermans, Greet
   Charususin, Noppawan
   Fivez, Tom
   Vanhorebeek, Ilse
   Van den Berghe, Greet
   Gosselink, Rik
TI Assessment of quadriceps muscle mass with ultrasound in critically ill
   patients: intra- and inter-observer agreement and sensitivity
SO INTENSIVE CARE MEDICINE
VL 41
IS 3
BP 562
EP 563
DI 10.1007/s00134-015-3668-6
PD MAR 2015
PY 2015
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0342-4642
UT WOS:000350695300035
PM 25631814
ER

PT J
AU Brogden, Thomas G.
   Bunin, J.
   Kwon, H.
   Lundy, J.
   Johnston, A. Mcd
   Bowley, D. M.
TI Strategies for ventilation in acute, severe lung injury after combat
   trauma
SO JOURNAL OF THE ROYAL ARMY MEDICAL CORPS
VL 161
IS 1
BP 14
EP 21
DI 10.1136/jramc-2013-000159
PD MAR 2015
PY 2015
AB Post-traumatic Acute Respiratory Distress Syndrome (ARDS) continues to
   be a major critical care challenge with a high associated mortality and
   extensive morbidity for those who survive. This paper explores the
   evolution in recognition and management of this condition and makes some
   recommendations for treatment of post-combat ARDS for military
   practitioners. It is aimed at the generalist in disciplines other than
   critical care, but will also be of interest to intensivists.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0035-8665
UT WOS:000350575400005
PM 24222262
ER

PT J
AU Thille, Arnaud W.
   Boissier, Florence
   Ben Ghezala, Hassen
   Razazi, Keyvan
   Mekontso-Dessap, Armand
   Brun-Buisson, Christian
TI Risk Factors for and Prediction by Caregivers of Extubation Failure in
   ICU Patients: A Prospective Study
SO CRITICAL CARE MEDICINE
VL 43
IS 3
BP 613
EP 620
DI 10.1097/CCM.0000000000000748
PD MAR 2015
PY 2015
AB Objective: The influence of delirium, ICU-acquired paresis, and cardiac
   performance on extubation outcome has never been evaluated together. We
   aimed to assess the respective role of these factors on the risk of
   extubation failure and to assess the predictive accuracy of caregivers.
   Design and Setting: Prospective observational study of all planned
   extubations in a 13-bed medical ICU of a teaching hospital.
   Interventions: On the day of extubation, muscle strength of the four
   limbs, criteria for delirium, cardiac performance, cough strength, and
   the risk of extubation failure predicted by caregivers were
   prospectively assessed. Extubation failure was defined as the need for
   reintubation within the following 7 days.
   Measurements and Main Results: Over the 18-month study period, 533
   patients required intubation. Among the 225 patients intubated for more
   than 24 hours who experienced a planned extubation attempt, 31 patients
   (14%) required reintubation within the 7 days following extubation. In
   multivariate analysis, duration of mechanical ventilation more than 7
   days prior to extubation, ineffective cough, and severe systolic left
   ventricular dysfunction were the three independent factors associated
   with extubation failure. Although patients considered at high risk for
   extubation failure had higher reintubation rate, prediction of
   extubation failure by caregivers at time of extubation had high
   specificity but low sensitivity.
   Conclusions: An ineffective cough, a prior duration of mechanical
   ventilation more than 7 days, and severe systolic left ventricular
   dysfunction were stronger predictors of extubation failure than delirium
   or ICU-acquired weakness. Only one-third patients who required
   reintubation were considered at high risk for extubation failure by
   caregivers.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0090-3493
UT WOS:000349963600026
PM 25479115
ER

PT J
AU Bloch, S. A. A.
   Lee, J. Y.
   Syburra, T.
   Rosendahl, U.
   Griffiths, M. J. D.
   Kemp, P. R.
   Polkey, M. I.
TI Increased expression of GDF-15 may mediate ICU-acquired weakness by
   down-regulating muscle microRNAs
SO THORAX
VL 70
IS 3
BP 219
EP 228
DI 10.1136/thoraxjnl-2014-206225
PD MAR 2015
PY 2015
AB Rationale The molecular mechanisms underlying the muscle atrophy of
   intensive care unit-acquired weakness (ICUAW) are poorly understood. We
   hypothesised that increased circulating and muscle growth and
   differentiation factor-15 (GDF-15) causes atrophy in ICUAW by changing
   expression of key microRNAs.
   Objectives To investigate GDF-15 and microRNA expression in patients
   with ICUAW and to elucidate possible mechanisms by which they cause
   muscle atrophy in vivo and in vitro.
   Methods In an observational study, 20 patients with ICUAW and seven
   elective surgical patients (controls) underwent rectus femoris muscle
   biopsy and blood sampling. mRNA and microRNA expression of target genes
   were examined in muscle specimens and GDF-15 protein concentration
   quantified in plasma. The effects of GDF-15 on C2C12 myotubes in vitro
   were examined.
   Measurements and main results Compared with controls, GDF-15 protein was
   elevated in plasma (median 7239 vs 2454 pg/mL, p=0.001) and GDF-15 mRNA
   in the muscle (median twofold increase p=0.006) of patients with ICUAW.
   The expression of microRNAs involved in muscle homeostasis was
   significantly lower in the muscle of patients with ICUAW. GDF-15
   treatment of C2C12 myotubes significantly elevated expression of muscle
   atrophy-related genes and down-regulated the expression of muscle
   microRNAs. miR-181a suppressed transforming growth factor-beta
   (TGF-beta) responses in C2C12 cells, suggesting increased sensitivity to
   TGF-beta in ICUAW muscle. Consistent with this suggestion, nuclear
   phospho-small mothers against decapentaplegic (SMAD) 2/3 was increased
   in ICUAW muscle.
   Conclusions GDF-15 may increase sensitivity to TGF-beta signalling by
   suppressing the expression of muscle microRNAs, thereby promoting muscle
   atrophy in ICUAW. This study identifies both GDF-15 and associated
   microRNA as potential therapeutic targets.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 0040-6376
UT WOS:000349850300007
PM 25516419
ER

PT J
AU Casaer, Michael P.
TI Muscle weakness and nutrition therapy in ICU
SO CURRENT OPINION IN CLINICAL NUTRITION AND METABOLIC CARE
VL 18
IS 2
BP 162
EP 168
DI 10.1097/MCO.0000000000000150
PD MAR 2015
PY 2015
AB Purpose of review
   Muscle wasting is common in severe critical illness. ICU-acquired
   weakness (ICU-AW) contributes to acute and long-term morbidity and
   mortality. The question remains whether nutrition therapy in ICU can
   prevent or attenuate these complications. This review aims at
   integrating the most recent clinical data in order to answer this
   important clinical and research question. Clinical evidence was obtained
   from randomized controlled trials (RCTs). Results from animal
   experiments and observational studies are referred to when respectively
   - providing possible explanatory mechanisms or new hypotheses.
   Recent findings
   Although muscle wasting has been reproducibly quantified early in ICU,
   its relationship with ICU-AW has not yet been convincingly established.
   All recent RCTs evaluating increased energy/protein intake during ICU
   week 1 failed to demonstrate a protective effect against ICU-AW or
   physical function limitations. In one RCT, early parenteral nutrition
   increased the incidence of ICU-AW. The latter finding might be explained
   by suppressed autophagy.
   Summary
   Current evidence does not support improved physical function with
   increased energy/protein provision in the first ICU week. Future RCTs
   aimed at reducing the burden of ICU-AW and improving long-term function
   should particularly focus on nutrition beyond the acute phase of
   critical illness and on non-nutritional interventions such as early
   mobilization.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1363-1950
UT WOS:000349402000009
PM 25603227
ER

PT J
AU Elke, Gunnar
   Kott, Matthias
   Weiler, Norbert
TI When and how should sepsis patients be fed?
SO CURRENT OPINION IN CLINICAL NUTRITION AND METABOLIC CARE
VL 18
IS 2
BP 169
EP 178
DI 10.1097/MCO.0000000000000151
PD MAR 2015
PY 2015
AB Purpose of review
   To provide an overview on the recent literature regarding metabolism
   during sepsis and outcome-related effects of nutrition therapy in septic
   patients. The question when and how these patients should be fed with
   respect to macronutrient intake is elaborated.
   Recent findings
   Although the incidence of severe sepsis has steadily increased over the
   past years, still no strong evidence is available with respect to the
   role of energy and protein provision in these patients. On the basis of
   recent large randomized trials in mixed patient populations, the updated
   sepsis guidelines recommend early but limited nutrition via the enteral
   route rather than targeted feeding. Lately, the results of a large trial
   challenged the importance of the route of feeding on the clinical
   outcome of critically ill patients. Four post-hoc analyses of
   prospective randomized trials including a large number of severely
   septic patients yielded conflicting results. One reported significant
   mortality reduction with near-target calorie and protein intake by
   exclusive enteral nutrition, whereas the second showed an advantage of
   enteral compared to combined nutrition, albeit resulting in a lower
   calorie and protein provision. The other two analyses found no
   association at all of either lower or higher daily caloric or protein
   intake, respectively, with clinical outcomes.
   Summary
   In the absence of strong clinical evidence, pathophysiological findings
   are discussed and nutritional strategies for septic patients derived.
   Future studies should explore the individual response to specific
   exogenous supply of macronutrients and micronutrients in the acute and
   persistent phase of severe systemic inflammation.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1363-1950
UT WOS:000349402000010
PM 25635596
ER

PT J
AU Barclay, Linda
   McDonald, Rachael
   Lentin, Primrose
TI Social and community participation following spinal cord injury: a
   critical review
SO INTERNATIONAL JOURNAL OF REHABILITATION RESEARCH
VL 38
IS 1
BP 1
EP 19
DI 10.1097/MRR.0000000000000085
PD MAR 2015
PY 2015
AB Evaluation of rehabilitation outcomes following acquired disability
   should include participation in social and community life. Evidence is
   needed to guide clinical practice to ensure that it is client-centered;
   therefore, findings from studies that report on social and community
   participation following spinal cord injury (SCI) need to be reviewed and
   synthesized. The objectives of this critical literature review are to
   examine the available evidence on social and community participation
   following SCI and to examine the factors that influence that
   participation. The barriers and facilitators will be identified and
   described in terms of the contextual factors - personal or
   environmental, as outlined by the International Classification of
   Functioning, Disability and Health. An additional objective is to
   appraise the quality of the evidence examined. A systematic literature
   search was completed in the databases OVID MEDLINE, AMED, CINAHL PLUS,
   PSYCHINFO, and hand searches were carried out. Quantitative,
   qualitative, and mixed methods studies were included. Twenty-three
   studies fulfilled the inclusion criteria: 17 quantitative, five
   qualitative, and one mixed methods. In general, studies were of low
   methodological quality, and no intervention studies were identified. The
   terms participation, social participation, and community participation
   were used interchangeably often without clarification of meaning.
   Adequate personal care assistance, appropriate social support, having
   adequate specialized equipment, and appropriate occupational therapy
   input were found to facilitate social and community participation,
   whereas problems with transport, inaccessibility of the natural and
   built environment, issues with healthcare services and rehabilitation
   providers, and pain were identified as barriers. In-depth investigation
   into what aspects of social and community participation are important to
   those living with SCI is needed so that client-focused solutions and
   interventions can be identified and developed, aimed at creating and
   promoting opportunities for social and community participation.
   Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0342-5282
UT WOS:000349395900001
PM 25305008
ER

PT J
AU Winkelman, Chris
   Johnson, Kimberly D.
   Gordon, Nahida
TI Associations Between Muscle-Related Cytokines and Selected Patient
   Outcomes in the ICU
SO BIOLOGICAL RESEARCH FOR NURSING
VL 17
IS 2
BP 125
EP 134
DI 10.1177/1099800414532709
PD MAR 2015
PY 2015
AB Introduction: Systemic cytokines produced by contracting skeletal
   muscles may affect the onset and severity of intensive care unit
   (ICU)-acquired weakness after critical illness.
   Aims: The purpose of this research was to determine the serum levels of
   interleukin (IL)-8, IL-15, and tumor necrosis factor- (TNF-) among
   patients receiving mechanical ventilation for >48 hr and examine the
   relationships of these myokines to outcomes of patient delirium, muscle
   strength, activities of daily living (ADLs), duration of mechanical
   ventilation, and length of ICU stay.
   Methods: In this exploratory, repeated-measures interventional study,
   the 36 participants received 20 min of once-daily in-bed or out-of-bed
   activity using an established early progressive mobility protocol after
   physiologic stability had been demonstrated for >4 hr in the ICU. Blood
   samples were drawn on 3 consecutive days, beginning on the day of study
   enrollment, for serum cytokine quantification.
   Results: IL-8, IL-15, and TNF- were highly variable and consistently
   elevated in participants compared to normal healthy adults. About 1/3 of
   participants were positive for significant muscle weakness at discharge
   from ICU. Repeated values of mean postactivity IL-8 serum values were
   significantly associated only with ADL following ICU discharge. There
   were no significant associations with repeated values of mean
   postactivity IL-15 or TNF- serum values and outcomes.
   Conclusion: Results provide preliminary data for exploring the potential
   effects of elevated serum values IL-8 and IL-15 in muscle health and
   TNF- for muscle damage, including effect sizes to calculate the sample
   sizes needed for future studies.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1099-8004
UT WOS:000349332300001
PM 24875632
ER

PT J
CA TEAM Study Investigators
TI Early mobilization and recovery in mechanically ventilated patients in
   the ICU: a bi-national, multi-centre, prospective cohort study
SO CRITICAL CARE
VL 19
AR 81
DI 10.1186/s13054-015-0765-4
PD FEB 26 2015
PY 2015
AB Introduction: The aim of this study was to investigate current
   mobilization practice, strength at ICU discharge and functional recovery
   at 6 months among mechanically ventilated ICU patients.
   Method: This was a prospective, multi-centre, cohort study conducted in
   twelve ICUs in Australia and New Zealand. Patients were previously
   functionally independent and expected to be ventilated for >48 hours. We
   measured mobilization during invasive ventilation, sedation depth using
   the Richmond Agitation and Sedation Scale (RASS), co-interventions,
   duration of mechanical ventilation, ICU-acquired weakness (ICUAW) at ICU
   discharge, mortality at day 90, and 6-month functional recovery
   including return to work.
   Results: We studied 192 patients (mean age 58.1 +/- 15.8 years; mean
   Acute Physiology and Chronic Health Evaluation (APACHE) (IQR) II score,
   18.0 (14 to 24)). Mortality at day 90 was 26.6% (51/192). Over 1,351
   study days, we collected information during 1,288 planned early
   mobilization episodes in patients on mechanical ventilation for the
   first 14 days or until extubation (whichever occurred first). We
   recorded the highest level of early mobilization. Despite the presence
   of dedicated physical therapy staff, no mobilization occurred in 1,079
   (84%) of these episodes. Where mobilization occurred, the maximum levels
   of mobilization were exercises in bed (N = 94, 7%), standing at the bed
   side (N = 11, 0.9%) or walking (N = 26, 2%). On day three, all patients
   who were mobilized were mechanically ventilated via an endotracheal tube
   (N = 10), whereas by day five 50% of the patients mobilized were
   mechanically ventilated via a tracheostomy tube (N = 18).
   In 94 of the 156 ICU survivors, strength was assessed at ICU discharge
   and 48 (52%) had ICU-acquired weakness (Medical Research Council Manual
   Muscle Test Sum Score (MRC-SS) score <48/60). The MRC-SS score was
   higher in those patients who mobilized while mechanically ventilated
   (50.0 +/- 11.2 versus 42.0 +/- 10.8, P = 0.003). Patients who survived
   to ICU discharge but who had died by day 90 had a mean MRC score of 28.9
   +/- 13.2 compared with 44.9 +/- 11.4 for day-90 survivors (P < 0.0001).
   Conclusions: Early mobilization of patients receiving mechanical
   ventilation was uncommon. More than 50% of patients discharged from the
   ICU had developed ICU-acquired weakness, which was associated with death
   between ICU discharge and day-90.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1466-609X
UT WOS:000351921900001
ER

PT J
AU Parry, Selina M.
   Berney, Sue
   Granger, Catherine L.
   Dunlop, Danielle L.
   Murphy, Laura
   El-Ansary, Doa
   Koopman, Rene
   Denehy, Linda
TI A new two-tier strength assessment approach to the diagnosis of weakness
   in intensive care: an observational study
SO CRITICAL CARE
VL 19
AR 52
DI 10.1186/s13054-015-0780-5
PD FEB 26 2015
PY 2015
AB Introduction: Intensive care unit-acquired weakness (ICU-AW) is a
   significant problem. There is currently widespread variability in the
   methods used for manual muscle testing and handgrip dynamometry (HGD) to
   diagnose ICU-AW. This study was conducted in two parts. The aims of this
   study were: to determine the inter-rater reliability and agreement of
   manual muscle strength testing using both isometric and through-range
   techniques using the Medical Research Council sum score and a new
   four-point scale, and to examine the validity of HGD and determine a
   cutoff score for the diagnosis of ICU-AW for the new four-point scale.
   Methods: Part one involved evaluation of muscle strength by two physical
   therapists in 29 patients ventilated >48 hours. Manual strength testing
   was performed by both physical therapists using two techniques:
   isometric and through range; and two scoring systems: traditional
   six-point Medical Research Council scale and a new collapsed four-point
   scale. Part two involved assessment of handgrip strength conducted on 60
   patients. A cutoff score for ICU-AW was identified for the new
   four-point scoring system.
   Results: The incidence of ICU-AW was 42% (n = 25/60) in this study
   (based on HGD). In part one the highest reliability and agreement was
   observed for the isometric technique using the four-point scale
   (intraclass correlation coefficient = 0.90: kappa = 0.72 respectively).
   Differences existed between isometric and through-range scores (mean
   difference = 1.76 points, P = 0.005). In part two, HGD had a sensitivity
   of 0.88 and specificity of 0.80 for diagnosing ICU-AW. A cutoff score of
   24 out of 36 points was identified for the four-point scale.
   Conclusions: The isometric technique is recommended with reporting on a
   collapsed four-point scale. Because HGD is easy to perform and
   sensitive, we recommend a new two-tier approach to diagnosing ICU-AW
   that first tests handgrip strength with follow-up strength assessment
   using the isometric technique for muscle strength testing if handgrip
   strength falls below cutoff scores. Whilst our results for the
   four-point scale are encouraging, further research is required to
   confirm the findings of this study and determine the validity of the
   four-point scoring system and cutoff score developed of less than 24 out
   of 36 before recommending adoption into clinical practice.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1466-609X
UT WOS:000351916400001
PM 25882719
ER

PT J
AU Beach, L.
   Granger, C.
   Sorohan, M.
TI An exploration of provision of physiotherapy treatment to patients with
   Intensive Care Unit acquired weakness: An observational study
SO AUSTRALIAN CRITICAL CARE
VL 28
IS 1
BP 44
EP 44
DI 10.1016/j.aucc.2014.10.019
PD FEB 2015
PY 2015
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1036-7314
UT WOS:000351228600024
ER

PT J
AU De Tanti, A.
   Zampolini, M.
   Pregno, S.
CA CC3 Grp
TI Recommendations for clinical practice and research in severe brain
   injury in intensive rehabilitation: the Italian Consensus Conference
SO EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
VL 51
IS 1
BP 89
EP 103
PD FEB 2015
PY 2015
AB The paper reports the final statements of the jury of a National
   Consensus Conference organized in November 2010 at Salsomaggiore (Parma)
   to draw up recommendations on the rehabilitation programs for acquired
   brain injury (sABI) patients in the intensive hospital phase. Because of
   the few clinical studies of good quality found by means of the
   literature research we choose a mixed approach: a systematic review of
   the published studies and a consensus conference in order to obtain
   recommendations that come, from the clinical evidence and the expert
   opinion. The final recommendations of the jury, based on the best
   available evidence combined with clinical expertise and the experience
   of persons with disabilities and other stalteholders cover 13 topics: 1)
   Management of paroxysmal manifestations (sympathetic storms); 2)
   management, of neuroendocrine problems; 3) nutrition; 4) swallowing; 5)
   ventilation/respiration, 6) clinical and instrument diagnosis and
   prognosis of (VS) and minimally conscious state and pharmacological
   facilitation of renewed contact with surroundings; 8) neuro-surgical
   complications and hydrocephalus; 9) sensorimotor impairment and
   disability; 10) rehabilitation methods; 11) assessment and treatment of
   cognitive-behavioural impairment and disability; 12) methodology and
   organization of care; 13) involving family and caregivers in
   rehabilitation.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1973-9087
UT WOS:000351031500011
PM 25184800
ER

PT J
AU Citerio, Giuseppe
   Bakker, Jan
   Bassetti, Matteo
   Benoit, Dominique
   Cecconi, Maurizio
   Curtis, J. Randall
   Doig, Gordon S.
   Herridge, Margaret
   Jaber, Samir
   Joannidis, Michael
   Papazian, Laurent
   Perner, Anders
   Peters, Mark J.
   Singer, Pierre
   Smith, Martin
   Soares, Marcio
   Torres, Antoni
   Vieillard-Baron, Antoine
   Timsit, Jean-Francois
   Azoulay, Elie
TI Year in review in Intensive Care Medicine 2014: I. Cardiac dysfunction
   and cardiac arrest, ultrasound, neurocritical care, ICU-acquired
   weakness, nutrition, acute kidney injury, and miscellaneous
SO INTENSIVE CARE MEDICINE
VL 41
IS 2
BP 179
EP 191
DI 10.1007/s00134-015-3665-9
PD FEB 2015
PY 2015
RI Soares, Marcio/B-3083-2013; Citerio, Giuseppe/B-1839-2015; Bakker, Jan/A-4011-2009
OI Soares, Marcio/0000-0003-2503-6088; Bakker, Jan/0000-0003-2236-7391
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0342-4642
UT WOS:000350694200001
PM 25634473
ER

PT J
AU Jolley, Sarah E
   Dale, Christopher R
   Hough, Catherine L
TI Hospital-level factors associated with report of physical activity in
   patients on mechanical ventilation across Washington State.
SO Annals of the American Thoracic Society
VL 12
IS 2
BP 209
EP 15
DI 10.1513/AnnalsATS.201410-480OC
PD 2015-Feb
PY 2015
AB RATIONALE: Use of physical and/or occupational therapy in the intensive
   care unit (ICU) is safe, feasible, and demonstrates improvements in
   functional status with early administration. Access to physical and/or
   occupational therapy in the ICU is variable, with little known regarding
   its use in community ICUs.
   OBJECTIVES: Determine what proportion of hospitals across Washington
   State report use of physical activity in mechanically ventilated
   patients and investigate process of care factors associated with
   reported activity delivery.
   METHODS: Cross-sectional telephone interview survey study of nurse
   managers in hospitals caring for patients on mechanical ventilation
   across Washington State in 2013. Survey responses were linked with
   hospital-level data available in the Washington State Department of
   Health Comprehensive Hospital Abstract Reporting System database.
   Chi-square testing was used to explore unadjusted associations between
   potential process of care factors and report on activity delivery. Two
   multivariable logistic regression models were developed to explore the
   association between presence of a mobility protocol and report on
   delivery of activity.
   MEASUREMENTS AND MAIN RESULTS: We identified 54 hospitals caring for
   patients on mechanical ventilation; 47 participated in the survey
   (response rate, 85.5%). Nurse managers from 36 (76.6%) hospitals
   reported use of physical activity in patients on mechanical ventilation,
   with 22 (46.8%) reporting use of high-level physical activity
   (transferring to chair, standing or ambulating) and 24 (51.1%) reporting
   use in high-severity patients (patients requiring mechanical ventilation
   and/or vasopressors). Presence of a written ICU activity protocol (odds
   ratio [OR], 5.54; 95% confidence interval [CI], 1.60-19.18; P=0.006),
   hospital volume (OR, 5.33; 95% CI, 1.54-18.48; P=0.008), and academic
   affiliation (OR, 4.40; 95% CI, 1.23-15.63; P=0.02) were associated with
   report of higher level activity. Presence of a written ICU activity
   protocol (OR, 6.00; 95% CI, 1.69-21.14; P=0.005) and academic
   affiliation (OR, 4.50; 95% CI, 1.21-16.46; P=0.02) were associated with
   report of delivery of physical activity to high-severity patients.
   CONCLUSIONS: Nurse managers at three-fourths (76.6%) of eligible
   hospitals across Washington State reported use of physical activity in
   patients on mechanical ventilation. Hospital-level factors including
   hospital volume, academic affiliation, and presence of a mobility
   protocol were associated with report of higher level activity and
   delivery of activity to high-severity patients.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:25565021
PM 25565021
ER

PT J
AU Penuelas, Oscar
   Thille, Arnaud W.
   Esteban, Andres
TI Discontinuation of ventilatory support: new solutions to old dilemmas
SO CURRENT OPINION IN CRITICAL CARE
VL 21
IS 1
BP 74
EP 81
DI 10.1097/MCC.0000000000000169
PD FEB 2015
PY 2015
AB Purpose of reviewWeaning from mechanical ventilation implies two
   separate but closely related aspects of care, the discontinuation of
   mechanical ventilation and removal of artificial airway, which implies
   routine clinical dilemmas. Extubation delay and extubation failure are
   associated with poor clinical outcomes. We sought to summarize recent
   evidence on weaning.Recent findingsTolerance to an unassisted breathing
   does not require routine use of weaning predictors and can be addressed
   using weaning protocols or by implementing automatic weaning methods.
   Spontaneous breathing trial can be performed on low levels of pressure
   support, continuous positive airway pressure, or T-piece.
   Echocardiographic tools may help to prevent the failure of extubation.
   Noninvasive ventilation can prevent respiratory failure after
   extubation, when used in hypercapnic patients. Recently, sedation
   protocols and early mobilization in ventilated critically ill patients
   may decrease weaning period and duration of mechanical ventilation, and
   prevent extubation failure and complications such as ICU-acquired
   weakness. New techniques have been performed to identify patients with
   high risk for extubation failure.SummaryThere is an interesting body of
   clinical research in the discontinuation of mechanical ventilation.
   Recent randomized controlled studies provide high-level evidence for the
   best approaches to weaning, especially in patients who fail the first
   spontaneous breathing trial or targeted populations.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1070-5295
UT WOS:000346977300012
PM 25546535
ER

PT J
AU Kho, Michelle E.
   Truong, Alexander D.
   Zanni, Jennifer M.
   Ciesla, Nancy D.
   Brower, Roy G.
   Palmer, Jeffrey B.
   Needham, Dale M.
TI Neuromuscular electrical stimulation in mechanically ventilated
   patients: A randomized, sham-controlled pilot trial with blinded outcome
   assessment
SO JOURNAL OF CRITICAL CARE
VL 30
IS 1
BP 32
EP 39
DI 10.1016/j.jcrc.2014.09.014
PD FEB 2015
PY 2015
AB Purpose: The purpose of the study is to compare neuromuscular electrical
   stimulation (NMES) vs sham on leg strength at hospital discharge in
   mechanically ventilated patients.
   Materials and methods: We conducted a randomized pilot study of NMES vs
   sham applied to 3 bilateral lower extremity muscle groups for 60 minutes
   daily in the intensive care unit (ICU). Between June 2008 and March
   2013, we enrolled adults who were receiving mechanical ventilation
   within the first week of ICU stay and who could transfer independently
   from bed to chair before hospital admission. The primary outcome was
   lower extremity muscle strength at hospital discharge using Medical
   Research Council score (maximum, 30). Secondary outcomes at hospital
   discharge included walking distance and change in lower extremity
   strength from ICU awakening. Clinicaltrials.gov: NCT00709124.
   Results: We stopped enrollment early after 36 patients due to slow
   patient accrual and the end of research funding. For NMES vs sham, mean
   (SD) lower extremity strength was 28 (2) vs 27 (3), P = .072. Among
   secondary outcomes, NMES vs sham patients had a greater mean (SD)
   walking distance (514 [389] vs 251 [210] ft, P = .050) and increase in
   muscle strength (5.7 [5.1] vs 1.8 [2.7], P = .019).
   Conclusions: In this pilot randomized trial, NMES did not significantly
   improve leg strength at hospital discharge. Significant improvements in
   secondary outcomes require investigation in future research. (C) 2014
   Elsevier Inc. All rights reserved.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0883-9441
UT WOS:000346238900007
PM 25307979
ER

PT J
AU Caminita, Frank
   van der Merwe, Marie
   Hance, Brittany
   Krishnan, Ramesh
   Miller, Sarah
   Buddington, Karyl
   Buddington, Randal K.
TI A preterm pig model of lung immaturity and spontaneous infant
   respiratory distress syndrome
SO AMERICAN JOURNAL OF PHYSIOLOGY-LUNG CELLULAR AND MOLECULAR PHYSIOLOGY
VL 308
IS 2
BP L118
EP L129
DI 10.1152/ajplung.00173.2014
PD JAN 15 2015
PY 2015
AB Respiratory distress syndrome (RDS) and bronchopulmonary dysplasia
   remain the leading causes of preterm infant morbidity, mortality, and
   lifelong disability. Research to improve outcomes requires translational
   large animal models for RDS. Preterm pigs delivered by caesarian section
   at gestation days (GD) 98, 100, 102, and 104 were provided 24 h of
   neonatal intensive care, monitoring (pulse oximetry, blood gases, serum
   biomarkers, radiography), and nutritional support, with or without
   intubation and mechanical ventilation (MV; pressure control ventilation
   with volume guarantee). Spontaneous development of RDS and mortality
   without MV are inversely related with GD at delivery and correspond with
   inadequacy of tidal volume and gas exchange. GD 98 and 100 pigs have
   consolidated lungs, immature alveolar architecture, and minimal
   surfactant protein-B expression, and MV is essential at GD 98. Although
   GD 102 pigs had some alveoli lined by pneumocytes and surfactant was
   released in response to MV, blood gases and radiography revealed limited
   recruitment 1-2 h after delivery, and mortality at 24 h was 66% (35/53)
   with supplemental oxygen provided by a mask and 69% (9/13) with bubble
   continuous positive airway pressure (8-9 cmH(2)O). The lungs at GD 104
   had higher densities of thin-walled alveoli that secreted surfactant,
   and MV was not essential. Between GD 98 and 102, preterm pigs have
   ventilation inadequacies and risks of RDS that mimic those of preterm
   infants born during the saccular phase of lung development, are
   compatible with standards of neonatal intensive care, and are
   alternative to fetal nonhuman primates and lambs.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1040-0605
UT WOS:000348147900002
PM 25398985
ER

PT J
AU Castro-Avila, Ana Cristina
   Seron, Pamela
   Fan, Eddy
   Gaete, Monica
   Mickan, Sharon
TI Effect of Early Rehabilitation during Intensive Care Unit Stay on
   Functional Status: Systematic Review and Meta-Analysis.
SO PloS one
VL 10
IS 7
BP e0130722
EP e0130722
DI 10.1371/journal.pone.0130722
PD 2015
PY 2015
AB BACKGROUND AND AIM: Critically ill survivors may have functional
   impairments even five years after hospital discharge. To date there are
   four systematic reviews suggesting a beneficial impact for mobilisation
   in mechanically ventilated and intensive care unit (ICU) patients,
   however there is limited information about the influence of timing,
   frequency and duration of sessions. Earlier mobilisation during ICU stay
   may lead to greater benefits. This study aims to determine the effect of
   early rehabilitation for functional status in ICU/high-dependency unit
   (HDU) patients.
   DESIGN: Systematic review and meta-analysis. MEDLINE, EMBASE, CINALH,
   PEDro, Cochrane Library, AMED, ISI web of science, Scielo, LILACS and
   several clinical trial registries were searched for randomised and
   non-randomised clinical trials of rehabilitation compared to usual care
   in adult patients admitted to an ICU/HDU. Results were screened by two
   independent reviewers. Primary outcome was functional status. Secondary
   outcomes were walking ability, muscle strength, quality of life, and
   healthcare utilisation. Data extraction and methodological quality
   assessment using the PEDro scale was performed by primary reviewer and
   checked by two other reviewers. The authors of relevant studies were
   contacted to obtain missing data.
   RESULTS: 5733 records were screened. Seven articles were included in the
   narrative synthesis and six in the meta-analysis. Early rehabilitation
   had no significant effect on functional status, muscle strength, quality
   of life, or healthcare utilisation. However, early rehabilitation led to
   significantly more patients walking without assistance at hospital
   discharge (risk ratio 1.42; 95% CI 1.17-1.72). There was a
   non-significant effect favouring intervention for walking distance and
   incidence of ICU-acquired weakness.
   CONCLUSIONS: Early rehabilitation during ICU stay was not associated
   with improvements in functional status, muscle strength, quality of life
   or healthcare utilisation outcomes, although it seems to improve walking
   ability compared to usual care. Results from ongoing studies may provide
   more data on the potential benefits of early rehabilitation in
   critically ill patients.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:26132803
PM 26132803
ER

PT J
AU Mehrholz, Jan
   Pohl, Marcus
   Kugler, Joachim
   Burridge, Jane
   Mueckel, Simone
   Elsner, Bernhard
TI Physical rehabilitation for critical illness myopathy and neuropathy
SO COCHRANE DATABASE OF SYSTEMATIC REVIEWS
IS 3
AR CD010942
DI 10.1002/14651858.CD010942.pub2
PD 2015
PY 2015
AB Background
   Intensive care unit (ICU) acquired or generalised weakness due to
   critical illness myopathy (CIM) and polyneuropathy (CIP) are major
   causes of chronically impaired motor function that can affect activities
   of daily living and quality of life. Physical rehabilitation of those
   affected might help to improve activities of daily living.
   Objectives
   Our primary objective was to assess the effects of physical
   rehabilitation therapies and interventions for people with CIP and CIM
   in improving activities of daily living such as walking, bathing,
   dressing and eating. Secondary objectives were to assess effects on
   muscle strength and quality of life, and to assess adverse effects of
   physical rehabilitation.
   Search methods
   On 16 July 2014 we searched the Cochrane Neuromuscular Disease Group
   Specialized Register and on 14 July 2014 we searched CENTRAL, MEDLINE,
   EMBASE and CINAHL Plus. In July 2014, we searched the Physiotherapy
   Evidence Database (PEDro, http://www.pedro.org.au/) and three trials
   registries for ongoing trials and further data about included studies.
   There were no language restrictions. We also handsearched relevant
   conference proceedings and screened reference lists to identify further
   trials.
   Selection criteria
   We planned to include randomised controlled trials (RCTs), quasi-RCTs
   and randomised controlled cross-over trials of any rehabilitation
   intervention in people with acquired weakness syndrome due to CIP/CIM.
   Data collection and analysis
   We would have extracted data, assessed the risk of bias and classified
   the quality of evidence for outcomes in duplicate, according to the
   standard procedures of The Cochrane Collaboration. Outcome data
   collection would have been for activities of daily living (for example,
   mobility, walking, transfers and self care). Secondary outcomes included
   muscle strength, quality of life and adverse events.
   Main results
   The search strategy retrieved 3587 references. After examination of
   titles and abstracts, we retrieved the full text of 24 potentially
   relevant studies. None of these studies met the inclusion criteria of
   our review. No data were suitable to be included in a meta-analysis.
   Authors' conclusions
   There are no published RCTs or quasi-RCTs that examine whether physical
   rehabilitation interventions improve activities of daily living for
   people with CIP and CIM. Large RCTs, which are feasible, need to be
   conducted to explore the role of physical rehabilitation interventions
   for people with CIP and CIM.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1469-493X
UT WOS:000352608900056
ER

PT J
AU Mehrholz, Jan
   Pohl, Marcus
   Kugler, Joachim
   Burridge, Jane
   Muckel, Simone
   Elsner, Bernhard
TI Physical rehabilitation for critical illness myopathy and neuropathy.
SO The Cochrane database of systematic reviews
VL 3
BP CD010942
EP CD010942
DI 10.1002/14651858.CD010942.pub2
PD 2015 Mar 04
PY 2015
AB BACKGROUND: Intensive care unit (ICU) acquired or generalised weakness
   due to critical illness myopathy (CIM) and polyneuropathy (CIP) are
   major causes of chronically impaired motor function that can affect
   activities of daily living and quality of life. Physical rehabilitation
   of those affected might help to improve activities of daily living.
   OBJECTIVES: Our primary objective was to assess the effects of physical
   rehabilitation therapies and interventions for people with CIP and CIM
   in improving activities of daily living such as walking, bathing,
   dressing and eating. Secondary objectives were to assess effects on
   muscle strength and quality of life, and to assess adverse effects of
   physical rehabilitation.
   SEARCH METHODS: On 16 July 2014 we searched the Cochrane Neuromuscular
   Disease Group Specialized Register and on 14 July 2014 we searched
   CENTRAL, MEDLINE, EMBASE and CINAHL Plus. In July 2014, we searched the
   Physiotherapy Evidence Database (PEDro, http://www.pedro.org.au/) and
   three trials registries for ongoing trials and further data about
   included studies. There were no language restrictions. We also
   handsearched relevant conference proceedings and screened reference
   lists to identify further trials.
   SELECTION CRITERIA: We planned to include randomised controlled trials
   (RCTs), quasi-RCTs and randomised controlled cross-over trials of any
   rehabilitation intervention in people with acquired weakness syndrome
   due to CIP/CIM.
   DATA COLLECTION AND ANALYSIS: We would have extracted data, assessed the
   risk of bias and classified the quality of evidence for outcomes in
   duplicate, according to the standard procedures of The Cochrane
   Collaboration. Outcome data collection would have been for activities of
   daily living (for example, mobility, walking, transfers and self care).
   Secondary outcomes included muscle strength, quality of life and adverse
   events.
   MAIN RESULTS: The search strategy retrieved 3587 references. After
   examination of titles and abstracts, we retrieved the full text of 24
   potentially relevant studies. None of these studies met the inclusion
   criteria of our review. No data were suitable to be included in a
   meta-analysis.
   AUTHORS' CONCLUSIONS: There are no published RCTs or quasi-RCTs that
   examine whether physical rehabilitation interventions improve activities
   of daily living for people with CIP and CIM. Large RCTs, which are
   feasible, need to be conducted to explore the role of physical
   rehabilitation interventions for people with CIP and CIM.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:25737049
PM 25737049
ER

PT J
AU Hodgson, Carol
   Bellomo, Rinaldo
   Berney, Susan
   Bailey, Michael
   Buhr, Heidi
   Denehy, Linda
   Harrold, Megan
   Higgins, Alisa
   Presneill, Jeff
   Saxena, Manoj
   Skinner, Elizabeth
   Young, Paul
   Webb, Steven
CA TEAM Study Investigators
TI Early mobilization and recovery in mechanically ventilated patients in
   the ICU: a bi-national, multi-centre, prospective cohort study.
SO Critical care (London, England)
VL 19
BP 81
EP 81
DI 10.1186/s13054-015-0765-4
PD 2015 Feb 26
PY 2015
AB INTRODUCTION: The aim of this study was to investigate current
   mobilization practice, strength at ICU discharge and functional recovery
   at 6months among mechanically ventilated ICU patients.
   METHOD: This was a prospective, multi-centre, cohort study conducted in
   twelve ICUs in Australia and New Zealand. Patients were previously
   functionally independent and expected to be ventilated for >48hours. We
   measured mobilization during invasive ventilation, sedation depth using
   the Richmond Agitation and Sedation Scale (RASS), co-interventions,
   duration of mechanical ventilation, ICU-acquired weakness (ICUAW) at ICU
   discharge, mortality at day 90, and 6-month functional recovery
   including return to work.
   RESULTS: We studied 192 patients (mean age 58.1±15.8years; mean Acute
   Physiology and Chronic Health Evaluation (APACHE) (IQR) II score, 18.0
   (14 to 24)). Mortality at day 90 was 26.6% (51/192). Over 1,351 study
   days, we collected information during 1,288 planned early mobilization
   episodes in patients on mechanical ventilation for the first 14days or
   until extubation (whichever occurred first). We recorded the highest
   level of early mobilization. Despite the presence of dedicated physical
   therapy staff, no mobilization occurred in 1,079 (84%) of these
   episodes. Where mobilization occurred, the maximum levels of
   mobilization were exercises in bed (N=94, 7%), standing at the bed side
   (N=11, 0.9%) or walking (N=26, 2%). On day three, all patients who were
   mobilized were mechanically ventilated via an endotracheal tube (N=10),
   whereas by day five 50% of the patients mobilized were mechanically
   ventilated via a tracheostomy tube (N=18).
   CONCLUSIONS: Early mobilization of patients receiving mechanical
   ventilation was uncommon. More than 50% of patients discharged from the
   ICU had developed ICU-acquired weakness, which was associated with death
   between ICU discharge and day-90.
   CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT01674608. Registered
   14 August 2012.
RI Presneill, Jeffrey/B-4894-2012
OI Presneill, Jeffrey/0000-0001-7177-7667
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:25715872
PM 25715872
ER

PT J
AU Singh, Shivinder
   Goyal, Rakhee
   Ramesh, G S
   Ravishankar, V
   Sharma, R M
   Bhargava, D V
   Singh, S K
   John, M K
   Sharma, Anoop
TI Control of hospital acquired infections in the ICU: Aservice
   perspective.
SO Medical journal, Armed Forces India
VL 71
IS 1
BP 28
EP 32
DI 10.1016/j.mjafi.2014.08.008
PD 2015-Jan
PY 2015
AB BACKGROUND: The service setting has some unique strengths and weaknesses
   that must be kept in mind when organizing Hospital acquired infections
   (HAI) prevention interventions.
   METHODS: Following an initial study to gather data regarding HAI in the
   Surgical intensive care unit (ICU) we put into place various infection
   control interventions. The present study was carried out to analyse the
   effect of these interventions on the incidence of HAI in the ICU.
   RESULTS: The total admissions to the ICU were 253 patients. Eighty eight
   patients (34.78%) were admitted for more than 48hr, 165 patients stayed
   for less than 48h. The frequency of HAI was 7.95% (95% CI 3.54, 15).
   Hospital acquired pneumonia was observed in 2 of the 88 patients (2.27%)
   (95% CI 0.38, 7.30) which amounted to 9.70 infections per 1000
   ventilator days. Bloodstream infection was detected in 3 out of 88
   patients (3.4%) (95% CI 0.87, 8.99) amounting to 6.54 fresh infections
   per 1000 Central Venous Catheter days. Urinary tract infection was
   observed in 2 (2.27%) (95% CI 0.38, 7.30) at 2.86 fresh infections per
   1000 catheter days. As compared to the previous study we found that
   there was a decline of HAI ranging from 60 to 70%.
   CONCLUSION: Our study demonstrated that by meticulously following
   infection control protocols especially tailored to the service setting
   the incidence of HAI's can be reduced. However, the challenge is in
   maintaining the gains achieved since there is a rapid turnover of
   manpower in the ICU and a lack of a structured ICU design model.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0377-1237
UT MEDLINE:25609860
PM 25609860
ER

PT J
AU Yosef-Brauner, Orna
   Adi, Nimrod
   Ben Shahar, Tamar
   Yehezkel, Ester
   Carmeli, Eli
TI Effect of physical therapy on muscle strength, respiratory muscles and
   functional parameters in patients with intensive care unit-acquired
   weakness
SO CLINICAL RESPIRATORY JOURNAL
VL 9
IS 1
BP 1
EP 6
DI 10.1111/crj.12091
PD JAN 2015
PY 2015
AB ObjectivesThe aim of this study was to evaluate the effect of an
   intensive physical therapy protocol in patients who contract intensive
   care unit-acquired weakness' (ICUAW), in terms of muscle strength,
   breathing and functional indices.
   MethodsThis was a prospective, single-blinded study in a general
   hospital intensive care unit (ICU). Patients who required mechanical
   ventilation longer than 48h and who were expected to remain mechanically
   ventilated for at least another 48h were randomly divided into two
   intervention groups: group I (n=9) - the routine care group, received
   physical therapy according to our daily custom protocol; and group II
   (n=9) - the intensive treatment group, were treated by the same protocol
   twice a day. The main outcome measures included the Medical Research
   Council (MRC) physical strength examination, maximal inspiratory
   pressure (MIP), hand grip dynamometer and sitting balance test.
   ResultsSignificant strength improvement from first (T1) to second (T2)
   measurements was demonstrated for variables MIP and MRC physical
   strength examination in favor of the intensive treatment group (P<0.05).
   The intensive treatment group also required shorter intensive care
   length of stay than the routine care group (P=0.043).
   ConclusionsIt is possible that an intensive therapy protocol may
   facilitate the initial recovery process in patients who suffer from
   ICUAW.
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 1752-6981
UT WOS:000347381800001
PM 24345055
ER

PT J
AU Koshiba, Mamiko
   Kakei, Hiroko
   Honda, Masakazu
   Karino, Genta
   Niitsu, Mamoru
   Miyaji, Toru
   Kishino, Hirohisa
   Nakamura, Shun
   Kunikata, Tetsuya
   Yamanouchi, Hideo
TI Early-infant diagnostic predictors of the neuro-behavioral development
   after neonatal care
SO BEHAVIOURAL BRAIN RESEARCH
VL 276
SI SI
BP 143
EP 150
DI 10.1016/j.bbr.2014.05.054
PD JAN 1 2015
PY 2015
AB Multidimensional diagnosis plays a central role in infant developmental
   care, which leads to the prediction of future disabilities. Information
   consolidated from objective and subjective, early and late, central and
   peripheral data may reveal neuro-pathological mechanisms and realize
   earlier and more precise preventive intervention.
   In the current study, we retrospectively searched correlating factors to
   the following neurological and behavioral development of 'Head Control'
   and 'Roll Over' using multivariate correlation analysis of different
   diagnostic domains over age, subject/object information of the patients
   who were previously admitted in our neonatal intensive care unit (NICU)
   and could be developmentally followed up in our outpatient clinic. Based
   on the hematologic and biochemical data, MRI brain anatomy during NICU
   hospitalization, we characterized all the acquired data distribution
   from 31 infants with either 'appeared neurologically normal (ANN, n =
   21)' or 'appeared neurologically abnormal (ANA, n = 10)' pro tempore,
   with a physician's clinical judgment before discharge. Besides single
   factor comparisons between ANN and ANA, we examined their development
   difference by using the multidimensional information processing,
   principal component analysis (PCA). The diagnostic predictors of
   neuro-behavioral development were selected by regression analysis with
   variable selection. It resulted that hematological and brain anatomical
   factors seemed correlated to both 'Head Control' and 'Roll Over'. This
   report suggested certain possibility of the cross-domain translational
   approach between subjective and objective developmental information
   through multivariate analyses, with candidate markers preliminarily to
   be evaluated in further studies. (C) 2014 The Authors. Published by
   Elsevier B.V. This is an open access article under the CC BY-NC-ND
   license (http://creativecommons.org/licenses/by-nc-nd/3.0/).
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0166-4328
UT WOS:000345478200016
PM 25594098
ER

PT J
AU Al-Dorzi, Hasan M.
   Tamim, Hani M.
   Mundekkadan, Shihab
   Sohail, Muhammad R.
   Arabi, Yaseen M.
TI Characteristics, management and outcomes of critically ill patients who
   are 80 years and older: a retrospective comparative cohort study
SO BMC ANESTHESIOLOGY
VL 14
AR 126
DI 10.1186/1471-2253-14-126
PD DEC 20 2014
PY 2014
AB Background: Older age is associated with chronic illnesses and
   disability, which contribute to increased admission to the intensive
   care unit (ICU). Our primary objective was to compare the
   characteristics, ICU management and outcomes of critically ill patients
   >= 80 year-old with those of younger patients.
   Methods: This was a retrospective cohort study of patients admitted to a
   tertiary-care ICU from 1999 to 2011. The characteristics, ICU management
   and outcomes of patients >= 80 year-old were compared with those 50-64.9
   and 65-79.9 year-old. Multivariate analysis was performed to determine
   the adjusted risk of Do-Not-Resuscitate orders and hospital mortality in
   patients >= 80 year-old compared with the younger groups.
   Results: During the study period, patients aged >= 80 years (N = 748)
   represented 7.9% of all ICU admissions and 12.8% of patients aged >= 50
   years. Chronic cardiac (32.2%) and respiratory (21.8%) diseases were
   more prevalent in them than the younger groups (p < 0.0001). The most
   common reasons for their ICU admission were cardiovascular (30.9%) and
   respiratory (40.4%) conditions. Sepsis was commonly present in them on
   admission (32.9%). Mechanical ventilation and renal replacement therapy
   were commonly provided (76.9% and 16.0%, respectively). During ICU stay,
   Do-Not-Resuscitate orders were more frequently written for patients aged
   >= 80 years (35.0%) compared with 21.9% for 50-64.9 year-old group, p <
   0.0001, and 25.4% for the 60-79.9 year-old group, p < 0.0001. On
   multivariate analysis, patients aged >= 80 years were more likely to
   receive these order compared with the 50-64.9 year-old patients
   (adjusted OR, 1.83; 95% CI, 1.45-2.31) and the 65-80 year-old patients
   (adjusted OR, 1.64; 95% CI, 1.32-2.04). The hospital mortality increased
   gradually with age and was highest (54.6%) in patients = 80 year-old (p
   < 0.0001). Patients >= 80 year-old had higher risk of hospital mortality
   compared with patients aged 50-64.9 years (adjusted OR, 2.16; 95% CI,
   1.73-2.69) and with those aged 65-79.9 years (adjusted OR, 1.51; 95% CI,
   1.23-1.86).
   Conclusions: Patients >= 80 year-old represented a significant
   proportion of ICU admissions. Although they received life sustaining
   measures similar to younger groups, they had higher adjusted mortality
   risk compared with the younger groups.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1471-2253
UT WOS:000347354200001
PM 25580090
ER

PT J
AU Fan, Eddy
   Cheek, Fern
   Chian, Linda
   Gosselink, Rik
   Hart, Nicholas
   Herridge, Margaret S.
   Hopkins, Ramona O.
   Hough, Catherine L.
   Kress, John P.
   Latronico, Nicola
   Moss, Marc
   Needham, Dale M.
   Rich, Mark M.
   Stevens, Robert D.
   Wilson, Kevin C.
   Winkelman, Chris
   Zochodne, Doug W.
   Ali, Naeem A.
CA ATS Comm ICU-acquired Weakness Adu
TI An Official American Thoracic Society Clinical Practice Guideline: The
   Diagnosis of Intensive Care Unit-acquired Weakness in Adults
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 190
IS 12
BP 1437
EP 1446
DI 10.1164/rccm.201411-2011ST
PD DEC 15 2014
PY 2014
AB Rationale: Profound muscle weakness during and after critical illness is
   termed intensive care unit-acquired weakness (ICUAW).
   Objectives: To develop diagnostic recommendations for ICUAW.
   Methods: A multidisciplinary expert committee generated diagnostic
   questions. A systematic review was performed, and recommendations were
   developed using the Grading, Recommendations, Assessment, Development,
   and Evaluation (GRADE) approach.
   Measurement and Main Results: Severe sepsis, difficult ventilator
   liberation, and prolonged mechanical ventilation are associated with
   ICUAW. Physical rehabilitation improves outcomes in heterogeneous
   populations of ICU patients. Because it may not be feasible to provide
   universal physical rehabilitation, an alternative approach is to
   identify patients most likely to benefit. Patients with ICUAW may be
   such a group. Our review identified only one case series of patients
   with ICUAW who received physical therapy. When compared with a case
   series of patients with ICUAW who did not receive structured physical
   therapy, evidence suggested those who receive physical rehabilitation
   were more frequently discharged home rather than to a rehabilitative
   facility, although confidence intervals included no difference. Other
   interventions show promise, but fewer data proving patient benefit
   existed, thus precluding specific comment. Additionally, prior
   comorbidity was insufficiently defined to determine its influence on
   outcome, treatment response, or patient preferences for diagnostic
   efforts. We recommend controlled clinical trials in patients with ICUAW
   that compare physical rehabilitation with usual care and further
   research in understanding risk and patient preferences.
   Conclusions: Research that identifies treatments that benefit patients
   with ICUAW is necessary to determine whether the benefits of diagnostic
   testing for ICUAW outweigh its burdens.
TC 6
ZB 1
Z8 0
ZS 0
Z9 6
SN 1073-449X
UT WOS:000346896000019
PM 25496103
ER

PT J
AU Volling, Cheryl
   Hassan, Kazi
   Mazzulli, Tony
   Green, Karen
   Al-Den, Ahmed
   Hunter, Paul
   Mangat, Rupi
   Ng, John
   McGeer, Allison
TI Respiratory syncytial virus infection-associated hospitalization in
   adults: a retrospective cohort study
SO BMC INFECTIOUS DISEASES
VL 14
AR 665
DI 10.1186/s12879-014-0665-2
PD DEC 13 2014
PY 2014
AB Background: Once considered primarily a pediatric concern, respiratory
   syncytial virus (RSV) infection is gaining recognition as a cause of
   significant morbidity and mortality in adults. A better understanding of
   RSV epidemiology and disease in adults is needed to guide patient
   management and to assess the need for prophylaxis, vaccines, and
   treatments.
   Methods: We conducted a retrospective cohort study of adults admitted to
   four hospitals in Toronto, Canada, between September 2012 and June 2013
   with RSV identified by a qualitative real-time reverse-transcriptase
   polymerase chain reaction assay in nasopharyngeal swab or bronchoscopy
   specimens. Main outcomes were hospital length of stay, need for
   intensive care unit (ICU) or mechanical ventilation, and all-cause
   mortality.
   Results: Eighty-six patients were identified as requiring
   hospitalization for RSV infection (56% female). Median age was 74 (range
   19-102) years; 29 (34%) were < 65 years. Eighty-three (97%) had
   underlying chronic medical conditions; 27 (31%) were immunosuppressed,
   and 10 (12%) known smokers. The most common symptoms and signs were
   cough in 73 (85%), shortness of breath in 68 (79%), sputum production in
   54 (63%), weakness in 43 (50%), fever in 41 (48%), and wheezing in 33
   (38%). Lower respiratory tract complications occurred in 45 (52%),
   cardiovascular complications occurred in 19 (22%), and possible
   co-pathogens were identified in 11 (13%). Sixty-seven (78%) were treated
   with antibiotics and 31 (36%) with anti-influenza therapy. Thirteen
   (15%) required ICU care and 8 (9%) required mechanical ventilation. Five
   (6%) died during hospitalization. Need for ICU and mechanical
   ventilation were associated with mortality (P <= 0.02). Median hospital
   length of stay was 6 days (mean 10.8 days).
   Conclusions: RSV infection is associated with the need for extended
   hospital stay, ICU care and mortality in adults of all ages with chronic
   underlying conditions. Presenting signs and symptoms are nonspecific,
   co-infections occur, and patients often receive antibiotics and
   anti-influenza therapy. There is need for ongoing research and
   development of RSV prophylaxis, vaccines and treatments for adults.
TC 1
ZB 1
Z8 0
ZS 0
Z9 1
SN 1471-2334
UT WOS:000347012600001
PM 25494918
ER

PT J
AU Bloch, S. A. A.
   Lee, J. Y.
   Syburrah, T.
   Rosendahl, U.
   Kemp, P. R.
   Griffiths, M. J. D.
   Polkey, M. I.
TI GDF-15 DOWN-REGULATION OF MUSCLE MICRORNA DRIVES INCREASED SENSITIVITY
   TO TGF-beta SIGNALLING; A NOVEL MECHANISM IN INTENSIVE CARE UNIT
   ACQUIRED WEAKNESS
SO THORAX
VL 69
MA S140
BP A75
EP A75
DI 10.1136/thoraxjnl-2014-206260.146
SU 2
PD DEC 2014
PY 2014
CT Meeting of the British-Thoracic-Society
CY DEC 03-05, 2014
CL London, ENGLAND
SP British Thorac Soc
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0040-6376
UT WOS:000353825200147
ER

PT J
AU Hraiech, Sami
   Dizier, Stephanie
   Papazian, Laurent
TI The Use of Paralytics in Patients with Acute Respiratory Distress
   Syndrome
SO CLINICS IN CHEST MEDICINE
VL 35
IS 4
BP 753
EP +
DI 10.1016/j.ccm.2014.08.012
PD DEC 2014
PY 2014
AB Interest in the role of neuromuscular blocking agents (NMBAs) in the
   treatment of acute respiratory distress syndrome (ARDS) has been renewed
   since a recent randomized clinical trial showed a reduction in mortality
   associated with the use of NMBAs. However, the role of paralytics in a
   protective mechanical ventilation strategy should be detailed. This
   review summarizes data in the literature concerning the clinical effects
   of NMBAs on the outcome of patients with ARDS, in an attempt to explain
   some pathophysiologic hypotheses concerning their action and to
   integrate them into the overall management strategy for the mechanical
   ventilation of ARDS patients.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0272-5231
UT WOS:000346214200012
PM 25453423
ER

PT J
AU Walsh, Christopher J.
   Batt, Jane
   Herridge, Margaret S.
   Dos Santos, Claudia C.
TI Muscle Wasting and Early Mobilization in Acute Respiratory Distress
   Syndrome
SO CLINICS IN CHEST MEDICINE
VL 35
IS 4
BP 811
EP +
DI 10.1016/j.com.2014.08.016
PD DEC 2014
PY 2014
AB Survivors of acute respiratory distress syndrome often sustain muscle
   wasting and functional impairment related to intensive care unit
   (ICU)-acquired weakness (ICUAW) and this disability may persist for
   years after ICU discharge. Early diagnosis in cooperative patients by
   physical examination is recommended to identify patients at risk for
   weaning failure and to minimize prolongation of risk factors for ICUAW.
   When possible, early rehabilitation in critically ill patients improves
   functional outcomes, likely by reducing disuse atrophy. Interventions
   designed to correct the functional impairment are lacking and further
   research to delineate the molecular pathways that give rise to ICUAW are
   needed.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0272-5231
UT WOS:000346214200016
PM 25453427
ER

PT J
AU Ascioglu, Sibel
   Samore, Matthew H.
   Lipsitch, Marc
TI A New Approach to the Analysis of Antibiotic Resistance Data from
   Hospitals
SO MICROBIAL DRUG RESISTANCE
VL 20
IS 6
BP 583
EP 590
DI 10.1089/mdr.2013.0173
PD DEC 1 2014
PY 2014
AB We aimed to develop a new approach to the analysis of antimicrobial
   resistance data from the hospitals, which allows simultaneous analysis
   of both individual- and population-level determinants of bacterial
   resistance. This was a retrospective cohort study that included adult
   patients who stayed in the hospital >2 days. We analyzed data using
   shared frailty Cox models and tested our approach using a priori
   hypotheses based on biology and epidemiology of antibiotic resistance.
   For gram-negative bacteria, the use of the major selecting antibiotic by
   an individual was the main risk factor for acquiring resistant species.
   Hazard ratios (HRs) were strikingly high for ceftazidime-resistant
   Enterobacter species (HR=11.17; 95% confidence interval [CI]:
   5.67-22.02), ciprofloxacin-resistant Pseudomonas aeruginosa (HR=4.41;
   95% CI: 2.14-9.08), and imipenem-resistant P. aeruginosa (HR=7.92; 95%
   CI: 4.35-14.43). Ward-level use was significant for vancomycin-resistant
   enterococci (VRE) (HR=1.40; 95% CI: 1.07-1.83) and for
   imipenem-resistant P. aeruginosa (HR=1.40; 95% CI: 1.08-1.83). Previous
   incidence of infection in the same ward increased the risk of acquiring
   methicillin-resistant Staphylococcus aureus (HR=1.22; 95% CI: 1.15-1.30)
   and VRE (HR=1.53; 95% CI: 1.38-1.70). Our results were consistent with
   our hypotheses and showed that combining population- and
   individual-level data is crucial for the exploration of antimicrobial
   resistance development.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1076-6294
UT WOS:000345616200012
PM 25055133
ER

PT J
AU Beckers, Stefan K.
   Brokmann, Joerg C.
   Rossaint, Rolf
TI Airway and ventilator management in trauma patients
SO CURRENT OPINION IN CRITICAL CARE
VL 20
IS 6
BP 626
EP 631
DI 10.1097/MCC.0000000000000160
PD DEC 2014
PY 2014
AB Purpose of review
   Securing the airway to provide sufficient oxygenation and ventilation is
   of paramount importance in the management of all types of emergency
   patients. Particularly in severely injured patients, strategies should
   be adapted according to useful recent literature findings.
   Recent findings
   The role of out-of-hospital endotracheal intubation in patients with
   severe traumatic brain injury as prevention of hypoxia still persists,
   and the ideal neuromuscular blocking agent will be a target of research.
   Standardized monitoring, including capnography and the use of
   standardized medication protocols without etomidate, can reduce further
   complications. Prophylactic noninvasive ventilation may be useful for
   patients with blunt chest trauma without respiratory insufficiency.
   Summary
   An algorithm-based approach to airway management can prevent
   complications due to inadequate oxygenation or procedural difficulties
   in trauma patients; therefore, advanced equipment for handling a
   difficult airway is needed. After securing the airway, ventilation must
   be monitored by capnography, and normoventilation involving the early
   use of protective ventilation with low-tidal volume and moderate
   positive end-expiratory pressure must be the target. After early
   identification of patients with blunt chest trauma at risk for
   respiratory failure, noninvasive ventilation might be a treatment
   strategy, which should be evaluated in future research.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1070-5295
UT WOS:000344529000007
PM 25314240
ER

PT J
AU Segers, Johan
   Hermans, Greet
   Bruyninckx, Frans
   Meyfroidt, Geert
   Langer, Daniel
   Gosselink, Rik
TI Feasibility of neuromuscular electrical stimulation in critically ill
   patients
SO JOURNAL OF CRITICAL CARE
VL 29
IS 6
BP 1082
EP 1088
DI 10.1016/j.jcrc.2014.06.024
PD DEC 2014
PY 2014
AB Objective: Critically ill patients often develop intensive care
   unit-acquired weakness. Reduction in muscle mass and muscle strength
   occurs early after admission to the intensive care unit (ICU). Although
   early active muscle training could attenuate this intensive care
   unit-acquired weakness, in the early phase of critical illness, a large
   proportion of patients are unable to participate in any active
   mobilization. Neuromuscular electrical stimulation (NMES) could be an
   alternative strategy for muscle training. The aim of this study was to
   investigate the safety and feasibility of NMES in critically ill
   patients.
   Design: This is an observational study.
   Setting: The setting is in the medical and surgical ICUs of a tertiary
   referral university hospital.
   Patients: Fifty patients with a prognosticated prolonged stay of at
   least 6 days were included on day 3 to 5 of their ICU stay. Patients
   with preexisting neuromuscular disorders and patients with
   musculoskeletal conditions limiting quadriceps contraction were
   excluded.
   Intervention: Twenty-five minutes of simultaneous bilateral NMES of the
   quadriceps femoris muscle. This intervention was performed 5 days per
   week (Monday-Friday). Effective muscle stimulation was defined as a
   palpable and visible contraction (partial or full muscle bulk).
   Measurements: The following parameters, potentially affecting
   contraction upon NMES, were assessed: functional status before admission
   to the ICU (Barthel index), type and severity of illness (Acute
   Physiology And Chronic Health Evaluation II score and sepsis),
   treatments possibly influencing the muscle contraction (corticosteroids,
   vasopressors, inotropes, aminoglycosides, and neuromuscular blocking
   agents), level of consciousness (Glasgow Coma Scale, score on 5
   standardized questions evaluating awakening, and sedation agitation
   scale), characteristics of stimulation (intensity of the NMES, number of
   sessions per patient, and edema), and neuromuscular electrophysiologic
   characteristics. Changes in heart rate, blood pressure, oxygen
   saturation, respiratory rate, and skin reactions were registered to
   assess the safety of the technique.
   Results: In 50% of the patients, an adequate quadriceps contraction was
   obtained in at least 75% of the NMES sessions. Univariate analysis
   showed that lower limb edema (P < .001), sepsis (P = .008), admission to
   the medical ICU (P = .041), and treatment with vasopressors (P = .011)
   were associated with impaired quadriceps contraction. A backward
   multivariate analysis identified presence of sepsis, lower limb edema,
   and use of vasopressors as independent predictors of impaired quadriceps
   contraction (R-2 = 59.5%). Patients responded better to NMES in the
   beginning of their ICU stay in comparison with after 1 week of ICU stay.
   There was no change in any of the safety end points with NMES.
   Conclusions: Critically ill patients having sepsis, edema, or receiving
   vasopressors were less likely to respond to NMES with an adequate
   quadriceps contraction. Neuromuscular electrical stimulation is a safe
   intervention to be administered in the ICU. (C) 2014 Elsevier Inc. All
   rights reserved.
TC 3
ZB 0
Z8 0
ZS 0
Z9 3
SN 0883-9441
UT WOS:000343588100035
PM 25108833
ER

PT J
AU Nemes, Reka
   Molnar, Levente
   Fulep, Zoltan
   Fekete, Kalra
   Berhes, Mariann
   Fulesdi, Bela
TI Critical illness associated neuromuscular disorders -- keep them in
   mind.
SO Ideggyogyaszati szemle
VL 67
IS 11-12
BP 364
EP 75
PD 2014-Nov-30
PY 2014
AB Neuromuscular disorders complicating sepsis and critical illness are not
   new and scarce phenomena yet they receive little attention in daily
   clinical practice. Critical illness polyneuropathy and myopathy affect
   nearly half of the patients with sepsis. The difficult weaning from the
   ventilator, the prolonged intensive care unit and hospital stay, the
   larger complication and mortality rate these disorders predispose to,
   put a large burden on the patient and the health care system. The aim of
   this review is to give an insight into the pathophysiological
   background, diagnostic possibilities and potential preventive and
   therapeutic measures in connection with these disorders to draw
   attention to their significance and underline the importance of
   preventive approach.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0019-1442
UT MEDLINE:25720238
PM 25720238
ER

PT J
AU Chao, Pei-wen
   Shih, Chia-Jen
   Lee, Yi-Jung
   Tseng, Ching-Min
   Kuo, Shu-Chen
   Shih, Yu-Ning
   Chou, Kun-Ta
   Tarng, Der-Cherng
   Li, Szu-Yuan
   Ou, Shuo-Ming
   Chen, Yung-Tai
TI Association of Postdischarge Rehabilitation with Mortality in Intensive
   Care Unit Survivors of Sepsis
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 190
IS 9
BP 1003
EP 1011
DI 10.1164/rccm.201406-1170OC
PD NOV 1 2014
PY 2014
AB Rationale: Intensive care unit (ICU)-acquired weakness is a common issue
   for sepsis survivors that is characterized by impaired muscle strength
   and causes functional disability. Although inpatient rehabilitation has
   not been found to reduce in-hospital mortality, the impact of
   postdischarge rehabilitation on sepsis survivors is uncertain.
   Objectives: To investigate the benefit of postdischarge rehabilitation
   to long-term mortality in sepsis survivors.
   Methods: We conducted a nationwide, population-based, high-dimensional
   propensity score-matched cohort study using Taiwan's National Health
   Insurance Research Database. The rehabilitation cohort comprised 15,535
   ICU patients who survived sepsis and received rehabilitation within 3
   months after discharge between 2000 and 2010. The control cohort
   consisted of 15,535 high-dimensional propensity score-matched subjects
   who did not receive rehabilitation within 3 months after discharge. The
   endpoint was mortality during the 10-year follow-up period.
   Measurements and Main Results: Compared with the control cohort, the
   rehabilitation cohort had a significantly lower risk of 10-year
   mortality (adjusted hazard ratio, 0.94; 95% confidence interval,
   0.92-0.97; P < 0.001), with an absolute risk reduction of 1.4 per 100
   person-years. The frequency of rehabilitation was inversely associated
   with 10-year mortality (>= 3 vs. 1 course: adjusted hazard ratio, 0.82;
   P < 0.001). Compared with the control cohort, improved survival was
   observed in the rehabilitation cohort among ill patients who had more
   comorbidities, required more prolonged mechanical ventilation, and had
   longer ICU or hospital stays, but not among those with the opposite
   conditions (i.e., less ill patients).
   Conclusions: Postdischarge rehabilitation may be associated With a
   reduced risk of 10-year mortality in the subset of patients with
   particularly long ICU courses.
RI Kuo, Shu-Chen/G-9108-2011
TC 3
ZB 2
Z8 0
ZS 0
Z9 3
SN 1073-449X
UT WOS:000345199900011
PM 25210792
ER

PT J
AU Wieske, Luuk
   Witteveen, Esther
   Verhamme, Camiel
   Dettling-Ihnenfeldt, Daniela S.
   van der Schaaf, Marike
   Schultz, Marcus J.
   van Schaik, Ivo N.
   Horn, Janneke
TI Early Prediction of Intensive Care Unit-Acquired Weakness Using Easily
   Available Parameters: A Prospective Observational Study
SO PLOS ONE
VL 9
IS 10
AR e111259
DI 10.1371/journal.pone.0111259
PD OCT 27 2014
PY 2014
AB Introduction: An early diagnosis of Intensive Care Unit-acquired
   weakness (ICU-AW) using muscle strength assessment is not possible in
   most critically ill patients. We hypothesized that development of ICU-AW
   can be predicted reliably two days after ICU admission, using patient
   characteristics, early available clinical parameters, laboratory results
   and use of medication as parameters.
   Methods: Newly admitted ICU patients mechanically ventilated >= 2 days
   were included in this prospective observational cohort study. Manual
   muscle strength was measured according to the Medical Research Council
   (MRC) scale, when patients were awake and attentive. ICU-AW was defined
   as an average MRC score < 4. A prediction model was developed by
   selecting predictors from an a-priori defined set of candidate
   predictors, based on known risk factors. Discriminative performance of
   the prediction model was evaluated, validated internally and compared to
   the APACHE IV and SOFA score.
   Results: Of 212 included patients, 103 developed ICU-AW. Highest lactate
   levels, treatment with any aminoglycoside in the first two days after
   admission and age were selected as predictors. The area under the
   receiver operating characteristic curve of the prediction model was 0.71
   after internal validation. The new prediction model improved
   discrimination compared to the APACHE IV and the SOFA score.
   Conclusion: The new early prediction model for ICU-AW using a set of 3
   easily available parameters has fair discriminative performance. This
   model needs external validation.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 1932-6203
UT WOS:000347994900058
PM 25347675
ER

PT J
AU Witteveen, Esther
   Wieske, Luuk
   Verhamme, Camiel
   Schultz, Marcus J.
   van Schaik, Ivo N.
   Horn, Janneke
TI Muscle and nerve inflammation in intensive care unit-acquired weakness:
   A systematic translational review
SO JOURNAL OF THE NEUROLOGICAL SCIENCES
VL 345
IS 1-2
BP 15
EP 25
DI 10.1016/j.jns.2014.07.014
PD OCT 15 2014
PY 2014
AB Background: Intensive care unit-acquired weakness (ICU-AW) is an
   important complication of critical illness. The main risk factors,
   sepsis and the systemic inflammatory response syndrome, suggest an
   inflammatory pathogenesis. In this systematic translational review we
   summarize current knowledge on inflammation in muscle and nerve tissue
   in animal models of ICU-AW and in critically ill patients with ICU-AW.
   Methods: We conducted a systematic search in the databases of MEDLINE,
   EMBASE and Web of Science using predefined search and selection
   criteria. From the included studies we extracted data on study
   characteristics and on inflammation in muscle and nerve tissue.
   Results: The literature search yielded 349 unique articles, of which 12
   animal studies and 20 human studies fulfilled the in- and exclusion
   criteria. All studies had important shortcomings in methodological
   quality. In the animal studies, inflammation of muscle tissue was found,
   represented by cellular infiltration and increased local levels of
   various inflammatory mediators. In human studies, high levels of various
   inflammatory mediators were found in muscle and nerve tissue of ICU-AW
   patients.
   Conclusion: This systematic translational review suggests a role for
   local inflammation in ICU-AW, but the available evidence is limited and
   studies have severe methodological limitations. (C) 2014 Elsevier B.V.
   All rights reserved.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0022-510X
UT WOS:000343689600004
PM 25128472
ER

PT J
AU Marhong, Jonathan
   Fan, Eddy
TI Carbon Dioxide in the Critically Ill: Too Much or Too Little of a Good
   Thing?
SO RESPIRATORY CARE
VL 59
IS 10
BP 1597
EP 1605
DI 10.4187/respcare.03405
PD OCT 2014
PY 2014
AB Hypercapnia and hypocapnia commonly complicate conditions that are
   present in critically ill patients. Both conditions have important
   physiologic effects that may impact the clinical management of these
   patients. For instance, hypercapnia results in bronchodilation and
   enhanced hypoxic vasoconstriction, leading to improved
   ventilation/perfusion matching. Hypocapnia reduces cerebral blood volume
   through arterial vasoconstriction. These effects have also been
   exploited for therapeutic aims. In patients with traumatic brain injury
   (TB!), hypocapnia is often utilized to control intracranial pressure.
   However, this effect is not sustained, and prolonged hypocapnia
   increases the risk of mortality and severe disability in patients with
   TBI. Hypercapnia and hypercapnic acidosis are common consequences of
   lung-protective ventilation in ARDS. Hypercapnic acidosis reduces
   ischemic lung injury and preserves lung compliance, but concern has
   arisen over hypercapnia-induced immunosuppression and the potential for
   bacterial proliferation in sepsis. Experimental studies suggest that
   buffering hypercapnic acidosis attenuates these effects, whereas
   hypocapnia appears to potentiate lung injury through increased capillary
   permeability and decreased lung compliance. Several areas of uncertainty
   surround the role of hypercapnia/hypocapnia in treating TB! and ARDS.
   Current data support recommendations to avoid hypocapnia in treating
   TB!, with the exception of emergent treatment of elevated intracranial
   pressure, while awaiting definitive management. Permissive hypercapnia
   is commonly accepted as a consequence of lung-protective ventilation in
   ARDS, but there is insufficient evidence to support the induction of
   hypercapnic acidosis in clinical practice. Buffering hypercapnic
   acidosis should be considered only for a specific clinical indication
   (eg, hemodynamic instability). For clinicians choosing to buffer
   hypercapnic acidosis, tris-hydroxymethyl aminomethane is recommended
   over sodium bicarbonate, as it is more effective in correcting pH and is
   not associated with increased carbon dioxide production. Future studies
   should aim to address these areas of uncertainty to help guide
   clinicians in the therapeutic use and management of
   hypercapnia/hypocapnia in critically ill patients.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0020-1324
UT WOS:000349200500018
PM 25261559
ER

PT J
AU Wageck, B.
   Nunes, G. S.
   Silva, F. L.
   Damasceno, M. C. P.
   de Noronha, M.
TI Application and effects of neuromuscular electrical stimulation in
   critically ill patients: Systematic review
SO MEDICINA INTENSIVA
VL 38
IS 7
BP 444
EP 454
DI 10.1016/j.medin.2013.12.003
PD OCT 2014
PY 2014
AB Objective: To investigate the applications and effects of neuromuscular
   electrical stimulation (NMES) in critically ill patients in ICU by means
   of a systematic review.
   Materials and methods: Electronic searches were conducted in the
   databases Medline, CINAHL, Cochrane Central Register of Controlled
   Trials, Web of Science, Embase, Pro Quest Health and Medical Complete,
   AMED, and PEDro. The PEDro score was used to assess the methodological
   quality of the eligible studies.
   Results: The search yielded a total of 9759 titles and nine articles
   satisfied the eligibility criteria. These studies showed that NMES can
   maintain or increase muscle mass, strength and volume, reduce time in
   mechanical ventilation and weaning time, and increase muscle degradation
   in critically ill patients in ICU. Two studies allowed a meta-analysis
   of the effects of NMES on quadriceps femoris strength and it showed a
   significant effect in favor of NMES in the Medical Research Council
   (MRC) Scale (standardized mean difference 0.77 points; p=0.02; 95% CI:
   0.13-1.40).
   Conclusions: The selected studies showed that NMES has good results when
   used for the maintenance of muscle mass and strength in critically ill
   patients in ICU. Future studies with high methodological quality should
   be conducted to provide more evidence for the use of NMES in an ICU
   setting. (C) 2013 Elsevier Espana, S.L. and SEMICYUC. All rights
   reserved.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0210-5691
UT WOS:000343689500006
PM 25060511
ER

PT J
AU Lord, Aaron S.
   Karinja, Sarah
   Lantigua, Hector
   Carpenter, Amanda
   Schmidt, J. Michael
   Claassen, Jan
   Agarwal, Sachin
   Connolly, E. Sander
   Mayer, Stephan A.
   Badjatia, Neeraj
TI Therapeutic Temperature Modulation for Fever After Intracerebral
   Hemorrhage
SO NEUROCRITICAL CARE
VL 21
IS 2
BP 200
EP 206
DI 10.1007/s12028-013-9948-5
PD OCT 2014
PY 2014
AB We sought to determine whether therapeutic temperature modulation (TTM)
   to treat fever after intracerebral hemorrhage (ICH) is associated with
   improved hospital complications and discharge outcomes.
   We performed a retrospective case-control study of patients admitted
   with spontaneous ICH having two consecutive fevers a parts per thousand
   yen38.3 A degrees C despite acetaminophen administration. Cases were
   enrolled from a prospective database of patients receiving TTM from 2006
   to 2010. All cases received TTM for fever control with goal temperature
   of 37 A degrees C with a shiver-control protocol. Controls were matched
   in severity by ICH score and retrospectively obtained from 2001 to 2004,
   before routine use of TTM for ICH. Primary outcome was
   discharge-modified Rankin score.
   Forty patients were enrolled in each group. Median admission ICH Score,
   ICH volume, and GCS were similar. TTM was initiated with a median of 3
   days after ICH onset and for a median duration of 7 days. Mean daily T
   (max) was significantly higher in the control group over the first 12
   days (38.1 vs. 38.7 A degrees C, p a parts per thousand currency sign
   0.001). The TTM group had more days of IV sedation (median 8 vs. 1, p <
   0.001) and mechanical ventilation (18 vs. 9, p = 0.003), and more
   frequently underwent tracheostomy (55 vs. 23 %, p = 0.005). Mean NICU
   length of stay was longer for TTM patients (15 vs. 11 days, p = 0.007).
   There was no difference in discharge outcomes between the two groups
   (overall mortality 33 %, moderate or severe disability 67 %).
   Therapeutic normothermia is associated with increased duration of
   sedation, mechanical ventilation, and NICU stay, but is not clearly
   associated with improved discharge outcome.
TC 1
ZB 1
Z8 0
ZS 0
Z9 1
SN 1541-6933
UT WOS:000343132900005
PM 24420694
ER

PT J
AU Nordon-Craft, Amy
   Schenkman, Margaret
   Edbrooke, Lara
   Malone, Daniel J.
   Moss, Marc
   Denehy, Linda
TI The Physical Function Intensive Care Test: Implementation in Survivors
   of Critical Illness
SO PHYSICAL THERAPY
VL 94
IS 10
BP 1499
EP 1507
DI 10.2522/ptj.20130451
PD OCT 2014
PY 2014
AB Background. Recent studies have demonstrated safety, feasibility, and
   decreased hospital length of stay for patients with weakness acquired in
   the intensive care unit (ICU) who receive early physical rehabilitation.
   The scored Physical Function in Intensive Care Test (PFIT-s) was
   specifically designed for this population and demonstrated excellent
   psychometrics in an Australian ICU population.
   Objective. The purpose of this study was to determine the responsiveness
   and predictive capabilities of the PFIT-s in patients in the United
   States admitted to the ICU who required mechanical ventilation (MV) for
   4 days or longer.
   Methods. This nested study within a randomized trial administered the
   PFIT-s, Medical Research Council (MRC) sum score, and grip strength test
   at ICU recruitment and then weekly until hospital discharge, including
   at ICU discharge. Spearman rho was used to determine validity. The
   effect size index was used to calculate measurement responsiveness for
   the PFIT-s. The receiver operating characteristic curve was used in
   predicting participants' ability to perform functional components of the
   PFIT-s.
   Results. From August 2009 to July 2012, 51 patients were recruited from
   4 ICUs in the Denver, Colorado, metro area. At ICU discharge, PFIT-s
   scores were highly correlated to MRC sum scores (rho=.923) and grip
   strength (rho=.763) (P<.0005). Using baseline test with ICU discharge
   (26 pairs), test responsiveness was large (1.14). At ICU discharge, an
   MRC sum score cut-point of 41.5 predicted participants' ability to
   perform the standing components of the PFIT-s.
   Limitations. The small sample size was a limitation. However, the
   findings are consistent with those in a larger sample from Australia.
   Conclusions. The PFIT-s is a feasible and valid measure of function for
   individuals who require MV for 4 days or longer and who are alert, able
   to follow commands, and have sufficient strength to participate.
TC 3
ZB 0
Z8 0
ZS 0
Z9 3
SN 0031-9023
UT WOS:000342734100013
PM 24810863
ER

PT J
AU Jolley, Sarah E.
   Regan-Baggs, Janet
   Dickson, Robert P.
   Hough, Catherine L.
TI Medical intensive care unit clinician attitudes and perceived barriers
   towards early mobilization of critically ill patients: a cross-sectional
   survey study
SO BMC ANESTHESIOLOGY
VL 14
AR 84
DI 10.1186/1471-2253-14-84
PD OCT 1 2014
PY 2014
AB Background: Early mobilization (EM) of patients on mechanical
   ventilation (MV) is shown to improve outcomes after critical illness.
   Little is known regarding clinician knowledge of EM or
   multi-disciplinary barriers to use of EM in the intensive care unit
   (ICU). The goal of this study was to assess clinician knowledge
   regarding EM and identify barriers to its provision.
   Methods: Simultaneous cross-sectional surveys of medical ICU (MICU)
   nurses (RN)/physical therapists (PT) respondents and physician (MD)
   respondents in a single MICU at an academic hospital in Seattle, WA in
   2010-2011. Responses were indicated on a 5 point Likert scale and
   reported as proportion of respondents agreeing or disagreeing.
   Chi-square testing and Fisher's exact testing was performed to determine
   whether responses differed by duration of employment or prior EM
   experience.
   Results: A total of 120 clinicians responded to the survey (91 MDs
   (response rate 82% (91/111)), 17 RNs (response rate 22%, (17/78)), and
   12 PTs (response rate 86%, (12/14)), overall response rate 86%). Most
   clinicians indicated knowledge regarding benefits of EM. More attending
   physicians reported knowledge of EM benefits, but also that risks of EM
   outweigh the benefits compared to trainees (p = 0.02 and 0.01).
   Clinicians across disciplines reported near universal agreement to use
   of EM for patients on MV, while the minority reported agreement to EM
   for patients on vasoactive agents. The most frequently reported
   cross-disciplinary barriers to EM were staffing and time. Risk of
   self-injury and excess work stress were indicated as barriers by RN and
   PT respondents.
   Conclusions: MICU clinicians, at our institution, reported knowledge of
   EM in the ICU. Staffing and clinician time were frequently identified
   cross-disciplinary barriers. Risk of self-injury and excess work stress
   were frequently reported RN and PT barriers.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 1471-2253
UT WOS:000342708200001
PM 25309124
ER

PT J
AU Rouze, Anahita
   Cottereau, Aurelie
   Nseir, Saad
TI Chronic obstructive pulmonary disease and the risk for
   ventilator-associated pneumonia
SO CURRENT OPINION IN CRITICAL CARE
VL 20
IS 5
BP 525
EP 531
DI 10.1097/MCC.0000000000000123
PD OCT 2014
PY 2014
AB Purpose of review
   To discuss recent data on the relationship between chronic obstructive
   pulmonary disease (COPD) and ventilator-associated pneumonia (VAP).
   Recent findings
   Despite increased use of noninvasive ventilation, a large proportion of
   COPD patients still require invasive mechanical ventilation. Intubated
   COPD patients are at increased risk for VAP compared with patients
   without COPD. VAP is associated with increased mortality and duration of
   mechanical ventilation in these patients. Specific risk factors for VAP
   in this population include prolonged duration of invasive mechanical
   ventilation, high incidence of microaspiration and bacterial
   colonization, and altered local and general host defense mechanisms.
   Skeletal and diaphragmatic muscle weakness resulting from malnutrition,
   inflammation, and systemic corticosteroids is the main cause for
   prolonged mechanical ventilation. Increased risk for microaspiration of
   contaminated secretions is related to gastro-esophageal reflux, and
   altered interaction between breathing and deglutition. Defective
   mucociliary clearance contributes to a high incidence of respiratory
   tract colonization in these patients. Further, increasing evidence
   suggests that COPD is associated with immunosuppression promoting
   pulmonary infection.
   Summary
   COPD is a risk factor for VAP. Future studies should focus on specific
   preventive measures in this population.
TC 1
ZB 1
Z8 0
ZS 0
Z9 1
SN 1070-5295
UT WOS:000341839100009
PM 24999921
ER

PT J
AU Bento, Claudia
   Martins, La Salete
   Almeida, Manuela
   Pedroso, Sofia
   Dias, Leonideo
   Henriques, Antonio Castro
   Cabrita, Antonio
TI A diagnosis not to forget in a long -term kidney transplant:
   Pneumocystis pneumonia
X1 Um diagnóstico a não esquecer em doentes transplantados renais de longa
   data: Pneumonia por pneumocystis
SO Portuguese Journal of Nephrology & Hypertension
VL 28
IS 3
BP 260
EP 264
PD 2014-09
PY 2014
AB Potential aetiologies of infection in kidney transplant patients are
   diverse, ranging from common community-acquired infectious diseases to
   uncommon opportunistic infections. Pneumocystis is a wellknown
   opportunistic fungus that can cause life-threatening pneumonia in kidney
   transplant patients mostly within the first 6 months
   post-transplantation. This en tity may occur after one year
   post-transplant, but the rate is very low. High immunosuppression,
   cytomegalovirus infection, previous history of acute rejection and poor
   GFR are risk factors for the occurrence of pneumocystis pneumonia (PCP)
   in kidney transplant patients. The treatment of choice is high-dose
   trimethoprim-sulfamethoxazol (TMP-SMX), reduction of immunosuppressive
   therapy and, in severe cases (defined by PaO2 < 70 mmHg or an
   arterial-alveolar gradient > 35 mmHg), association with steroids. We
   report a case of PCP 12.5 years after renal transplant. A 51-yearold
   male presented to the hospital with a 3-day history of asthenia, fever
   and genitourinary complains. Despite the initial treatment for cystitis
   he kept fever (> 38.5°C) and developed dry cough, hypoxaemia and rapidly
   progressive dyspnea. Physical examination revealed increased respiratory
   rate, tachycardia, cyanosis, wheezing and crackles on pulmonary
   auscultation. Radiographic alterations showed a bilateral interstitial
   infiltrates (not present on admission). On the 3th day, he was
   transferred to the intensive care unit and started non-invasive
   ventilation. The diagnosis was established by the identification of
   Pneumocystis in bronchoalveolar lavage. Treatment was made with
   high-dose intravenous TMP-SMX plus steroids and resulted in clinical
   improvement of the symptoms and complaints. Early diagnosis and prompt
   administration of empiric antimicrobial therapy are the cornerstones of
   successful treatment since the disease is associated with high mortality
   rate. This diagnosis should never be forgotten. 
Y4 Complicações infeciosas nos doentes transplantados renais são diversas e
   ocorrem quer por microrganismos habituais, quer por microrganismos
   oportunistas. Pneumocystis jiroveci, fungo oportunista, pode provocar
   pneumonia ameaçadora à vida nos doentes transplantados renais
   principalmente nos primeiros 6 meses após o transplante renal. Esta
   infeção pode ocorrer 1 ano após o transplante renal, mas a sua
   frequência é muito baixa. Elevada dose de imunossupressão, infeção por
   citomegalovirus, rejeição aguda e baixa taxa de filtração glomerular são
   fatores de risco para o desenvolvimento de pneumonia por pneumocystis
   nos doentes transplantados renais. O tratamento de escolha é realizado
   com doses elevadas de trimetoprim-sulfametoxazol, redução da dose de
   imunossupressão e em casos de severidade (definido: PaO2 < 70 mmHg ou
   gradiente arterio-alveolar > 35 mmHg), associação com esteroides é
   recomendada. Apresentamos o caso de pneumonia por pneumocystis jiroveci,
   12,5 anos após o transplante renal. Doente do sexo masculino de 51 anos
   que recorreu ao hospital por astenia, febre e queixas geniturinárias com
   3 dias de evolução. Apesar do tratamento inicial para a cistite ele
   manteve febre (> 38,5°C) e desenvolveu de novo tosse seca, hipoxemia e
   dispneia súbita. Ao exame físico a realçar taquicardia, cianose, sibilos
   e crepitações na auscultação pulmonar. Alterações radiográficas a
   demonstrar infiltrado intersticial bilateral (não presente aquando da
   admissão). Transferido ao 3º dia para a unidade de cuidados intensivos
   para início de ventilação não invasiva. O diagnóstico foi realizado pelo
   isolamento de pneumocystis no lavado broncoalveolar. O tratamento foi
   realizado com doses elevadas de trimetoprim-sulfametoxazol endovenoso em
   associação com corticoide com melhoria clínica. O diagnóstico adequado e
   a administração precoce de antibiótico foram os pontos-chave para o
   sucesso terapêutico, uma vez que esta patologia se associa a elevada
   taxa de mortalidade. Este diagnóstico não deverá ser esquecido 
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0872-0169
UT SCIELO:S0872-01692014000300010
ER

PT J
AU Taylor, Sandra D.
   Toth, Balazs
   Townsend, Wendy M.
   Bentley, Robin Timothy
TI Mechanical ventilation and management of an adult horse with presumptive
   botulism
SO JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE
VL 24
IS 5
BP 594
EP 601
DI 10.1111/vec.12196
PD SEP-OCT 2014
PY 2014
AB Objective - To describe the clinical course, management, and outcome of
   a horse with a presumptive diagnosis of botulism treated with long-term
   mechanical ventilation.
   Case Summary - A 6-year-old Quarter Horse gelding with a history of
   esophageal obstruction was evaluated for progressive tetraparesis.
   Generalized and progressive skeletal muscle weakness characterized by
   recumbency, decreased tongue, tail, eyelid, and anal tone, and
   respiratory failure was observed. Anticholinergic signs including
   decreased salivation, xerophthalmia, and ileus were also noted. A
   presumptive diagnosis of botulism was made, although mouse inoculation
   and spore identification testing were negative. Pentavalent botulism
   antitoxin was administered on Day 3. The horse was maintained on a water
   mattress and was managed with mechanical ventilation for 2 weeks.
   Complications encountered included necrotic rhinitis, intertrigo,
   decubital ulceration, jugular and cephalic vein thrombophlebitis,
   corneal ulceration, and transient ventricular tachycardia. The horse
   showed marked improvement in skeletal muscle strength and
   parasympathetic nervous system function, allowing it to be successfully
   weaned from the ventilator but suffered large colon volvulus on Day 21
   and was euthanized.
   New or Unique Information Provided - To the authors' knowledge, this is
   the first report of successful weaning from long-term mechanical
   ventilation and management of recumbency using a water mattress in an
   adult horse with presumptive botulism.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 1479-3261
UT WOS:000342905000015
PM 25041561
ER

PT J
AU Patel, Bhakti K.
   Pohlman, Anne S.
   Hall, Jesse B.
   Kress, John P.
TI Impact of Early Mobilization on Glycemic Control and ICU-Acquired
   Weakness in Critically Ill Patients Who Are Mechanically Ventilated
SO CHEST
VL 146
IS 3
BP 583
EP 589
DI 10.1378/chest.13-2046
PD SEP 2014
PY 2014
AB BACKGROUND: ICU-acquired weakness (ICU-AW) has immediate and long-term
   consequences for critically ill patients. Strategies for the prevention
   of weakness include modification of known risk factors, such as
   hyperglycemia and immobility. Intensive insulin therapy (IIT) has been
   proposed to prevent critical illness polyneuropathy. However, the effect
   of insulin and early mobilization on clinically apparent weakness is not
   well known.
   METHODS: This is a secondary analysis of all patients with mechanical
   ventilation (N = 104) previously enrolled in a randomized controlled
   trial of early occupational and physical therapy vs conventional
   therapy, which evaluated the end point of functional independence. Every
   patient had IIT and blinded muscle strength testing on hospital
   discharge to determine the incidence of clinically apparent weakness.
   The effects of insulin dose and early mobilization on the incidence of
   ICU-AW were assessed.
   RESULTS: On logistic regression analyses, early mobilization and
   increasing insulin dose prevented the incidence of ICU-AW (OR, 0.18, P =
   .001; OR, 0.001, P = .011; respectively) independent of known risk
   factors for weakness. Early mobilization also significantly reduced
   insulin requirements to achieve similar glycemic goals as compared with
   control patients (0.07 units/kg/d vs 0.2 units/kg/d, P < .001).
   CONCLUSIONS: The duel effect of early mobilization in reducing
   clinically relevant ICU-AW and promoting euglycemia suggests its
   potential usefulness as an alternative to IIT.
TC 3
ZB 1
Z8 0
ZS 0
Z9 3
SN 0012-3692
UT WOS:000342425800037
PM 25180722
ER

PT J
AU Bone, Meredith F.
   Feinglass, Joseph M.
   Goodman, Denise M.
TI Risk Factors for Acquiring Functional and Cognitive Disabilities During
   Admission to a PICU
SO PEDIATRIC CRITICAL CARE MEDICINE
VL 15
IS 7
BP 640
EP 648
DI 10.1097/PCC.0000000000000199
PD SEP 2014
PY 2014
AB Objective: To describe the risk factors for acquiring functional or
   cognitive disabilities during admission to a PICU.
   Design: Retrospective analysis of a multicenter PICU database.
   Setting: Twenty-four PICUs in the Virtual PICU Performance System
   network from January 1, 2009, through December 31, 2010.
   Patients: Consecutive patients, who are 1 month to 18 years old, who
   survived to discharge.
   Interventions: None.
   Measurements and Main Results: Primary outcomes were acquired global
   functional disability and cognitive disability during admission to a
   PICU, measured by change in Pediatric Overall Performance Category or in
   Pediatric Cerebral Performance Category scores, respectively. The
   primary analysis cohort consisted of 29,352 admissions to the 24 Virtual
   PICU Performance System sites which collected the main outcome
   variables. Respectively, 10.3% and 3.4% of the cohort acquired global
   functional or cognitive disability. Trauma diagnosis (odds ratio, 4.50;
   95% CI, 3.83-5.29; odds ratio, 3.91; 95% CI, 3.07-4.98), unscheduled
   admission to the PICU (odds ratio, 2.67; 95% CI, 2.27-3.12; odds ratio,
   1.52; 95% CI, 1.16-2.00), highest risk of mortality category (odds
   ratio, 1.19; 95% CI, 1.02-1.39; odds ratio, 2.70; 95% CI, 2.15-3.40),
   oncologic primary diagnoses (odds ratio, 5.61; 95% CI, 4.56-6.91; odds
   ratio, 4.30; 95% CI, 2.97-6.24), and neurologic primary diagnoses (odds
   ratio, 2.04, 95% CI, 1.70-2.44; odds ratio, 4.29, 95% CI, 3.18-5.78)
   were independently associated with acquiring both functional and
   cognitive disability. Intervention risk factors for acquiring both
   functional and cognitive disability included invasive mechanical
   ventilation (odds ratio, 1.79; 95% CI, 1.60-2.00; odds ratio, 2.83; 95%
   CI, 2.36-3.39), renal replacement therapy (odds ratio, 2.43; 95% CI,
   1.73-3.42; odds ratio, 1.76, 95% CI, 1.08-2.85), cardiopulmonary
   resuscitation (odds ratio, 1.91; 95% CI, 1.24-2.95; odds ratio, 1.81;
   95% CI, 1.02-3.23), and extracorporeal membrane oxygenation (odds ratio,
   7.40, 95% CI, 4.10-13.36; odds ratio, 14.04, 95% CI, 7.51-26.26).
   Conclusions: We identified a subset of patients whose potential for
   acquiring global functional and cognitive disability during admission to
   the PICU is high. This population may benefit from interventions that
   could mitigate this risk and from focused follow-up after discharge from
   the PICU.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 1529-7535
UT WOS:000341975400015
PM 25072478
ER

PT J
AU Ichinoseki-Sekine, Noriko
   Yoshihara, Toshinori
   Kakigi, Ryo
   Sugiura, Takao
   Powers, Scott K.
   Naito, Hisashi
TI Heat stress protects against mechanical ventilation-induced
   diaphragmatic atrophy
SO JOURNAL OF APPLIED PHYSIOLOGY
VL 117
IS 5
BP 518
EP 524
DI 10.1152/japplphysiol.00170.2014
PD SEP 1 2014
PY 2014
AB Mechanical ventilation (MV) is a life-saving intervention in patients
   who are incapable of maintaining adequate pulmonary gas exchange due to
   respiratory failure or other disorders. However, prolonged MV is
   associated with the development of respiratory muscle weakness. We
   hypothesized that a single exposure to whole body heat stress would
   increase diaphragm expression of heat shock protein 72 (HSP72) and that
   this treatment would protect against MV-induced diaphragmatic atrophy.
   Adult male Wistar rats (n = 38) were randomly assigned to one of four
   groups: an acutely anesthetized control group (CON) with no MV; 12-h
   controlled MV group (CMV); 1-h whole body heat stress (HS); or 1-h whole
   body heat stress 24 h prior to 12-h controlled MV (HSMV). Compared with
   CON animals, diaphragmatic HSP72 expression increased significantly in
   the HS and HSMV groups (P < 0.05). Prolonged MV resulted in significant
   atrophy of type I, type IIa, and type IIx fibers in the costal diaphragm
   (P < 0.05). Whole body heat stress attenuated this effect. In contrast,
   heat stress did not protect against MV-induced diaphragm contractile
   dysfunction. The mechanisms responsible for this heat stress-induced
   protection remain unclear but may be linked to increased expression of
   HSP72 in the diaphragm.
RI YOSHIHARA, TOSHINORI/G-5199-2011
TC 2
ZB 2
Z8 0
ZS 0
Z9 2
SN 8750-7587
UT WOS:000341311400012
PM 25059237
ER

PT J
AU Koch, Susanne
   Wollersheim, Tobias
   Bierbrauer, Jeffrey
   Haas, Kurt
   Moergeli, Rudolf
   Deja, Maria
   Spies, Claudia D.
   Spuler, Simone
   Krebs, Martin
   Weber-Carstens, Steffen
TI LONG-TERM RECOVERY IN CRITICAL ILLNESS MYOPATHY IS COMPLETE, CONTRARY TO
   POLYNEUROPATHY
SO MUSCLE & NERVE
VL 50
IS 3
BP 431
EP 436
DI 10.1002/mus.24175
PD SEP 2014
PY 2014
AB Introduction: Muscle weakness in critically ill patients after discharge
   varies. It is not known whether the electrophysiological distinction
   between critical illness myopathy (CIM) and critical illness
   polyneuropathy (CIP) during the early part of a patient's stay in the
   intensive care unit (ICU) predicts long-term prognosis. Methods: This
   was a prospective cohort study of mechanically ventilated ICU patients
   undergoing conventional nerve conduction studies and direct muscle
   stimulation in addition to neurological examination during their ICU
   stay and 1 year after ICU discharge. Results: Twenty-six patients (7 ICU
   controls, 8 CIM patients, and 11 CIM/CIP patients) were evaluated 1 year
   after discharge from the ICU. Eighty-eight percent (n=7) of CIM patients
   recovered within 1 year compared with 55% (n=6) of CIM/CIP patients.
   Thirty-six percent (n=4) of CIM/CIP patients still needed assistance
   during their daily routine (P=0.005). Conclusions: Early
   electrophysiological testing predicts long-term outcome in ICU
   survivors. CIM has a significantly better prognosis than CIM/CIP.
TC 4
ZB 1
Z8 0
ZS 0
Z9 4
SN 0148-639X
UT WOS:000340531800019
PM 24415656
ER

PT J
AU Herridge, Margaret S.
   Batt, Jane
   Dos Santos, Claudia
TI ICU-acquired Weakness, Morbidity, and Death
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 190
IS 4
BP 360
EP 362
PD AUG 15 2014
PY 2014
TC 1
ZB 1
Z8 0
ZS 0
Z9 1
SN 1073-449X
UT WOS:000340690900004
PM 25127302
ER

PT J
AU Hermans, Greet
   Van Mechelen, Helena
   Clerckx, Beatrix
   Vanhullebusch, Tine
   Mesotten, Dieter
   Wilmer, Alexander
   Casaer, Michael P.
   Meersseman, Philippe
   Debaveye, Yves
   Van Cromphaut, Sophie
   Wouters, Pieter J.
   Gosselink, Rik
   Van den Berghe, Greet
TI Acute Outcomes and 1-Year Mortality of Intensive Care Unit-acquired
   Weakness A Cohort Study and Propensity-matched Analysis
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 190
IS 4
BP 410
EP 420
DI 10.1164/rccm.201312-2257OC
PD AUG 15 2014
PY 2014
AB Rationale: Intensive care unit (ICU)-acquired weakness is a frequent
   complication of critital illness. It is unclear whether it is a marker
   or mediator of poor Outcomes.
   Objectives: To determine acute outcomes, 1-year mortality, and costs of
   ICU-acquired weakness among long-stay (>= 8 d) ICU patients and to
   assess the impact of recovery of weakness at ICU discharge.
   Methods: Data were prospectively collected during a randomized
   controlled trial. Impact of weakness on outcomes and costs was analyzed
   with a one-to-one propensity-score-matching for baseline
   characteristics, illness severity, and risk factor exposure before
   assessment Among weak patients, impact of persistent weakness at ICU
   discharge on risk of death after 1 year was examined with multivariable
   Cox proportional hazards analysis.
   Measurements and Main Results: A total of 78.6% were admitted to the
   surgical ICU; 227 of 415 (55%) long-stay assessable ICU patients were
   weak; 122 weak patients were matched to 122 not-weak patients. As
   compared with matched not-weak patients, weak patients had a lower
   likelihood for live weaning from mechanical ventilation (hazard ratio
   [HR], 0.709 [0.549-0.888]; P = 0.009), live ICU (HR, 0.698
   [0.553-0.861]; P = 0.008) and hospital discharge (HR, 0.680
   [0.514-0.871]; P = 0.007). In-hospital costs per patient (+30.5%, +5,443
   Euro per patient; P = 0.04) and 1-year mortality (30.6% vs. 17.2%; P =
   0.015) were also higher. The 105 of 227 (46%) weak patients not
   matchable to not-weak patients had even worse prognosis and higher
   costs. The 1-year risk of death was further increased if weakness
   persisted and was more severe as compared with recovery of weakness at
   ICU discharge (P < 0.001).
   Conclusions: After careful matching the data suggest that ICU-acquired
   weakness worsens acute morbidity and increases healthcare-related costs
   and 1-year mortality. Persistence and severity of weakness at ICU
   discharge further increased 1-year mortality.
TC 14
ZB 2
Z8 1
ZS 1
Z9 16
SN 1073-449X
UT WOS:000340690900012
PM 24825371
ER

PT J
AU van den Berg, Bianca
   Walgaard, Christa
   Drenthen, Judith
   Fokke, Christiaan
   Jacobs, Bart C.
   van Doorn, Pieter A.
TI Guillain-Barre syndrome: pathogenesis, diagnosis, treatment and
   prognosis
SO NATURE REVIEWS NEUROLOGY
VL 10
IS 8
BP 469
EP 482
DI 10.1038/nrneurol.2014.121
PD AUG 2014
PY 2014
AB Guillain-Barre syndrome (GBS) is a potentially life-threatening
   postinfectious disease characterized by rapidly progressive, symmetrical
   weakness of the extremities. About 25% of patients develop respiratory
   insufficiency and many show signs of autonomic dysfunction. Diagnosis
   can usually be made on clinical grounds, but lumbar puncture and
   electrophysiological studies can help to substantiate the diagnosis and
   to differentiate demyelinating from axonal subtypes of GBS. Molecular
   mimicry of pathogen-borne antigens, leading to generation of
   crossreactive antibodies that also target gangliosides, is part of the
   pathogenesis of GBS; the subtype and severity of the syndrome are partly
   determined by the nature of the antecedent infection and specificity of
   such antibodies. Intravenous immunoglobulin and plasma exchange are
   proven effective treatments but many patients have considerable residual
   deficits. Discrimination of patients with treatment-related fluctuations
   from those with acute-onset chronic inflammatory demyelinating
   polyneuropathy is important, as these conditions may require different
   treatments. Novel prognostic models can accurately predict outcome and
   the need for artificial ventilation, which could aid the selection of
   patients with a poor prognosis for more-individualized care. This Review
   summarizes the clinical features of and diagnostic criteria for GBS, and
   discusses its pathogenesis, treatment and prognosis.
TC 0
ZB 1
Z8 0
ZS 0
Z9 1
SN 1759-4758
UT WOS:000341791700009
PM 25023340
ER

PT J
AU Athota, Krishna P.
   Millar, D.
   Branson, Richard D.
   Tsuei, Betty J.
TI A practical approach to the use of prone therapy in acute respiratory
   distress syndrome
SO EXPERT REVIEW OF RESPIRATORY MEDICINE
VL 8
IS 4
BP 453
EP 463
DI 10.1586/17476348.2014.918850
PD AUG 2014
PY 2014
AB In this article we propose a practical approach to the use of prone
   therapy for acute respiratory distress syndrome (ARDS). We have
   attempted to provide information to improve the understanding and
   implementation of prone therapy based on the literature available and
   our own experience. We review the basic physiology behind ARDS and the
   theoretical mechanism by which prone therapy can be of benefit. The
   findings of the most significant studies regarding prone therapy in ARDS
   as they pertain to its implementation are summarized. Also provided is a
   discussion of the nuances of utilizing prone therapy, including
   potential pitfalls, complications, and contraindications. The specific
   considerations of prone therapy in open abdomens and traumatic brain
   injuries are discussed as well. Finally, we supply suggested protocols
   for the implementation of prone therapy discussing criteria for
   initiation and cessation of therapy as well as addressing issues such as
   the use of neuromuscular blockade and nutritional supplementation.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1747-6348
UT WOS:000340135800009
PM 24832577
ER

PT J
AU Sousa, Paulo
   Uva, Antonio Sousa
   Serranheira, Florentino
   Nunes, Carla
   Leite, Ema S.
TI Estimating the incidence of adverse events in Portuguese hospitals: a
   contribution to improving quality and patient safety
SO BMC HEALTH SERVICES RESEARCH
VL 14
AR 311
DI 10.1186/1472-6963-14-311
PD JUL 18 2014
PY 2014
AB Background: Several review studies have shown that 3.4% to 16.6% of
   patients in acute care hospitals experience one or more adverse events.
   Adverse events (AEs) in hospitals constitute a significant problem with
   serious consequences and a challenge for public health. The occurrence
   of AEs in Portuguese hospitals has not yet been systematically studied.
   The main purpose of this study is to estimate the incidence, impact and
   preventability of adverse events in Portuguese hospitals. It is also our
   aim to examine the feasibility of applying to Portuguese acute hospitals
   the methodology of detecting AEs through record review, previously used
   in other countries.
   Methods: This work is based on a retrospective cohort study and was
   carried out at three acute care hospitals in the Administrative Region
   of Lisbon. The identification of AEs and their impact was done using a
   two-stage structured retrospective medical records review based on the
   use of 18 screening criteria. A random sample of 1,669 medical records
   (representative of 47,783 hospital admissions) for the year 2009 was
   analyzed.
   Results: The main results found in this study were an incidence rate of
   11.1% AEs, of which around 53.2% were considered preventable. The
   majority of AEs were associated with surgical procedures (27%), drug
   errors (18.3%) and hospital acquired infections (12.2%). Most AEs (61%)
   resulted in minimal or no physical impairment or disability, and 10.8%
   were associated with death. In 58.6% of the AEs' cases, the length of
   stay was prolonged on average 10.7 days. Additional direct costs
   amounted to is an element of 470,380.00.
   Conclusion: The magnitude of these results was critical, reinforcing the
   need of more detailed studies in this area. The knowledge of the
   incidence and nature of AEs that occur in hospitals should be seen as a
   first step towards the improvement of quality and safety in health care.
RI Serranheira, Florentino/I-2123-2012; Nunes, Carla/H-1732-2011; Sousa-Uva, A./G-9515-2011
OI Serranheira, Florentino/0000-0001-7211-2843; Nunes,
   Carla/0000-0003-4562-1057; Sousa-Uva, A./0000-0002-1575-2788
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 1472-6963
UT WOS:000339571900001
PM 25034870
ER

PT J
AU Kalb, Robert
TI ICU-Acquired Weakness and Recovery from Critical Illness
SO NEW ENGLAND JOURNAL OF MEDICINE
VL 371
IS 3
BP 287
EP 287
PD JUL 17 2014
PY 2014
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0028-4793
UT WOS:000338999800024
PM 25014704
ER

PT J
AU Kress, John P.
   Hall, Jesse B.
TI ICU-Acquired Weakness and Recovery from Critical Illness REPLY
SO NEW ENGLAND JOURNAL OF MEDICINE
VL 371
IS 3
BP 287
EP 288
PD JUL 17 2014
PY 2014
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0028-4793
UT WOS:000338999800026
PM 25014703
ER

PT J
AU von Haehling, Stephan
TI ICU-Acquired Weakness and Recovery from Critical Illness
SO NEW ENGLAND JOURNAL OF MEDICINE
VL 371
IS 3
BP 287
EP 287
PD JUL 17 2014
PY 2014
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0028-4793
UT WOS:000338999800025
PM 25014705
ER

PT J
AU Rahman, Adam
   Wilund, Kenneth
   Fitschen, Peter J.
   Jeejeebhoy, Khursheed
   Agarwala, Ravi
   Drover, John W.
   Mourtzakis, Marina
TI Elderly Persons With ICU-Acquired Weakness: The Potential Role for
   beta-Hydroxy-beta- Methylbutyrate (HMB) Supplementation?
SO JOURNAL OF PARENTERAL AND ENTERAL NUTRITION
VL 38
IS 5
BP 567
EP 575
DI 10.1177/0148607113502545
PD JUL 2014
PY 2014
AB Intensive care unit (ICU)-acquired weakness is common and characterized
   by muscle loss, weakness, and paralysis. It is associated with poor
   short-term outcomes, including increased mortality, but the consequences
   of reduced long-term outcomes, including decreased physical function and
   quality of life, can be just as devastating. ICU-acquired weakness is
   particularly relevant to elderly patients who are increasingly consuming
   ICU resources and are at increased risk for ICU-acquired weakness and
   complications, including mortality. Elderly patients often enter
   critical illness with reduced muscle mass and function and are also at
   increased risk for accelerated disuse atrophy with acute illness.
   Increasingly, intensivists and researchers are focusing on strategies
   and therapies aimed at improving longterm neuromuscular
   function.beta-Hydroxy-beta -methylbutyrate (HMB), an ergogenic
   supplement, has shown efficacy in elderly patients and certain clinical
   populations in counteracting muscle loss. The present review discusses
   ICU-acquired weakness, as well as the unique physiology of muscle loss
   and skeletal muscle function in elderly patients, and then summarizes
   the evidence for HMB in elderly patients and in clinical populations. We
   subsequently postulate on the potential role and strategies in studying
   HMB in elderly ICU patients to improve muscle mass and function.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0148-6071
UT WOS:000340201600004
PM 24072740
ER

PT J
AU Burton, Catherine
   Vaudry, Wendy
   Moore, Dorothy
   Bettinger, Julie A.
   Dat Tran
   Halperin, Scott A.
   Scheifele, David W.
CA IMPACT Investigators
TI Burden of Seasonal Influenza in Children With Neurodevelopmental
   Conditions
SO PEDIATRIC INFECTIOUS DISEASE JOURNAL
VL 33
IS 7
BP 710
EP 714
DI 10.1097/INF.0000000000000272
PD JUL 2014
PY 2014
AB Background: Studies have identified certain neurologic and
   neurodevelopmental conditions (NNC) as risk factors for severe influenza
   infection. The Canadian National Advisory Committee on Immunization does
   not currently recognize children with NNC as having a high risk of
   complicated influenza infection unless their condition compromises
   handling of respiratory secretions. We describe the burden of influenza
   in hospitalized children with NNC, focusing on those without potential
   airway compromise.
   Methods: Using multi-year surveillance data obtained by the Canadian
   Immunization Monitoring Program, Active (IMPACT), we examined presenting
   signs and symptoms, risk factors and outcomes of children hospitalized
   with seasonal influenza at 12 Canadian pediatric referral centers.
   Comparisons were made between children with various NNC and other
   medical conditions, with and without influenza vaccine indications. The
   analysis is descriptive with selected comparisons made among groups for
   important indicators of disease severity.
   Results: We identified 1991 children hospitalized with influenza over 5
   seasons: 293 had NNC, 115 of whom did not have airway compromise or
   another vaccine indication. The latter group presented with seizures
   more frequently than those with NNC and a vaccine indication (41.7% vs.
   26.4%; P = 0.006) and required intensive care unit admission (20.9% vs.
   11.8%; P = 0.02) and mechanical ventilation (14.8% vs. 4.5%; P < 0.001)
   more often than children without NNC but with a vaccine indication.
   Conclusions: The burden of influenza infection in children with NNC,
   even those whose conditions do not obviously compromise respiratory
   function, is significant. All children with NNC should be recognized as
   having a high risk of complicated influenza infection and be targeted to
   receive influenza immunization.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0891-3668
UT WOS:000338127900011
PM 24918745
ER

PT J
AU Smith, Ira J.
   Godinez, Guillermo L.
   Singh, Baljit K.
   McCaughey, Kelly M.
   Alcantara, Raniel R.
   Gururaja, Tarikere
   Ho, Melissa S.
   Nguyen, Henry N.
   Friera, Annabelle M.
   White, Kathy A.
   McLaughlin, John R.
   Hansen, Derek
   Romero, Jason M.
   Baltgalvis, Kristen A.
   Claypool, Mark D.
   Li, Wei
   Lang, Wayne
   Yam, George C.
   Gelman, Marina S.
   Ding, Rongxian
   Yung, Stephanie L.
   Creger, Daniel P.
   Chen, Yan
   Singh, Rajinder
   Smuder, Ashley J.
   Wiggs, Michael P.
   Kwon, Oh-Sung
   Sollanek, Kurt J.
   Powers, Scott K.
   Masuda, Esteban S.
   Taylor, Vanessa C.
   Payan, Donald G.
   Kinoshita, Taisei
   Kinsella, Todd M.
TI Inhibition of Janus kinase signaling during controlled mechanical
   ventilation prevents ventilation-induced diaphragm dysfunction
SO FASEB JOURNAL
VL 28
IS 7
BP 2790
EP 2803
DI 10.1096/fj.13-244210
PD JUL 2014
PY 2014
AB Controlled mechanical ventilation (CMV) is associated with the
   development of diaphragm atrophy and contractile dysfunction, and
   respiratory muscle weakness is thought to contribute significantly to
   delayed weaning of patients. Therefore, therapeutic strategies for
   preventing these processes may have clinical benefit. The aim of the
   current study was to investigate the role of the Janus kinase
   (JAK)/signal transducer and activator of transcription 3 (STAT3)
   signaling pathway in CMV-mediated diaphragm wasting and weakness in
   rats. CMV-induced diaphragm atrophy and contractile dysfunction
   coincided with marked increases in STAT3 phosphorylation on both
   tyrosine 705 (Tyr705) and serine 727 (Ser727). STAT3 activation was
   accompanied by its translocation into mitochondria within diaphragm
   muscle and mitochondrial dysfunction. Inhibition of JAK signaling during
   CMV prevented phosphorylation of both target sites on STAT3, eliminated
   the accumulation of phosphorylated STAT3 within the mitochondria, and
   reversed the pathologic alterations in mitochondrial function, reduced
   oxidative stress in the diaphragm, and maintained normal diaphragm
   contractility. In addition, JAK inhibition during CMV blunted the
   activation of key proteolytic pathways in the diaphragm, as well as
   diaphragm atrophy. These findings implicate JAK/STAT3 signaling in the
   development of diaphragm muscle atrophy and dysfunction during CMV and
   suggest that the delayed extubation times associated with CMV can be
   prevented by inhibition of Janus kinase signaling.
TC 1
ZB 1
Z8 0
ZS 0
Z9 1
SN 0892-6638
UT WOS:000337949400006
PM 24671708
ER

PT J
AU Tsai, Wen-Hui
   Hwang, Yea-Shwu
   Hung, Te-Yu
   Weng, Shih-Feng
   Lin, Shio-Jean
   Chang, Wen-Tsan
TI Association between mechanical ventilation and neurodevelopmental
   disorders in a nationwide cohort of extremely low birth weight infants.
SO Research in developmental disabilities
VL 35
IS 7
BP 1544
EP 50
DI 10.1016/j.ridd.2014.03.048
PD 2014-Jul
PY 2014
AB Mechanical ventilation for preterm infants independently contributes to
   poor neurodevelopmental performance. However, few studies have
   investigated the association between the duration of mechanical
   ventilation and the risk for various developmental disorders in
   extremely low birth weight (ELBW) (<1000g) infants. Using a large
   nationwide database, we did a 10-year retrospective follow-up study to
   explore the effect of mechanical ventilation on the incidence of
   cerebral palsy (CP), autism spectrum disorder (ASD), intellectual
   disability (ID), and attention-deficit/hyperactivity disorder (ADHD) in
   ELBW infants born between 1998 and 2001. Seven hundred twenty-eight ELBW
   infants without diagnoses of brain insults or focal brain lesions in the
   initial hospital stay were identified and divided into three groups
   (days on ventilator: ≦2, 3-14, ≧15 days). After adjusting for
   demographic and medical factors, the infants in the ≧15 days group had
   higher risks for CP (adjusted hazard ratio: 2.66; 95% confidence
   interval: 1.50-4.59; p<0.001) and ADHD (adjusted hazard ratio: 1.95; 95%
   confidence interval: 1.02-3.76; p<0.05), than did infants in the ≦2 days
   group. The risk for ASD or ID was not significantly different between
   the three groups. We conclude that mechanical ventilation for ≧15 days
   increased the risk for CP and ADHD in ELBW infants even without
   significant neonatal brain damage. Developing a brain-protective
   respiratory support strategy in response to real-time cerebral
   hemodynamic and oxygenation changes has the potential to improve
   neurodevelopmental outcomes in ELBW infants.
TC 3
ZB 3
Z8 0
ZS 0
Z9 3
UT MEDLINE:24769371
PM 24769371
ER

PT J
AU Chen, Tai-Heng
   Hsu, Jong-Hau
   Wu, Jiunn-Ren
   Dai, Zen-Kong
   Chen, I-Chen
   Liang, Wen-Chen
   Yang, San-Nan
   Jong, Yuh-Jyh
TI Combined Noninvasive Ventilation and Mechanical In-Exsufflator in the
   Treatment of Pediatric Acute Neuromuscular Respiratory Failure
SO PEDIATRIC PULMONOLOGY
VL 49
IS 6
BP 589
EP 596
DI 10.1002/ppul.22827
PD JUN 2014
PY 2014
AB ObjectivesThe present study aims to evaluate the efficacy and
   complications of combined noninvasive ventilation (NIV) and assisted
   coughing by mechanical in-exsufflator (MIE) for acute respiratory
   failure (ARF) in children with neuromuscular disease (NMD).
   MethodsA prospective study was conducted in the pediatric intensive care
   unit. Children with NMD and ARF treated by combined NIV and MIE were
   included. Treatment success was defined as freedom from tracheal
   intubation during the hospital stay. Physiologic indices including PaO2,
   PaCO2, pH, and PaO2/FiO(2) were recorded before and 12, 24hr after the
   use of NIV/MIE.
   ResultsCombined NIV/MIE was used in 15 NMD children (mean: 8.1 years,
   range: 3 months to 18 years) with 16 cases of ARF. There was no
   mortality in this cohort. Treatment success was achieved in 12 cases
   (75%), including six cases (38%) demanding Do Not Intubate. ARF was due
   to pneumonia, with a mean baseline PaCO2 of 73.219.0mmHg. In the success
   group, hypercarbia and acidosis improved after use of NIV/MIE for 24hr
   (PaCO2: 71.7 +/- 18.6mmHg vs. 55.8 +/- 11.6mmHg, P<0.01; pH: 7.29 +/-
   0.07 vs. 7.38 +/- 0.05, P<0.01). All patients tolerated NIV/MIE well
   despite transient skin pressure sores in five cases.
   ConclusionsCombined NIV/MIE is a safe and effective approach to rapidly
   improve physiologic indices and decrease the need for intubation in NMD
   children with ARF. NIV/MIE provides a good alternative for those
   refusing intubation. Pediatr Pulmonol. 2014; 49:589-596. (c) 2013 Wiley
   Periodicals, Inc.
TC 5
ZB 0
Z8 0
ZS 0
Z9 5
SN 8755-6863
UT WOS:000335392800013
PM 23775906
ER

PT J
AU Hocker, Sara E
   Wijdicks, Eelco F M
TI Neurologic complications of sepsis.
SO Continuum (Minneapolis, Minn.)
VL 20
IS 3 Neurology of Systemic Disease
BP 598
EP 613
DI 10.1212/01.CON.0000450968.53581.ff
PD 2014-Jun
PY 2014
AB PURPOSE OF REVIEW: This article reviews the current understanding of
   sepsis, a critical and often fatal illness that results from infection
   and multiorgan failure and impacts the brain, peripheral nervous system,
   and muscle.
   RECENT FINDINGS: Encephalopathy occurs early in association with sepsis,
   and its severity correlates with mortality. Neuroimaging in patients
   with CNS manifestations is typically normal. EEG is nonspecific. EMG is
   commonly diagnostic, showing a combination of nerve and muscle injury
   already early in the clinical course. Rapid recognition and correction
   of reversible causes of encephalopathy and avoidance of risk factors for
   intensive care unit-acquired weakness may limit sequelae. Major
   deficiencies in our understanding of the complications of sepsis remain.
   Studies to improve the recognition and rehabilitation of these patients
   are imperative in a clinical syndrome affecting countless patients each
   year.
   SUMMARY: The risk of later cognitive and physical disability may be
   increased after sepsis; therefore, attention to neurologic complications
   is urgent.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:24893236
PM 24893236
ER

PT J
AU Baldwin, Matthew R.
   Reid, M. Cary
   Westlake, Amanda A.
   Rowe, John W.
   Granieri, Evelyn C.
   Wunsch, Hannah
   Thuy-Tien Dam
   Rabinowitz, Daniel
   Goldstein, Nathan E.
   Maurer, Mathew S.
   Lederer, David J.
TI The feasibility of measuring frailty to predict disability and mortality
   in older medical intensive care unit survivors
SO JOURNAL OF CRITICAL CARE
VL 29
IS 3
BP 401
EP 408
DI 10.1016/j.jcrc.2013.12.019
PD JUN 2014
PY 2014
AB Purpose: To determine whether frailty can be measured within 4 days
   prior to hospital discharge in older intensive care unit (ICU) survivors
   of respiratory failure and whether it is associated with post-discharge
   disability and mortality.
   Materials and Methods: We performed a single-center prospective cohort
   study of 22 medical ICU survivors age 65 years or older who had received
   noninvasive or invasive mechanical ventilation for at least 24 hours.
   Frailty was defined as a score of >= 3 using Fried's 5-point scale. We
   measured disability with the Katz Activities of Daily Living. We
   estimated unadjusted associations between Fried's frailty score and
   incident disability at 1-month and 6-month mortality using Cox
   proportional hazard models.
   Results: The mean (SD) age was 77 (9) years, mean Acute Physiology and
   Chronic Health Evaluation II score was 27 (9.7), mean frailty score was
   3.4 (1.3), and 18 (82%) were frail. Nine subjects (41%) died within 6
   months, and all were frail. Each 1-point increase in frailty score was
   associated with a 90% increased rate of incident disability at 1-month
   (rate ratio: 1.9, 95% CI 0.7-4.9) and a threefold increase in 6-month
   mortality (rate ratio: 3.0, 95% CI 1.4-6.3).
   Conclusions: Frailty can be measured in older ICU survivors near
   hospital discharge and is associated with 6-month mortality in
   unadjusted analysis. Larger studies to determine if frailty
   independently predicts outcomes are warranted. (C) 2014 Elsevier Inc.
   All rights reserved.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 0883-9441
UT WOS:000335818300016
PM 24559575
ER

PT J
AU Glascoe, Frances Page
   Trimm, Franklin
TI Brief Approaches to Developmental- Behavioral Promotion in Primary Care:
   Updates on Methods and Technology
SO PEDIATRICS
VL 133
IS 5
BP 884
EP 897
DI 10.1542/peds.2013-1859
PD MAY 2014
PY 2014
AB Well-child visits are a critical opportunity to promote learning and
   development, encourage positive parenting practices, help children
   acquire behavioral self-control, enhance the development and well-being
   of children and their families, identify problems not amenable to brief
   in-office counseling, and refer for services when needed. This article
   outlines the communication skills, instructional methods, and resource
   options that enable clinicians to best assist families. Also covered is
   how to monitor progress and outcomes. A total of 239 articles and 52 Web
   sites on parent/patient education were reviewed for this study.
   Providers require a veritable armamentarium of instructional methods.
   Skills in nonverbal and verbal communication are needed to elicit the
   parent/patient agenda, winnow topics to a manageable subset, and create
   the teachable moment. Verbal suggestions, with or without standardized
   spoken instructions, are useful for conveying simple messages. However,
   for complex issues, such as discipline, it is necessary to use a
   combination of verbal advice, written information, and teach-back, aided
   by role-playing/modeling or multimedia approaches. Selecting the
   approaches most likely to be effective depends on the topic and family
   characteristics (eg, parental literacy and language skills, family
   psychosocial risk and resilience factors, children's
   developmental-behavioral status). When providers collaborate well (with
   parents, patients, and other service providers) and select appropriate
   educational methods, families are better able to act on advice, leading
   to improvements in children's well-being, health, and
   developmental-behavioral outcomes. Provided are descriptions of methods,
   links to parenting resources such as cell phone applications, Web sites
   (in multiple languages), interactive technology, and parent training
   courses.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0031-4005
UT WOS:000335236800016
PM 24777220
ER

PT J
AU Moss, Marc
   Yang, Michele
   Macht, Madison
   Sottile, Peter
   Gray, Laura
   McNulty, Monica
   Quan, Dianna
TI Screening for critical illness polyneuromyopathy with single nerve
   conduction studies
SO INTENSIVE CARE MEDICINE
VL 40
IS 5
BP 683
EP 690
DI 10.1007/s00134-014-3251-6
PD MAY 2014
PY 2014
AB The ability to diagnose patients with critical illness polyneuromyopathy
   (CIPNM) is hampered by impaired patient sensorium, technical
   limitations, and the time-intensive nature of performing
   electrophysiological testing. Therefore, we sought to determine whether
   single nerve conduction studies (NCS) could accurately screen for CIPNM.
   Critically ill patients at increased risk for developing CIPNM were
   identified. Bilateral NCS of six nerves, and concentric needle
   electromyography were performed within 24 h of meeting inclusion
   criteria, and subsequently on a weekly basis until CIPNM was diagnosed
   or the patient was discharged from the intensive care unit (ICU).
   A total of 75 patients were enrolled into the study. Patients who
   developed CIPNM had a higher hospital mortality (50 vs. 13 %, p =
   0.002), and fewer ICU-free days (0 vs. 11, p = 0.04). There were no
   differences between the right and left amplitudes (p = 0.59, 0.91, and
   0.21) for nerves that could be simultaneously tested bilaterally (sural,
   peroneal, and tibial). The amplitudes for each of the six individual
   nerves were significantly diminished in patients with CIPNM when
   compared to patients without CIPNM. The nerves with the best diagnostic
   accuracy were the peroneal nerve [AUC = 0.8856; sensitivity = 94 % (95 %
   CI = 88-100 %); specificity = 74 % (95 % CI = 63-85 %)], and the sural
   nerve [AUC = 0.8611; sensitivity = 94 % (95 % CI = 88-100 %);
   specificity = 70 % (95 % CI = 59-81 %)]. The combined diagnostic
   accuracy for the amplitudes of the peroneal and sural nerves increased
   significantly [AUC = 0.9336; sensitivity = 100 % (95 % CI = 100-100 %)
   and specificity = 81 % (95 % CI = 71-91 %)].
   Unilateral peroneal and sural NCS can accurately screen for CIPNM in ICU
   patients and detect a limited number of patients that would need
   concentric needle electromyography to confirm a diagnosis of CIPNM.
   These results identify a more streamlined method to diagnose CIPNM that
   may facilitate routine diagnostic testing and monitoring of weakness in
   critically ill patients.
TC 4
ZB 0
Z8 0
ZS 0
Z9 4
SN 0342-4642
UT WOS:000335662400006
PM 24623137
ER

PT J
AU Balas, Michele C.
   Vasilevskis, Eduard E.
   Olsen, Keith M.
   Schmid, Kendra K.
   Shostrom, Valerie
   Cohen, Marlene Z.
   Peitz, Gregory
   Gannon, David E.
   Sisson, Joseph
   Sullivan, James
   Stothert, Joseph C.
   Lazure, Julie
   Nuss, Suzanne L.
   Jawa, Randeep S.
   Freihaut, Frank
   Ely, E. Wesley
   Burke, William J.
TI Effectiveness and Safety of the Awakening and Breathing Coordination,
   Delirium Monitoring/Management, and Early Exercise/Mobility Bundle
SO CRITICAL CARE MEDICINE
VL 42
IS 5
BP 1024
EP 1036
DI 10.1097/CCM.0000000000000129
PD MAY 2014
PY 2014
AB Objective:
   The debilitating and persistent effects of ICU-acquired delirium and
   weakness warrant testing of prevention strategies. The purpose of this
   study was to evaluate the effectiveness and safety of implementing the
   Awakening and Breathing Coordination, Delirium monitoring/management,
   and Early exercise/mobility bundle into everyday practice.
   Design:
   Eighteen-month, prospective, cohort, before-after study conducted
   between November 2010 and May 2012.
   Setting:
   Five adult ICUs, one step-down unit, and one oncology/hematology special
   care unit located in a 624-bed tertiary medical center.
   Patients:
   Two hundred ninety-six patients (146 prebundle and 150 postbundle
   implementation), who are 19 years old or older, managed by the
   institutions' medical or surgical critical care service.
   Interventions:
   Awakening and Breathing Coordination, Delirium monitoring/management,
   and Early exercise/mobility bundle.
   Measurements and Main Results:
   For mechanically ventilated patients (n = 187), we examined the
   association between bundle implementation and ventilator-free days. For
   all patients, we used regression models to quantify the relationship
   between Awakening and Breathing Coordination, Delirium
   monitoring/management, and Early exercise/mobility bundle implementation
   and the prevalence/duration of delirium and coma, early mobilization,
   mortality, time to discharge, and change in residence. Safety outcomes
   and bundle adherence were monitored. Patients in the postimplementation
   period spent three more days breathing without mechanical assistance
   than did those in the preimplementation period (median [interquartile
   range], 24 [7-26] vs 21 [0-25]; p = 0.04). After adjusting for age, sex,
   severity of illness, comorbidity, and mechanical ventilation status,
   patients managed with the Awakening and Breathing Coordination, Delirium
   monitoring/management, and Early exercise/mobility bundle experienced a
   near halving of the odds of delirium (odds ratio, 0.55; 95% CI,
   0.33-0.93; p = 0.03) and increased odds of mobilizing out of bed at
   least once during an ICU stay (odds ratio, 2.11; 95% CI, 1.29-3.45; p =
   0.003). No significant differences were noted in self-extubation or
   reintubation rates.
   Conclusions:
   Critically ill patients managed with the Awakening and Breathing
   Coordination, Delirium monitoring/management, and Early
   exercise/mobility bundle spent three more days breathing without
   assistance, experienced less delirium, and were more likely to be
   mobilized during their ICU stay than patients treated with usual care.
RI Balas, Michele/C-6683-2014
TC 19
ZB 3
Z8 3
ZS 0
Z9 22
SN 0090-3493
UT WOS:000335383900017
PM 24394627
ER

PT J
AU Kress, John P.
   Hall, Jesse B.
TI CRITICAL CARE MEDICINE ICU-Acquired Weakness and Recovery from Critical
   Illness
SO NEW ENGLAND JOURNAL OF MEDICINE
VL 370
IS 17
BP 1626
EP 1635
DI 10.1056/NEJMra1209390
PD APR 24 2014
PY 2014
TC 16
ZB 3
Z8 1
ZS 0
Z9 17
SN 0028-4793
UT WOS:000336120500009
PM 24758618
ER

PT J
AU Nenadovic, Vera
   Velazquez, Jose Luis Perez
   Hutchison, James Saunders
TI Phase Synchronization in Electroencephalographic Recordings
   Prognosticates Outcome in Paediatric Coma
SO PLOS ONE
VL 9
IS 4
AR e94942
DI 10.1371/journal.pone.0094942
PD APR 21 2014
PY 2014
AB Brain injury from trauma, cardiac arrest or stroke is the most important
   cause of death and acquired disability in the paediatric population. Due
   to the lifetime impact of brain injury, there is a need for methods to
   stratify patient risk and ultimately predict outcome. Early prognosis is
   fundamental to the implementation of interventions to improve recovery,
   but no clinical model as yet exists. Healthy physiology is associated
   with a relative high variability of physiologic signals in organ
   systems. This was first evaluated in heart rate variability research.
   Brain variability can be quantified through electroencephalographic
   (EEG) phase synchrony. We hypothesised that variability in brain signals
   from EEG recordings would correlate with patient outcome after brain
   injury. Lower variability in EEG phase synchronization, would be
   associated with poor patient prognosis. A retrospective study, spanning
   10 years (2000-2010) analysed the scalp EEGs of children aged 1 month to
   17 years in coma (Glasgow Coma Scale, GCS, < 8) admitted to the
   paediatric critical care unit (PCCU) following brain injury from TBI,
   cardiac arrest or stroke. Phase synchrony of the EEGs was evaluated
   using the Hilbert transform and the variability of the phase synchrony
   calculated. Outcome was evaluated using the 6 point Paediatric
   Performance Category Score (PCPC) based on chart review at the time of
   hospital discharge. Outcome was dichotomized to good outcome (PCPC score
   1 to 3) and poor outcome (PCPC score 4 to 6). Children who had a poor
   outcome following brain injury secondary to cardiac arrest, TBI or
   stroke, had a higher magnitude of synchrony (R index), a lower spatial
   complexity of the synchrony patterns and a lower temporal variability of
   the synchrony index values at 15 Hz when compared to those patients with
   a good outcome.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1932-6203
UT WOS:000335227400021
PM 24752289
ER

PT J
AU Sharshar, Tarek
   Citerio, Giuseppe
   Andrews, Peter J. D.
   Chieregato, Arturo
   Latronico, Nicola
   Menon, David K.
   Puybasset, Louis
   Sandroni, Claudio
   Stevens, Robert D.
TI Neurological examination of critically ill patients: a pragmatic
   approach. Report of an ESICM expert panel
SO INTENSIVE CARE MEDICINE
VL 40
IS 4
BP 484
EP 495
DI 10.1007/s00134-014-3214-y
PD APR 2014
PY 2014
AB Many patients admitted to the intensive care unit (ICU) have
   pre-existing or acquired neurological disorders which significantly
   affect their short-term and long-term outcomes. The ESICM NeuroIntensive
   Care Section convened an expert panel to establish a pragmatic approach
   to neurological examination (NE) of the critically ill patient.
   The group conducted a comprehensive review of published studies on the
   NE of patients with coma, delirium, seizures and neuromuscular weakness
   in critically ill patients. Quality of data was rated as high, moderate,
   low, or very low, and final recommendations as strong, weak, or best
   practice.
   The group made the following recommendations: (1) NE should be performed
   in all patients admitted to ICUs; (2) NE should include an assessment of
   consciousness and cognition, brainstem function, and motor function; (3)
   sedation should be managed to maximize the clinical detection of
   neurological dysfunction, except in patients with reduced intracranial
   compliance in whom withdrawal of sedation may be deleterious; (4) the
   need for additional tests, including neurophysiological and
   neuroradiological investigations, should be guided by the NE; (5)
   selected features of the NE have prognostic value which should be
   considered in well-defined patient populations.
RI Latronico, Nicola/F-1557-2010; Citerio, Giuseppe/B-1839-2015
OI Latronico, Nicola/0000-0002-2521-5871; 
TC 9
ZB 0
Z8 0
ZS 0
Z9 9
SN 0342-4642
UT WOS:000334074400002
PM 24522878
ER

PT J
AU Wollersheim, Tobias
   Woehlecke, Janine
   Krebs, Martin
   Hamati, Jida
   Lodka, Doerte
   Luther-Schroeder, Anja
   Langhans, Claudia
   Haas, Kurt
   Radtke, Theresa
   Kleber, Christian
   Spies, Claudia
   Labeit, Siegfried
   Schuelke, Markus
   Spuler, Simone
   Spranger, Joachim
   Weber-Carstens, Steffen
   Fielitz, Jens
TI Dynamics of myosin degradation in intensive care unit-acquired weakness
   during severe critical illness
SO INTENSIVE CARE MEDICINE
VL 40
IS 4
BP 528
EP 538
DI 10.1007/s00134-014-3224-9
PD APR 2014
PY 2014
AB Intensive care unit (ICU)-acquired muscle wasting is a devastating
   complication leading to persistent weakness and functional disability.
   The mechanisms of this myopathy are unclear, but a disturbed balance of
   myosin heavy chain (MyHC) is implicated.
   To investigate pathways of myosin turnover in severe critically ill
   patients at high risk of ICU-acquired weakness.
   Prospective, mechanistic, observational study.
   Interdisciplinary ICUs of a university hospital.
   Twenty-nine patients with Sequential Organ Failure Assessment (SOFA)
   scores of at least 8 on three consecutive days within the first 5 days
   in ICU underwent two consecutive open skeletal muscle biopsies from the
   vastus lateralis at median days 5 and 15. Control biopsy specimens were
   from healthy subjects undergoing hip-replacement surgery.
   None.
   Time-dependent changes in myofiber architecture, MyHC synthesis, and
   degradation were determined and correlated with clinical data.
   ICU-acquired muscle wasting was characterized by early, disrupted
   myofiber ultrastructure followed by atrophy of slow- and fast-twitch
   myofibers at later time points. A rapid decrease in MyHC mRNA and
   protein expression occurred by day 5 and persisted at day 15 (P < 0.05).
   Expression of the atrophy genes MuRF-1 and Atrogin1 was increased at day
   5 (P < 0.05). Early MuRF-1 protein content was closely associated with
   late myofiber atrophy and the severity of weakness.
   Decreased synthesis and increased degradation of MyHCs contribute to
   ICU-acquired muscle wasting. The rates and time frames suggest that
   pathogenesis of muscle failure is initiated very early during critical
   illness. The persisting reduction of MyHC suggests that sustained
   treatment is required.
TC 11
ZB 2
Z8 0
ZS 0
Z9 11
SN 0342-4642
UT WOS:000334074400006
PM 24531339
ER

PT J
AU Kannan Kanikannan, Meena Angamuthu
   Durga, Padmaja
   Venigalla, Naveen Kumar
   Kandadai, Rukmini Mridula
   Jabeen, Sheik Afshan
   Borgohain, Rupam
TI Simple bedside predictors of mechanical ventilation in patients with
   Guillain-Barre syndrome.
SO Journal of critical care
VL 29
IS 2
BP 219
EP 23
DI 10.1016/j.jcrc.2013.10.026
PD 2014-Apr
PY 2014
AB OBJECTIVE: The objective of the study is to develop and validate a
   predictor score for assessing the requirement of mechanical ventilation
   (MV) in patients with Guillain-Barre syndrome (GBS).
   STUDY DESIGN: The study was conducted in patients admitted with GBS in
   neurointensive care unit in a tertiary care hospital. The demographic,
   clinical factors, electrophysiological, and spirometric data of all
   consecutive patients were prospectively collected. The study was
   undertaken in 2 stages. In the first stage, data were collected for
   development of a predictor score. In the second stage, the score
   developed was validated on a separate set of patient data.
   RESULTS: The data collected were compared between the 2 groups
   (ventilated vs nonventilated). On univariate analysis, time taken to
   reach maximum deficit, neck weakness, bulbar weakness, facial weakness,
   single breath count (SBC), forced vital capacity, and phrenic nerve
   latency predicted the need for MV. On multivariate analysis, only neck
   weakness, bulbar weakness, SBC, and forced vital capacity were
   independent predictors of MV. There was a good correlation between SBC
   and the spirometric tests and phrenic nerve distal motor latency, as
   reflected in receiver operating characteristics curve. The predictor
   score developed using the regression coefficient of independent
   predictors showed that the best cutoff score for prediction of
   ventilation was 60 (sensitivity, 0.95; 1--specificity, 0.065). Internal
   cross validation of the neck weakness, SBC, and bulbar palsy (NSB) score
   showed good correlation (Pearson R = 0.76; P = .00). There was no
   statistically significant difference between predicted and observed
   outcomes (sensitivity, 95%; specificity, 93%).
   CONCLUSION: Several independent risk factors were found to predict the
   requirement for MV in patients with GBS at admission. However, after
   scoring and analyzing them, it was found that combining a few of them
   was more useful to predict the need for MV. A model using NSB score,
   developed using clinical variables, accurately predicted the requirement
   of MV. In addition, among the NSB score parameters, simple bedside SBC
   could adequately assess the adequacy of vital capacity.
TC 1
ZB 1
Z8 0
ZS 0
Z9 1
UT MEDLINE:24378177
PM 24378177
ER

PT J
AU Langhans, Claudia
   Weber-Carstens, Steffen
   Schmidt, Franziska
   Hamati, Jida
   Kny, Melanie
   Zhu, Xiaoxi
   Wollersheim, Tobias
   Koch, Susanne
   Krebs, Martin
   Schulz, Herbert
   Lodka, Doerte
   Saar, Kathrin
   Labeit, Siegfried
   Spies, Claudia
   Hubner, Norbert
   Spranger, Joachim
   Spuler, Simone
   Boschmann, Michael
   Dittmar, Gunnar
   Butler-Browne, Gillian
   Mouly, Vincent
   Fielitz, Jens
TI Inflammation-Induced Acute Phase Response in Skeletal Muscle and
   Critical Illness Myopathy
SO PLOS ONE
VL 9
IS 3
AR e92048
DI 10.1371/journal.pone.0092048
PD MAR 20 2014
PY 2014
AB Objectives: Systemic inflammation is a major risk factor for
   critical-illness myopathy (CIM) but its pathogenic role in muscle is
   uncertain. We observed that interleukin 6 (IL-6) and serum amyloid A1
   (SAA1) expression was upregulated in muscle of critically ill patients.
   To test the relevance of these responses we assessed inflammation and
   acute-phase response at early and late time points in muscle of patients
   at risk for CIM.
   Design: Prospective observational clinical study and prospective animal
   trial.
   Setting: Two intensive care units (ICU) and research laboratory.
   Patients/Subjects: 33 patients with Sequential Organ Failure Assessment
   scores >= 8 on 3 consecutive days within 5 days in ICU were
   investigated. A subgroup analysis of 12 patients with, and 18 patients
   without CIM (non-CIM) was performed. Two consecutive biopsies from
   vastus lateralis were obtained at median days 5 and 15, early and late
   time points. Controls were 5 healthy subjects undergoing elective
   orthopedic surgery. A septic mouse model and cultured myoblasts were
   used for mechanistic analyses.
   Measurements and Main Results: Early SAA1 expression was significantly
   higher in skeletal muscle of CIM compared to non-CIM patients.
   Immunohistochemistry showed SAA1 accumulations in muscle of CIM patients
   at the early time point, which resolved later. SAA1 expression was
   induced by IL-6 and tumor necrosis factor-alpha in human and mouse
   myocytes in vitro. Inflammation-induced muscular SAA1 accumulation was
   reproduced in a sepsis mouse model.
   Conclusions: Skeletal muscle contributes to general inflammation and
   acute-phase response in CIM patients. Muscular SAA1 could be important
   for CIM pathogenesis.
TC 3
ZB 0
Z8 0
ZS 0
Z9 3
SN 1932-6203
UT WOS:000333352800066
PM 24651840
ER

PT J
AU Lodha, Abhay
   Sauve, Reg
   Bhandari, Vineet
   Tang, Selphee
   Christianson, Heather
   Bhandari, Anita
   Amin, Harish
   Singhal, Nalini
TI Need for Supplemental Oxygen at Discharge in Infants with
   Bronchopulmonary Dysplasia Is Not Associated with Worse
   Neurodevelopmental Outcomes at 3 Years Corrected Age
SO PLOS ONE
VL 9
IS 3
AR e90843
DI 10.1371/journal.pone.0090843
PD MAR 19 2014
PY 2014
AB Objectives: To determine if chronic oxygen dependency (discharge home on
   supplemental oxygen) in children with bronchopulmonary dysplasia (BPD;
   defined as requirement for supplemental O-2 at 36 weeks postmenstrual
   age) predicts neurodevelopmental disability rates and growth outcomes at
   36 months corrected age (CA).
   Study Design: Longitudinal cohort study.
   Setting: Southern Alberta regional center located at high altitude.
   Participants: Preterm infants weighing <= 1250 grams with no BPD, BPD,
   and BPD with chronic oxygen dependency.
   Main outcome measures: Neurodevelopmental and growth outcomes.
   Results: Of 1563 preterm infants admitted from 1995-2007, 1212 survived.
   Complete follow-up data were available for 1030 (85%) children. Children
   in BPD and BPD with chronic oxygen dependency groups had significantly
   lower birth weights, gestational ages, prolonged mechanical ventilation
   and oxygen supplementation and received more postnatal steroids,
   compared to those without BPD. Children with BPD and BPD with chronic
   oxygen dependency were more likely to be below the 5th centile in weight
   and height compared to those without BPD but there was little difference
   between the BPD and BPD with chronic oxygen dependency groups. After
   controlling for confounding variables, children who had BPD and BPD with
   chronic oxygen dependency had higher odds of neurodevelopmental
   disability compared to those without BPD [OR (odds ratio) 1.9 (95% CI
   1.1 to 3.5) and OR 1.8 (1.1 to 2.9), respectively], with no significant
   difference between BPD and BPD with chronic oxygen dependency [OR 0.9
   (95% CI 0.6 to 1.5)].
   Conclusions: BPD and BPD with chronic oxygen dependency in children
   predicts abnormal neurodevelopmental outcomes at 36 months CA. However,
   the neurodevelopmental disability rates were not significantly higher in
   BPD with chronic oxygen dependency children compared to children with
   BPD only. Compared to those without BPD, growth is impaired in children
   with BPD and BPD with chronic oxygen dependency, but no difference
   between the latter two groups.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1932-6203
UT WOS:000333348500018
PM 24646665
ER

PT J
AU Bitner-Glindzicz, Maria
   Rahman, Shamima
   Chant, Kathy
   Marlow, Neil
TI Gentamicin, genetic variation and deafness in preterm children
SO BMC PEDIATRICS
VL 14
AR 66
DI 10.1186/1471-2431-14-66
PD MAR 5 2014
PY 2014
AB Background: Hearing loss in children born before 32 weeks of gestation
   is more prevalent than in full term infants. Aminoglycoside antibiotics
   are routinely used to treat bacterial infections in babies on neonatal
   intensive care units. However, this type of medication can have harmful
   effects on the auditory system. In order to avoid this blood levels
   should be maintained in the therapeutic range. However in individuals
   with a mitochondrial genetic variant (m.1555A > G), permanent hearing
   loss can occur even when drug levels are within normal limits. The aim
   of the study is to investigate the burden that the m.1555A > G mutation
   represents to deafness in very preterm infants.
   Method: This is a case control study of children born at less than 32
   completed weeks of gestation with confirmed hearing loss. Children in
   the control group will be matched for sex, gestational age and neonatal
   intensive care unit on which they were treated, and will have normal
   hearing. Saliva samples will be taken from children in both groups; DNA
   will be extracted and tested for the mutation. Retrospective
   pharmacological data and clinical history will be abstracted from the
   medical notes. Risk associated with gentamicin, m.1555A > G and other
   co-morbid risk factors will be evaluated using conditional logistic
   regression.
   Discussion: If there is an increased burden of hearing loss with m.1555A
   > G and aminoglycoside use, consideration will be given to genetic
   testing during pregnancy, postnatal testing prior to drug
   administration, or the use of an alternative first line antibiotic.
   Detailed perinatal data collection will also allow greater definition of
   the causal pathway of acquired hearing loss in very preterm children.
RI Marlow, Neil/D-2918-2009; Rahman, Shamima/C-5232-2008
OI Marlow, Neil/0000-0001-5890-2953; Rahman, Shamima/0000-0003-2088-730X
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1471-2431
UT WOS:000335410900001
PM 24593698
ER

PT J
AU Lin, Kai
   Lloyd-Jones, Donald M.
   Li, Debiao
   Carr, James C.
TI Quantitative imaging biomarkers for the evaluation of cardiovascular
   complications in type 2 diabetes mellitus
SO JOURNAL OF DIABETES AND ITS COMPLICATIONS
VL 28
IS 2
BP 234
EP 242
DI 10.1016/j.jdiacomp.2013.09.008
PD MAR-APR 2014
PY 2014
AB Type 2 diabetes mellitus (T2DM) is a prevalent condition in aged
   populations. Cardiovascular diseases are leading causes of death and
   disability in patients with T2DM. Traditional strategies for controlling
   the cardiovascular complications of diabetes primarily target a cluster
   of well-defined risk factors, such as hyperglycemia, lipid disorders and
   hypertension. However, there is controversy over some recent clinical
   trials aimed at evaluating efficacy of intensive treatments for T2DM. As
   a powerful tool for quantitative cardiovascular risk estimation,
   multi-disciplinary cardiovascular imaging have been applied to detect
   and quantify morphological and functional abnormalities in the
   cardiovascular system. Quantitative imaging biomarkers acquired with
   advanced imaging procedures are expected to provide new insights to
   stratify absolute cardiovascular risks and reduce the overall costs of
   health care for people with T2DM by facilitating the selection of
   optimal therapies. This review discusses principles of state-of-the-art
   cardiovascular imaging techniques and compares applications of those
   techniques in various clinical circumstances. Individuals measurements
   of cardiovascular disease burdens from multiple aspects, which are
   closely related to existing biomarkers and clinical outcomes, are
   recommended as promising candidates for quantitative imaging biomarkers
   to assess the responses of the cardiovascular system during diabetic
   regimens. (C) 2014 Elsevier Inc. All rights reserved.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 1056-8727
UT WOS:000333542900024
PM 24309215
ER

PT J
AU Williams, Cydni N.
   Belzer, Jennifer S.
   Riva-Cambrin, Jay
   Presson, Angela P.
   Bratton, Susan L.
TI The incidence of postoperative hyponatremia and associated neurological
   sequelae in children with intracranial neoplasms
SO JOURNAL OF NEUROSURGERY-PEDIATRICS
VL 13
IS 3
BP 283
EP 290
DI 10.3171/2013.12.PEDS13364
PD MAR 2014
PY 2014
AB Object. Intracranial tumors are common pediatric neoplasms and account
   for substantial morbidity among children with cancer. Hyponatremia is a
   known complication of neurosurgical procedures and is associated with
   higher. morbidity among neurosurgical patients. The authors aimed to
   estimate the incidence of hyponatremia, identify clinical
   characteristics associated with hyponatremia, and assess the association
   between hyponatremia and patient outcome among children undergoing
   surgery for intracranial tumors.
   Methods. This is a retrospective cohort study of children ranging in age
   from 0 to 19 years who underwent an initial neurosurgical procedure for
   an intracranial tumor between January 2001 and February 2012.
   Hyponatremia was defined as serum sodium <= 130 mEq/L during admission.
   Results. Hyponatremia during admission occurred in 39 (12%) of 319
   patients and was associated with young age and obstructive hydrocephalus
   (relative risk [RR] 2.9 [95% CI 1.3-6.3]). Hyponatremic patients were
   frequently symptomatic; 21% had seizures and 41% had altered mental
   status. Hyponatremia was associated with complicated care including
   mechanical ventilation (RR 4.4 [95% CI 2.5-7.9]), physical therapy (RR 4
   [95% CI 1.8-8.8]), supplemental nutrition (RR 5.7 [95% CI 3.3-9.8]), and
   infection (RR 5.7 [95% CI 3.3-9.5]). Hyponatremic patients had a 5-fold
   increased risk of moderate or severe disability on the basis of their
   Pediatric Cerebral Performance Category score at discharge (RR 5.3 [95%
   CI 2.9-9.8]). Obstructive hydrocephalus (adjusted odds ratio [aOR] 3.24
   [95% CI 1.38-8.94]) and young age (aOR 0.92 [95% CI 0.85-0.99]) were
   independently associated with hyponatremia during admission.
   Hyponatremia was independently associated with moderate or worse
   disability by Pediatric Cerebral Performance Category score at discharge
   (aOR 6.2 [95% CI 3.0-13.03]).
   Conclusions. Hyponatremia was common, particularly among younger
   children and those with hydrocephalus. Hyponatremia was frequently
   symptomatic and was associated with more complicated hospital courses.
   Hyponatremia was independently associated with worse neurological
   outcome when adjusted for age and tumor factors. This study serves as an
   exploratory analysis identifying important risk factors for hyponatremia
   and associated sequelae. Further research into the causes of
   hyponatremia and the association with poor outcome is needed to
   determine if prevention and treatment of hyponatremia can improve
   outcomes in these children.
TC 7
ZB 0
Z8 0
ZS 0
Z9 7
SN 1933-0707
UT WOS:000332048900009
PM 24410125
ER

PT J
AU Kean, Susanne
   Smith, Graeme D.
TI Surviving critical illness: Intensive care and beyond
SO JOURNAL OF CLINICAL NURSING
VL 23
IS 5-6
SI SI
BP 603
EP 604
PD MAR 2014
PY 2014
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0962-1067
UT WOS:000331460200001
PM 24589228
ER

PT J
AU Serpa Neto, Ary
   Nagtzaam, Liselotte
   Schultz, Marcus J
TI Ventilation with lower tidal volumes for critically ill patients without
   the acute respiratory distress syndrome: a systematic translational
   review and meta-analysis.
SO Current opinion in critical care
VL 20
IS 1
BP 25
EP 32
DI 10.1097/MCC.0000000000000044
PD 2014-Feb
PY 2014
AB PURPOSE OF REVIEW: There is convincing evidence for benefit from
   lung-protective mechanical ventilation with lower tidal volumes in
   patients with the acute respiratory distress syndrome (ARDS). It is
   uncertain whether this strategy benefits critically ill patients without
   ARDS as well. This manuscript systematically reviews recent preclinical
   studies of ventilation in animals with uninjured lungs, and clinical
   trials of ventilation in ICU patients without ARDS on the association
   between tidal volume size and pulmonary complications and outcome.
   RECENT FINDINGS: Successive preclinical studies almost without exception
   show that ventilation with lower tidal volumes reduces the injurious
   effects of ventilation in animals with uninjured lungs. This finding is
   in line with results from recent trials in ICU patients without ARDS,
   demonstrating that ventilation with lower tidal volumes has a strong
   potential to prevent development of pulmonary complications and maybe
   even to improve survival. However, evidence mostly comes from
   nonrandomized clinical trials, and concerns are expressed regarding
   unselected use of lower tidal volumes in the ICU, that is, in all
   ventilated critically ill patients, since this strategy could also
   increase needs for sedation and/or neuromuscular blockade, and maybe
   even cause respiratory muscle fatigue. These all then could in fact
   worsen outcome, possibly counteracting the beneficial effects of
   ventilation with lower tidal volumes.
   SUMMARY: Ventilation with lower tidal volumes protects against pulmonary
   complications, but well-powered randomized controlled trials are
   urgently needed to determine whether this ventilation strategy truly
   benefits all ventilated ICU patients without ARDS.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:24275571
PM 24275571
ER

PT J
AU Kukreti, Vinay
   Shamim, Mosharraf
   Khilnani, Praveen
TI Intensive care unit acquired weakness in children: Critical illness
   polyneuropathy and myopathy.
SO Indian journal of critical care medicine : peer-reviewed, official
   publication of Indian Society of Critical Care Medicine
VL 18
IS 2
BP 95
EP 101
DI 10.4103/0972-5229.126079
PD 2014-Feb
PY 2014
AB BACKGROUND AND AIMS: Intensive care unit acquired weakness (ICUAW) is a
   common occurrence in patients who are critically ill. It is most often
   due to critical illness polyneuropathy (CIP) or to critical illness
   myopathy (CIM). ICUAW is increasingly being recognized partly as a
   consequence of improved survival in patients with severe sepsis and
   multi-organ failure, partly related to commonly used agents such as
   steroids and muscle relaxants. There have been occasional reports of CIP
   and CIM in children, but little is known about their prevalence or
   clinical impact in the pediatric population. This review summarizes the
   current understanding of pathophysiology, clinical presentation,
   diagnosis and treatment of CIP and CIM in general with special reference
   to published literature in the pediatric age group.
   SUBJECTS AND METHODS: Studies were identified through MedLine and Embase
   using relevant MeSH and Key words. Both adult and pediatric studies were
   included.
   RESULTS: ICUAW in children is a poorly described entity with unknown
   incidence, etiology and unclear long-term prognosis.
   CONCLUSIONS: Critical illness polyneuropathy and myopathy is relatively
   rare, but clinically significant sequelae of multifactorial origin
   affecting morbidity, length of intensive care unit (ICU) stay and
   possibly mortality in critically ill children admitted to pediatric ICU.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0972-5229
UT MEDLINE:24678152
PM 24678152
ER

PT J
AU Diaz, Magda C.
   Ospina-Tascon, Gustavo A.
   Salazar C, Blanca C.
TI Respiratory Muscle Dysfunction: A Multicausal Entity in the Critically
   Ill Patient Undergoing Mechanical Ventilation
SO ARCHIVOS DE BRONCONEUMOLOGIA
VL 50
IS 2
BP 73
EP 77
DI 10.1016/j.arbres.2013.03.005
PD FEB 2014
PY 2014
AB Respiratory muscle dysfunction, particularly of the diaphragm, may play
   a key role in the pathophysiological mechanisms that lead to difficulty
   in weaning patients from mechanical ventilation. The limited mobility of
   critically ill patients, and of the diaphragm in particular when
   prolonged mechanical ventilation support is required, promotes the early
   onset of respiratory muscle dysfunction, but this can also be caused or
   exacerbated by other factors that are common in these patients, such as
   sepsis, malnutrition, advanced age, duration and type of ventilation,
   and use of certain medications, such as steroids and neuromuscular
   blocking agents. In this review we will study in depth this multicausal
   origin, in which a common mechanism is altered protein metabolism,
   according to the findings reported in various models. The understanding
   of this multicausality produced by the same pathophysiological mechanism
   could facilitate the management and monitoring of patients undergoing
   mechanical ventilation. (C) 2012 SEPAR. Published by Elsevier Espana,
   S.L. All rights reserved.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0300-2896
UT WOS:000331353300005
PM 23669061
ER

PT J
AU Brummel, Nathan E.
   Jackson, James C.
   Pandharipande, Pratik P.
   Thompson, Jennifer L.
   Shintani, Ayumi K.
   Dittus, Robert S.
   Gill, Thomas M.
   Bernard, Gordon R.
   Ely, E. Wesley
   Girard, Timothy D.
TI Delirium in the ICU and Subsequent Long-Term Disability Among Survivors
   of Mechanical Ventilation
SO CRITICAL CARE MEDICINE
VL 42
IS 2
BP 369
EP 377
DI 10.1097/CCM.0b013e3182a645bd
PD FEB 2014
PY 2014
AB Objective: Survivors of critical illness are frequently left with
   long-lasting disability. The association between delirium and disability
   in critically ill patients has not been described. We hypothesized that
   the duration of delirium in the ICU would be associated with subsequent
   disability and worse physical health status following a critical
   illness.
   Design: Prospective cohort study nested within a randomized controlled
   trial of a paired sedation and ventilator weaning strategy.
   Setting: A single-center tertiary-care hospital.
   Patients: One hundred twenty-six survivors of a critical illness.
   Measurements and Main Results: Confusion Assessment Method for the ICU,
   Katz activities of daily living, Functional Activities Questionnaire
   (measuring instrumental activities of daily living), Medical Outcomes
   Study 36-item Short Form General Health Survey Physical Components
   Score, and Awareness Questionnaire were used. Associations between
   delirium duration and outcomes were determined via proportional odds
   logistic regression with generalized estimating equations (for Katz
   activities of daily living and Functional Activities Questionnaire
   scores) or via generalized least squares regression (for Medical
   Outcomes Study 36-item Short Form General Health Survey Physical
   Components Score and Awareness Questionnaire scores). Excluding patients
   who died prior to follow-up but including those who withdrew or were
   lost to follow-up, we assessed 80 of 99 patients (81%) at 3 months and
   63 of 87 patients (72%) at 12 months. After adjusting for covariates,
   delirium duration was associated with worse activities of daily living
   scores (p = 0.002) over the course of the 12-month study period but was
   not associated with worse instrumental activities of daily living scores
   (p = 0.15) or worse Medical Outcomes Study 36-item Short Form General
   Health Survey Physical Components Score (p = 0.58). Duration of delirium
   was also associated with lower Awareness Questionnaire Motor/Sensory
   Factors scores (p 0.02).
   Conclusion: In the setting of critical illness, longer delirium duration
   is independently associated with increased odds of disability in
   activities of daily living and worse motor-sensory function in the
   following year. These data point to a need for further study into the
   determinants of functional outcomes in ICU survivors.
TC 13
ZB 3
Z8 1
ZS 0
Z9 15
SN 0090-3493
UT WOS:000329863400034
PM 24158172
ER

PT J
AU Corner, Evelyn J.
   Brett, Stephen J.
TI Early identification of patients at risk of long-term critical
   illness-associated physical disability: is it possible?
SO CRITICAL CARE
VL 18
IS 6
AR 629
DI 10.1186/s13054-014-0629-3
PD 2014
PY 2014
AB ICU-acquired weakness can hinder and determine the course of recovery
   from critical illness, leading to life-changing disability. Risk factors
   include multiorgan failure and prolonged bed rest; however, no
   prognostic model or screening tool for new-onset disability has been
   established to date. With no way of targeting the at-risk population, it
   is difficult to demonstrate the benefit of rehabilitation interventions
   in research and prioritize resources clinically. In a recent issue of
   Critical Care, Schandl and colleagues aimed to establish a predictive
   screening tool for new-onset disability using 23 possible predictors.
   They found that using the following risk factors - low educational
   level, fractures, reduced core stability and length of ICU stay over 2
   days - they were able to develop a risk score predictive of disability
   at 2 months after hospital discharge. These investigators propose that
   this will help to identify patients requiring follow-up and may increase
   the power to detect change in interventional studies. Whilst this is
   promising work, further validation is essential: firstly, to make it a
   clinically workable tool in terms of appropriate 'cut offs'; secondly,
   to ensure that it is transferable in different socio-economic
   environments; and finally, to make sure that those identified as 'at
   risk' are those that would benefit the most from targeted intervention.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1466-609X
UT WOS:000355092500043
PM 25672518
ER

PT J
AU Bain, Sarah
   Littlepage, Meagan
TI A promising new therapy may assist efforts to combat ICU-acquired
   weakness
SO CRITICAL CARE
VL 18
IS 5
AR 573
DI 10.1186/s13054-014-0573-2
PD 2014
PY 2014
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1466-609X
UT WOS:000351850600087
PM 25672926
ER

PT J
AU Schmidt, Franziska
   Kny, Melanie
   Zhu, Xiaoxi
   Wollersheim, Tobias
   Persicke, Kathleen
   Langhans, Claudia
   Lodka, Doerte
   Kleber, Christian
   Weber-Carstens, Steffen
   Fielitz, Jens
TI The E3 ubiquitin ligase TRIM62 and inflammation-induced skeletal muscle
   atrophy
SO CRITICAL CARE
VL 18
IS 5
AR 545
DI 10.1186/s13054-014-0545-6
PD 2014
PY 2014
AB Introduction: ICU-acquired weakness (ICUAW) complicates the disease
   course of critically ill patients. Inflammation and acute-phase response
   occur directly within myocytes and contribute to ICUAW. We observed that
   tripartite motif-containing 62 (TRIM62), an E3 ubiquitin ligase and
   modifier of inflammation, is increased in the skeletal muscle of ICUAW
   patients. We investigated the regulation and function of muscular TRIM62
   in critical illness.
   Methods: Twenty-six critically ill patients with Sequential Organ
   Failure Assessment scores >= 8 underwent two skeletal muscle biopsies
   from the vastus lateralis at median days 5 and 15 in the ICU. Four
   patients undergoing elective orthopedic surgery served as controls.
   TRIM62 expression and protein content were analyzed in these biopsies.
   The kinetics of Trim62, Atrogin1 and MuRF1 expression were determined in
   the gastrocnemius/plantaris and tibialis anterior muscles from mouse
   models of inflammation-, denervation- and starvation-induced muscle
   atrophy to differentiate between these contributors to ICUAW. Cultured
   myocytes were used for mechanistic analyses.
   Results: TRIM62 expression and protein content were increased early and
   remained elevated in muscles from critically ill patients. In all three
   animal models, muscular Trim62 expression was early and continuously
   increased. Trim62 was expressed in myocytes, and its overexpression
   activated the atrophy-inducing activator protein 1 signal transduction
   pathway. Knockdown of Trim62 by small interfering RNA inhibited
   lipopolysaccharide-induced interleukin 6 expression.
   Conclusions: TRIM62 is activated in the muscles of critically ill
   patients. It could play a role in the pathogenesis of ICUAW by
   activating and maintaining inflammation in myocytes.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 1466-609X
UT WOS:000351850600061
PM 25263070
ER

PT J
AU Annane, Djillali
   Orlikowski, David
   Chevret, Sylvie
TI Nocturnal mechanical ventilation for chronic hypoventilation in patients
   with neuromuscular and chest wall disorders.
SO The Cochrane database of systematic reviews
VL 12
BP CD001941
EP CD001941
DI 10.1002/14651858.CD001941.pub3
PD 2014 Dec 13
PY 2014
AB BACKGROUND: Chronic alveolar hypoventilation is a common complication of
   many neuromuscular and chest wall disorders. Long-term nocturnal
   mechanical ventilation is commonly used to treat it. This is a 2014
   update of a review first published in 2000 and previously updated in
   2007.
   OBJECTIVES: To examine the effects on mortality of nocturnal mechanical
   ventilation in people with neuromuscular or chest wall disorders.
   Subsidiary endpoints were to examine the effects of respiratory
   assistance on improvement of chronic hypoventilation, sleep quality,
   hospital admissions and quality of life.
   SEARCH METHODS: We searched the Cochrane Neuromuscular Disease Group
   Specialized Register, CENTRAL, MEDLINE and EMBASE on 10 June 2014. We
   contacted authors of identified trials and other experts in the field.
   SELECTION CRITERIA: We searched for quasi-randomised or randomised
   controlled trials of participants of all ages with neuromuscular or
   chest wall disorder-related stable chronic hypoventilation of all
   degrees of severity, receiving any type and any mode of long-term
   nocturnal mechanical ventilation. The primary outcome measure was
   one-year mortality and secondary outcomes were unplanned hospital
   admission, short-term and long-term reversal of hypoventilation-related
   clinical symptoms and daytime hypercapnia, improvement of lung function
   and sleep breathing disorders.
   DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology to
   select studies, extract data and assess the risk of bias in included
   studies.
   MAIN RESULTS: The 10 eligible trials included a total of 173
   participants. Roughly half of the trials were at low risk of selection,
   attrition or reporting bias, and almost all were at high risk of
   performance and detection bias. Four trials reported mortality data in
   the long term. The pooled risk ratio (RR) of dying was 0.62 (95%
   confidence interval (CI) 0.42 to 0.91, P value = 0.01) in favour of
   nocturnal mechanical ventilation compared to spontaneous breathing.
   There was considerable and significant heterogeneity between the trials,
   possibly related to differences between the study populations.
   Information on unplanned hospitalisation was available from two studies.
   The corresponding pooled RR was 0.25 (95% CI 0.08 to 0.82, P value =
   0.02) in favour of nocturnal mechanical ventilation. For most of the
   outcome measures there was no significant long-term difference between
   nocturnal mechanical ventilation and no ventilation. Most of the
   secondary outcomes were not assessed in the eligible trials. Three out
   of the 10 trials, accounting for 39 participants, two with a cross-over
   design and one with two parallel groups, compared volume- and
   pressure-cycled non-invasive mechanical ventilation in the short term.
   From the only trial (16 participants) on parallel groups, there was no
   difference in mortality (one death in each arm) between volume- and
   pressure-cycled mechanical ventilation. Data from the two cross-over
   trials suggested that compared with pressure-cycled ventilation,
   volume-cycled ventilation was associated with less sleep time spent with
   an arterial oxygen saturation below 90% (mean difference (MD) 6.83
   minutes, 95% CI 4.68 to 8.98, P value = 0.00001) and a lower
   apnoea-hypopnoea (per sleep hour) index (MD -0.65, 95% CI -0.84 to
   -0.46, P value = 0.00001). We found no study that compared invasive and
   non-invasive mechanical ventilation or intermittent positive pressure
   versus negative pressure ventilation.
   AUTHORS' CONCLUSIONS: Current evidence about the therapeutic benefit of
   mechanical ventilation is of very low quality, but is consistent,
   suggesting alleviation of the symptoms of chronic hypoventilation in the
   short term. In four small studies, survival was prolonged and unplanned
   hospitalisation was reduced, mainly in participants with motor neuron
   diseases. With the exception of motor neuron disease and Duchenne
   muscular dystrophy, for which the natural history supports the survival
   benefit of mechanical ventilation against no ventilation, further larger
   randomised trials should assess the long-term benefit of different types
   and modes of nocturnal mechanical ventilation on quality of life,
   morbidity and mortality, and its cost-benefit ratio in neuromuscular and
   chest wall diseases.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:25503955
PM 25503955
ER

PT J
AU Annane, Djillali
   Orlikowski, David
   Chevret, Sylvie
TI Nocturnal mechanical ventilation for chronic hypoventilation in patients
   with neuromuscular and chest wall disorders
SO COCHRANE DATABASE OF SYSTEMATIC REVIEWS
IS 12
AR CD001941
DI 10.1002/14651858.CD001941.pub3
PD 2014
PY 2014
AB Background
   Chronic alveolar hypoventilation is a common complication of many
   neuromuscular and chest wall disorders. Long-term nocturnal mechanical
   ventilation is commonly used to treat it. This is a 2014 update of a
   review first published in 2000 and previously updated in 2007.
   Objectives
   To examine the effects on mortality of nocturnal mechanical ventilation
   in people with neuromuscular or chest wall disorders. Subsidiary
   endpoints were to examine the effects of respiratory assistance on
   improvement of chronic hypoventilation, sleep quality, hospital
   admissions and quality of life.
   Search methods
   We searched the Cochrane Neuromuscular Disease Group Specialized
   Register, CENTRAL, MEDLINE and EMBASE on 10 June 2014. We contacted
   authors of identified trials and other experts in the field.
   Selection criteria
   We searched for quasi-randomised or randomised controlled trials of
   participants of all ages with neuromuscular or chest wall
   disorder-related stable chronic hypoventilation of all degrees of
   severity, receiving any type and any mode of long-term nocturnal
   mechanical ventilation. The primary outcome measure was one-year
   mortality and secondary outcomes were unplanned hospital admission,
   short-term and long-term reversal of hypoventilation-related clinical
   symptoms and daytime hypercapnia, improvement of lung function and sleep
   breathing disorders.
   Data collection and analysis
   We used standard Cochrane methodology to select studies, extract data
   and assess the risk of bias in included studies.
   Main results The 10 eligible trials included a total of 173
   participants. Roughly half of the trials were at low risk of selection,
   attrition or reporting bias, and almost all were at high risk of
   performance and detection bias. Four trials reported mortality data in
   the long term. The pooled risk ratio (RR) of dying was 0.62 (95%
   confidence interval (CI) 0.42 to 0.91, P value = 0.01) in favour of
   nocturnal mechanical ventilation compared to spontaneous breathing.
   There was considerable and significant heterogeneity between the trials,
   possibly related to differences between the study populations.
   Information on unplanned hospitalisation was available from two studies.
   The corresponding pooled RR was 0.25 (95% CI 0.08 to 0.82, P value =
   0.02) in favour of nocturnal mechanical ventilation. For most of the
   outcome measures there was no significant long-term difference between
   nocturnal mechanical ventilation and no ventilation. Most of the
   secondary outcomes were not assessed in the eligible trials. Three out
   of the 10 trials, accounting for 39 participants, two with a cross-over
   design and one with two parallel groups, compared volume-and
   pressure-cycled non-invasive mechanical ventilation in the short term.
   From the only trial (16 participants) on parallel groups, there was no
   difference in mortality (one death in each arm) between volume-and
   pressure-cycled mechanical ventilation. Data from the two cross-over
   trials suggested that compared with pressure-cycled ventilation,
   volume-cycled ventilation was associated with less sleep time spent with
   an arterial oxygen saturation below 90% (mean difference (MD) 6.83
   minutes, 95% CI 4.68 to 8.98, P value = 0.00001) and a lower
   apnoea-hypopnoea (per sleep hour) index (MD -0.65, 95% CI -0.84 to
   -0.46, P value = 0.00001). We found no study that compared invasive and
   non-invasive mechanical ventilation or intermittent positive pressure
   versus negative pressure ventilation.
   Authors' conclusions
   Current evidence about the therapeutic benefit of mechanical ventilation
   is of very low quality, but is consistent, suggesting alleviation of the
   symptoms of chronic hypoventilation in the short term. In four small
   studies, survival was prolonged and unplanned hospitalisation was
   reduced, mainly in participants with motor neuron diseases. With the
   exception of motor neuron disease and Duchenne muscular dystrophy, for
   which the natural history supports the survival benefit of mechanical
   ventilation against no ventilation, further larger randomised trials
   should assess the long-term benefit of different types and modes of
   nocturnal mechanical ventilation on quality of life, morbidity and
   mortality, and its cost-benefit ratio in neuromuscular and chest wall
   diseases.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1469-493X
UT WOS:000347646300005
ER

PT J
AU Bissett, Bernie
   Leditschke, I. Anne
   Neeman, Teresa
   Boots, Robert
   Paratz, Jennifer
TI Weaned but weary: One third of adult intensive care patients
   mechanically ventilated for 7 days or more have impaired inspiratory
   muscle endurance after successful weaning
SO HEART & LUNG
VL 44
IS 1
BP 15
EP 20
DI 10.1016/j.hrtlng.2014.10.001
PD JAN-FEB 2014
PY 2014
AB Objectives: The purpose of this study was to establish whether intensive
   care unit (ICU) patients have impaired inspiratory muscle (IM) endurance
   immediately following weaning from prolonged mechanical ventilation
   (MV), and whether IM weakness is related to function or perceived
   exertion.
   Background: Impaired IM endurance may hinder recovery from MV, however
   it is unknown whether this affects patients' function or perceived
   exertion.
   Methods: Prospective observational study of 43 adult ICU patients
   following weaning from MV (>7 days duration). IM endurance was measured
   using the fatigue resistance index (FRI).
   Results: IM endurance was impaired (FRI = mean 0.90, SD 0.31), with 37%
   scoring below 0.80. IM strength did not significantly correlate with
   function (r = 0.24, p = 0.12) or perceived exertion during exercise (r =
   0.146, p = 0.37).
   Conclusions: IM endurance is reduced in one third of patients, while IM
   weakness does not appear closely associated with function or perceived
   exertion immediately following successful weaning. (C) 2015 Elsevier
   Inc. All rights reserved.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0147-9563
UT WOS:000346693400004
PM 25455911
ER

PT J
AU Ijaz, Mohsin
   Tariq, Hassan
   Niazi, Masooma
   Lvovsky, Dmitry
TI Complete heart block and persistent lactic acidosis as an initial
   presentation of non-hodgkin lymphoma in a critically ill newly diagnosed
   AIDS patient.
SO Case reports in critical care
VL 2014
BP 214970
EP 214970
DI 10.1155/2014/214970
PD 2014
PY 2014
AB A 66-year-old male with newly diagnosed untreated acquired
   immunodeficiency syndrome (AIDS) presented with chronic nonspecific
   complaints of weakness, fatigue, myalgia, and weight loss. His initial
   EKG showed complete heart block necessitating temporary pacemaker
   placement. He had no previous history of cardiac disease. He was also
   found to have a persistent lactic acidosis and imaging studies showed
   abdominal lymphadenopathy. The patient underwent biopsy of these lymph
   nodes and was found to have diffuse large B-cell lymphoma. The hospital
   course was complicated by respiratory failure requiring mechanical
   ventilator support and cardiac arrest. Patient remained critically ill;
   he was not a candidate for chemotherapy and, after a month of
   hospitalization, he died. Lactic acidosis and heart block as an initial
   presentation of non-Hodgkin lymphoma in an AIDS patient are an unusual
   and unique presentation. 
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 2090-6420
UT MEDLINE:25431684
PM 25431684
ER

PT J
AU Polanowska, Katarzyna Ewa
   Sarzynska-Dlugosz, Iwona Marta
   Paprot, Agnieszka Ewa
   Sikorska, Swietlana
   Seniow, Joanna Barbara
   Karpinski, Grzegorz
   Kowalik, Robert
   Opolski, Grzegorz
   Czlonkowska, Anna
TI Neuropsychological and neurological sequelae of out-of-hospital cardiac
   arrest and the estimated need for neurorehabilitation: a prospective
   pilot study
SO KARDIOLOGIA POLSKA
VL 72
IS 9
BP 814
EP 822
DI 10.5603/KP.a2014.0087
PD 2014
PY 2014
AB Background: Diffuse brain injury is a key component of post-cardiac
   arrest syndrome reported in 30-80% of survivors of out-of-hospital
   cardiac arrest (OHCA). It is responsible for a high mortality rate, and
   is a common cause of cognitive and neurological deficits and disability.
   Symptom variability and dynamics and the rehabilitation potential remain
   poorly understood.
   Aim: To investigate symptom prevalence, type, and severity and the
   natural course of recovery within 12 months after OHCA, and to estimate
   neurorehabilitation needs.
   Methods: Study participants were selected from OHCA survivors admitted
   consecutively to a cardiac intensive care unit (CICU) serving 250,000 of
   Warsaw's inhabitants, according to the following inclusion criteria:
   first ever nontraumatic, normothermic cardiac arrest, age <= 75 years;
   cardiology ward survival until discharge, and no history of pre-existing
   brain disease. Patients' cognitive and neurological status and
   disability were evaluated in the first days after onset and three, six
   and 12 months later. Neuropsychological assessment focused on attention,
   memory, executive, linguistic and visuo-spatial abilities. Neurological
   examination included assessment of cranial nerves, muscle strength and
   tone, deep tendon reflexes, cerebellar function, sensory function, and
   gait. The general psychophysical state was classified using the
   Disability Rating Scale. Patients' neurorehabilitation needs were
   determined using data collected three months post-OHCA. This data was
   used to estimate future demands for such resources in Poland.
   Results: During a 28-month study period, of 69 OHCA patients admitted to
   the CICU, 29 met the study criteria (33 survived until discharge from
   cardiology unit; four did not meet further criteria). Severe
   consciousness disorders were most frequent in the early post-OHCA phase
   (28%); no unresponsive patients were identified 12 months later. Of
   responsive patients who were capable of at least minimal co-operation,
   100% (early after OHCA) to 57% (12 months after OHCA) had cognitive
   impairment, usually with neurological symptoms. Memory impairment was
   the most common and severe problem, followed by executive, attentional,
   language and visuo-spatial dysfunctions. The prevalence of neurological
   deficits ranged from 88% (early after OHCA) to 43% (12 months after
   OHCA). Due to acquired deficits, between 71% (early post-OHCA) and 36%
   (12 months post-OHCA) of patients were significantly disabled and often
   dependent. Although dysfunctions tended to improve, over 50% of the
   patients remained impaired 12 months post-OHCA, and over 30% were
   significantly disabled. We estimated that about 800 OHCA survivors/year
   in Poland will develop symptoms requiring neurorehabilitation.
   Conclusions: Cognitive and neurological symptoms are common after
   cardiac arrest brain injury. Establishing specialised
   neurorehabilitation centres is essential for treating these patients.
TC 4
ZB 0
Z8 0
ZS 0
Z9 4
SN 0022-9032
UT WOS:000346119900007
PM 24846356
ER

PT J
AU Mehrholz, Jan
   Mueckel, Simone
   Oehmichen, Frank
   Pohl, Marcus
TI The General Weakness Syndrome Therapy (GymNAST) study: protocol for a
   cohort study on recovery on walking function
SO BMJ OPEN
VL 4
IS 10
AR e006168
DI 10.1136/bmjopen-2014-006168
PD 2014
PY 2014
AB Introduction: Critical illness myopathy (CIM) and polyneuropathy (CIP)
   are common complications of critical illness that frequently occur
   together. Both cause so called intensive care unit (ICU)-acquired muscle
   weakness. This weakness of limb muscles increases morbidity and delay
   rehabilitation and recovery of walking ability. Although full recovery
   has been reported people with severe weakness may take months to improve
   walking. Focused physical rehabilitation of people with ICU-acquired
   muscle weakness is therefore of great importance. However, although
   physical rehabilitation is common, detailed knowledge about the pattern
   and the time course of recovery of walking function are not well
   understood. Therefore, the aim of the General Weakness Syndrome Therapy
   (GymNAST) study is to describe the time course of recovery of walking
   function and other activities of daily living in these patients.
   Methods and analysis: We conduct a prospective cohort study of people
   with ICU-acquired muscle weakness with defined diagnosis of CIM or CIP.
   Based on our sample size calculation, approximately 150 patients will be
   recruited from the ICU of our hospital in Germany. Amount and content of
   physical rehabilitation, clinical tests for example, muscle strength and
   motor function and neuropsychological assessments will be used as
   independent variables. The primary outcomes will include recovery of
   walking function and mobility. Secondary outcomes will include global
   motor function, activities in daily life and participation.
   Ethics and dissemination: The study is being carried out in agreement
   with the Declaration of Helsinki and conducted with the approval of the
   local medical Ethics Committee (Landesarztekammer Sachsen, Germany,
   reference number EK-BR-32/13-1) and with the understanding and written
   consent of each patient's guardian. The results of this study will be
   published in peer-reviewed journals and disseminated to the medical
   society and general public.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 2044-6055
UT WOS:000344774500067
PM 25344484
ER

PT J
AU Winfield, Naomi R
   Barker, Nicola J
   Turner, Esme R
   Quin, Gemma L
TI Non-pharmaceutical management of respiratory morbidity in children with
   severe global developmental delay.
SO The Cochrane database of systematic reviews
VL 10
BP CD010382
EP CD010382
DI 10.1002/14651858.CD010382.pub2
PD 2014 Oct 19
PY 2014
AB BACKGROUND: Children with severe global developmental delay (SGDD) have
   significant intellectual disability and severe motor impairment; they
   are extremely limited in their functional movement and are dependent
   upon others for all activities of daily living. SGDD does not directly
   cause lung dysfunction, but the combination of immobility, weakness,
   skeletal deformity and parenchymal damage from aspiration can lead to
   significant prevalence of respiratory illness. Respiratory pathology is
   a significant cause of morbidity and mortality for children with SGDD;
   it can result in frequent hospital admissions and impacts upon quality
   of life. Although many treatment approaches are available, there
   currently exists no comprehensive review of the literature to inform
   best practice. A broad range of treatment options exist; to focus the
   scope of this review and allow in-depth analysis, we have excluded
   pharmaceutical interventions.
   OBJECTIVES: To assess the effects of non-pharmaceutical treatment
   modalities for the management of respiratory morbidity in children with
   severe global developmental delay.
   SEARCH METHODS: We conducted comprehensive searches of the following
   databases from inception to November 2013: the Cochrane Central Register
   of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Allied and
   Complementary Medicine Database (AMED) and the Cumulative Index to
   Nursing and Allied Health Literature (CINAHL). We searched the Web of
   Science and clinical trials registries for grey literature and for
   planned, ongoing and unpublished trials. We checked the reference lists
   of all primary included studies for additional relevant references.
   SELECTION CRITERIA: Randomised controlled trials, controlled trials and
   cohort studies of children up to 18 years of age with a diagnosis of
   severe neurological impairment and respiratory morbidity were included.
   Studies of airways clearance techniques, suction, assisted coughing,
   non-invasive ventilation, tracheostomy and postural management were
   eligible for inclusion.
   DATA COLLECTION AND ANALYSIS: We used standard methodological procedures
   as expected by The Cochrane Collaboration. As the result of
   heterogeneity, we could not perform meta-analysis. We have therefore
   presented our results using a narrative approach.
   MAIN RESULTS: Fifteen studies were included in the review. Studies
   included children with a range of severe neurological impairments in
   differing settings, for example, home and critical care. Several
   different treatment modalities were assessed, and a wide range of
   outcome measures were used. Most studies used a non-randomised design
   and included small sample groups. Only four randomised controlled trials
   were identified. Non-randomised design, lack of information about how
   participants were selected and who completed outcome measures and
   incomplete reporting led to high or unclear risk of bias in many
   studies. Results from low-quality studies suggest that use of
   non-invasive ventilation, mechanically assisted coughing, high-frequency
   chest wall oscillation (HFCWO), positive expiratory pressure and
   supportive seating may confer potential benefits. No serious adverse
   effects were reported for ventilatory support or airway clearance
   interventions other than one incident in a clinically unstable child
   following mechanically assisted coughing. Night-time positioning
   equipment and spinal bracing were shown to have a potentially negative
   effect for some participants. However, these findings must be considered
   as tentative and require testing in future randomised trials.
   AUTHORS' CONCLUSIONS: This review found no high-quality evidence for any
   single intervention for the management of respiratory morbidity in
   children with severe global developmental delay. Our search yielded data
   on a wide range of interventions of interest. Significant differences in
   study design and in outcome measures precluded the possibility of
   meta-analysis. No conclusions on efficacy or safety of interventions for
   respiratory morbidity in children with severe global developmental delay
   can be made based upon the findings of this review.A co-ordinated
   approach to future research is vital to ensure that high-quality
   evidence becomes available to guide treatment for this vulnerable
   patient group.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:25326792
PM 25326792
ER

PT J
AU Callahan, Leigh A.
   Supinski, Gerald S.
TI Hyperglycemia-induced diaphragm weakness is mediated by oxidative stress
SO CRITICAL CARE
VL 18
IS 3
AR R88
DI 10.1186/cc13855
PD 2014
PY 2014
AB Introduction: A major consequence of ICU-acquired weakness (ICUAW) is
   diaphragm weakness, which prolongs the duration of mechanical
   ventilation. Hyperglycemia (HG) is a risk factor for ICUAW. However, the
   mechanisms underlying HG-induced respiratory muscle weakness are not
   known. Excessive reactive oxygen species (ROS) injure multiple tissues
   during HG, but only one study suggests that excessive ROS generation may
   be linked to HG-induced diaphragm weakness. We hypothesized that
   HG-induced diaphragm dysfunction is mediated by excessive superoxide
   generation and that administration of a specific superoxide scavenger,
   polyethylene glycol superoxide dismutase (PEG-SOD), would ameliorate
   these effects.
   Methods: HG was induced in rats using streptozotocin (60 mg/kg
   intravenously) and the following groups assessed at two weeks: controls,
   HG, HG + PEG-SOD (2,000U/kg/d intraperitoneally for seven days), and HG
   + denatured (dn)PEG-SOD (2000U/kg/d intraperitoneally for seven days).
   PEG-SOD and dnPEG-SOD were administered on day 8, we measured diaphragm
   specific force generation in muscle strips, force-pCa relationships in
   single permeabilized fibers, contractile protein content and indices of
   oxidative stress.
   Results: HG reduced diaphragm specific force generation, altered single
   fiber force-pCa relationships, depleted troponin T, and increased
   oxidative stress. PEG-SOD prevented HG-induced reductions in diaphragm
   specific force generation (for example 80 Hz force was 26.4 +/- 0.9,
   15.4 +/- 0.9, 24.0 +/- 1.5 and 14.9 +/- 0.9 N/cm(2) for control, HG, HG
   + PEG-SOD, and HG + dnPEG-SOD groups, respectively, P <0.001). PEG-SOD
   also restored HG-induced reductions in diaphragm single fiber force
   generation (for example, Fmax was 182.9 +/- 1.8, 85.7 +/- 2.0, 148.6 +/-
   2.4 and 90.9 +/- 1.5 kPa in control, HG, HG + PEG-SOD, and HG +
   dnPEG-SOD groups, respectively, P <0.001). HG-induced troponin T
   depletion, protein nitrotyrosine formation, and carbonyl modifications
   were largely prevented by PEG-SOD.
   Conclusions: HG-induced reductions in diaphragm force generation occur
   largely at the level of the contractile proteins, are associated with
   depletion of troponin T and increased indices of oxidative stress,
   findings not previously reported. Importantly, administration of PEG-SOD
   largely ablated these derangements, indicating that superoxide
   generation plays a major role in hyperglycemia-induced diaphragm
   dysfunction. This new mechanistic information could explain how HG
   alters diaphragm function during critical illness.
TC 3
ZB 1
Z8 0
ZS 0
Z9 3
SN 1466-609X
UT WOS:000341163800002
PM 24886999
ER

PT J
AU Vivodtzev, Isabelle
   Devost, Andree-Anne
   Saey, Didier
   Villeneuve, Sophie
   Boilard, Genevieve
   Gagnon, Philippe
   Provencher, Steeve
   Simon, Mathieu
   Baillot, Richard
   Maltais, Francois
   Lellouche, Francois
TI Severe and early quadriceps weakness in mechanically ventilated patients
SO CRITICAL CARE
VL 18
IS 3
AR 431
DI 10.1186/cc13888
PD 2014
PY 2014
RI Vivodtzev, Isabelle/M-7368-2014
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 1466-609X
UT WOS:000341163800097
PM 25033092
ER

PT J
AU Corner, Evelyn J.
   Soni, Neil
   Handy, Jonathan M.
   Brett, Stephen J.
TI Construct validity of the Chelsea critical care physical assessment
   tool: an observational study of recovery from critical illness
SO CRITICAL CARE
VL 18
IS 2
AR R55
DI 10.1186/cc13801
PD 2014
PY 2014
AB Introduction: Intensive care unit-acquired weakness (ICU-AW) is common
   in survivors of critical illness, resulting in global weakness and
   functional deficit. Although ICU-AW is well described subjectively in
   the literature, the value of objective measures has yet to be
   established. This project aimed to evaluate the construct validity of
   the Chelsea Critical Care Physical Assessment tool (CPAx) by analyzing
   the association between CPAx scores and hospital-discharge location, as
   a measure of functional outcome.
   Methods: The CPAx was integrated into practice as a service-improvement
   initiative in an 11-bed intensive care unit (ICU). For patients admitted
   for more than 48 hours, between 10 May 2010 and 13 November 2013, the
   last CPAx score within 24 hours of step down from the ICU or death was
   recorded (n = 499). At hospital discharge, patients were separated into
   seven categories, based on continued rehabilitation and care needs.
   Descriptive statistics were used to explore the association between ICU
   discharge CPAx score and hospital-discharge location.
   Results: Of the 499 patients, 171 (34.3%) returned home with no ongoing
   rehabilitation or care input; 131 (26.2%) required community support; 28
   (5.6%) went to inpatient rehabilitation for < 6 weeks; and 25 (5.0%)
   went to inpatient rehabilitation for > 6 weeks; 27 (5.4%) required
   nursing home level of care; 80 (16.0%) died in the ICU, and 37 (7.4%)
   died in hospital. A significant difference was found in the median CPAx
   score between groups (P < 0.0001). Four patients (0.8%) scored full
   marks (50) on the CPAx, all of whom went home with no ongoing needs; 16
   patients (3.2%) scored 0 on the CPAx, all of whom died within 24 hours.
   A 0.8% ceiling effect and a 3.2% floor effect of the CPAx is found in
   the ICU. Compliance with completion of the CPAx stabilized at 78% of all
   ICU admissions.
   Conclusion: The CPAx score at ICU discharge has displayed construct
   validity by crudely discriminating between groups with different
   functional needs at hospital discharge. The CPAx has a limited floor and
   ceiling effect in survivors of critical illness. A significant
   proportion of patients had a requirement for postdischarge care and
   rehabilitation.
TC 4
ZB 0
Z8 0
ZS 0
Z9 4
SN 1466-609X
UT WOS:000339627400073
PM 24669784
ER

PT J
AU Paparoupa, Maria
   Pietrzak, Sebastian
   Gillissen, Adrian
TI Acute rhabdomyolysis associated with coadministration of levofloxacin
   and simvastatin in a patient with normal renal function.
SO Case reports in medicine
VL 2014
BP 562929
EP 562929
DI 10.1155/2014/562929
PD 2014
PY 2014
AB We report a rare case of severe acute rhabdomyolysis in association with
   coadministration of levofloxacin and simvastatin in a patient with
   normal renal function. A 70-year-old Caucasian male was treated due to
   community acquired pneumonia with levofloxacin in a dosage of 500mg once
   and then twice a day. On the 8th day of hospitalization the patient
   presented with acute severe rhabdomyolysis requiring an intensive care
   support. After discontinuation of levofloxacin and concomitant
   medication with simvastatin 80mg/day, clinical and laboratory effects
   were totally reversible. Up to now, levofloxacin has been reported to
   induce rhabdomyolysis mainly in patients with impaired renal function,
   as the medication has a predominant renal elimination. In our case renal
   function remained normal during the severe clinical course. According to
   a recent case report rhabdomyolysis was observed due to interaction of
   simvastatin and ciprofloxacin. To our best knowledge this is the first
   case of interaction between simvastatin and levofloxacin to be reported.
   This case emphasizes the need of close monitoring of creatine kinase in
   patients under more than one potentially myotoxic medication especially
   when patients develop muscle weakness. 
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1687-9627
UT MEDLINE:25140181
PM 25140181
ER

PT J
AU Wieske, Luuk
   Witteveen, Esther
   Petzold, Axel
   Verhamme, Camiel
   Schultz, Marcus J.
   van Schaik, Ivo N.
   Horn, Janneke
TI Neurofilaments as a plasma biomarker for ICU-acquired weakness: an
   observational pilot study
SO CRITICAL CARE
VL 18
IS 1
AR R18
DI 10.1186/cc13699
PD 2014
PY 2014
AB Introduction: Early diagnosis of intensive care unit - acquired weakness
   (ICU-AW) using the current reference standard, that is, assessment of
   muscle strength, is often hampered due to impaired consciousness.
   Biological markers could solve this problem but have been scarcely
   investigated. We hypothesized that plasma levels of neurofilaments are
   elevated in ICU-AW and can diagnose ICU-AW before muscle strength
   assessment is possible.
   Methods: For this prospective observational cohort study, neurofilament
   levels were measured using ELISA (NfH(SMI35) antibody) in daily plasma
   samples (index test). When patients were awake and attentive, ICU-AW was
   diagnosed using the Medical Research Council scale (reference standard).
   Differences and discriminative power (using the area under the receiver
   operating characteristic curve; AUC) of highest and cumulative
   (calculated using the area under the neurofilament curve) neurofilament
   levels were investigated in relation to the moment of muscle strength
   assessment for each patient.
   Results: Both the index test and reference standard were available for
   77 ICU patients. A total of 18 patients (23%) fulfilled the clinical
   criteria for ICU-AW. Peak neurofilament levels were higher in patients
   with ICU-AW and had good discriminative power (AUC: 0.85; 95% CI: 0.72
   to 0.97). However, neurofilament levels did not peak before muscle
   strength assessment was possible. Highest or cumulative neurofilament
   levels measured before muscle strength assessment could not diagnose
   ICU-AW (AUC 0.59; 95% CI 0.37 to 0.80 and AUC 0.57; 95% CI 0.32 to 0.81,
   respectively).
   Conclusions: Plasma neurofilament levels are raised in ICU-AW and may
   serve as a biological marker for ICU-AW. However, our study suggests
   that an early diagnosis of ICU-AW, before muscle strength assessment, is
   not possible using neurofilament levels in plasma.
RI Petzold, Axel/C-1090-2009
OI Petzold, Axel/0000-0002-0344-9749
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 1466-609X
UT WOS:000338991900055
PM 24443841
ER

PT J
AU Ogilvie, Hannah
   Larsson, Lars
TI The Effect of Nutritional Status in the Pathogenesis of Critical Illness
   Myopathy (CIM).
SO Biology
VL 3
IS 2
BP 368
EP 82
DI 10.3390/biology3020368
PD 2014 May 30
PY 2014
AB The muscle wasting and loss of specific force associated with Critical
   Illness Myopathy (CIM) is, at least in part, due to a preferential loss
   of the molecular motor protein myosin. This acquired myopathy is common
   in critically ill immobilized and mechanically ventilated intensive care
   patients (ICU). There is a growing understanding of the mechanisms
   underlying CIM, but the role of nutritional factors triggering this
   serious complication of modern intensive care remains unknown. This
   study aims at establishing the effect of nutritional status in the
   pathogenesis of CIM. An experimental ICU model was used where animals
   are mechanically ventilated, pharmacologically paralysed
   post-synaptically and extensively monitored for up to 14 days. Due to
   the complexity of the experimental model, the number of animals included
   is small. After exposure to this ICU condition, animals develop a
   phenotype similar to patients with CIM. The results from this study show
   that the preferential myosin loss, decline in specific force and muscle
   fiber atrophy did not differ between low vs. eucaloric animals. In both
   experimental groups, passive mechanical loading had a sparing effect of
   muscle weight independent on nutritional status. Thus, this study
   confirms the strong impact of the mechanical silencing associated with
   the ICU condition in triggering CIM, overriding any potential effects of
   caloric intake in triggering CIM. In addition, the positive effects of
   passive mechanical loading on muscle fiber size and force generating
   capacity was not affected by the nutritional status in this study.
   However, due to the small sample size these pilot results need to be
   validated in a larger cohort. 
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:24887774
PM 24887774
ER

PT J
AU Gelaye, Alehegn
   Patel, Brijesh
   Farra, Wassim
   Kole, Bruce
TI Difficult-to-wean: High index of suspicion.
SO The American journal of case reports
VL 15
BP 163
EP 7
DI 10.12659/AJCR.890284
PD 2014
PY 2014
AB PATIENT: Female, 57 FINAL DIAGNOSIS: Syryngomyelia  cervical
   SYMPTOMS: Acute respiratory insufficiency Medication: - Clinical
   Procedure: - Specialty: Pulmonology.
   OBJECTIVE: Rare disease.
   BACKGROUND: Failed planned extubation occurs in a minority of patients
   with acute respiratory failure requiring invasive mechanical
   ventilation. In patients presenting with acute respiratory failure with
   no identifiable cardiopulmonary causes, uncommon conditions, such as
   cervical spondylotic myelopathy, should be considered. In very rare
   instances, when cervical spondylotic myelopathy and syringomyelia
   present concomitantly, they can be devastating.
   CASE REPORT: A 57-year-old woman visited the emergency room (ER) after
   feeling unwell for several days. She was brought to the ER with acute
   respiratory distress and obtunded state with GCS of 6/15. She was
   hypotensive and agonally breathing. Her initial neurologic evaluation
   was unrevealing. Based on these findings, she was intubated. Over the
   next several days, she was difficult to wean from the ventilator and had
   persistent respiratory acidosis. After a short-lived extubation, the
   patient was again re-intubated. This time the neurologic evaluation
   showed decreased movements of all muscle groups against gravity and
   forces, with generalized weakness. An MRI of the brain and cervical
   spine demonstrated moderate degenerative disc disease and syringomyelia
   extending from C2 to C7 level. The patient underwent de-compression
   laminectomy. After failing several weaning trials, she underwent
   bronchoscopically-assisted tracheotomy.
   CONCLUSIONS: Acute cardiopulmonary and intensive care unit-acquired
   neuromuscular conditions have been attributed as a major cause of
   difficult weaning and extubation. Failure to identify and correct other
   rare combinations (such as cervical degenerative disc disease and
   syringomyelia) may cause acute respiratory failure and subsequent
   failure to wean and extubation, resulting in high rates of mortality and
   morbidity.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:24790685
PM 24790685
ER

PT J
AU Argov, Zohar
   Latronico, Nicola
TI Neuromuscular complications in intensive care patients.
SO Handbook of clinical neurology
VL 121
BP 1673
EP 85
DI 10.1016/B978-0-7020-4088-7.00108-5
PD 2014
PY 2014
AB Increased survival of critically ill patients has focused the attention
   on secondary complications of intensive care unit (ICU) stay, mainly
   ICU-acquired weakness (ICUAW). ICUAW is relatively common with
   significant impact on recovery. Prolonging mechanical ventilation and
   overall hospitalization time, increased mortality, and persistent
   disability are the main problems associated with ICUAW. The chapter
   deals mainly with the differential diagnosis of neuromuscular
   generalized weakness that develops in the ICU, but focal ICUAW is
   reviewed too. The approach to the diagnosis and the yield of various
   techniques (mainly electrophysiological and histological) is discussed.
   Possible therapeutic interventions of this condition that modify the
   course of this deleterious situation and lead to better rehabilitation
   are discussed. The current postulated mechanisms associated with ICUAW
   (mainly the more frequent critical illness neuropathy and myopathy) are
   reviewed. 
RI Latronico, Nicola/F-1557-2010
OI Latronico, Nicola/0000-0002-2521-5871
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0072-9752
UT MEDLINE:24365440
PM 24365440
ER

PT J
AU Hsieh, Emily
   Oh, Scott S
   Chellappa, Parkavi
   Szeftel, Roxy
   Jones, Heather D
TI Management of autism in the adult intensive care unit.
SO Journal of intensive care medicine
VL 29
IS 1
BP 47
EP 52
DI 10.1177/0885066612470236
PD 2014 Jan-Feb
PY 2014
AB Autism comprises a growing segment of the population and can be a
   management challenge in the intensive care unit (ICU). We present the
   case of a 22-year-old male with severe autism and intellectual disorder
   who developed respiratory failure and required a prolonged ICU course.
   This patient exhibited severe distress, aggression, and self-injurious
   behavior. Management challenges included sedation, weaning from
   sedation, and liberation from mechanical ventilation. Success was
   achieved with a multispecialty team and by tailoring the environment and
   interactions to the patient's known preferences. The use of
   dexmedetomidine to wean high-dose benzodiazepines and opiates also
   permitted successful liberation from mechanical ventilation. 
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:23753225
PM 23753225
ER

PT J
AU Hermans, Greet
   De Jonghe, Bernard
   Bruyninckx, Frans
   Van den Berghe, Greet
TI Interventions for preventing critical illness polyneuropathy and
   critical illness myopathy.
SO The Cochrane database of systematic reviews
VL 1
BP CD006832
EP CD006832
DI 10.1002/14651858.CD006832.pub3
PD 2014 Jan 30
PY 2014
AB BACKGROUND: Critical illness polyneuropathy or myopathy (CIP/CIM) is a
   frequent complication in the intensive care unit (ICU) and is associated
   with prolonged mechanical ventilation, longer ICU stay and increased
   mortality. This is an interim update of a review first published in 2009
   (Hermans 2009). It has been updated to October 2011, with further
   potentially eligible studies from a December 2013 search characterised
   as awaiting assessment.
   OBJECTIVES: To systematically review the evidence from RCTs concerning
   the ability of any intervention to reduce the incidence of CIP or CIM in
   critically ill individuals.
   SEARCH METHODS: On 4 October 2011, we searched the Cochrane
   Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, and
   EMBASE. We checked the bibliographies of identified trials and contacted
   trial authors and experts in the field. We carried out an additional
   search of these databases on 6 December 2013 to identify recent studies.
   SELECTION CRITERIA: All randomised controlled trials (RCTs), examining
   the effect of any intervention on the incidence of CIP/CIM in people
   admitted to adult medical or surgical ICUs. The primary outcome was the
   incidence of CIP/CIM in ICU, based on electrophysiological or clinical
   examination. Secondary outcomes included duration of mechanical
   ventilation, duration of ICU stay, death at 30 and 180 days after ICU
   admission and serious adverse events from the treatment regimens.
   DATA COLLECTION AND ANALYSIS: Two authors independently extracted the
   data and assessed the risk of bias in included studies.
   MAIN RESULTS: We identified five trials that met our inclusion criteria.
   Two trials compared intensive insulin therapy (IIT) to conventional
   insulin therapy (CIT). IIT significantly reduced CIP/CIM in the screened
   (n = 825; risk ratio (RR) 0.65, 95% confidence interval (CI) 0.55 to
   0.77) and total (n = 2748; RR 0.70, 95% CI 0.60 to 0.82) population
   randomised. IIT reduced duration of mechanical ventilation, ICU stay and
   180-day mortality, but not 30-day mortality compared with CIT.
   Hypoglycaemia increased with IIT but did not cause early deaths.One
   trial compared corticosteroids with placebo (n = 180). The trial found
   no effect of treatment on CIP/CIM (RR 1.27, 95% CI 0.77 to 2.08),
   180-day mortality, new infections, glycaemia at day seven, or episodes
   of pneumonia, but did show a reduction of new shock events.In the fourth
   trial, early physical therapy reduced CIP/CIM in 82/104 evaluable
   participants in ICU (RR 0.62. 95% CI 0.39 to 0.96). Statistical
   significance was lost when we performed a full intention-to-treat
   analysis (RR 0.81, 95% CI 0.60 to 1.08). Duration of mechanical
   ventilation but not ICU stay was significantly shorter in the
   intervention group. Hospital mortality was not affected but 30- and
   180-day mortality results were not available. No adverse effects were
   noticed.The last trial found a reduced incidence of CIP/CIM in 52
   evaluable participants out of a total of 140 who were randomised to
   electrical muscle stimulation (EMS) versus no stimulation (RR 0.32, 95%
   CI 0.10 to 1.01). These data were prone to bias due to imbalances
   between treatment groups in this subgroup of participants. After we
   imputed missing data and performed an intention-to-treat analysis, there
   was still no significant effect (RR 0.94, 95% CI 0.78 to 1.15). The
   investigators found no effect on duration of mechanical ventilation and
   noted no difference in ICU mortality, but did not report 30- and 180-day
   mortality.We updated the searches in December 2013 and identified nine
   potentially eligible studies that will be assessed for inclusion in the
   next update of the review.
   AUTHORS' CONCLUSIONS: There is moderate quality evidence from two large
   trials that intensive insulin therapy reduces CIP/CIM, and high quality
   evidence that it reduces duration of mechanical ventilation, ICU stay
   and 180-day mortality, at the expense of hypoglycaemia. Consequences and
   prevention of hypoglycaemia need further study. There is moderate
   quality evidence which suggestsno effect of corticosteroids on CIP/CIM
   and high quality evidence that steroids do not affect secondary
   outcomes, except for fewer new shock episodes. Moderate quality evidence
   suggests a potential benefit of early rehabilitation on CIP/CIM which is
   accompanied by a shorter duration of mechanical ventilation but without
   an effect on ICU stay. Very low quality evidence suggests no effect of
   EMS, although data are prone to bias. Strict diagnostic criteria for
   CIP/CIM are urgently needed for research purposes. Large RCTs need to be
   conducted to further explore the role of early rehabilitation and EMS
   and to develop new preventive strategies.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:24477672
PM 24477672
ER

PT J
AU Hermans, Greet
   De Jonghe, Bernard
   Bruyninckx, Frans
   Van den Berghe, Greet
TI Interventions for preventing critical illness polyneuropathy and
   critical illness myopathy
SO COCHRANE DATABASE OF SYSTEMATIC REVIEWS
IS 1
DI 10.1002/14651858.CD006832.pub3
PD 2014
PY 2014
AB Background
   Critical illness polyneuropathy or myopathy (CIP/CIM) is a frequent
   complication in the intensive care unit (ICU) and is associated with
   prolonged mechanical ventilation, longer ICU stay and increased
   mortality. This is an interim update of a review first published in 2009
   (Hermans 2009). It has been updated to October 2011, with further
   potentially eligible studies from a December 2013 search characterised
   as awaiting assessment.
   Objectives
   To systematically review the evidence from RCTs concerning the ability
   of any intervention to reduce the incidence of CIP or CIM in critically
   ill individuals.
   Search methods
   On 4 October 2011, we searched the Cochrane Neuromuscular Disease Group
   Specialized Register, CENTRAL, MEDLINE, and EMBASE. We checked the
   bibliographies of identified trials and contacted trial authors and
   experts in the field. We carried out an additional search of these
   databases on 6 December 2013 to identify recent studies.
   Selection criteria
   All randomised controlled trials (RCTs), examining the effect of any
   intervention on the incidence of CIP/CIM in people admitted to adult
   medical or surgical ICUs. The primary outcome was the incidence of
   CIP/CIM in ICU, based on electrophysiological or clinical examination.
   Secondary outcomes included duration of mechanical ventilation, duration
   of ICU stay, death at 30 and 180 days after ICU admission and serious
   adverse events from the treatment regimens.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 1469-493X
UT WOS:000330508100028
ER

PT J
AU Raurich, J. M.
   Rialp, G.
   Llompart-Pou, J. A.
   Ayestaran, I.
   Perez-Barcena, J.
   Ibanez, J.
TI Respiratory CO2 response in acute cervical spinal cord injury (CO2
   response in spinal cord injury)
SO SPINAL CORD
VL 52
IS 1
BP 39
EP 43
DI 10.1038/sc.2013.115
PD JAN 2014
PY 2014
AB Study design: Retrospective study.
   Objectives: The objective of this study was to compare the CO2 response
   of acute tetraplegic cervical spinal cord injury (SCI) patients
   undergoing mechanical ventilation with a control group of critically ill
   patients ready for weaning of mechanical ventilation and successfully
   extubated.
   Setting: This study was conducted at the intensive care unit of a
   University Hospital in Mallorca, Spain.
   Methods: CO2 response was studied in 12 acute tetraplegic cervical SCI
   patients at the C4-C7 level and 22 control patients. The control group
   patients were consecutively selected from a database of patients with
   mechanical ventilation and who were successfully extubated after a CO2
   response test. To increase the CO2, we used the method of re-inhalation
   of expired air, and we evaluated the hypercapnic ventilatory response,
   the change in minute ventilation induced by the increase of partial
   pressure of arterial carbon dioxide (PaCO2), which measures the whole
   respiratory system (metabolic control, neuromuscular or ventilatory
   apparatus), and the hypercapnic drive response, the change in the airway
   occlusion pressure at 100ms induced by the increase in PaCO2, which
   measures the chemosensitivity of the respiratory center.
   Results: Cervical SCI patients were younger than the control group
   patients (26+/-7 and 62+/-12 years, respectively; P<0.001). Mean values
   of the hypercapnic ventilatory response in cervical SCI and control
   groups were 0.52+/-0.31 and 0.64+/-0.33 l min(-1) per mmHg (P = 0.40),
   respectively, and the hypercapnic drive response was 0.24+/-0.16 and
   0.48+/-0.23cm H2O per mmHg (P = 0.001), respectively.
   Conclusion: Acute tetraplegic cervical SCI patients had reduced
   hypercapnic drive response that may contribute to the difficult weaning,
   without reduction in hypercapnic ventilatory response.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 1362-4393
UT WOS:000329221100009
PM 24100664
ER

PT J
AU Baldwin, Claire E.
   Bersten, Andrew D.
TI Alterations in Respiratory and Limb Muscle Strength and Size in Patients
   With Sepsis Who Are Mechanically Ventilated
SO PHYSICAL THERAPY
VL 94
IS 1
BP 68
EP 82
DI 10.2522/ptj.20130048
PD JAN 2014
PY 2014
AB Background. Skeletal muscle wasting and weakness are common in patients
   with sepsis in the intensive care unit, although less is known about
   deficits in diaphragm and limb muscles when mechanical ventilation also
   is required.
   Objective. The objective of this study was to concurrently investigate
   relative differences in both thickness and strength of respiratory and
   peripheral muscles during routine care.
   Design. A prospective, cross-sectional study of 16 alert patients with
   sepsis and 16 people who were healthy (control group) was used.
   Methods. Assessment was made of the diaphragm, upper arm, forearm, and
   thigh muscle thicknesses with the use of ultrasound; respiratory muscle
   strength by means of maximal inspiratory pressure; and isometric
   handgrip, elbow flexion, and knee extension forces with the use of
   portable dynamometry. To describe relative changes, data also were
   normalized to fat-free body mass (PPM) measured by bioelectrical
   impedance spectroscopy.
   Results. Patients (9 men, 7 women; mean age=62 years, SD=17) were
   assessed after a median of 16 days (interquartile range=11-29) of
   intensive care unit admission. Patients' diaphragm thickness did not
   differ from that of the control group, even for a given FFM. When
   normalized to FFM, only the difference in patients' mid-thigh muscle
   size significantly deviated from that of the control group. Within the
   patient sample, all peripheral muscle groups were thinner compared with
   the diaphragm. Patients were significantly weaker than were the control
   group participants in all muscle groups, including for a given PPM.
   Within the critically ill group, limb weakness was greater than the
   already-significant respiratory muscle weakness.
   Limitations. Volitional strength tests were applied such that successive
   measurements from earlier in the course of illness could not be reliably
   obtained.
   Conclusions. When measured at bedside, survivors of sepsis and a period
   of mechanical ventilation may have respiratory muscle weakness without
   remarkable diaphragm wasting. Furthermore, deficits in peripheral muscle
   strength and size may exceed those in the diaphragm.
RI Baldwin, Claire/F-4478-2013
OI Baldwin, Claire/0000-0002-5022-8498
TC 5
ZB 0
Z8 1
ZS 0
Z9 6
SN 0031-9023
UT WOS:000329010500006
PM 24009347
ER

PT J
AU Williams, Nicola
   Flynn, Maria
TI A review of the efficacy of neuromuscular electrical stimulation in
   critically ill patients
SO PHYSIOTHERAPY THEORY AND PRACTICE
VL 30
IS 1
BP 6
EP 11
DI 10.3109/09593985.2013.811567
PD JAN 2014
PY 2014
AB Background: Muscle wasting in critical illness has been identified as a
   major clinical concern which can lead to persistent muscle weakness,
   impede recovery and limit physical function and quality of life in
   survivors. Neuromuscular electrical stimulation (NMES) has been
   suggested as an alternative to active exercise in critically ill
   patients. Objectives: To evaluate the efficacy of NMES in critically ill
   patients by evaluating the research literature. Methods: Structured
   database searches of the Cochrane Library, Ovid (Medline), CINHAL,
   Scopus and PEDro were completed. Results: Eight papers were retrieved
   and methodological quality evaluated using the Critical Appraisal and
   Skills Program tool. The NMES protocols, outcomes and findings were
   analysed and, given the methodological heterogeneity, the study findings
   were synthesised as a narrative. Analysis showed minimal adverse effects
   in the use of NMES and some potential benefits of NMES on preservation
   of muscle strength, decreased duration of mechanical ventilation and
   shorter Intensive Care Unit (ICU) length of stay. Conclusions: Evidence
   of the clinical benefits of NMES in the ICU is inconclusive and provides
   minimal guidance for use in clinical practice. There is a need for
   further research in this area.
TC 4
ZB 0
Z8 0
ZS 0
Z9 4
SN 0959-3985
UT WOS:000328150600002
PM 23855510
ER

PT J
AU Angelopoulos, Epameinondas
   Karatzanos, Eleftherios
   Dimopoulos, Stavros
   Mitsiou, Georgios
   Stefanou, Christos
   Patsaki, Irini
   Kotanidou, Anastasia
   Routsi, Christina
   Petrikkos, George
   Nanas, Serafeim
TI Acute microcirculatory effects of medium frequency versus high frequency
   neuromuscular electrical stimulation in critically ill patients - a
   pilot study
SO ANNALS OF INTENSIVE CARE
VL 3
AR 39
DI 10.1186/2110-5820-3-39
PD DEC 19 2013
PY 2013
AB Background: Intensive care unit-acquired weakness (ICUAW) is a common
   complication, associated with significant morbidity. Neuromuscular
   electrical stimulation (NMES) has shown promise for prevention. NMES
   acutely affects skeletal muscle microcirculation; such effects could
   mediate the favorable outcomes. However, optimal current characteristics
   have not been defined. This study aimed to compare the effects on muscle
   microcirculation of a single NMES session using medium and high
   frequency currents.
   Methods: ICU patients with systemic inflammatory response syndrome
   (SIRS) or sepsis of three to five days duration and patients with ICUAW
   were studied. A single 30-minute NMES session was applied to the lower
   limbs bilaterally using current of increasing intensity. Patients were
   randomly assigned to either the HF (75 Hz, pulse 400 mu s, cycle 5
   seconds on-21 seconds off) or the MF (45 Hz, pulse 400 mu s, cycle 5
   seconds on-12 seconds off) protocol. Peripheral microcirculation was
   monitored at the thenar eminence using near-infrared spectroscopy (NIRS)
   to obtain tissue O-2 saturation (StO(2)); a vascular occlusion test was
   applied before and after the session. Local microcirculation of the
   vastus lateralis was also monitored using NIRS.
   Results: Thirty-one patients were randomized. In the HF protocol (17
   patients), peripheral microcirculatory parameters were: thenar O-2
   consumption rate (%/minute) from 8.6 +/- 2.2 to 9.9 +/- 5.1 (P = 0.08),
   endothelial reactivity (%/second) from 2.7 +/- 1.4 to 3.2 +/- 1.9 (P =
   0.04), vascular reserve (seconds) from 160 +/- 55 to 145 +/- 49 (P =
   0.03). In the MF protocol: thenar O-2 consumption rate (%/minute) from
   8.8 +/- 3.8 to 9.9 +/- 3.6 (P = 0.07), endothelial reactivity (%/second)
   from 2.5 +/- 1.4 to 3.1 +/- 1.7 (P = 0.03), vascular reserve (seconds)
   from 163 +/- 37 to 144 +/- 33 (P = 0.001). Both protocols showed a
   similar effect. In the vastus lateralis, average muscle O-2 consumption
   rate was 61 +/- 9%/minute during the HF protocol versus 69 +/-
   23%/minute during the MF protocol (P = 0.5). The minimum amplitude in
   StO(2) was 5 +/- 4 units with the HF protocol versus 7 +/- 4 units with
   the MF protocol (P = 0.3). Post-exercise, StO(2) increased by 6 +/- 7
   units with the HF protocol versus 5 +/- 4 units with the MF protocol (P
   = 0.6). These changes correlated well with contraction strength.
   Conclusions: A single NMES session affected local and systemic skeletal
   muscle microcirculation. Medium and high frequency currents were equally
   effective.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 2110-5820
UT WOS:000345155200001
PM 24355422
ER

PT J
AU Verma, Rajesh
   Chaudhari, Tejendra Sukdeo
   Raut, Tushar Premraj
   Garg, Ravindra Kumar
TI Clinico-electrophysiological profile and predictors of functional
   outcome in Guillain-Barre syndrome (GBS)
SO JOURNAL OF THE NEUROLOGICAL SCIENCES
VL 335
IS 1-2
BP 105
EP 111
DI 10.1016/j.jns.2013.09.002
PD DEC 15 2013
PY 2013
AB Introduction: Guillain-Barre syndrome (GBS) is an acute
   polyradiculoneuropathy with varied severity of presentation.
   Aims: To study the clinical and electrophysiological profile of patients
   with CBS and to determine the factors associated with poor functional
   outcome and need for mechanical ventilation.
   Settings and design: It was a hospital-based prospective observational
   study.
   Methods and material: 90 patients with CBS diagnosed as per Asbury and
   Cornblath criteria were enrolled and followed up for 6 months. Various
   epidemiological, clinical and electrophysiological parameters were
   evaluated. Hughes motor scale was used to measure functional outcome.
   Factors associated with poor functional outcome and need for mechanical
   ventilation were determined.
   Results: 90 patients (56 males; 34 females; mean age of 29.3 +/- 15.2
   years) were enrolled in this study. Amongst these 6 (6.7%) patients died
   during in-hospital stay. Antecedent infection was present in 29 (32.2%),
   autonomic dysfunction in 31(34.4%), bulbar palsy in 21 (23.3%), neck
   flexor weakness in 52 (57.8%). 60 cases (66.7%) were of axonal variety
   and 30 (333%) of demyelinating variety. On univariate analysis,
   predictors associated with poor functional outcome at 6 months were
   autonomic dysfunction (p = 0.013), neck flexor weakness (p = 0.009),
   requirement of ventilatory assistance (p = <0.001), MRC sum score < 30
   on admission (p = <0.001) and axonal pattern on electrophysiological
   assessment (p = <0.001). On multivariate analysis, MRC sum score <30 on
   admission (p = 0.007) and axonal pattern on electrophysiological
   assessment (p = <0.001) were independently associated with poor
   functional outcome at 6 months. Factors associated with need for
   mechanical ventilation were presence of autonomic dysfunction (p =
   <0.001), cranial nerve palsy including facial palsy (p = <0.001) and
   bulbar palsy (p = 0.002), neck flexor weakness (p = <0.001), low MRC sum
   score (<30) (p = 0.001), and low proximal CPN CMAP amplitude to distal
   CPN CMAP amplitude ratio (p = 0.042); none of them being significant on
   multivariate analysis.
   Conclusions: Detailed evaluation of the clinical and
   electrophysiological profile may help in predicting the functional
   outcome and need for mechanical ventilation in patients with GBS. (C)
   2013 Elsevier B.V. All rights reserved.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0022-510X
UT WOS:000328596900018
PM 24064258
ER

PT J
AU Yoshimoto, Kenji
   Okuma, Yusuke
   Nakamura, Takashi
   Mita, Tomoki
   Mitsumoto, Atsuko
   Yamasaki, Nobuya
   Tobimatsu, Yoshiko
   Akai, Masami
TI Limb fitting for quadruple amputees: Report of two cases of symmetrical
   peripheral gangrene caused by pneumococcal purpura fulminans
SO PROSTHETICS AND ORTHOTICS INTERNATIONAL
VL 37
IS 6
BP 489
EP 494
DI 10.1177/0309364613481797
PD DEC 2013
PY 2013
AB Background: We report our experiences of prosthetic fitting in quadruple
   amputees. Two patients underwent quadruple amputation after suffering
   from disseminated intravascular coagulation in conjunction with
   pneumococcemia with purpura fulminans.
   Case Description and Methods: The first patient, a 52-year-old man,
   underwent bilateral transradial, left transtibial, and right
   transfemoral amputation, and the second patient, a 62-year-old man,
   underwent bilateral transradial and bilateral transfemoral amputation,
   both for symmetrical peripheral gangrene subsequent to septic shock.
   Findings and Outcomes: The amputations were accompanied by skin damage
   due to ischemic tissue changes both on the stumps and on the nose and/or
   lips. The combination of the intensive prosthetic rehabilitation program
   and supportive medical care led to completely independent functioning,
   including driving a car, with the use of four prosthetic limbs and a
   wheelchair in both cases.
   Conclusion: Early initiation of a multidisciplinary approach can
   properly address impairments and minimize future disability.
   Clinical relevance We have reported our experience of limb fitting in
   two patients who had undergone quadruple amputation after suffering
   peripheral gangrene. Appropriate limb fitting that provides support in
   daily activities can address impairments and minimize disability.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0309-3646
UT WOS:000329762800010
PM 23558402
ER

PT J
AU Yang, Meirong
   Wang, Haitao
   Han, Guangwei
   Chen, Lianhua
   Huang, Lina
   Jiang, Jihong
   Li, Shitong
TI PHRENIC NERVE STIMULATION PROTECTS AGAINST MECHANICAL
   VENTILATION-INDUCED DIAPHRAGM DYSFUNCTION IN RATS
SO MUSCLE & NERVE
VL 48
IS 6
BP 958
EP 962
DI 10.1002/mus.23850
PD DEC 2013
PY 2013
AB Introduction: We investigated a novel application of phrenic nerve
   stimulation (PNS) in diaphragm dysfunction induced by mechanical
   ventilation (MV). Methods: Twenty-one Sprague-Dawley rats were assigned
   randomly to 3 groups: spontaneous breathing, 18-h controlled MV, and
   18-h controlled MV with PNS. Upon completion of the experimental
   protocol, diaphragm contractility, gene expression of insulin-like
   growth factor-1 (IGF-1) and ubiquitin ligases, and serum IGF-1 levels
   were analyzed. Results: Compared with the spontaneously breathing rats,
   impaired diaphragm contractile function, including force-related
   properties and force-frequency responses, were pronounced with MV.
   Furthermore, MV suppressed IGF-1 and induced muscle ring finger 1 mRNA
   expression in the diaphragm. In contrast, PNS counteracted MV-induced
   gene expression changes in the diaphragm and restored diaphragm
   function. Conclusions: PNS exerted a protective effect against
   MV-induced diaphragm dysfunction by counteracting altered expression of
   IGF-1 and ubiquitin ligase in the diaphragm. Muscle Nerve48: 958-962,
   2013
TC 5
ZB 4
Z8 0
ZS 0
Z9 5
SN 0148-639X
UT WOS:000327982300016
PM 23512776
ER

PT J
AU Mendez-Tellez, Pedro A.
   Dinglas, Victor D.
   Colantuoni, Elizabeth
   Ciesla, Nancy
   Sevransky, Jonathan E.
   Shanholtz, Carl
   Pronovost, Peter J.
   Needham, Dale M.
TI Factors associated with timing of initiation of physical therapy in
   patients with acute lung injury
SO JOURNAL OF CRITICAL CARE
VL 28
IS 6
BP 980
EP 984
DI 10.1016/j.jcrc.2013.06.001
PD DEC 2013
PY 2013
AB Objectives: Early initiation of physical therapy (PT) in mechanically
   ventilated patients is associated with improved outcomes. However, PT is
   frequently delayed until after extubation or discharge from the
   intensive care unit (ICU). We evaluated factors associated with the
   timing of initiation of PT in patients with acute lung injury (ALI)
   admitted to ICUs without an emphasis on early rehabilitation.
   Design: A secondary analysis of a prospective cohort study was
   conducted.
   Settings: The study was conducted in 11 ICUs in 3 teaching hospitals.
   Patients: A total of 503 patients with ALI were included in the study.
   Interventions: No interventions were used in this study.
   Measurements and Main Results: Thirty-four percent of patients ever
   received PT. In multivariable analysis, factors associated with later PT
   were a higher Sequential Organ Failure Assessment score (hazard ratio,
   0.89; 95% confidence interval, 0.85-0.93), higher fraction of inspired
   oxygen (0.97, 0.96-0.98), mechanical ventilation (0.31, 0.16-0.59), coma
   (0.32, 0.20-0.51), delirium (0.72, 0.50-1.03), and continuous sedation
   (with daily sedation interruption: 0.49, 0.30-0.81; without daily
   sedation interruption: 0.59, 0.39-0.89). Factors associated with earlier
   PT were an admitting diagnosis of trauma (3.31, 1.74-6.31) and hospital
   study site (2.84, 1.89-4.26).
   Conclusions: In 11 ICUs without emphasis on early rehabilitation,
   patients with ALI frequently received no PT. Severity of illness, mental
   status, sedation practices, and hospital site were significant barriers
   to initiating PT. Understanding these barriers may be important when
   introducing early ICU physical rehabilitation. (C) 2013 Elsevier Inc.
   All rights reserved.
TC 6
ZB 1
Z8 0
ZS 0
Z9 6
SN 0883-9441
UT WOS:000326945100019
PM 23845792
ER

PT J
AU Parsons, Elizabeth C.
   Kross, Erin K.
   Ali, Naeem A.
   Vandevusse, Lisa K.
   Caldwell, Ellen S.
   Watkins, Timothy R.
   Heckbert, Susan R.
   Hough, Catherine L.
TI Red blood cell transfusion is associated with decreased in-hospital
   muscle strength among critically ill patients requiring mechanical
   ventilation
SO JOURNAL OF CRITICAL CARE
VL 28
IS 6
BP 1079
EP 1085
DI 10.1016/j.jcrc.2013.06.020
PD DEC 2013
PY 2013
AB Purpose: Red blood cell (RBC) transfusion is linked to poor functional
   recovery after surgery and trauma. To investigate one potential
   mechanism, we examined the association between RBC transfusion and
   muscle strength in a cohort of critically ill patients.
   Methods: We performed a secondary analysis of 124 critically ill,
   mechanically ventilated patients enrolled in 2 prospective cohort
   studies where muscle strength testing was performed at a median of 12
   days after mechanical ventilation onset. We examined the association
   between RBC transfusion and dynamometry handgrip strength using
   multivariable linear regression, adjusting for study site, age, sex,
   Acute Physiology and Chronic Health Evaluation, Sequential Organ Failure
   Assessment score, days from hospital admission to examination, and
   steroid use. Secondary outcomes included systematic manual muscle
   strength and intensive care unit-acquired paresis.
   Results: Among 124 subjects, 73 (59%)received RBC transfusion in the 30
   days before examination. In adjusted analyses, RBC transfusion was
   significantly associated with weaker handgrip (adjusted mean difference,
   - 9.9 kg; 95% confidence interval, - 16.6 to - 3.2; P < .01) and
   proximal manual muscle strength (adjusted mean difference in Medical
   Research Council score, - 0.5; 95% confidence interval, - 0.7 to - 0.2;
   P < .01) but not intensive care unit-acquired paresis.
   Conclusions: Red blood cell transfusion was associated with decreased
   muscle strength in this cohort of critically ill patients after
   adjusting for illness severity and organ dysfunction. Further studies
   are needed to validate these results and probe mechanisms. (C) 2013
   Published by Elsevier Inc.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0883-9441
UT WOS:000326945100035
PM 23937968
ER

PT J
AU Daniel Martin, A
   Smith, Barbara K
   Gabrielli, Andrea
TI Mechanical ventilation, diaphragm weakness and weaning: a rehabilitation
   perspective.
SO Respiratory physiology & neurobiology
VL 189
IS 2
BP 377
EP 83
DI 10.1016/j.resp.2013.05.012
PD 2013-Nov-1
PY 2013
AB Most patients are easily liberated from mechanical ventilation (MV)
   following resolution of respiratory failure and a successful trial of
   spontaneous breathing, but about 25% of patients experience difficult
   weaning. MV use leads to cellular changes and weakness, which has been
   linked to weaning difficulties and has been labeled ventilator induced
   diaphragm dysfunction (VIDD). Aggravating factors in human studies with
   prolonged weaning include malnutrition, chronic electrolyte
   abnormalities, hyperglycemia, excessive resistive and elastic loads,
   corticosteroids, muscle relaxant exposure, sepsis and compromised
   cardiac function. Numerous animal studies have investigated the effects
   of MV on diaphragm function. Virtually all these studies have concluded
   that MV use rapidly leads to VIDD and have identified cellular and
   molecular mechanisms of VIDD. Molecular and functional studies on the
   effects of MV on the human diaphragm have largely confirmed the animal
   results and identified potential treatment strategies. Only recently
   potential VIDD treatments have been tested in humans, including
   pharmacologic interventions and diaphragm "training". A limited number
   of human studies have found that specific diaphragm training can
   increase respiratory muscle strength in FTW patients and facilitate
   weaning, but larger, multicenter trials are needed. 
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:23692928
PM 23692928
ER

PT J
AU Gilstrap, Daniel
   MacIntyre, Neil
TI Patient-Ventilator Interactions Implications for Clinical Management
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 188
IS 9
BP 1058
EP 1068
DI 10.1164/rccm.201212-2214CI
PD NOV 1 2013
PY 2013
AB Assisted/supported modes of mechanical ventilation offer significant
   advantages over controlled modes in terms of ventilator muscle
   function/recovery and patient comfort (and sedation needs). However,
   assisted/supported breaths must interact with patient demands during all
   three phases of breath delivery: trigger, target, and cycle. Synchronous
   interactions match ventilator support with patient demands;
   dyssynchronous interactions do not. Dyssynchrony imposes high pressure
   loads on ventilator muscles, promoting muscle overload/fatigue and
   increasing sedation needs. On current modes of ventilation there are a
   number of features that can monitor and enhance synchrony. These include
   adjustments of the trigger variable, the use of pressure versus fixed
   flow targeted breaths, and a number of manipulations of the cycle
   variable. Clinicians need to know how to use these modalities and
   monitor them properly, especially understanding airway pressure and flow
   graphics. Future strategies are emerging that have theoretical appeal
   but they await good clinical outcome studies before they become
   commonplace.
TC 10
ZB 2
Z8 0
ZS 0
Z9 10
SN 1073-449X
UT WOS:000326962700007
PM 24070493
ER

PT J
AU Luks, Andrew M.
TI Ventilatory strategies and supportive care in acute respiratory distress
   syndrome
SO INFLUENZA AND OTHER RESPIRATORY VIRUSES
VL 7
SI SI
BP 8
EP 17
DI 10.1111/irv.12178
SU 3
PD NOV 2013
PY 2013
AB While antiviral therapy is an important component of care in patients
   with the acute respiratory distress syndrome (ARDS) following influenza
   infection, it is not sufficient to ensure good outcomes, and additional
   measures are usually necessary. Patients usually receive high levels of
   supplemental oxygen to counteract the hypoxemia resulting from severe
   gas exchange abnormalities. Many patients also receive invasive
   mechanical ventilation for support for oxygenation, while in
   resource-poor settings, supplemental oxygen via face mask may be the
   only available intervention. Patients with ARDS receiving mechanical
   ventilation should receive lung-protective ventilation, whereby tidal
   volume is decreased to 6ml/kg of their predicted weight and distending
   pressures are maintained 30cm H2O, as well as increased inspired oxygen
   concentrations and positive end-expiratory pressure (PEEP) to prevent
   atelectasis and support oxygenation. While these measures are sufficient
   in most patients, a minority develop refractory hypoxemia and may
   receive additional therapies, including prone positioning, inhaled
   vasodilators, extracorporeal membrane oxygenation, recruitment maneuvers
   followed by high PEEP, and neuromuscular blockade, although recent data
   suggest that this last option may be warranted earlier in the clinical
   course before development of refractory hypoxemia. Application of these
   rescue strategies is complicated by the lack of guidance in the
   literature regarding implementation. While much attention is devoted to
   these strategies, clinicians must not lose sight of simple interventions
   that affect patient outcomes including head of bed elevation,
   prophylaxis against venous thromboembolism and gastrointestinal
   bleeding, judicious use of fluids in the post-resuscitative phase, and a
   protocol-based approach to sedation and spontaneous breathing trials.
TC 0
ZB 0
Z8 1
ZS 0
Z9 1
SN 1750-2640
UT WOS:000326959200002
PM 24215377
ER

PT J
AU Farivar, Behzad S.
   Eiref, Simon D.
   Leitman, I. Michael
TI Strategies to prevent sepsis-induced intensive care unit-acquired
   weakness: are there any options? Commentary on "Comparison of melatonin
   and oxytocin in the prevention of critical illness polyneuropathy in
   rats with surgically induced sepsis"
SO JOURNAL OF SURGICAL RESEARCH
VL 185
IS 1
BP E39
EP E42
DI 10.1016/j.jss.2012.12.019
PD NOV 2013
PY 2013
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0022-4804
UT WOS:000325951100015
PM 23295195
ER

PT J
AU Chaves, Sandra S.
   Aragon, Deborah
   Bennett, Nancy
   Cooper, Tara
   D'Mello, Tiffany
   Farley, Monica
   Fowler, Brian
   Hancock, Emily
   Kirley, Pam Daily
   Lynfield, Ruth
   Ryan, Patricia
   Schaffner, William
   Sharangpani, Ruta
   Tengelsen, Leslie
   Thomas, Ann
   Thurston, Diana
   Williams, Jean
   Yousey-Hindes, Kimberly
   Zansky, Shelley
   Finelli, Lyn
TI Patients Hospitalized With Laboratory-Confirmed Influenza During the
   2010-2011 Influenza Season: Exploring Disease Severity by Virus Type and
   Subtype
SO JOURNAL OF INFECTIOUS DISEASES
VL 208
IS 8
BP 1305
EP 1314
DI 10.1093/infdis/jit316
PD OCT 15 2013
PY 2013
AB Background. The 2010-2011 influenza season was dominated by influenza
   A(H3N2) virus, but influenza A(H1N1) pdm09 (pH1N1) and B viruses
   cocirculated. This provided an opportunity to explore within-season
   predictors of severity among hospitalized patients, avoiding biases
   associated with season-to-season differences in strain virulence,
   population immunity, and healthcare seeking.
   Methods. Population-based, laboratory-confirmed influenza
   hospitalization surveillance data were used to examine the association
   between virus type/subtype and outcomes in children and adults.
   Multivariable analysis explored virus type/subtype, prompt antiviral
   treatment, medical conditions, and age as predictors for severity
   (intensive care unit admission or death).
   Results. In children, pH1N1 (adjusted odds ratio [aOR], 2.19; 95%
   confidence interval [CI], 1.11-4.3), chronic metabolic disease (aOR,
   5.23; 95% CI, 1.74-15.69), and neuromuscular disorder (aOR, 4.84; 95%
   CI, 2.02-11.58) were independently associated with severity. In adults,
   independent predictors were pH1N1 (aOR, 2.21; 95% CI, 1.66-2.94),
   chronic lung disease (aOR, 1.46, 95% CI, 1.12-1.89), and neuromuscular
   disorder (aOR, 1.68; 95% CI, 1.11-2.52). Antiviral treatment reduced the
   odds of severity among adults (aOR, 0.47; 95% CI, .33-.68).
   Conclusions. During the 2010-2011 season, pH1N1 caused more severe
   disease than H3N2 or B in hospitalized patients. Underlying medical
   conditions increased severity despite virus strain. Antiviral treatment
   reduced severity among adults. Our findings underscore the importance of
   influenza prevention.
TC 9
ZB 4
Z8 0
ZS 0
Z9 9
SN 0022-1899
UT WOS:000324832800015
PM 23863950
ER

PT J
AU Hefner, Jennifer L
   Tsai, Wan Chong
TI Ventilator-dependent children and the health services system. Unmet
   needs and coordination of care.
SO Annals of the American Thoracic Society
VL 10
IS 5
BP 482
EP 9
DI 10.1513/AnnalsATS.201302-036OC
PD 2013-Oct
PY 2013
AB RATIONALE: Children dependent on mechanical ventilation are a vulnerable
   population by virtue of their chronic disability and are therefore at
   increased risk for health disparities and access barriers. The present
   study is the first, to our knowledge, to conduct a large-scale survey of
   caregivers of ventilator-dependent children to develop a comprehensive
   socio-demographic profile.
   OBJECTIVES: To describe the demographic and health status profile of
   ventilator-dependent children, to identify the types of unmet needs
   families caring for a child on a ventilator face, and to determine the
   correlates of access to care coordination.
   METHODS: A survey was administered to 122 parents whose children
   attended a pediatric home ventilator clinic at a large tertiary
   Midwestern medical center (84% of the clinic population).
   MEASUREMENTS AND MAIN RESULTS: Half of the patient population had severe
   functional limitations, and 70% had one or more comorbidities. One
   quarter of caregivers reported current financial struggles, and 16%
   screened positive for a probable depressive disorder. More than half of
   families reported unmet needs for care, most frequently therapeutic
   services and skilled nursing care. Of those reporting an unmet need for
   skilled nursing care, lack of adequate staffing was the main barrier
   (71.1%). Financial struggles and a probable caregiver depressive
   disorder were significantly associated with an unmet need for care
   coordination.
   CONCLUSIONS: This is the first large-scale quantitative study to
   investigate the themes of unmet need and care coordination within this
   vulnerable population. The results suggest these families face barriers
   accessing therapeutic and skilled nursing services, and caregiver mental
   health and financial struggles may be important points of intervention
   for service providers through the inclusion of multidisciplinary care
   teams and the strengthening of social services referral networks.
TC 1
ZB 1
Z8 0
ZS 0
Z9 1
UT MEDLINE:23987826
PM 23987826
ER

PT J
CA Committee on pediatric workforce
TI Enhancing pediatric workforce diversity and providing culturally
   effective pediatric care: implications for practice, education, and
   policy making.
SO Pediatrics
VL 132
IS 4
BP e1105
EP 16
DI 10.1542/peds.2013-2268
PD 2013-Oct
PY 2013
AB This policy statement serves to combine and update 2 previously
   independent but overlapping statements from the American Academy of
   Pediatrics (AAP) on culturally effective health care (CEHC) and
   workforce diversity. The AAP has long recognized that with the
   ever-increasing diversity of the pediatric population in the United
   States, the health of all children depends on the ability of all
   pediatricians to practice culturally effective care. CEHC can be defined
   as the delivery of care within the context of appropriate physician
   knowledge, understanding, and appreciation of all cultural distinctions,
   leading to optimal health outcomes. The AAP believes that CEHC is a
   critical social value and that the knowledge and skills necessary for
   providing CEHC can be taught and acquired through focused curricula
   across the spectrum of lifelong learning. This statement also addresses
   workforce diversity, health disparities, and affirmative action. The
   discussion of diversity is broadened to include not only race,
   ethnicity, and language but also cultural attributes such as gender,
   religious beliefs, sexual orientation, and disability, which may affect
   the quality of health care. The AAP believes that efforts must be
   supported through health policy and advocacy initiatives to promote the
   delivery of CEHC and to overcome educational, organizational, and other
   barriers to improving workforce diversity. 
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:24081998
PM 24081998
ER

PT J
AU Bunnell, A.
   Ney, J.
   Hough, C.
   Gellhorn, A.
TI QUANTITATIVE NEUROMUSCULAR ULTRASOUND IN INTENSIVE CARE UNIT ACQUIRED
   WEAKNESS: A SYSTEMATIC REVIEW
SO MUSCLE & NERVE
VL 48
IS 4
BP 672
EP 672
PD OCT 2013
PY 2013
CT 60th Annual Meeting of the
   American-Association-of-Neuromuscular-and-Electrodiagnostic-Medicine
   (AANEM)
CY OCT 16-19, 2013
CL San Antonio, TX
SP Amer Assoc Neuromuscular & Electrodiagnost Med
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0148-639X
UT WOS:000327884200105
ER

PT J
AU Hough, Catherine L.
TI Improving physical function during and after critical care
SO CURRENT OPINION IN CRITICAL CARE
VL 19
IS 5
BP 488
EP 495
DI 10.1097/MCC.0b013e328364d7ef
PD OCT 2013
PY 2013
AB Purpose of reviewAlthough it has been demonstrated that physical
   functional impairments are common among survivors of critical illness,
   few studies have proven benefits of intervention. This review will
   discuss assessment of physical functional impairment, recent and ongoing
   interventional studies, and implementation of rehabilitation beginning
   in the ICU, hospital ward, and after hospital discharge.Recent
   findingsNew studies confirm challenges around measurement of physical
   function both during and after critical illness, and offer potential new
   modalities that could inform mechanism and treatment. Longitudinal
   cohort studies emphasize the importance of recognition and measurement
   of premorbid status. Although no recent studies have proven new
   approaches to improving physical function in survivors of critical
   illness, emerging data support the safety, feasibility, and
   cost-effectiveness of providing physical rehabilitation early in the
   course of critical illness. Pilot and ongoing studies hold promise for
   improving physical function and quality of life for future survivors of
   critical illness.SummaryImproving physical function for survivors of
   critical illness will require careful application of current knowledge,
   as well as rigorous investigation into causes, research methodologies,
   and implementation of results of future interventional studies.
TC 6
ZB 3
Z8 0
ZS 0
Z9 6
SN 1070-5295
UT WOS:000326575200017
PM 23995133
ER

PT J
AU Grill, Eva
   Klein, Anke-Maria
   Howell, Kaitlen
   Arndt, Marion
   Bodrozic, Lydia
   Herzog, Juergen
   Jox, Ralf
   Koenig, Eberhardt
   Mansmann, Ulrich
   Mueller, Friedemann
   Mueller, Thomas
   Nowak, Dennis
   Schaupp, Matthias
   Straube, Andreas
   Bender, Andreas
TI Rationale and Design of the Prospective German Registry of Outcome in
   Patients With Severe Disorders of Consciousness After Acute Brain Injury
SO ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
VL 94
IS 10
BP 1870
EP 1876
DI 10.1016/j.apmr.2012.10.040
PD OCT 2013
PY 2013
AB Objective: To describe the rationale and design of a new patient
   registry (Koma Outcome von Patienten der Fruhrehabilitation-Register
   [KOPF-R; Registry for Coma Outcome in Patients Undergoing Acute
   Rehabilitation]) that has the scope to examine determinants of long-term
   outcome and functioning of patients with severe disorders of
   consciousness (DOC).
   Design: Prospective multicenter neurologic rehabilitation registry.
   Setting: Five specialized neurologic rehabilitation facilities.
   Participants: Patients (N=42) with DOC in vegetative state or minimally
   conscious state (MCS) as defined by the Coma Recovery Scale Revised
   (CRS-R) after brain injury. Patients are being continuously enrolled.
   The data presented here cover the enrollment period from August 2011 to
   January 2012.
   Interventions: Not applicable.
   Main Outcome Measures: CRS-R, FIM, and emergence from MCS.
   Results: The registry was set up in 5 facilities across the state of
   Bavaria/Germany with a special expertise in the rehabilitation of
   acquired brain injury. Inclusion of patients started in August 2011.
   Measures include sociodemographic and clinical characteristics, course
   of acute therapy, electrophysiologic measures (evoked potentials,
   electroencephalogram), neuron-specific enolase, current medication,
   functioning, cognition, participation, quality of life, quantity and
   characteristics of rehabilitation therapy, caregiver burden, and
   attitudes toward end-of-life decisions. Main diagnoses were traumatic
   brain injury (24%), intracerebral or subarachnoid hemorrhage (31%), and
   anoxic-ischemic encephalopathy (45%). Mean CRS-R score +/- SD at
   admission to rehabilitation was 5.9 +/- 3.3, and mean FIM score +/- SD
   at admission was 18 +/- 0.4.
   Conclusions: The KOPF-R aspires to contribute prospective data on
   prognosis in severe DOC. (c) 2013 by the American Congress of
   Rehabilitation Medicine
RI Grill, Eva/D-1875-2010
OI Grill, Eva/0000-0002-0273-7984
TC 5
ZB 3
Z8 0
ZS 0
Z9 5
SN 0003-9993
UT WOS:000325442100004
PM 23732165
ER

PT J
AU Macht, Madison
   Wimbish, Tim
   Bodine, Cathy
   Moss, Marc
TI ICU-Acquired Swallowing Disorders
SO CRITICAL CARE MEDICINE
VL 41
IS 10
BP 2396
EP 2405
DI 10.1097/CCM.0b013e31829caf33
PD OCT 2013
PY 2013
AB Objectives: Patients hospitalized in the ICU can frequently develop
   swallowing disorders, resulting in an inability to effectively transfer
   food, liquids, and pills from their mouth to stomach. The complications
   of these disorders can be devastating, including aspiration,
   reintubation, pneumonia, and a prolonged hospital length of stay. As a
   result, critical care practitioners should understand the optimal
   diagnostic strategies, proposed mechanisms, and downstream complications
   of these ICU-acquired swallowing disorders.
   Data Sources: Database searches and a review of the relevant medical
   literature.
   Data Synthesis: A significant portion of the estimated 400,000 patients
   who annually develop acute respiratory failure, require endotracheal
   intubation, and survive to be extubated are determined to have
   dysfunctional swallowing. This group of swallowing disorders has
   multiple etiologies, including local effects of endotracheal tubes,
   neuromuscular weakness, and an altered sensorium. The diagnosis of
   dysfunctional swallowing is usually made by a speech-language
   pathologist using a bedside swallowing evaluation. Major complications
   of swallowing disorders in hospitalized patients include aspiration,
   reintubation, pneumonia, and increased hospitalization. The national
   yearly cost of swallowing disorders in hospitalized patients is
   estimated to be over $500 million. Treatment modalities focus on
   changing the consistency of food, changing mealtime position, and/or
   placing feeding tubes to prevent aspiration.
   Conclusions: Swallowing disorders are costly and clinically important in
   a large population of ICU patients. The development of effective
   screening strategies and national diagnostic standards will enable
   further studies aimed at understanding the precise mechanisms for these
   disorders. Further research should also concentrate on identifying
   modifiable risk factors and developing novel treatments aimed at
   reducing the significant burden of swallowing dysfunction in critical
   illness survivors.
TC 5
ZB 1
Z8 0
ZS 1
Z9 6
SN 0090-3493
UT WOS:000324935000036
PM 23939361
ER

PT J
AU Parry, Selina M.
   Berney, Sue
   Granger, Catherine L.
   Koopman, Rene
   El-Ansary, Doa
   Denehy, Linda
TI Electrical Muscle Stimulation in the Intensive Care Setting: A
   Systematic Review
SO CRITICAL CARE MEDICINE
VL 41
IS 10
BP 2406
EP 2418
DI 10.1097/CCM.0b013e3182923642
PD OCT 2013
PY 2013
AB Context: The role of electrical muscle stimulation in intensive care has
   not previously been systematically reviewed.
   Objectives: To identify, evaluate, and synthesize the evidence examining
   the effectiveness and the safety of electrical muscle stimulation in the
   intensive care, and the optimal intervention variables.
   Data Sources: A systematic review of articles using eight electronic
   databases (Cumulative Index to Nursing and Allied Health Literature,
   Cochrane Library, Excerpta Medica Database, Expanded Academic ASAP,
   MEDLINE, Physiotherapy Evidence Database, PubMed, and Scopus) personal
   files were searched, and cross-referencing was undertaken.
   Eligibility Criteria: Quantitative studies published in English,
   assessing electrical muscle stimulation in intensive care, were
   included.
   Data Extraction and Data Synthesis: One reviewer extracted data using a
   standardized form, which were cross-checked by a second reviewer.
   Quality appraisal was undertaken by two independent reviewers using the
   Physiotherapy Evidence Database and Newcastle-Ottawa scales, and the
   National Health and Medical Research Council Hierarchy of Evidence
   Scale. Preferred Reporting Items for Systematic Reviews guidelines were
   followed.
   Results: Nine studies on six individual patient groups of 136
   participants were included. Eight were randomized controlled trials,
   with four studies reporting on the same cohort of participants.
   Electrical muscle stimulation appears to preserve muscle mass and
   strength in long-stay participants and in those with less acuity. No
   such benefits were observed when commenced prior to 7 days or in
   patients with high acuity. One adverse event was reported. Optimal
   training variables and safety of the intervention require further
   investigation.
   Conclusions: Electrical muscle stimulation is a promising intervention;
   however, there is conflicting evidence for its effectiveness when
   administered acutely. Outcomes measured are heterogeneous with small
   sample sizes.
TC 7
ZB 1
Z8 0
ZS 0
Z9 7
SN 0090-3493
UT WOS:000324935000037
PM 23921276
ER

PT J
AU Callahan, Leigh Ann
   Supinski, Gerald S.
TI Prevention and Treatment of ICU-Acquired Weakness: Is There a
   Stimulating Answer?
SO CRITICAL CARE MEDICINE
VL 41
IS 10
BP 2457
EP 2458
DI 10.1097/CCM.0b013e31829824da
PD OCT 2013
PY 2013
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0090-3493
UT WOS:000324935000054
PM 24060784
ER

PT J
AU Rimsza, Mary Ellen
   Basco, William T.
   Hotaling, Andrew J.
   Sigrest, Ted D.
   Simon, Frank A.
CA COMM PEDIAT WORKFORCE
TI Enhancing Pediatric Workforce Diversity and Providing Culturally
   Effective Pediatric Care: Implications for Practice, Education, and
   Policy Making
SO PEDIATRICS
VL 132
IS 4
BP E1105
EP E1116
DI 10.1542/peds.2013-2268
PD OCT 2013
PY 2013
AB This policy statement serves to combine and update 2 previously
   independent but overlapping statements from the American Academy of
   Pediatrics (AAP) on culturally effective health care (CEHC) and
   workforce diversity. The AAP has long recognized that with the
   ever-increasing diversity of the pediatric population in the United
   States, the health of all children depends on the ability of all
   pediatricians to practice culturally effective care. CEHC can be defined
   as the delivery of care within the context of appropriate physician
   knowledge, understanding, and appreciation of all cultural distinctions,
   leading to optimal health outcomes. The AAP believes that CEHC is a
   critical social value and that the knowledge and skills necessary for
   providing CEHC can be taught and acquired through focused curricula
   across the spectrum of lifelong learning. This statement also addresses
   workforce diversity, health disparities, and affirmative action. The
   discussion of diversity is broadened to include not only race,
   ethnicity, and language but also cultural attributes such as gender,
   religious beliefs, sexual orientation, and disability, which may affect
   the quality of health care. The AAP believes that efforts must be
   supported through health policy and advocacy initiatives to promote the
   delivery of CEHC and to overcome educational, organizational, and other
   barriers to improving workforce diversity.
TC 4
ZB 0
Z8 0
ZS 0
Z9 4
SN 0031-4005
UT WOS:000325095400035
ER

PT J
AU Vianello, Andrea
   Semplicini, Claudio
   Paladini, Luciana
   Concas, Alessandra
   Ravaglia, Sabrina
   Servidei, Serenella
   Toscano, Antonio
   Mongini, Tiziana
   Angelini, Corrado
   Pegoraro, Elena
TI Enzyme Replacement Therapy Improves Respiratory Outcomes in Patients
   with Late-Onset Type II Glycogenosis and High Ventilator Dependency
SO LUNG
VL 191
IS 5
BP 537
EP 544
DI 10.1007/s00408-013-9489-x
PD OCT 2013
PY 2013
AB Type II glycogenosis (GSDII) is a rare and often fatal neuromuscular
   disorder caused by acid alpha-glucosidase deficiency. Although
   alglucosidase alfa enzyme replacement therapy (ERT) significantly
   improves outcomes in subjects with the infantile form, its efficacy in
   patients with the late-onset one is not entirely clear. The long-term
   efficacy of ERT in late-onset GSGII complicated by severe pulmonary
   impairment causing high mechanical ventilation dependency was
   investigated in this study.
   The long-term clinical efficacy of ERT was assessed in eight late-onset
   GSDII patients using home mechanical ventilation (HMV) by comparing
   their outcomes with those of six historical control patients (GSDII
   patients) who had received HMV alone. The number of hospitalizations due
   to pulmonary exacerbations and of hours of daily use of HMV were
   considered the study's primary efficacy endpoints.
   The treatment group showed an increased tendency toward shorter
   follow-up compared to the control group (35.8 +/- A 29.2 vs. 52.6 +/- A
   8.55 months; p = 0.04). At the end of the study period, the daily use of
   HMV (12.5 +/- A 7.6 vs. 19 +/- A 14.3 h; p = 0.004) and the
   hospitalization rate [incidence rate ratio = 0.43 (95 % confidence
   interval 0.18-0.93); p = 0.03] were significantly lower in the patients
   receiving ERT. The differences in the forced vital capacity absolute
   value and percentage change from baseline were not significantly
   different in the two groups.
   ERT reduces ventilator dependency in late-onset GSDII patients and the
   need for hospitalization due to respiratory exacerbations.
TC 2
ZB 2
Z8 0
ZS 0
Z9 2
SN 0341-2040
UT WOS:000324330300012
PM 23839583
ER

PT J
AU Batt, J.
   Herridge, M. S.
   Gage, W.
   Mathur, S.
   Cameron, J.
   dos Santos, C.
TI INTENSIVE-CARE UNIT ACQUIRED WEAKNESS (ICUAW): SPECTRUM OF DISABILITY IN
   SURVIVORS OF PROLONGED MECHANICAL VENTILATION AT 7 DAYS AND 6 MONTHS
   POST ICU DISCHARGE
SO INTENSIVE CARE MEDICINE
VL 39
MA 0920
BP S472
EP S472
SU 2
PD OCT 2013
PY 2013
CT ESICM 26th Annual Congress
CY OCT 05-09, 2013
CL Paris, FRANCE
SP ESICM
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0342-4642
UT WOS:000342431601214
ER

PT J
AU Witteveen, E.
   Hoogland, I. C. M.
   Wieske, L.
   Verhamme, C.
   van Schaik, I. N.
   Schultz, M. J.
   Horn, J.
TI INTENSIVE CARE UNIT-ACQUIRED WEAKNESS: GRIP STRENGTH DOES NOT DECLINE IN
   AN E. COLI PERITONITIS MOUSE MODEL
SO INTENSIVE CARE MEDICINE
VL 39
MA 1017
BP S500
EP S500
SU 2
PD OCT 2013
PY 2013
CT ESICM 26th Annual Congress
CY OCT 05-09, 2013
CL Paris, FRANCE
SP ESICM
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0342-4642
UT WOS:000342431601310
ER

PT J
AU Wollersheim, T.
   Woehlecke, J.
   Krebs, M.
   Hamati, J.
   Lodka, D.
   Langhans, C.
   Luther-Schroeder, A.
   Haas, R.
   Rathke, T.
   Kleber, C.
   Spies, C.
   Labeit, S.
   Schuelke, M.
   Spuler, S.
   Spranger, J.
   Weber-Carstens, S.
   Fielitz, J.
TI RAPID MYOSIN LOSS IN INTENSIVE CARE UNIT ACQUIRED WEAKNESS
SO INTENSIVE CARE MEDICINE
VL 39
MA 0228
BP S277
EP S277
SU 2
PD OCT 2013
PY 2013
CT ESICM 26th Annual Congress
CY OCT 05-09, 2013
CL Paris, FRANCE
SP ESICM
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0342-4642
UT WOS:000342431600227
ER

PT J
AU Hermans, Greet
   Casaer, Michael P.
   Clerckx, Beatrix
   Guiza, Fabian
   Vanhullebusch, Tine
   Derde, Sarah
   Meersseman, Philippe
   Derese, Inge
   Mesotten, Dieter
   Wouters, Pieter J.
   Van Cromphaut, Sophie
   Debaveye, Yves
   Gosselink, Rik
   Gunst, Jan
   Wilmer, Alexander
   Van den Berghe, Greet
   Vanhorebeek, Ilse
TI Effect of tolerating macronutrient deficit on the development of
   intensive-care unit acquired weakness: a subanalysis of the EPaNIC trial
SO LANCET RESPIRATORY MEDICINE
VL 1
IS 8
BP 621
EP 629
DI 10.1016/S2213-2600(13)70183-8
PD OCT 2013
PY 2013
AB Background Patients who are critically ill can develop so-called
   intensive-care unit acquired weakness, which delays rehabilitation.
   Reduced muscle mass, quality, or both might have a role. The Early
   Parenteral Nutrition Completing Enteral Nutrition in Adult Critically
   Ill Patients (EPaNIC) trial (registered with ClinicalTrials.gov, number
   NCT00512122) showed that tolerating macronutrient deficit for 1 week in
   intensive-care units (late parenteral nutrition [PN]) accelerated
   recovery compared with early PN. The role of weakness was unclear. Our
   aim was to assess whether late PN and early PN differentially affect
   muscle weakness and autophagic quality control of myofibres.
   Methods In this prospectively planned subanalysis of the EPaNIC trial,
   weakness (MRC sum score) was assessed in 600 awake, cooperative
   patients. Skeletal muscle biopsies, harvested from 122 patients 8 days
   after randomisation and from 20 matched healthy controls, were studied
   for autophagy and atrophy. We determined the significance of differences
   with Mann-Whitney U, Median, Kruskal-Wallis, or chi(2) (exact) tests, as
   appropriate.
   Findings With late PN, 105 (34%) of 305 patients had weakness on first
   assessment (median day 9 post-randomisation) compared with 127 (43%) of
   295 patients given early PN (absolute difference -9%, 95% CI -16 to -1;
   p=0.030). Weakness recovered faster with late PN than with early PN
   (p=0.021). Myofibre cross-sectional area was less and density was lower
   in critically ill patients than in healthy controls, similarly with
   early PN and late PN. The LC3 (microtubule-associated protein light
   chain 3) II to LC3I ratio, related to autophagosome formation, was
   higher in patients given late PN than early PN (p=0.026), reaching
   values almost double those in the healthy control group (p=0.0016), and
   coinciding with less ubiquitin staining (p=0.019). A higher LC3II to
   LC3I ratio was independently associated with less weakness (p=0.047).
   Expression of mRNA encoding contractile myofibrillary proteins was lower
   and E3-ligase expression higher in muscle biopsies from patients than in
   control participants (p <= 0.0006), but was unaffected by nutrition.
   Interpretation Tolerating a substantial macronutrient deficit early
   during critical illness did not affect muscle wasting, but allowed more
   efficient activation of autophagic quality control of myofibres and
   reduced weakness.
TC 20
ZB 4
Z8 0
ZS 0
Z9 20
SN 2213-2600
UT WOS:000342690300016
PM 24461665
ER

PT J
AU Jenkins, Rachel
   Othieno, Caleb
   Okeyo, Stephen
   Aruwa, Julyan
   Kingora, James
   Jenkins, Ben
TI Health system challenges to integration of mental health delivery in
   primary care in Kenya-perspectives of primary care health workers
SO BMC HEALTH SERVICES RESEARCH
VL 13
AR 368
DI 10.1186/1472-6963-13-368
PD SEP 30 2013
PY 2013
AB Background: Health system weaknesses in Africa are broadly well known,
   constraining progress on reducing the burden of both communicable and
   non-communicable disease (Afr Health Monitor, Special issue, 2011,
   14-24), and the key challenges in leadership, governance, health
   workforce, medical products, vaccines and technologies, information,
   finance and service delivery have been well described (Int Arch Med,
   2008, 1: 27). This paper uses focus group methodology to explore health
   worker perspectives on the challenges posed to integration of mental
   health into primary care by generic health system weakness.
   Methods: Two ninety minute focus groups were conducted in Nyanza
   province, a poor agricultural region of Kenya, with 20 health workers
   drawn from a randomised controlled trial to evaluate the impact of a
   mental health training programme for primary care, 10 from the
   intervention group clinics where staff had received the training
   programme, and 10 health workers from the control group where staff had
   not received the training).
   Results: These focus group discussions suggested that there are a number
   of generic health system weaknesses in Kenya which impact on the ability
   of health workers to care for clients with mental health problems and to
   implement new skills acquired during a mental health continuing
   professional development training programmes. These weaknesses include
   the medicine supply, health management information system, district
   level supervision to primary care clinics, the lack of attention to
   mental health in the national health sector targets, and especially its
   absence in district level targets, which results in the exclusion of
   mental health from such district level supervision as exists, and the
   lack of awareness in the district management team about mental health.
   The lack of mental health coverage included in HIV training courses
   experienced by the health workers was also striking, as was the
   intensive focus during district supervision on HIV to the detriment of
   other health issues.
   Conclusion: Generic health system weaknesses in Kenya impact on efforts
   for horizontal integration of mental health into routine primary care
   practice, and greatly frustrate health worker efforts.
   Improvement of medicine supplies, information systems, explicit
   inclusion of mental health in district level targets, management and
   supervision to primary care are likely to greatly improve primary care
   health worker effectiveness, and enable training programmes to be
   followed by better use in the field of newly acquired skills. A major
   lever for horizontal integration of mental health into the health system
   would be the inclusion of mental health in the national health sector
   reform strategy at community, primary care and district levels rather
   than just at the higher provincial and national levels, so that
   supportive supervision from the district level to primary care would
   become routine practice rather than very scarce activity.
TC 5
ZB 0
Z8 0
ZS 0
Z9 5
SN 1472-6963
UT WOS:000328114600001
PM 24079756
ER

PT J
AU Latronico, Nicola
   Filosto, Massimiliano
   Fagoni, Nazzareno
   Gheza, Laura
   Guarneri, Bruno
   Todeschini, Alice
   Lombardi, Raffaella
   Padovani, Alessandro
   Lauria, Giuseppe
TI Small Nerve Fiber Pathology in Critical Illness
SO PLOS ONE
VL 8
IS 9
AR e75696
DI 10.1371/journal.pone.0075696
PD SEP 30 2013
PY 2013
AB Background: Degeneration of intraepidermal nerve fibers (IENF) is a
   hallmark of small fiber neuropathy of different etiology, whose clinical
   picture is dominated by neuropathic pain. It is unknown if critical
   illness can affect IENF.
   Methods: We enrolled 14 adult neurocritical care patients with prolonged
   intensive care unit (ICU) stay and artificial ventilation (>= 3 days),
   and no previous history or risk factors for neuromuscular disease. All
   patients underwent neurological examination including evaluation of
   consciousness, sensory functions, muscle strength, nerve conduction
   study and needle electromyography, autonomic dysfunction using the
   finger wrinkling test, and skin biopsy for quantification of IENF and
   sweat gland innervation density during ICU stay and at follow-up visit.
   Development of infection, sepsis and multiple organ failure was recorded
   throughout the ICU stay.
   Results: Of the 14 patients recruited, 13 (93%) had infections, sepsis
   or multiple organ failure. All had severe and non-length dependent loss
   of IENF. Sweat gland innervation was reduced in all except one patient.
   Of the 7 patients available for follow-up visit, three complained of
   diffuse sensory loss and burning pain, and another three showed clinical
   dysautonomia.
   Conclusions: Small fiber pathology can develop in the acute phase of
   critical illness and may explain chronic sensory impairment and pain in
   neurocritical care survivors. Its impact on long term disability
   warrants further studies involving also non-neurologic critical care
   patients.
RI Latronico, Nicola/F-1557-2010
OI Latronico, Nicola/0000-0002-2521-5871
TC 4
ZB 1
Z8 0
ZS 0
Z9 4
SN 1932-6203
UT WOS:000325423500087
PM 24098716
ER

PT J
AU Balas, Michele C.
   Burke, William J.
   Gannon, David
   Cohen, Marlene Z.
   Colburn, Lois
   Bevil, Catherine
   Franz, Doug
   Olsen, Keith M.
   Ely, E. Wesley
   Vasilevskis, Eduard E.
TI Implementing the Awakening and Breathing Coordination, Delirium
   Monitoring/Management, and Early Exercise/Mobility Bundle into Everyday
   Care: Opportunities, Challenges, and Lessons Learned for Implementing
   the ICU Pain, Agitation, and Delirium Guidelines
SO CRITICAL CARE MEDICINE
VL 41
IS 9
BP S116
EP S127
DI 10.1097/CCM.0b013e3182a17064
SU 1
PD SEP 2013
PY 2013
AB Objective: The awakening and breathing coordination, delirium
   monitoring/management, and early exercise/mobility bundle is an
   evidence-based interprofessional multicomponent strategy for minimizing
   sedative exposure, reducing duration of mechanical ventilation, and
   managing ICU-acquired delirium and weakness. The purpose of this study
   was to identify facilitators and barriers to awakening and breathing
   coordination, delirium monitoring/management, and early
   exercise/mobility bundle adoption and to evaluate the extent to which
   bundle implementation was effective, sustainable, and conducive to
   dissemination.
   Design: Prospective, before-after, mixed-methods study.
   Setting: Five adult ICUs, one step-down unit, and a special care unit
   located in a 624-bed academic medical center
   Subjects: Interprofessional ICU team members at participating
   institution.
   Interventions and Measurements: In collaboration with the participating
   institution, we developed, implemented, and refined an awakening and
   breathing coordination, delirium monitoring/management, and early
   exercise/mobility bundle policy. Over the course of an 18-month period,
   all ICU team members were offered the opportunity to participate in
   numerous multimodal educational efforts. Three focus group sessions,
   three online surveys, and one educational evaluation were administered
   in an attempt to identify facilitators and barriers to bundle adoption.
   Main Results: Factors believed to facilitate bundle implementation
   included: 1) the performance of daily, interdisciplinary, rounds; 2)
   engagement of key implementation leaders; 3) sustained and diverse
   educational efforts; and 4) the bundle's quality and strength. Barriers
   identified included: 1) intervention-related issues (e. g., timing of
   trials, fear of adverse events), 2) communication and care coordination
   challenges, 3) knowledge deficits, 4) workload concerns, and 5)
   documentation burden. Despite these challenges, participants believed
   implementation ultimately benefited patients, improved interdisciplinary
   communication, and empowered nurses and other ICU team members.
   Conclusions: In this study of the implementation of the awakening and
   breathing coordination, delirium monitoring/management, and early
   exercise/mobility bundle in a tertiary care setting, clear factors were
   identified that both advanced and impeded adoption of this complex
   intervention that requires interprofessional education, coordination,
   and cooperation. Focusing on these factors preemptively should enable a
   more effective and lasting implementation of the bundle and better care
   for critically ill patients. Lessons learned from this study will also
   help healthcare providers optimize implementation of the recent ICU
   pain, agitation, and delirium guidelines, which has many similarities
   but also some important differences as compared with the awakening and
   breathing coordination, delirium monitoring/management, and early
   exercise/mobility bundle.
RI Balas, Michele/C-6683-2014
TC 11
ZB 0
Z8 0
ZS 0
Z9 11
SN 0090-3493
UT WOS:000331152200010
PM 23989089
ER

PT J
AU Carrothers, Kathleen M.
   Barr, Juliana
   Spurlock, Bruce
   Ridgely, M. Susan
   Damberg, Cheryl L.
   Ely, E. Wesley
TI Contextual Issues Influencing Implementation and Outcomes Associated
   With an Integrated Approach to Managing Pain, Agitation, and Delirium in
   Adult ICUs
SO CRITICAL CARE MEDICINE
VL 41
IS 9
BP S128
EP S135
DI 10.1097/CCM.0b013e3182a2c2b1
SU 1
PD SEP 2013
PY 2013
AB Objective: This pilot study was designed to identify which contextual
   factors facilitate/hinder the implementation of the awakening,
   breathing, coordination, delirium, and early mobility (ABCDE) bundle for
   guidance in future studies.
   Design: The sources of data for this study included document review,
   planned site visits (including interviews and observations), a brief
   online contextual factors survey, and self-reported process and outcome
   data.
   Patients: All patients in the four participating SF Bay Area ICUs were
   eligible to be included in this pilot study.
   Setting: This study took place in the four San Francisco Bay Area ICUs
   participating in the ICU Clinical Impact Interest Group, funded by the
   Gordon and Betty Moore Foundation from January 2012 through June 2013.
   Interventions: This was a pilot evaluation study to identify factors
   that facilitated/hindered the implementation of the ABCDE bundle,
   interventions designed to decrease the prevalence of ICU-acquired
   delirium and muscle weakness. The ABCDE bundle consists of spontaneous
   awakening trials, spontaneous breathing trials, coordination of
   awakening and breathing trials, choice of sedation, delirium screening
   and treatment, and early progressive mobility.
   Measurements: Process data related to bundle element compliance were
   collected at baseline and monthly during the intervention period.
   Outcome data (average ICU length of stay and average days on mechanical
   ventilation) were collected at baseline and quarterly during the
   intervention period. Hospital-specific results of the online contextual
   factors survey and information gathered through interviews and
   observations during site visits also contributed to the analysis.
   Main Results: Factors related to structural characteristics of the ICU,
   an organizational-wide patient safety culture, an ICU culture of quality
   improvement, implementation planning, training/support, and
   prompts/documentation are believed to have facilitated the rate and
   success of ABCDE bundle implementation. Excessive turnover (both in
   project and ICU leadership), staff morale issues, lack of respect among
   disciplines, knowledge deficits, and excessive use of registry staff are
   believed to have hindered implementation.
   Conclusions: Successful implementation of the elements of the ABCDE
   bundle can result in significant improvements in ICU patient care. The
   results of this study highlight specific structural and cultural
   elements of ICUs and hospitals that can positively and negatively
   influence the implementation of complex care bundles like the ABCDE
   bundle. Further research is needed to assess the influence of these
   contextual factors across a broader variety of ICUs and hospitals.
TC 7
ZB 1
Z8 0
ZS 0
Z9 7
SN 0090-3493
UT WOS:000331152200011
PM 23989090
ER

PT J
AU Davidson, Judy E.
   Harvey, Maurene A.
   Bemis-Dougherty, Anita
   Smith, James M.
   Hopkins, Ramona O.
TI Implementation of the Pain, Agitation, and Delirium Clinical Practice
   Guidelines and Promoting Patient Mobility to Prevent Post-Intensive Care
   Syndrome
SO CRITICAL CARE MEDICINE
VL 41
IS 9
BP S136
EP S145
DI 10.1097/CCM.0b013e3182a24105
SU 1
PD SEP 2013
PY 2013
AB Surviving critical illness is associated with persistent and severe
   physical, cognitive, and psychological morbidities. The Society of
   Critical Care Medicine has developed pain, agitation, and delirium
   guidelines and promoted mobility to improve care of critically ill
   patients. A task force has developed tools to facilitate and rapidly
   implement the translation of guideline care recommendations into
   practice. The Society of Critical Care Medicine has also assembled a
   task force to assess the long-term consequences of critical illness.
   This article will explore relationships between the pain, agitation, and
   delirium guidelines, mobility recommendations, and post-intensive care
   syndrome initiative. Implementation of the pain, agitation, and delirium
   guidelines taking into account current data regarding post-intensive
   care syndrome outcomes and potential interventions are an important
   first step toward improving outcomes for patients and their families.
   Research is needed to reduce the impact of long-term negative
   consequences of critical illness and to fully understand the best
   within- and post-ICU interventions, along with the optimal timing and
   dose of such interventions to produce the best long-term outcomes.
RI Davidson, Judy/G-6967-2014
OI Davidson, Judy/0000-0003-1459-181X
TC 4
ZB 0
Z8 0
ZS 0
Z9 4
SN 0090-3493
UT WOS:000331152200012
PM 23989091
ER

PT J
AU Engel, Heidi J.
   Needham, Dale M.
   Morris, Peter E.
   Gropper, Michael A.
TI ICU Early Mobilization: From Recommendation to Implementation at Three
   Medical Centers
SO CRITICAL CARE MEDICINE
VL 41
IS 9
BP S69
EP S80
DI 10.1097/CCM.0b013e3182a240d5
SU 1
PD SEP 2013
PY 2013
AB Objective: To compare and contrast the process used to implement an
   early mobility program in ICUs at three different medical centers and to
   assess their impact on clinical outcomes in critically ill patients.
   Design: Three ICU early mobilization quality improvement projects are
   summarized utilizing the Institute for Healthcare Improvement framework
   of Plan-Do-Study-Act.
   Intervention: Each of the three ICU early mobilization programs required
   an interprofessional team-based approach to plan, educate, and implement
   the ICU early mobility program. Champions from each profession-nursing,
   physical therapy, physician, and respiratory care-were identified to
   facilitate changes in ICU culture and clinical practice and to identify
   and address barriers to early mobility program implementation at each
   institution.
   Setting: The medical ICU at Wake Forest University, the medical ICU at
   Johns Hopkins Hospital, and the mixed medical-surgical ICU at the
   University of California San Francisco Medical Center.
   Results: Establishing an ICU early mobilization quality improvement
   program resulted in a reduced ICU and hospital length of stay at all
   three institutions and decreased rates of delirium and the need for
   sedation for the patients enrolled in the Johns Hopkins ICU early
   mobility program.
   Conclusion: Instituting a planned, structured ICU early mobility quality
   improvement project can result in improved outcomes and reduced costs
   for ICU patients across healthcare systems.
TC 8
ZB 0
Z8 0
ZS 0
Z9 8
SN 0090-3493
UT WOS:000331152200007
PM 23989097
ER

PT J
AU Wilcox, M. Elizabeth
   Brummel, Nathan E.
   Archer, Kristin
   Ely, E. Wesley
   Jackson, James C.
   Hopkins, Ramona O.
TI Cognitive Dysfunction in ICU Patients: Risk Factors, Predictors, and
   Rehabilitation Interventions
SO CRITICAL CARE MEDICINE
VL 41
IS 9
BP S81
EP S98
DI 10.1097/CCM.0b013e3182a16946
SU 1
PD SEP 2013
PY 2013
AB In contrast to other clinical outcomes, long-term cognitive function in
   critical care survivors has not been deeply studied. In this narrative
   review, we summarize the existing literature on the prevalence,
   mechanisms, risk factors, and prediction of cognitive impairment after
   surviving critical illness. Depending on the exact clinical subgroup, up
   to 100% of critical care survivors may suffer some degree of long-term
   cognitive impairment at hospital discharge; in approximately 50%,
   decrements in cognitive function will persist years later. Although the
   mechanisms of acquiring this impairment are poorly understood, several
   risk factors have been identified. Unfortunately, no easy means of
   predicting long-term cognitive impairment exists. Despite this barrier,
   research is ongoing to test possible treatments for cognitive
   impairment. In particular, the potential role of exercise on cognitive
   recovery is an exciting area of exploration. Opportunities exist to
   incorporate physical and cognitive rehabilitation strategies across a
   spectrum of environments (in the ICU, on the hospital ward, and at home,
   posthospital discharge).
TC 9
ZB 0
Z8 1
ZS 0
Z9 10
SN 0090-3493
UT WOS:000331152200008
PM 23989098
ER

PT J
AU Falsaperla, Raffaele
   Elli, Marco
   Pavone, Piero
   Isotta, Gentile
   Lubrano, Riccardo
TI Noninvasive ventilation for acute respiratory distress in children with
   central nervous system disorders
SO RESPIRATORY MEDICINE
VL 107
IS 9
BP 1370
EP 1375
DI 10.1016/j.rmed.2013.07.005
PD SEP 2013
PY 2013
AB Background: Acute respiratory distress (ARD) is a relatively frequent
   occurrence in patients suffering from central nervous system disorders
   (CNSD) and moderate to severe mental retardation. Whenever conventional
   therapy is little effective, noninvasive mechanical ventilation (NIV) is
   the additional treatment in patients with diseases of the peripheral
   nervous system. However, NIV is traditionally little employed in the
   acute phase in patients suffering from CNSD. In the latter, either
   conventional therapy is maintained or invasive mechanical ventilation is
   instituted if the patient's condition worsens severely. To challenge the
   traditional view, we conducted the study to prove that NIV is both
   applicable and effective in the treatment of ARD also in children with
   moderate to severe mental retardation.
   Methods: We studied 44 children with ARD secondary to pneumonia and CNSD
   causing moderate to severe mental retardation. The children were divided
   in two groups. One group received conventional therapy and NIV, the
   other conventional therapy only, before being advanced to invasive
   ventilator support when nonresponding. On admission to hospital and one
   hour following admission we registered pH, PaCO2, PaO2, A - a DO2 and
   the PaO2/FiO2 ratio. The mean hospital stay was also recorded.
   Results: After one hour on NIV PaO2 and pH increased, PaCO2 decreased, A
   - a DO2 and PaO2/FiO2 ratio improved. No changes in the above parameters
   were observed in children on conventional therapy only. Hospital stay
   was shorter when NIV was instituted.
   Conclusions: NIV is both applicable and beneficial in stabilizing blood
   gases, respiratory and cardiovascular parameters also in children with
   CNSD. Moreover its use shortens the hospital stay. (C) 2013 Elsevier
   Ltd. All rights reserved.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0954-6111
UT WOS:000330271600011
PM 23906815
ER

PT J
AU Powers, Scott K.
   Wiggs, Michael P.
   Sollanek, Kurt J.
   Smuder, Ashley J.
TI Ventilator-induced diaphragm dysfunction: cause and effect
SO AMERICAN JOURNAL OF PHYSIOLOGY-REGULATORY INTEGRATIVE AND COMPARATIVE
   PHYSIOLOGY
VL 305
IS 5
BP R464
EP R477
DI 10.1152/ajpregu.00231.2013
PD SEP 2013
PY 2013
AB Mechanical ventilation (MV) is used clinically to maintain gas exchange
   in patients that require assistance in maintaining adequate alveolar
   ventilation. Common indications for MV include respiratory failure,
   heart failure, drug overdose, and surgery. Although MV can be a
   life-saving intervention for patients suffering from respiratory
   failure, prolonged MV can promote diaphragmatic atrophy and contractile
   dysfunction, which is referred to as ventilator-induced diaphragm
   dysfunction (VIDD). This is significant because VIDD is thought to
   contribute to problems in weaning patients from the ventilator. Extended
   time on the ventilator increases health care costs and greatly increases
   patient morbidity and mortality. Research reveals that only 18-24 h of
   MV is sufficient to develop VIDD in both laboratory animals and humans.
   Studies using animal models reveal that MV-induced diaphragmatic atrophy
   occurs due to increased diaphragmatic protein breakdown and decreased
   protein synthesis. Recent investigations have identified calpain,
   caspase-3, autophagy, and the ubiquitin-proteasome system as key
   proteases that participate in MV-induced diaphragmatic proteolysis. The
   challenge for the future is to define the MV-induced signaling pathways
   that promote the loss of diaphragm protein and depress diaphragm
   contractility. Indeed, forthcoming studies that delineate the signaling
   mechanisms responsible for VIDD will provide the knowledge necessary for
   the development of a pharmacological approach that can prevent VIDD and
   reduce the incidence of weaning problems.
TC 15
ZB 8
Z8 1
ZS 0
Z9 16
SN 0363-6119
UT WOS:000324066000002
PM 23842681
ER

PT J
AU Iwashyna, Theodore J.
   Prescott, Hallie C.
TI When Is Critical Illness Not Like an Asteroid Strike?
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 188
IS 5
BP 525
EP 527
DI 10.1164/rccm.201306-1092ED
PD SEP 1 2013
PY 2013
TC 3
ZB 1
Z8 0
ZS 0
Z9 3
SN 1073-449X
UT WOS:000324106200005
PM 23992586
ER

PT J
AU Wieske, L.
   Yin, D. R. P. P. Chan Pin
   Verhamme, C.
   Schultz, M. J.
   van Schaik, I. N.
   Horn, J.
TI Autonomic dysfunction in ICU-acquired weakness: a prospective
   observational pilot study
SO INTENSIVE CARE MEDICINE
VL 39
IS 9
BP 1610
EP 1617
DI 10.1007/s00134-013-2991-z
PD SEP 2013
PY 2013
AB Intensive care unit-acquired weakness (ICU-AW) is a frequent
   complication of critical illness. It is unknown if patients with ICU-AW
   also have autonomic dysfunction, another frequent neurological
   complication of critical illness. We hypothesized that patients who
   develop ICU-AW also develop autonomic dysfunction. Furthermore, we
   hypothesized that patients with ICU-AW are more prone to develop
   autonomic dysfunction compared to patients without ICU-AW.
   This was an observational cohort study of patients newly admitted to the
   ICU. Autonomic dysfunction was measured daily using heart rate
   variability (HRV) to a maximum of 15 days after admission. ICU-AW was
   diagnosed using the Medical Research Council score. Abnormal HRV was
   defined using age-matched reference values. The association between
   ICU-AW and HRV was analyzed using linear mixed effects models.
   We included 83 patients, 15 (18 %) of whom were diagnosed with ICU-AW.
   Of 279 HRV measurements, 204 could be analyzed. Abnormal HRV was found
   in all critically ill patients irrespective of the presence of ICU-AW
   (ICU-AW 100 % (IQR 71-100) vs. no ICU-AW 100 % (IQR 40-100); p = 0.40).
   Mechanical ventilation, sedation, norepinephrine, heart rate, and HRV
   artifacts were identified as confounders for HRV. ICU-AW was not
   associated with HRV.
   Abnormal HRV is frequent in critically ill patients, both with and
   without ICU-AW. It is unlikely that patients with ICU-AW are more prone
   to develop abnormal HRV. However, we found that abnormal HRV may not be
   an accurate indicator of autonomic dysfunction because of confounders.
TC 6
ZB 1
Z8 0
ZS 0
Z9 6
SN 0342-4642
UT WOS:000322675500011
PM 23793889
ER

PT J
AU Trittmann, J. K.
   Nelin, L. D.
   Klebanoff, M. A.
TI Bronchopulmonary dysplasia and neurodevelopmental outcome in extremely
   preterm neonates
SO EUROPEAN JOURNAL OF PEDIATRICS
VL 172
IS 9
BP 1173
EP 1180
DI 10.1007/s00431-013-2016-5
PD SEP 2013
PY 2013
AB We tested the hypothesis that the use of supplemental oxygen (sO(2)) at
   discharge from the NICU in extremely preterm neonates is associated with
   a greater risk of neurodevelopmental impairment (NDI) at 18 months
   corrected gestational age (CGA) than the risk of NDI of those neonates
   discharged in room air. Four hundred twenty-four charts were
   retrospectively reviewed from infants born at < 27 weeks and transferred
   to Nationwide Children's Hospital from December 1, 2004 to June 14,
   2010. Use of sO(2) was evaluated on day of life (dol) 28, at 36 weeks
   post-menstrual age (PMA), and at discharge. Logistic regression was used
   to identify postnatal risk factors associated with sO(2) at discharge
   and NDI. At dol 28, 96 % of surviving patients received sO(2), and
   therefore had bronchopulmonary dysplasia (BPD) by definition from a
   National Institutes of Child Health and Human Development workshop. At
   36 weeks PMA, 89 % continued on sO(2) (moderate/severe BPD), and at
   discharge, 74 % continued on sO(2). When factors associated with NDI
   were examined, the need for mechanical ventilation a parts per thousand
   yen28 days (adjOR = 3.21, p = 0.01), grade III-IV intraventricular
   hemorrhage (IVH) (adjOR = 4.61, p < 0.01), and discharge at > 43 weeks
   PMA (adjOR = 2.12, p = 0.04) were the strongest predictors of NDI at 18
   months CGA. There was no difference in Bayley Scales of Infant
   Development, third edition composite scores between patients with
   no/mild BPD and patients with moderate/severe BPD (cognitive p = 0.60,
   communication p = 0.53, motor p = 0.19) or those scores between patients
   on and off oxygen at discharge (cognitive p = 0.58, communication p =
   0.70, motor p = 0.62). Conclusions: The need for sO(2) at discharge is
   not associated with an increased risk of NDI in these patients. The
   strongest predictors of poor neurodevelopmental outcome in this
   population were prolonged positive pressure support, grade III-IV IVH,
   and discharge at > 43 weeks PMA.
TC 3
ZB 3
Z8 1
ZS 0
Z9 4
SN 0340-6199
UT WOS:000323248800004
PM 23644648
ER

PT J
AU Mirzakhani, Hooman
   Williams, June-Noelle
   Mello, Jennifer
   Joseph, Sharma
   Meyer, Matthew J.
   Waak, Karen
   Schmidt, Ulrich
   Kelly, Emer
   Eikermann, Matthias
TI Muscle Weakness Predicts Pharyngeal Dysfunction and Symptomatic
   Aspiration in Long-term Ventilated Patients
SO ANESTHESIOLOGY
VL 119
IS 2
BP 389
EP 397
PD AUG 2013
PY 2013
AB Background: Prolonged mechanical ventilation is associated with muscle
   weakness, pharyngeal dysfunction, and symptomatic aspiration. The
   authors hypothesized that muscle strength measurements can be used to
   predict pharyngeal dysfunction (endoscopic evaluation-primary
   hypothesis), as well as symptomatic aspiration occurring during a
   3-month follow-up period.
   Methods: Thirty long-term ventilated patients admitted in two intensive
   care units at Massachusetts General Hospital were included. The authors
   conducted a fiberoptic endoscopic evaluation of swallowing and measured
   muscle strength using medical research council score within 24 h of each
   fiberoptic endoscopic evaluation of swallowing. A medical research
   council score less than 48 was considered clinically meaningful muscle
   weakness. A retrospective chart review was conducted to identify
   symptomatic aspiration events.
   Results: Muscle weakness predicted pharyngeal dysfunction, defined as
   either valleculae and pyriform sinus residue scale of more than 1, or
   penetration aspiration scale of more than 1. Area under the curve of the
   receiver-operating curves for muscle strength (medical research council
   score) to predict pharyngeal, valleculae, and pyriform sinus residue
   scale of more than 1, penetration aspiration scale of more than 1, and
   symptomatic aspiration were 0.77 (95% CI, 0.63-0.97; P = 0.012), 0.79
   (95% CI, 0.56-1; P = 0.02), and 0.74 (95% CI, 0.56-0.93; P = 0.02),
   respectively. Seventy percent of patients with muscle weakness showed
   symptomatic aspiration events. Muscle weakness was associated with an
   almost 10-fold increase in the symptomatic aspiration risk (odds ratio =
   9.8; 95% CI, 1.6-60; P = 0.009).
   Conclusion: In critically ill patients, muscle weakness is an
   independent predictor of pharyngeal dysfunction and symptomatic
   aspiration. Manual muscle strength testing may help identify patients at
   risk of symptomatic aspiration.
TC 6
ZB 3
Z8 0
ZS 0
Z9 6
SN 0003-3022
UT WOS:000329062100018
PM 23584384
ER

PT J
AU Rehder, Kyle J.
   Turner, David A.
   Hartwig, Matthew G.
   Williford, W. Lee
   Bonadonna, Desiree
   Walczak, Richard J., Jr.
   Davis, R. Duane
   Zaas, David
   Cheifetz, Ira M.
TI Active Rehabilitation During Extracorporeal Membrane Oxygenation as a
   Bridge to Lung Transplantation
SO RESPIRATORY CARE
VL 58
IS 8
BP 1291
EP 1298
DI 10.4187/respcare.02155
PD AUG 2013
PY 2013
AB BACKGROUND: Patients with end-stage lung disease often progress to
   critical illness, which dramatically reduces their chance of survival
   following lung transplantation. Pre-transplant deconditioning has a
   significant impact on outcomes for all lung transplant patients, and is
   likely a major contributor to increased mortality in critically ill lung
   transplant recipients. The aim of this report is to describe a series of
   patients bridged to lung transplant with extracorporeal membrane
   oxygenation (ECMO) and to examine the potential impact of active
   rehabilitation and ambulation during pre-transplant ECMO. METHODS: This
   retrospective case series reviews all patients bridged to lung
   transplantation with ECMO at a single tertiary care lung transplant
   center. Pre-transplant ECMO patients receiving active rehabilitation and
   ambulation were compared to those patients who were bridged with ECMO
   but did not receive pre-transplant rehabilitation. RESULTS: Nine
   consecutive subjects between April 2007 and May 2012 were identified for
   inclusion. One-year survival for all subjects was 100%, with one subject
   alive at 4 months post-transplant. The 5 subjects participating in
   pre-transplant rehabilitation had shorter mean post-transplant
   mechanical ventilation (4 d vs 34 d, P = .01), ICU stay (11 d vs 45 d, P
   = .01), and hospital stay (26 d vs 80 d, P = .01). No subject who
   participated in active rehabilitation had post-transplant myopathy,
   compared to 3 of 4 subjects who did not participate in pre-transplant
   rehabilitation on ECMO. CONCLUSIONS: Bridging selected critically ill
   patients to transplant with ECMO is a viable treatment option, and
   active participation in physical therapy, including ambulation, may
   provide a more rapid post-transplantation recovery. This innovative
   strategy requires further study to fully evaluate potential benefits and
   risks.
TC 15
ZB 2
Z8 0
ZS 0
Z9 15
SN 0020-1324
UT WOS:000323139300003
PM 23232742
ER

PT J
AU Ambrosino, Nicolino
   Confalonieri, Marco
   Crescimanno, Grazia
   Vianello, Andrea
   Vitacca, Michele
TI The role of respiratory management of Pompe disease
SO RESPIRATORY MEDICINE
VL 107
IS 8
BP 1124
EP 1132
DI 10.1016/j.rmed.2013.03.004
PD AUG 2013
PY 2013
AB Respiratory failure is an unavoidable event in the natural history of
   some neuromuscular diseases, while appearing very infrequently in
   others. In some cases, such as Pompe disease, respiratory failure
   progresses more rapidly than motor impairment, sometimes being the onset
   event. Home mechanical ventilation improves survival and quality of life
   of these patients, with a reduction in healthcare costs. Therefore,
   pulmonologists must improve their skills in order to play a more
   relevant role in the care of these patients. The aim of this statement
   is to provide pulmonologists with some simple information in order for
   them to fulfil their role of primary caregiver, enabling appropriate and
   rapid diagnosis and treatment. (C) 2013 Elsevier Ltd. All rights
   reserved.
TC 1
ZB 1
Z8 0
ZS 0
Z9 1
SN 0954-6111
UT WOS:000323094900002
PM 23587901
ER

PT J
AU Balas, Michele
   Buckingham, Rose
   Braley, Tami
   Saldi, Sarah
   Vasilevskis, Eduard E.
TI Extending the ABCDE Bundle to the Post-Intensive Care Unit Setting
SO JOURNAL OF GERONTOLOGICAL NURSING
VL 39
IS 8
BP 39
EP 51
DI 10.3928/00989134-20130530-06
PD AUG 2013
PY 2013
AB A recently proposed interprofessional, evidence-based, multicomponent
   approach to mitigating the effects of intensive care unit (ICU)-acquired
   delirium and weakness has the potential to radically transform the way
   care is delivered to older adults requiring sedation, mechanical
   ventilation, or both. The Awakening and Breathing Coordination, Delirium
   Monitoring and Management, and Early Mobility (ABCDE) bundle empowers
   members of the interdisciplinary ICU team to implement the best
   available evidence regarding mechanical ventilation, sedation, weakness,
   and delirium in a safe, effective, and patient-centered manner.
   Considering that critically ill older adults are cared for in a number
   of different settings during the course of hospitalization and recovery,
   the purpose of this article is to explore the rationale and possible
   benefits of extending the ABCDE bundle into the post-ICU setting. We
   provide a case study that illustrates how ABCDE bundle adoption could be
   the key to improving the quality of care provided to seriously ill older
   adults in the ICU and beyond.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0098-9134
UT WOS:000323430800005
PM 23758115
ER

PT J
AU Herridge, Margaret
   Batt, Jane
   Dos Santos, Claudia C.
   Cameron, Jill I.
TI Lung-Injured Patients Do Not Need a Specialized Rehabilitation Program:
   ICUAW as a Case Study
SO SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE
VL 34
IS 4
BP 522
EP 528
DI 10.1055/s-0033-1351126
PD AUG 2013
PY 2013
AB An episode of critical illness is transformative. Patients suffer
   important new nerve, brain, and muscle injury. The spectrum of morbidity
   varies according to individual risks, but prevalent disabilities
   transcend diagnostic groupings. In the context of intensive care
   unit-acquired weakness (ICUAW), each patient who enters the ICU will
   begin to degrade muscle through upregulation of different proteolytic
   pathways, and, although the inciting stimulus, or its magnitude, may
   differ somewhat across patients, the result is the same. This argues for
   an approach to rehabilitation that is etiologically neutral and based on
   an understanding of molecular pathophysiology that can be mapped to
   functional outcome and tailored to individual need.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 1069-3424
UT WOS:000322911200010
PM 23934721
ER

PT J
AU Borenstein, Jeff
   Aronow, Harriet Udin
   Bolton, Linda Burnes
   Choi, Jua
   Bresee, Catherine
   Braunstein, Glenn D.
TI Early recognition of risk factors for adverse outcomes during
   hospitalization among Medicare patients: a prospective cohort study
SO BMC GERIATRICS
VL 13
AR 72
DI 10.1186/1471-2318-13-72
PD JUL 8 2013
PY 2013
AB Background: There is a persistently high incidence of adverse events
   during hospitalization among Medicare beneficiaries. Attributes of
   vulnerability are prevalent, readily apparent, and therefore potentially
   useful for recognizing those at greatest risk for hospital adverse
   events who may benefit most from preventive measures. We sought to
   identify patient characteristics associated with adverse events that are
   present early in a hospital stay.
   Methods: An interprofessional panel selected characteristics thought to
   confer risk of hospital adverse events and measurable within the setting
   of acute illness. A convenience sample of 214 Medicare beneficiaries
   admitted to a large, academic medical center were included in a quality
   improvement project to develop risk assessment protocols. The data were
   subsequently analyzed as a prospective cohort study to test the
   association of risk factors, assessed within 24 hours of hospital
   admission, with falls, hospital-acquired pressure ulcers (HAPU) and
   infections (HAI), adverse drug reactions (ADE) and 30-day readmissions.
   Results: Mean age = 75(+/- 13.4) years. Risk factors with highest
   prevalence included >4 active comorbidities (73.8%), polypharmacy
   (51.7%), and anemia (48.1%). One or more adverse hospital outcomes
   occurred in 46 patients (21.5%); 56 patients (26.2%) were readmitted
   within 30 days. Cluster analysis described three adverse outcomes:
   30-day readmission, and two groups of in-hospital outcomes. Distinct
   regression models were identified: Weight loss (OR = 3.83; 95% CI =
   1.46, 10.08) and potentially inappropriate medications (OR = 3.05; 95%
   CI = 1.19, 7.83) were associated with falls, HAPU, procedural
   complications, or transfer to intensive care; cognitive impairment (OR =
   2.32; 95% CI = 1.24, 4.37), anemia (OR = 1.87; 95% CI = 1.00, 3.51) and
   weight loss (OR = 2.89; 95% CI = 1.38, 6.07) were associated with HAI,
   ADE, or length of stay >7 days; hyponatremia (OR = 3.49; 95% CI = 1.30,
   9.35), prior hospitalization within 30 days (OR = 2.66; 95% CI = 1.31,
   5.43) and functional impairment (OR = 2.05; 95% CI = 1.02, 4.13) were
   associated with 30-day readmission.
   Conclusions: Patient characteristics recognizable within 24 hours of
   admission can be used to identify increased risk for adverse events and
   30-day readmission.
RI Bresee, Catherine/A-9148-2015
OI Bresee, Catherine/0000-0002-5710-4906
TC 5
ZB 1
Z8 0
ZS 0
Z9 5
SN 1471-2318
UT WOS:000321779900001
PM 23834816
ER

PT J
AU Roch, Antoine
   Hraiech, Sami
   Dizier, Stephanie
   Papazian, Laurent
TI Pharmacological interventions in acute respiratory distress syndrome
SO ANNALS OF INTENSIVE CARE
VL 3
AR 20
DI 10.1186/2110-5820-3-20
PD JUL 3 2013
PY 2013
AB Pharmacological interventions are commonly considered in acute
   respiratory distress syndrome (ARDS) patients. Inhaled nitric oxide
   (iNO) and neuromuscular blockers (NMBs) are used in patients with severe
   hypoxemia. No outcome benefit has been observed with the systematic use
   of iNO. However, a sometimes important improvement in oxygenation can
   occur shortly after starting administration. Therefore, its ease of use
   and its good tolerance justify iNO optionally combined with almitirne as
   a rescue therapy on a trial basis. Recent data from the literature
   support the use of a 48-h infusion of NMBs in patients with a PaO2 to
   FiO(2) ratio < 120 mmHg. No strong evidence exists on the increase of
   ICU-acquired paresis after a short course of NMBs. Fluid management with
   the goal to obtain zero fluid balance in ARDS patients without shock or
   renal failure significantly increases the number of days without
   mechanical ventilation. On the other hand, patients with hemodynamic
   failure must receive early and adapted fluid resuscitation. Liberal and
   conservative fluid strategies therefore are complementary and should
   ideally follow each other in time in the same patient whose hemodynamic
   state progressively stabilizes. At present, albumin treatment does not
   appear to be justified for limitation of pulmonary edema and respiratory
   morbidity. Aerosolized beta 2-agonists do not improve outcome in
   patients with ARDS and one study strongly suggests that intravenous
   salbutamol may worsen outcome in those patients. The early use of high
   doses of corticosteroids for the prevention of ARDS in septic shock
   patients or in patients with confirmed ARDS significantly reduced the
   duration of mechanical ventilation but had no effect or even increased
   mortality. In patients with persistent ARDS after 7 to 28 days, a
   randomized trial showed no reduction in mortality with moderate doses of
   corticosteroids but an increased PaO2 to FiO(2) ratio and
   thoracopulmonary compliance were found, as well as shorter durations of
   mechanical ventilation and of ICU stay. Conflicting data exist on the
   interest of low doses of corticosteroids (200 mg/day of hydrocortisone)
   in ARDS patients. In the context of a persistent ARDS with histological
   proof of fibroproliferation, a corticosteroid treatment with a
   progressive decrease of doses can be proposed.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 2110-5820
UT WOS:000345070100001
PM 23822630
ER

PT J
AU Amidei, Christina
   Sole, Mary Lou
TI PHYSIOLOGICAL RESPONSES TO PASSIVE EXERCISE IN ADULTS RECEIVING
   MECHANICAL VENTILATION
SO AMERICAN JOURNAL OF CRITICAL CARE
VL 22
IS 4
BP 337
EP 348
DI 10.4037/ajcc2013284
PD JUL 1 2013
PY 2013
AB Background Critical illness may weaken muscles, with long-term
   consequences.
   Objective To assess physiological responses to an early standardized
   passive exercise protocol to prevent muscle weakness in adults receiving
   mechanical ventilation.
   Methods A quasi-experimental within-subjects repeated-measures design
   was used. Within 72 hours of intubation, 30 patients had 20 minutes of
   bilateral passive leg movement delivered by continuous-passive-motion
   machines at a standardized rate and flexion-extension. Heart rate, mean
   blood pressure, oxygen saturation, and cytokine levels were measured
   before, during, and after the intervention. The Behavioral Pain Scale
   was used to measure patients' comfort. Repeated-measures analysis of
   variance was used to analyze the effect of the exercise on independent
   variables.
   Results Patients were mostly white men with a mean age of 56.5 years
   (SD, 16.9) with moderate mortality risk and illness severity. Heart
   rate, mean blood pressure, and oxygen saturation did not differ from
   baseline at any time measured. Pain scores were significantly reduced
   (F-2.43,F-70.42 = 4.08; P = .02) 5 and 10 minutes after exercise started
   and remained reduced at the end of exercise and 1 hour later.
   Interleukin 6 levels were significantly reduced (F-1.60,F-43.1 = 4.35; P
   = .03) at the end of exercise but not after the final rest period.
   Interleukin 10 levels did not differ significantly. Ratios of
   interleukin 6 to interleukin 10 decreased significantly (F-1.61,F-43.38
   = 3.42; P = .05) at the end of exercise and again after 60 minutes'
   rest.
   Conclusion The exercise was well tolerated, and comfort improved during
   and after the intervention. Cytokine levels provided physiological
   rationale for benefits of early exercise.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 1062-3264
UT WOS:000324534700010
PM 23817823
ER

PT J
AU Hammond, Kendra
   You, David
   Collins, Eileen G.
   Leehey, David J.
   Laghi, Franco
TI Life-threatening hypokalemia following rapid correction of respiratory
   acidosis
SO HEART & LUNG
VL 42
IS 4
BP 287
EP 289
DI 10.1016/j.hrtlng.2013.03.004
PD JUL-AUG 2013
PY 2013
AB A 56-year-old woman with a history of paraplegia and chronic pain due to
   neuromyelitis optica (Devic's syndrome) was admitted to a spinal cord
   injury unit for management of a sacral decubitus ulcer. During the
   hospitalization, she required emergency transfer to the intensive care
   unit. (ICU) because of progressive deterioration Of respiratory muscle
   function, severe respiratory acidosis, obtundation and hypotension. Upon
   transfer to the ICU, arterial blood gas revealed severe acute-on-chronic
   respiratory acidosis (pH 7.00, PCO2 120 mm Hg, PO2 211 mm Hg). The
   patient was immediately intubated and mechanically ventilated.
   Intravenous fluid boluses of normal saline (10.5 L in about 24 h) and
   vaso-pressors were started with rapid correction of hypotension. In
   addition, she was given hydrocortisone. Within 40 min of initiation of
   mechanical ventilation, there was improvement in acute respiratory
   acidosis. Sixteen hours later, however, the patient developed
   life-threatening hypokalemia (K+ of 2.1 mEq/L) and hypomagnesemia (Mg of
   1.4 mg/dL). Despite aggressive potassium supplementation, hypokalemia
   continued to worsen over the next several hours (K+ of 1.7 mEq/L). Urine
   studies revealed renal potassium wasting. We reason that the
   recalcitrant life-threatening hypokalemia was caused by several
   mechanisms including total body potassium depletion (chronic respiratory
   acidosis), a shift of potassium from the extracellular to intracellular
   space (rapid correction of respiratory acidosis with mechanical
   ventilation), increased sodium delivery to the distal nephron (normal
   saline resuscitation), hyperaldosteronism (secondary to hypotension plus
   administration of hydrocortisone) and hypomagnesemia. We conclude that
   rapid correction of respiratory acidosis, especially in the setting of
   hypotension, can lead to life-threatening hypokalemia. Serum potassium
   levels must be monitored closely in these patients, as failure to do so
   can lead to potentially lethal consequences. (C) 2013 Elsevier Inc. All
   rights reserved.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0147-9563
UT WOS:000322927400012
PM 23669409
ER

PT J
AU Engel, Heidi J.
   Tatebe, Shintaro
   Alonzo, Philip B.
   Mustille, Rebecca L.
   Rivera, Monica J.
TI Physical Therapist-Established Intensive Care Unit Early Mobilization
   Program: Quality Improvement Project for Critical Care at the University
   of California San Francisco Medical Center
SO PHYSICAL THERAPY
VL 93
IS 7
BP 975
EP 985
DI 10.2522/ptj.20110420
PD JUL 2013
PY 2013
AB Background. Long-term weakness and disability are common after an
   intensive care unit (ICU) stay. Usual care in the ICU prevents most
   patients from receiving preventative early mobilization.
   Objective. The study objective was to describe a quality improvement
   project established by a physical therapist at the University of
   California San Francisco Medical Center from 2009 to 2011. The goal of
   the program was to reduce patients' ICU length of stay by increasing the
   number of patients in the ICU receiving physical therapy and decreasing
   the time from ICU admission to physical therapy initiation.
   Design. This study was a 9-month retrospective analysis of a quality
   improvement project.
   Methods. An interprofessional ICU Early Mobilization Group established
   and promoted guidelines for mobilizing patients in the ICU. A physical
   therapist was dedicated to a 16-bed medical-surgical ICU to provide
   physical therapy to selected patients within 48 hours of ICU admission.
   Patients receiving early physical therapy intervention in the ICU in
   2010 were compared with patients receiving physical therapy under usual
   care practice in the same ICU in 2009.
   Results. From 2009 to 2010, the number of patients receiving physical
   therapy in the ICU increased from 179 to 294. The median times
   (interquartile ranges) from ICU admission to physical therapy evaluation
   were 3 days (9 days) in 2009 and 1 day (2 days) in 2010. The ICU length
   of stay decreased by 2 days, on average, and the percentage of
   ambulatory patients discharged to home increased from 55% to 77%.
   Limitations. This study relied upon the retrospective analysis of data
   from 6 collectors, and the intervention lacked physical therapy coverage
   for 7 days per week.
   Conclusions. The improvements in outcomes demonstrated the value and
   feasibility of a physical therapist-led early mobilization program.
TC 6
ZB 0
Z8 0
ZS 0
Z9 6
SN 0031-9023
UT WOS:000321320000012
PM 23559525
ER

PT J
AU Schena, E.
   Saccomandi, P.
   Cappelli, S.
   Silvestri, S.
TI Mechanical ventilation with heated humidifiers: measurements of
   condensed water mass within the breathing circuit according to
   ventilatory settings
SO PHYSIOLOGICAL MEASUREMENT
VL 34
IS 7
BP 813
EP 821
DI 10.1088/0967-3334/34/7/813
PD JUL 2013
PY 2013
AB Heated wire humidifiers (HWHs) are widely used to heat and humidify
   gases during mechanical ventilation. The control strategy implemented on
   commercial HWHs, based on maintaining constant gas temperature at the
   chamber outlet, shows weaknesses: humidifying performances depend on
   environmental temperature and ventilatory settings, and often
   condensation occurs. Herein, we analyzed in vitro HWH performances
   focusing on the condensation amount according to ventilatory settings.
   We used a physical model to define the parameters which mainly influence
   the HWH performances. In order to investigate the influence of minute
   volume (MV) and frequency rate (f(r)) on condensation, the other
   influencing parameters were kept constant during experiments, and we
   introduced a novel approach to estimate the condensation. The method,
   based on measuring the condensed vapor mass (Delta m), provided more
   objective information than the visual-based scale used in previous
   studies. Thanks to both the control of other influencing factors and the
   accurate Delta m measures, the investigation showed the Delta m increase
   with MV and f(r). Substantial condensation after 7 h of ventilation and
   the influence of MV and f(r) on Delta m (i.e., Delta m = 3 g at MV = 1.5
   L min(-1) and f(r) = 8 bpm and Delta m = 9.4 g at MV = 8 L min(-1) and
   f(r) = 20 bpm) confirm the weaknesses of 'single-point temperature'
   control strategies.
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 0967-3334
UT WOS:000320815000006
PM 23780625
ER

PT J
AU Duerden, Emma G.
   Taylor, Margot J.
   Miller, Steven P.
TI Brain Development in Infants Born Preterm: Looking Beyond Injury
SO SEMINARS IN PEDIATRIC NEUROLOGY
VL 20
IS 2
BP 65
EP 74
DI 10.1016/j.spen.2013.06.007
PD JUN 2013
PY 2013
AB Infants born very preterm are high risk for acquired brain injury and
   disturbances in brain maturation. Although survival rates for preterm
   infants have increased in the last decades owing to improved neonatal
   intensive care, motor disabilities including cerebral palsy persist, and
   impairments in cognitive, language, social, and executive functions have
   not decreased. Evidence from neuroimaging studies exploring brain
   structure, function, and metabolism has indicated abnormalities in the
   brain development trajectory of very preterm-born infants that persist
   through to adulthood. In this chapter, we review neuroimaging approaches
   for the identification of brain injury in the preterm neonate. Advances
   in medical imaging and availability of specialized equipment necessary
   to scan infants have facilitated the feasibility of conducting
   longitudinal studies to provide greater understanding of early brain
   injury and atypical brain development and their effects on
   neurodevelopmental outcome. Improved understanding of the risk factors
   for acquired brain injury and associated factors that affect brain
   development in this population is setting the stage for improving the
   brain health of children born preterm. ;Semin Pediatr Neurol 20:65-74
   (C) 2013 Elsevier Inc. All rights reserved.
TC 3
ZB 3
Z8 1
ZS 0
Z9 4
SN 1071-9091
UT WOS:000323585700003
PM 23948681
ER

PT J
AU MacIntyre, Neil R.
TI The Ventilator Discontinuation Process: An Expanding Evidence Base
SO RESPIRATORY CARE
VL 58
IS 6
BP 1074
EP 1082
DI 10.4187/respcare.02284
PD JUN 2013
PY 2013
AB The ventilator discontinuation process is an essential component of
   overall ventilator management. Undue delay leads to excess stay,
   iatrogenic lung injury, unnecessary sedation, and even higher mortality.
   On the other hand, premature withdrawal can lead to muscle fatigue,
   dangerous gas exchange impairment, loss of airway protection, and also a
   higher mortality. Continued ventilator dependence can be a result of
   persistent illness or can be a result of poor management. It is
   obviously important for the clinician to be able to assess both of these
   issues. An evidence-based task force has recommended regular assessments
   focusing on the causes of ventilator dependence, regular assessments for
   evidence of disease stability/reversal, use of regular spontaneous
   breathing trials (SBTs) as the primary assessment tool for ventilator
   discontinuation potential, use of separate assessments to evaluate the
   need for an artificial airway in patients tolerating the SBT, and the
   use of comfortable, interactive ventilator modes (that do not need to be
   "weaned") in between regular SBTs. More recent developments have focused
   on the importance of linking sedation reduction protocols to ventilator
   discontinuation protocols. Patients with repeated SBT failures are often
   considered to require prolonged mechanical ventilation (PMV). These
   patients often receive tracheostomies and are probably better managed
   with more gradual reductions in support and gradually lengthened
   spontaneous breathing periods. PMV patients have a high 1-year
   mortality, and many may ultimately require lifelong support. This
   evidence base is growing, but the earlier guidelines are standing the
   test of time. Indeed, practice patterns are evolving in accordance with
   them. Nevertheless, there is still room for improvement, and further
   clinical studies, especially in the patient requiring PMV, are needed.
   (C) 2013 Daedalus Enterprises
TC 4
ZB 1
Z8 1
ZS 0
Z9 5
SN 0020-1324
UT WOS:000320422900020
PM 23709201
ER

PT J
AU Witteveen, E.
   Wieske, L.
   Verhamme, C.
   Schultz, M. J.
   van Schaik, I. N.
   Horn, J.
TI INFLAMMATION IN INTENSIVE CARE UNIT-ACQUIRED WEAKNESS: A SYSTEMATIC
   REVIEW
SO JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM
VL 18
BP 126
EP 126
SU 2
PD JUN 2013
PY 2013
CT Meeting of the Peripheral-Nerve-Society
CY JUN 29-JUL 03, 2013
CL Saint Malo, FRANCE
SP Peripheral Nerve Soc
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1085-9489
UT WOS:000320620200322
ER

PT J
AU Pichot, C.
   Petitjeans, F.
   Ghignone, M.
   Quintin, L.
TI Is there a place for pressure-support ventilation and high positive
   end-expiratory pressure combined to alpha-2 agonists early in severe
   diffuse acute respiratory distress syndrome?
SO MEDICAL HYPOTHESES
VL 80
IS 6
BP 732
EP 737
DI 10.1016/j.mehy.2013.02.023
PD JUN 2013
PY 2013
AB Acute respiratory distress syndrome (ARDS) is associated with a high
   mortality linked primarily to comorbidities (sepsis, cardiac failure,
   multiple organ failure, etc.). When the lung is the single failing
   organ, quick resolution of ARDS should skip some complications arising
   from a prolonged stay in the critical care unit. In severe ARDS
   (PaO2/FIO2 = P/F < 100 with positive end-expiratory pressure (PEEP) >= 5
   cm H2O), current recommendations are to intubate the trachea of the
   patient and use mechanical ventilation, low tidal volume, high PEEP,
   prone positioning and possibly neuromuscular blockade in association
   with intravenous sedation.
   Another strategy is possible. Firstly, spontaneous ventilation (SV)
   coupled with pressure support (PS) ventilation and high PEEP is possible
   from tracheal intubation onwards, with the possible exception of the
   short period following immediately tracheal intubation. Secondly, using
   alpha-2 adrenergic agonists (e.g. clonidine, dexmedetomidine) can
   provide first-line sedation from the beginning of mechanical
   ventilation, as they preserve respiratory drive, lower oxygen
   consumption and pulmonary hypertension and increase diuresis. Alpha-2
   agonists are to be supplemented, if appropriate, by drugs devoid of
   effect on respiratory drive (neuroleptics, etc.). The expected benefits
   would be to prevent acquired diaphragmatic weakness, accumulation of
   sedation, cognitive dysfunction, and presumably improved outcome. This
   hypothesis should be tested in a double blind randomized controlled
   trial. (C) 2013 Elsevier Ltd. All rights reserved.
TC 1
ZB 1
Z8 0
ZS 0
Z9 1
SN 0306-9877
UT WOS:000319634800013
PM 23561575
ER

PT J
AU Kayambu, Geetha
   Boots, Robert
   Paratz, Jennifer
TI Physical Therapy for the Critically Ill in the ICU: A Systematic Review
   and Meta-Analysis
SO CRITICAL CARE MEDICINE
VL 41
IS 6
BP 1543
EP 1554
DI 10.1097/CCM.0b013e31827ca637
PD JUN 2013
PY 2013
AB Objective: The purpose of this systematic review was to review the
   evidence base for exercise in critically ill patients.
   Data Sources and Study Selection: Using keywords critical care and
   physical therapy and related synonyms, randomized controlled trials,
   meta-analyses, and systematic reviews were identified through electronic
   database searches and citation tracking. Clinical trials with outcomes
   of mortality, length of hospital and ICU stay, physical function and
   quality of life, muscle strength, and ventilator-free days were
   included.
   Data Extraction and Synthesis: Two reviewers abstracted data and
   assessed quality independently. Effect sizes and 95% confidence
   intervals were calculated. From 3,126 screened abstracts, 10 randomized
   controlled trials and five reviews were found. The mean Physiotherapy
   Evidence Database score was 5.4. Overall there was a significant
   positive effect favoring physical therapy for the critically ill to
   improve the quality of life (g = 0.40, 95% confidence interval 0.08,
   0.71), physical function (g = 0.46, 95% confidence interval 0.13, 0.78),
   peripheral muscle strength (g = 0.27, 95% confidence interval 0.02,
   0.52), and respiratory muscle strength (g = 0.51, 95% confidence
   interval 0.12, 0.89). Length of hospital (g = -0.34, 95% confidence
   interval -0.53, -0.15) and ICU stay (g = -0.34, 95% confidence interval
   -0.51, -0.18) significantly decreased and ventilator-free days increased
   (g = 0.38, 95% confidence interval 0.16, 0.59) following physical
   therapy in the ICU. There was no effect on mortality.
   Conclusion: Physical therapy in the ICU appears to confer significant
   benefit in improving quality of life, physical function, peripheral and
   respiratory muscle strength, increasing ventilator-free days, and
   decreasing hospital and ICU stay. However, further controlled trials of
   better quality and larger sample sizes are required to verify the
   strength of these tentative associations.
RI Boots, Rob/K-1159-2013
TC 31
ZB 3
Z8 1
ZS 1
Z9 33
SN 0090-3493
UT WOS:000319269400038
PM 23528802
ER

PT J
AU Brown, Kate L.
   Ichord, Rebecca
   Marino, Bradley S.
   Thiagarajan, Ravi R.
TI Outcomes Following Extracorporeal Membrane Oxygenation in Children With
   Cardiac Disease
SO PEDIATRIC CRITICAL CARE MEDICINE
VL 14
IS 5
BP S73
EP S83
DI 10.1097/PCC.0b013e318292e3fc
SU S
PD JUN 2013
PY 2013
AB Extracorporeal membrane oxygenation is a commonly used form of
   mechanical circulatory support in children with congenital or acquired
   heart disease and cardiac failure refractory to conventional medical
   therapies. In children with heart disease who suffer cardiac arrest,
   extracorporeal membrane oxygenation has been successfully used to
   provide cardiopulmonary support when conventional resuscitation has
   failed to establish return of spontaneous circulation. Survival to
   hospital discharge for children with heart disease support is
   approximately 40% but varies widely based on age, indication for
   support, and underlying cardiac disease. Although extracorporeal
   membrane oxygenation is lifesaving in many instances, it is associated
   with many complications and is expensive. Thus, a clear understanding of
   survival to discharge and long-term functional and neurologic outcomes
   are essential to guide the use of extracorporeal membrane oxygenation
   now and in the future. This review, part of the Pediatric Cardiac
   Intensive Care Society/Extracorporeal Life Support Organization Joint
   Statement on Mechanical Circulatory Support, summarizes current
   knowledge on short- and long-term outcomes for extracorporeal membrane
   oxygenation used to support children with cardiac disease.
TC 7
ZB 1
Z8 0
ZS 0
Z9 7
SN 1529-7535
UT WOS:000336519300012
PM 23735990
ER

PT J
AU Maffiuletti, Nicola A.
   Roig, Marc
   Karatzanos, Eleftherios
   Nanas, Serafim
TI Neuromuscular electrical stimulation for preventing skeletal-muscle
   weakness and wasting in critically ill patients: a systematic review
SO BMC MEDICINE
VL 11
AR UNSP 137
DI 10.1186/1741-7015-11-137
PD MAY 23 2013
PY 2013
AB Background: Neuromuscular electrical stimulation (NMES) therapy may be
   useful in early musculoskeletal rehabilitation during acute critical
   illness. The objective of this systematic review was to evaluate the
   effectiveness of NMES for preventing skeletal-muscle weakness and
   wasting in critically ill patients, in comparison with usual care.
   Methods: We searched PubMed, CENTRAL, CINAHL, Web of Science, and PEDro
   to identify randomized controlled trials exploring the effect of NMES in
   critically ill patients, which had a well-defined NMES protocol,
   provided outcomes related to skeletal-muscle strength and/or mass, and
   for which full text was available. Two independent reviewers extracted
   data on muscle-related outcomes (strength and mass), and participant and
   intervention characteristics, and assessed the methodological quality of
   the studies. Owing to the lack of means and standard deviations (SDs) in
   some studies, as well as the lack of baseline measurements in two
   studies, it was impossible to conduct a full meta-analysis. When means
   and SDs were provided, the effect sizes of individual outcomes were
   calculated, and otherwise, a qualitative analysis was performed.
   Results: The search yielded 8 eligible studies involving 172 patients.
   The methodological quality of the studies was moderate to high. Five
   studies reported an increase in strength or better preservation of
   strength with NMES, with one study having a large effect size. Two
   studies found better preservation of muscle mass with NMES, with small
   to moderate effect sizes, while no significant benefits were found in
   two other studies.
   Conclusions: NMES added to usual care proved to be more effective than
   usual care alone for preventing skeletal-muscle weakness in critically
   ill patients. However, there is inconclusive evidence for its benefit in
   prevention of muscle wasting.
TC 14
ZB 2
Z8 0
ZS 0
Z9 14
SN 1741-7015
UT WOS:000319765300001
PM 23701811
ER

PT J
AU Doig, Gordon S.
   Simpson, Fiona
   Sweetman, Elizabeth A.
   Finfer, Simon R.
   Cooper, D. Jamie
   Heighes, Philippa T.
   Davies, Andrew R.
   O'Leary, Michael
   Solano, Tom
   Peake, Sandra
CA Early PN Investigators ANZICS Clin
TI Early Parenteral Nutrition in Critically Ill Patients With Short-term
   Relative Contraindications to Early Enteral Nutrition A Randomized
   Controlled Trial
SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
VL 309
IS 20
BP 2130
EP 2138
DI 10.1001/jama.2013.5124
PD MAY 22 2013
PY 2013
AB Importance Systematic reviews suggest adult patients in intensive care
   units (ICUs) with relative contraindications to early enteral nutrition
   (EN) may benefit from parenteral nutrition (PN) provided within 24 hours
   of ICU admission.
   Objective To determine whether providing early PN to critically ill
   adults with relative contraindications to early EN alters outcomes.
   Design, Setting, and Participants Multicenter, randomized, single-blind
   clinical trial conducted between October 2006 and June 2011 in ICUs of
   31 community and tertiary hospitals in Australia and New Zealand.
   Participants were critically ill adults with relative contraindications
   to early EN who were expected to remain in the ICU longer than 2 days.
   Interventions Random allocation to pragmatic standard care or early PN.
   Main Outcomes and Measures Day-60 mortality; quality of life,
   infections, and body composition.
   Results A total of 1372 patients were randomized (686 to standard care,
   686 to early PN). Of 682 patients receiving standard care, 199 patients
   (29.2%) initially commenced EN, 186 patients (27.3%) initially commenced
   PN, and 278 patients (40.8%) remained unfed. Time to EN or PN in
   patients receiving standard care was 2.8 days (95% CI, 2.3 to 3.4).
   Patients receiving early PN commenced PN a mean of 44 minutes after
   enrollment (95% CI, 36 to 55). Day-60 mortality did not differ
   significantly (22.8% for standard care vs 21.5% for early PN; risk
   difference, -1.26%; 95% CI, -6.6 to 4.1; P=.60). Early PN patients rated
   day-60 quality of life (RAND-36 General Health Status) statistically,
   but not clinically meaningfully, higher (45.5 for standard care vs 49.8
   for early PN; mean difference, 4.3; 95% CI, 0.95 to 7.58; P=.01). Early
   PN patients required fewer days of invasive ventilation (7.73 vs 7.26
   days per 10 patient x ICU days, risk difference, -0.47; 95% CI, -0.82 to
   -0.11; P=.01) and, based on Subjective Global Assessment, experienced
   less muscle wasting (0.43 vs 0.27 score increase per week; mean
   difference, -0.16; 95% CI, -0.28 to -0.038; P=.01) and fat loss (0.44 vs
   0.31 score increase per week; mean difference, -0.13; 95% CI, -0.25 to
   -0.01; P=.04).
   Conclusions and Relevance The provision of early PN to critically ill
   adults with relative contraindications to early EN, compared with
   standard care, did not result in a difference in day-60 mortality. The
   early PN strategy resulted in significantly fewer days of invasive
   ventilation but not significantly shorter ICU or hospital stays.
RI Cooper, D. James/G-7961-2013
OI Cooper, D. James/0000-0002-5872-9051
TC 77
ZB 18
Z8 2
ZS 0
Z9 79
SN 0098-7484
UT WOS:000319229600029
PM 23689848
ER

PT J
AU Char, Danton S.
   Ibsen, Laura M.
   Ramamoorthy, Chandra
   Bratton, Susan L.
TI Volatile Anesthetic Rescue Therapy in Children With Acute Asthma:
   Innovative but Costly or Just Costly?*
SO PEDIATRIC CRITICAL CARE MEDICINE
VL 14
IS 4
BP 343
EP 350
DI 10.1097/PCC.0b013e3182772e29
PD MAY 2013
PY 2013
AB Objectives: To describe volatile anesthesia (VA) use for pediatric
   asthma, including complications and outcomes.
   Design: Retrospective cohort study.
   Setting: Children's hospitals contributing to the Pediatric Health
   Information System between 2004-2008.
   Patients: Children 2-18 years old with a primary diagnosis code for
   asthma supported with mechanical ventilation.
   Intervention: Those treated with VA were compared to those not treated
   with VA or extracorporeal membrane oxygenation. Hospital VA use was
   grouped as none, <5%, 5-10% and >10% among intubated children.
   Measurements and Main Results: One thousand five hundred and fifty-eight
   patients received mechanical ventilation at 40 hospitals for asthma: 47
   (3%) received VA treatment at 11 (28%) hospitals. Those receiving a VA
   were significantly less likely to receive inhaled b-agonists,
   ipratropium bromide, and heliox, but more likely to receive
   neuromuscular blocking agents than patients treated without VA. Length
   of mechanical ventilation, hospital stay (length of stay [LOS]) and
   charges were significantly greater for those treated with VA. Aspiration
   was more common but death and air leak did not differ. Patients at
   hospitals with VA use >10% were significantly less likely to receive
   inhaled b agonist, ipratropium bromide, methylxanthines, and heliox, but
   more likely to receive systemic b agonist, neuromuscular blocking agents
   compared to those treated at hospitals not using VA. LOS, duration of
   ventilation, and hospital charges were significantly greater for
   patients treated at centers with high VA use.
   Conclusions: Mortality does not differ between centers that use VA or
   not. Patients treated at centers with high VA use had significantly
   increased hospital charges and increased LOS.
TC 3
ZB 0
Z8 0
ZS 0
Z9 3
SN 1529-7535
UT WOS:000318680000007
PM 23439466
ER

PT J
AU Witsch, J.
   Galldiks, N.
   Bender, A.
   Kollmar, R.
   Boesel, J.
   Hobohm, C.
   Guenther, A.
   Schirotzek, I.
   Fuchs, K.
   Juettler, E.
TI Long-term outcome in patients with Guillain-Barr, syndrome requiring
   mechanical ventilation
SO JOURNAL OF NEUROLOGY
VL 260
IS 5
BP 1367
EP 1374
DI 10.1007/s00415-012-6806-x
PD MAY 2013
PY 2013
AB We aimed to determine long-term disability and quality of life in
   patients with Guillain-Barr, syndrome (GBS) who required mechanical
   ventilation (MV) in the acute phase. Our retrospective cohort study
   included 110 GBS patients admitted to an intensive care unit and
   requiring MV (01/1999-08/2010) in nine German tertiary academic medical
   centers. Outcome was determined 1 year or longer after hospital
   admission using the GBS disability scale, Barthel index (BI),
   EuroQuol-5D (EQ-5D) and Fatigue Severity Scale. Linear/multivariate
   regression analysis was used to analyze predicting factors for outcome.
   Mean time to follow up was 52.6 months. Hospital mortality was 5.5 % and
   long-term mortality 13.6 %. Overall 53.8 % had a favorable outcome (GBS
   disability score 0-1) and 73.7 % of survivors had no or mild disability
   (BI 90-100). In the five dimensions of the EQ-5D "mobility",
   "self-care", "usual activities", "pain" and "anxiety/depression" no
   impairments were stated by 50.6, 58.4, 36.4, 36.4 and 50.6 % of
   patients, respectively. A severe fatigue syndrome was present in 30.4 %
   of patients. Outcome was statistically significantly correlated with
   age, type of therapy and number of immunoglobulin courses. In
   GBS-patients requiring MV in the acute phase in-hospital, and long-term
   mortality are lower than that in previous studies, while long-term
   quality of life is compromised in a large fraction of patients, foremost
   by immobility and chronic pain. Efforts towards improved treatment
   approaches should address autonomic dysfunction to further reduce
   hospital mortality while improved rehabilitation concepts might
   ameliorate long-term disability.
TC 3
ZB 0
Z8 0
ZS 0
Z9 3
SN 0340-5354
UT WOS:000318625400019
PM 23299621
ER

PT J
AU Overman, Alison E.
   Liu, Meixia
   Kurachek, Stephen C.
   Shreve, Michael R.
   Maynard, Roy C.
   Mammel, Mark C.
   Moore, Brooke M.
TI Tracheostomy for Infants Requiring Prolonged Mechanical Ventilation: 10
   Years' Experience
SO PEDIATRICS
VL 131
IS 5
BP E1491
EP E1496
DI 10.1542/peds.2012-1943
PD MAY 2013
PY 2013
AB BACKGROUND: Despite advances in care of critically ill neonates,
   extended mechanical ventilation and tracheostomy are sometimes required.
   Few studies focus on complications and clinical outcomes. Our aim was to
   provide long-term outcomes for a cohort of infants who required
   tracheostomy.
   METHODS: This study is a retrospective review of 165 infants born
   between January 1, 2000 and December 31, 2010 who required tracheostomy
   and ventilator support. Children with complex congenital heart disease
   were excluded.
   RESULTS: Median gestational age was 27 weeks (range 22-43), and birth
   weight was 820 g (range 360-4860). The number of male (53.9%) and female
   (46.1%) infants was similar (P = .312). Infants were divided into 2
   groups based on birth weight <= 1000 g (A) and.1000 g (B). Group A: 87
   (57.6%) infants; group B 64 (42.4%). Overall tracheostomy rate was 6.9%
   (87/1345) for group A versus 0.9% (64/6818) for B (P < .001). Group A
   had a longer time from intubation to positive pressure ventilation
   independence, 505 days (range 62-1287) vs 372 days (range 15-1270; P =
   .011). Infants who had >1 reason for tracheostomy comprised 78.8% of the
   sample; 69.1% of infants were discharged on ventilators. Birth weight
   did not affect time from tracheostomy to decannulation (P = .323). More
   group A infants were decannulated (P = .023). laryngotracheal
   reconstruction rate was 35.8%. Five-year survival was 89%. Group B had
   higher mortality (P = .033). 64.2% of infants had developmental delays;
   74.2% had >= 2 comorbidities.
   CONCLUSIONS: Tracheostomy rates were higher for extremely low birth
   weight infants than previously reported rates for all infants.
   Decannulation rates and laryngotracheal reconstruction rates were
   consistent with previous studies. Survival rates were high, but
   developmental delay and comorbidities were frequent.
TC 8
ZB 3
Z8 0
ZS 0
Z9 8
SN 0031-4005
UT WOS:000318270700014
PM 23569088
ER

PT J
AU van Huijzen, Selma
   van Staa, Anneloes
TI Chronic ventilation and social participation: experiences of men with
   neuromuscular disorders
SO SCANDINAVIAN JOURNAL OF OCCUPATIONAL THERAPY
VL 20
IS 3
BP 209
EP 216
DI 10.3109/11038128.2013.765033
PD MAY 2013
PY 2013
AB Objective: The purpose of this study was to investigate how mechanical
   ventilation-dependent adults with neuromuscular disorders experience
   their occupational and social participation. Methods: Data were
   collected through two successive focus-group discussions with six men
   (aged 23-40 years) living in the same specialized nursing home in the
   Netherlands. Results: The results showed that the participants wanted to
   be involved in activities that provide interaction with others in
   society or community; they desired social participation. Thematic
   analysis brought out that the participants wanted to be taken seriously
   in all aspects of life. Four themes emerged: "Responsibility for
   risk-taking", "The influence of dependency", "Being treated as an
   employee", and "Maintaining optimism". These men appreciated good
   information from health care providers, wanted to have more autonomy in
   decision-making and risk-taking - and did not wish to be patronized.
   They wanted to have a social network to help them suction their tracheal
   cannula. Also, they would like activities at the activity centre to be
   more contributing to society and wished to be treated as employees
   rather than as clients. In view of their short life expectancy, they
   would also welcome discussions of end-of-life issues in group sessions
   led by a professional. Facilitating aspects of social participation,
   i.e. the experience of meaningful occupations in connection with
   autonomy and self-determination, would provide a more client-centred
   approach.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1103-8128
UT WOS:000318357800007
PM 23339717
ER

PT J
AU Matamis, Dimitrios
   Soilemezi, Eleni
   Tsagourias, Matthew
   Akoumianaki, Evangelia
   Dimassi, Saoussen
   Boroli, Filippo
   Richard, Jean-Christophe M.
   Brochard, Laurent
TI Sonographic evaluation of the diaphragm in critically ill patients.
   Technique and clinical applications
SO INTENSIVE CARE MEDICINE
VL 39
IS 5
BP 801
EP 810
DI 10.1007/s00134-013-2823-1
PD MAY 2013
PY 2013
AB The use of ultrasonography has become increasingly popular in the
   everyday management of critically ill patients. It has been demonstrated
   to be a safe and handy bedside tool that allows rapid hemodynamic
   assessment and visualization of the thoracic, abdominal and major
   vessels structures. More recently, M-mode ultrasonography has been used
   in the assessment of diaphragm kinetics. Ultrasounds provide a simple,
   non-invasive method of quantifying diaphragmatic movement in a variety
   of normal and pathological conditions. Ultrasonography can assess the
   characteristics of diaphragmatic movement such as amplitude, force and
   velocity of contraction, special patterns of motion and changes in
   diaphragmatic thickness during inspiration. These sonographic
   diaphragmatic parameters can provide valuable information in the
   assessment and follow up of patients with diaphragmatic weakness or
   paralysis, in terms of patient-ventilator interactions during controlled
   or assisted modalities of mechanical ventilation, and can potentially
   help to understand post-operative pulmonary dysfunction or weaning
   failure from mechanical ventilation. This article reviews the technique
   and the clinical applications of ultrasonography in the evaluation of
   diaphragmatic function in ICU patients.
TC 31
ZB 9
Z8 1
ZS 1
Z9 32
SN 0342-4642
UT WOS:000317692900001
PM 23344830
ER

PT J
AU Salekeen, Sirajus
   Mahmood, Khalid
   Naqvi, Iftikhar Haider
   Baig, Mirza Yousuf
   Akhter, Syed Tehssen
   Abbasi, Amanullah
TI Clinical course, complications and predictors of mortality in patients
   with tuberculous meningitis - an experience of fifty two cases at Civil
   Hospital Karachi, Pakistan
SO JOURNAL OF THE PAKISTAN MEDICAL ASSOCIATION
VL 63
IS 5
BP 563
EP 567
PD MAY 2013
PY 2013
AB Objective: To assess the clinical course, complications and predictors
   of mortality in reducing the consequent morbidity and mortality in
   patients with tuberculous meningitis.
   Methods: A prospective study was carried out at Civil Hospital Karachi
   from January 2009 to January 2011. Fifty-two confirmed cases, of
   tuberculous meningitis were included. The entire clinical course with
   complications and predictors of mortality were assessed. Data was
   analyzed using SPSS version 17.0.
   Results: The mean age of the patients was 36.29 +/- 16.7 years with an
   equal gender distribution. The presenting complaints were fever 51
   (98.1%), neck-stiffness 44 (84.61%), and altered level of consciousness
   40 (76.9%), headache 31 (59.6%), vomiting 19 (36.5%) and focal weakness
   10 (19.2%). Among CNS signs, 47 (90.4%) patients had signs of meningeal
   irritation, 14 (26.9%) had cranial nerve palsies with abducent nerve
   being the most commonly involved cranial nerve (25%). Mean GCS was 11.4
   +/- 2.9 and most of the patients presented with medical research council
   Stage 2 of tuberculous meningitis (which is minimally altered level of
   consciousness with minor focal neurological signs). Overall mortality
   was 21.1%. Univariate analysis revealed old age; advanced stage of
   tuberculous meningitis, serum sodium < 125 mmol/l, TLC >9000/mu L
   development of hydrocephalus and use of mechanical ventilation as major
   predictors of mortality.
   Conclusion: Tuberculous meningitis is a frequently reported problem in
   our part of the world. Hydrocephalus along with other sequelae are
   common complications. All patients should be assessed for the presence
   of risk factors affecting mortality of the disease.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0030-9982
UT WOS:000317872600005
PM 23757980
ER

PT J
AU Harrod, Molly
   Kowalski, Christine P.
   Saint, Sanjay
   Forman, Jane
   Krein, Sarah L.
TI Variations in risk perceptions: a qualitative study of why unnecessary
   urinary catheter use continues to be problematic
SO BMC HEALTH SERVICES RESEARCH
VL 13
AR 151
DI 10.1186/1472-6963-13-151
PD APR 26 2013
PY 2013
AB Background: Catheter associated urinary tract infection (CAUTI) is one
   of the most commonly acquired health care associated infections within
   the United States. We examined the implementation of an initiative to
   prevent CAUTI, to better understand how health care providers'
   perceptions of risk influenced their use of prevention practices and the
   potential impact these risk perceptions have on patient care decisions.
   Understanding such perceptions are critical for developing more
   effective approaches to ensure the successful uptake of key patient
   safety practices and thus safer care for hospitalized patients.
   Methods: We conducted semi-structured phone and in-person interviews
   with staff from 12 hospitals. A total of 42 interviews were analyzed
   using open coding and a constant comparative approach. This analysis
   identified "risk" as a central theme and a "risk explanatory framework"
   was identified for its sensitizing constructs to organize and explain
   our findings.
   Results: We found that multiple perceptions of risk, some non-evidence
   based, were used by healthcare providers to determine if use of the
   indwelling urethral catheter was necessary. These risks included
   normative work where staff deal with competing priorities and must
   decide which ones to attend too; loosely coupled errors where negative
   outcomes and the use of urinary catheters were not clearly linked;
   process weaknesses where risk seemed to be related to both the existing
   organizational processes and the new initiative being implemented and;
   workarounds that consisted of health care workers developing workarounds
   in order to bypass some of the organizational processes created to
   dissuade catheter use.
   Conclusions: Hospitals that are implementing patient safety initiatives
   aimed at reducing indwelling urethral catheters should be aware that the
   risk to the patient is not the only risk of perceived importance;
   implementation plans should be formulated accordingly.
RI Krein, Sarah/E-2742-2014
OI Krein, Sarah/0000-0003-2111-8131
TC 4
ZB 0
Z8 0
ZS 0
Z9 4
SN 1472-6963
UT WOS:000318527100002
PM 23622427
ER

PT J
AU Vucinic, Slavica
   Antonijevic, Biljana
   Ilic, Nela V.
   Ilic, Tihomir V.
TI Oxime and atropine failure to prevent intermediate syndrome development
   in acute organophosphate poisoning
SO VOJNOSANITETSKI PREGLED
VL 70
IS 4
BP 420
EP 423
DI 10.2298/VSP120229037V
PD APR 2013
PY 2013
AB Introduction. Intermediate syndrome ([MS) was described a few decades
   ago, however, there is still a controversy regarding its exact etiology,
   risk factors, diagnostic parameters and required therapy. Considering
   that acute poisonings are treated in different types of medical
   institutions this serious complication of organophosphate insecticide
   (OPI) poisoning is frequently overlooked. The aim of this paper was to
   present a case of IMS in organophosphate poisoning, which, we believe,
   provides additional data on the use of oxime or atropine. Case report.
   After a well-resolved cholinergic crisis, the patient developed clinical
   presentation of IMS within the first 72 h from deliberate malathion
   ingestion. The signs of IMS were weakness of proximal limb muscles and
   muscles innervated by motor cranial nerves, followed by the weakness of
   respiratory muscles and serious respiratory insufficiency. Malathion and
   its active metabolite were confirmed by analytical procedure (liquid
   chromatography-mass spectrometry). Pralidoxime methylsulphate,
   adiministered as a continuous infusion until day 8 (total dose 38.4 g),
   and atropine until the day 10 (total dose 922 mg) did not prevent the
   development of IMS, hence the mechanical ventilation that was stopped
   after 27 h had to be continued until the day 10. Conclusion. Continuous
   pralidoxime methylsulphate infusion with atropine did not prevent the
   development of IMS, most likely due to the delayed treatment and
   insufficient oxime dose but also because of chemical structure and
   lipophilicity of ingested OPI. A prolonged intensive care monitoring and
   respiratory care are the key management for the intermediate syndrome.
TC 0
ZB 0
Z8 2
ZS 0
Z9 2
SN 0042-8450
UT WOS:000318129300015
PM 23700950
ER

PT J
AU Bloch, Susannah A. A.
   Lee, Jen Y.
   Wort, S. John
   Polkey, Michael I.
   Kemp, Paul R.
   Griffiths, Mark J. D.
TI Sustained Elevation of Circulating Growth and Differentiation Factor-15
   and a Dynamic Imbalance in Mediators of Muscle Homeostasis Are
   Associated With the Development of Acute Muscle Wasting Following
   Cardiac Surgery
SO CRITICAL CARE MEDICINE
VL 41
IS 4
BP 982
EP 989
DI 10.1097/CCM.0b013e318274671b
PD APR 2013
PY 2013
AB Objectives: Acute muscle wasting in the critically ill is common and
   causes significant morbidity. In a novel human model of acute muscle
   wasting following cardiac surgery, known or potential circulating
   modulators of muscle mass-insulin-like growth factor-1, myostatin, and
   growth and differentiation factor-15-were measured over a week. It was
   hypothesized that patients who developed acute muscle wasting would show
   distinct patterns of change in these mediators.
   Design: A prospective longitudinal observational study of high-risk
   elective cardiac surgical patients identifying, by ultrasound, those
   developing muscle wasting.
   Setting: Tertiary cardiothoracic referral center: Royal Brompton
   Hospital, London, UK.
   Patients: Forty-two patients undergoing elective high-risk
   cardiothoracic surgery.
   Interventions: Circulating insulin-like growth factor-1, myostatin, and
   growth and differentiation factor-15 were assayed preoperatively and
   over the first week postoperatively. The ability of growth and
   differentiation factor-15 to cause muscle wasting in vitro was
   determined in C2C12 myotubes.
   Measurements and Main Results: Of the 42 patients, 23 (55%) developed
   quadriceps atrophy. There was an acute decrease in insulin-like growth
   factor-1 and unexpectedly myostatin, known mediators of muscle
   hypertrophy and atrophy, respectively. By contrast, plasma growth and
   differentiation factor-15 concentrations increased in all patients. This
   increase in growth and differentiation factor-15 was sustained at day 7
   in those who developed muscle wasting (day 7 compared with baseline, p <
   0.01), but recovered in the nonwasting group (p > 0.05). Insulin-like
   growth factor-1 did not recover in those who developed muscle wasting
   (day 7 compared with baseline, p < 0.01) but did in the nonwasting group
   (p > 0.05). Finally, we demonstrated that growth and differentiation
   factor-15 caused atrophy of myotubes in vitro.
   Conclusion: These data support the hypothesis that acute muscle loss
   occurs as a result of an imbalance between drivers of muscle atrophy and
   hypertrophy. Growth and differentiation factor-15 is a potential novel
   factor associated with muscle atrophy, which may become a therapeutic
   target in patients with ICU acquired paresis and other forms of acute
   muscle wasting. (Crit Care Med 2013; 41: 982-989)
TC 7
ZB 2
Z8 1
ZS 0
Z9 8
SN 0090-3493
UT WOS:000316731800016
PM 23328263
ER

PT J
AU Nardelli, Paul
   Khan, Jaffar
   Powers, Randall
   Cope, Tim C.
   Rich, Mark M.
TI Reduced motoneuron excitability in a rat model of sepsis
SO JOURNAL OF NEUROPHYSIOLOGY
VL 109
IS 7
BP 1775
EP 1781
DI 10.1152/jn.00936.2012
PD APR 2013
PY 2013
AB Nardelli P, Khan J, Powers R, Cope TC, Rich MM. Reduced motoneuron
   excitability in a rat model of sepsis. J Neurophysiol 109: 17751781,
   2013. First published January 9, 2013; doi:10.1152/jn.00936.2012.-Many
   critically ill patients in intensive care units suffer from an
   infection-induced whole body inflammatory state known as sepsis, which
   causes severe weakness in patients who survive. The mechanisms by which
   sepsis triggers intensive care unit-acquired weakness (ICUAW) remain
   unclear. Currently, research into ICUAW is focused on dysfunction of the
   peripheral nervous system. During electromyographic studies of patients
   with ICUAW, we noticed that recruitment was limited to few motor units,
   which fired at low rates. The reduction in motor unit rate modulation
   suggested that functional impairment within the central nervous system
   contributes to ICUAW. To understand better the mechanism underlying
   reduced firing motor unit firing rates, we moved to the rat cecal
   ligation and puncture model of sepsis. In isoflurane-anesthetized rats,
   we studied the response of spinal motoneurons to injected current to
   determine their capacity for initiating and firing action potentials
   repetitively. Properties of single action potentials and passive
   membrane properties of motoneurons from septic rats were normal,
   suggesting excitability was normal. However, motoneurons exhibited
   striking dysfunction during repetitive firing. The sustained firing that
   underlies normal motor unit activity and smooth force generation was
   slower, more erratic, and often intermittent in septic rats. Our data
   are the first to suggest that reduced excitability of neurons within the
   central nervous system may contribute to ICUAW.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0022-3077
UT WOS:000316995200009
PM 23303860
ER

PT J
AU Rybojad, Beata
   Lesiuk, Witold
   Fijalkowska, Anna
   Rybojad, Pawel
   Sawicki, Marek
   Lesiuk, Leszek
TI Management of myasthenic crisis in a child.
SO Anaesthesiology intensive therapy
VL 45
IS 2
BP 82
EP 4
DI 10.5603/AIT.2013.0018
PD 2013 Apr-Jun
PY 2013
AB Myasthenia gravis is an autoimmune disorder of peripheral nervous
   system, leading to fluctuating muscle weakness. It is caused by
   circulating antibodies that block acetylcholine nicotinic postsynaptic
   receptors at the postsynaptic neuromuscular junction. Myasthenic crisis
   is a life-threatening complication, which is defined as weakness from
   acquired myasthenia gravis. In this paper we described a 15-year-old boy
   who was admitted to the Paediatric Intensive Care Unit due to myasthenic
   crisis. He had suffered not only from myasthenia gravis but also
   hypothyroidism, cerebral palsy and epilepsy. The patient required
   mechanical ventilation and was successfully treated with both
   plasmapheresis and intravenous immunoglobulins. He recovered from the
   crisis and then thymectomy was performed. Perioperative period and
   anaesthesia passed uncomplicated. Discharged home from the hospital
   after 2.5 month-treatment, for the last 4 years, he has only come on
   scheduled outpatient medical appointments. This case reveals that
   myasthenic crisis, albeit rare, may occur in male adolescents. In such
   cases multidisciplinary care followed by surgery becomes a procedure of
   choice. Concomitant medical problems, if well controlled, do not affect
   the results of outcome of the underlying disease. 
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:23877900
PM 23877900
ER

PT J
AU van der Kooi, A W
   Tulen, J H M
   van Eijk, M M J
   de Weerd, A W
   van Uitert, M J G
   van Munster, B C
   Slooter, A J C
TI Sleep monitoring by actigraphy in short-stay ICU patients.
SO Critical care nursing quarterly
VL 36
IS 2
BP 169
EP 73
DI 10.1097/CNQ.0b013e318283cff3
PD 2013 Apr-Jun
PY 2013
AB Sleep deprivation is common in intensive care unit (ICU) patients. The
   criterion standard for sleep monitoring, polysomnography, is impractical
   in ICU. Actigraphy (a wrist watch indicating amount of sleep) proved to
   be a good alternative in non-ICU patients, but not in prolonged
   mechanically ventilated patients, probably due to ICU-acquired weakness.
   Short-stay ICU patients do not suffer from ICU-acquired weakness.
   However, the accuracy of actigraphy is unknown in these patients.
   Therefore, we compared actigraphy to polysomnography in short-stay ICU
   patients. Sleep measurements were conducted in 7 postcardiothoracic
   surgery patients. The sensitivity (percentage of actigraphy data that
   agreed with sleep determined using polysomnography) and specificity
   (percentage of actigraphy data that agreed with awake determined using
   polysomnography) were calculated. The result showed that actigraphy
   underestimated the amount of wake time and overestimated the amount of
   sleep. The median specificity for actigraphy was always less than 19%
   and sensitivity more than 94%. Therefore, actigraphy is not reliable for
   sleep monitoring in short-stay ICU patients.
TC 1
ZB 1
Z8 0
ZS 0
Z9 1
UT MEDLINE:23470702
PM 23470702
ER

PT J
AU Drozdov, Daniel
   Thomer, Anja
   Meili, Marc
   Schwarz, Stefanie
   Kouegbe, Rita Bossart
   Regez, Katharina
   Guglielmetti, Merih
   Schild, Ursula
   Conca, Antoinette
   Schaefer, Petra
   Reutlinger, Barbara
   Ottiger, Cornelia
   Buchkremer, Florian
   Litke, Alexander
   Schuetz, Philipp
   Huber, Andreas
   Buergi, Ulrich
   Fux, Christoph A.
   Bock, Andreas
   Mueller, Beat
   Albrich, Werner C.
CA Triple P Study Grp
TI Procalcitonin, pyuria and proadrenomedullin in the management of urinary
   tract infections - 'triple p in uti': study protocol for a randomized
   controlled trial
SO TRIALS
VL 14
AR 84
DI 10.1186/1745-6215-14-84
PD MAR 22 2013
PY 2013
AB Background: Urinary tract infections (UTIs) are among the most common
   infectious diseases and drivers of antibiotic use and in-hospital days.
   A reduction of antibiotic use potentially lowers the risk of antibiotic
   resistance. An early and adequate risk assessment combining medical,
   biopsychosocial and functional risk scores has the potential to optimize
   site-of-care decisions and thus allocation of limited health-care
   resources. The aim of this factorial design study is twofold: first, for
   Intervention A, it investigates antibiotic exposure of patients treated
   with a protocol based on the type of UTI, procalcitonin (PCT) and
   pyuria. Second, for Intervention B, it investigates the usefulness of
   the prognostic biomarker proadrenomedullin (ProADM) integrated into an
   interdisciplinary assessment bundle for site-of-care decisions.
   Methods and design: This randomized controlled open-label trial has a
   factorial design (2 x 2). Randomization of patients will be based on a
   pre-specified computer-generated randomization list and independent for
   the two interventions. Adults with UTI presenting to the emergency
   department (ED) will be screened and enrolled after providing informed
   consent.
   For our first Intervention (A), we developed a protocol based on
   previous observational research to recommend initiation and duration of
   antibiotic use based on the clinical presentation of UTI, pyuria and PCT
   levels. For our second intervention (B), an algorithm was developed to
   support site-of care decisions based on the prognostic marker ProADM and
   distinct nursing factors on days 1 and 3. Both interventions will be
   compared with a control group conforming to the guidelines.
   The primary endpoints for the two interventions will be: (A) overall
   exposure to antibiotics and (B) length of physician-led hospitalization
   within a follow-up of 30 days. Endpoints are assessed at discharge from
   hospital, and 30 and 90 days after admission. We plan to screen 300
   patients and enroll 250 for an anticipated estimated loss of follow-up
   of 20%. This will provide adequate power for the two interventions.
   Discussion: This trial investigates two strategies for improved
   individualized medical care in patients with UTI. The minimally
   effective duration of antibiotic therapy is not known for UTIs, which is
   important for reducing the selection pressure for antibiotic resistance,
   costs and drug-related side effects. Triage decisions must be improved
   to reflect the true medical, biopsychosocial and functional risks in
   order to allocate patients to the most appropriate care setting and
   reduce hospital-acquired disability.
TC 3
ZB 3
Z8 0
ZS 0
Z9 3
SN 1745-6215
UT WOS:000317082900002
PM 23522152
ER

PT J
AU Lee, I-Hsin
   How, Chorng-Kuang
   Lu, Wen-Hua
   Tzeng, Tuann-Meei
   Chen, Ying-Ju
   Chern, Chii-Hwa
   Kao, Wei-Fong
   Yen, David Hung-Tsang
   Huang, Mu-Shun
TI Improved survival outcome with continuous chest compressions with
   ventilation compared to 5:1 compressions-to-ventilations mechanical
   cardiopulmonary resuscitation in out-of-hospital cardiac arrest
SO JOURNAL OF THE CHINESE MEDICAL ASSOCIATION
VL 76
IS 3
BP 158
EP 163
DI 10.1016/j.jcma.2013.01.001
PD MAR 2013
PY 2013
AB Background: Fewer pauses and better chest compression quality are
   thought to improve overall survival following cardiac arrest. This study
   aimed to measure the outcomes of adult nontraumatic out-of-hospital
   cardiac arrests (OHCAs) treated with 5:1 compressions-to-ventilations
   (Thumper 1007) or continuous chest compressions with ventilation
   (Thumper 1008 CCV) mechanical cardiopulmonary resuscitation (CPR) within
   a specified period of time.
   Methods: A retrospective observational cohort study of 515 adults with
   OHCA was conducted at the emergency department of an urban tertiary
   hospital. There were 307 patients in the Thumper 1007 phase (January
   2008 to December 2009) and 208 patients in the Thumper 1008 CCV phase
   (January 2010 to May 2011). Return of spontaneous circulation (ROSC) and
   survival to hospital discharge were the primary outcome measures.
   Results: Patients in the Thumper 1007 and Thumper 1008 CCV phases had
   comparable results with the following exceptions: less hypertension
   (42.4% vs. 62.0%), cerebrovascular accidents (11.4% vs. 25.0%), and
   faster emergency medical service response time intervals (mean, 3.7 vs.
   4.5 minutes) with the Thumper 1007. The average ambulance transport time
   was 6.1 minutes in both phases. The rates of ROSC [35.1% vs. 23.5%;
   adjusted odds ratio (OR), 1.616; 95% confidence interval (CI),
   1.073-2.432] and survival to hospital discharge (10.1% vs. 4.2%;
   adjusted OR 2.431; 95% CI, 1.154-5.120) were significantly higher with
   the Thumper 1008 CCV than with the Thumper 1007. Favorable neurologic
   outcome upon discharge, defined as cerebral performance category scores
   of 1 (good performance) or 2 (moderate disability), was not
   significantly different between the two phases [1.6% (5/307) vs. 1.9%
   (4/208); p = 0.802] The Thumper 1008 CCV provided significantly faster
   average chest compression rates and shorter no-chest compression
   intervals than the Thumper 1007 after activation.
   Conclusion: In an emergency department with short ambulance transport
   times, continuous chest compressions with ventilation through mechanical
   CPR showed improved outcomes, including ROSC and survival to hospital
   discharge, in an adult with OHCA. However, there are a variety of
   confounding influences that may affect the validity of conclusions that
   have been drawn. Copyright (C) 2013 Elsevier Taiwan LLC and the Chinese
   Medical Association. All rights reserved.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1726-4901
UT WOS:000317945700008
PM 23497969
ER

PT J
AU Rialp, Gemma
   Maria Raurich, Joan
   Antonio Llompart-Pou, Juan
   Ayestaran, Ignacio
   Ibanez, Jordi
TI Central Respiratory Drive in Patients With Neuromuscular Diseases
SO RESPIRATORY CARE
VL 58
IS 3
BP 450
EP 457
DI 10.4187/respcare.01873
PD MAR 2013
PY 2013
AB BACKGROUND: The contribution of the central respiratory drive in the
   hypercapnic respiratory failure of neuromuscular diseases (NMD) is
   controversial. OBJECTIVE: To compare the CO2 response and the duration
   of weaning of mechanical ventilation between a group of NMD patients and
   a group of quadriplegic patients due to ICU-acquired weakness (ICU-AW).
   METHODS: We prospectively studied 16 subjects with NMD and 26 subjects
   with ICU-AW ready for weaning, using the method of the re-inhalation of
   expired air. We measured the hypercapnic drive response, defined as the
   ratio of change in airway occlusion pressure 0.1 second after the start
   of inspiration (Delta P-0.1) to the change in PaCO2 (Delta PaCO2), and
   the hypercapnic ventilatory response, defined as the ratio of the change
   in minute ventilation (Delta(V)over dot(E)) to Delta PaCO2. We
   considered a value of <= 0.19 cm H2O/mm Hg as reduced hypercapnic drive
   response. RESULTS: Hypercapnic drive response (Delta P-0.1/Delta PaCO2 =
   0.14 +/- 0.08 cm H2O/mm Hg vs 0.37 +/- 0.27 cm H2O/mm Hg, P = .002) and
   hypercapnic ventilatory response (Delta(V)over dot(E)/Delta PaCO2 = 0.21
   +/- 0.19 L/min/mm Hg vs 0.44 +/- 0.40 L/min/mm Hg, P = .02) were lower
   in the NMD than in the ICU-AW subjects. Duration of weaning values,
   according to the Kaplan-Meier curves, were similar in both groups
   (Log-rank = 0.03, P = .96). Eleven NMD (69%) and 9 ICU-AW (35%) subjects
   had hypercapnic drive response <= 0.19 cm H2O/mm Hg. The duration of
   weaning was longer in subjects with hypercapnic drive response <= 0.19
   cm H2O/mm Hg (log-rank = 15.4, P < .001). CONCLUSIONS: Subjects with
   acute hypercapnic respiratory failure due to NMD had reduced hypercapnic
   drive response, compared to ICU-AW subjects. The duration of weaning was
   longer in subjects with reduced hypercapnic drive response.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0020-1324
UT WOS:000316434700005
PM 22780920
ER

PT J
AU Smania, Nicola
   Avesani, Renato
   Roncari, Laura
   Ianes, Patrizia
   Girardi, Paolo
   Varalta, Valentina
   Gambini, Maria Grazia
   Fiaschi, Antonio
   Gandolfi, Marialuisa
TI Factors Predicting Functional and Cognitive Recovery Following Severe
   Traumatic, Anoxic, and Cerebrovascular Brain Damage
SO JOURNAL OF HEAD TRAUMA REHABILITATION
VL 28
IS 2
BP 131
EP 140
DI 10.1097/HTR.0b013e31823c0127
PD MAR-APR 2013
PY 2013
AB Objectives: To compare demographic data, clinical data, and rate of
   functional and cognitive recovery in patients with severe traumatic,
   cerebrovascular, or anoxic acquired brain injury (ABI) and to identify
   factors predicting discharge home. Participants: Three hundred
   twenty-nine patients with severe ABI (192 with traumatic, 104 with
   cerebrovascular, and 33 with anoxic brain injury). Design: Longitudinal
   prospective study of inpatients attending the intensive Rehabilitation
   Department of the "Sacro Cuore" Don Calabria Hospital (Negrar, Verona,
   Italy). Main measures: Etiology, sex, age, rehabilitation admission
   interval, rehabilitation length of stay, discharge destination, Glasgow
   Coma Scale, Disability Rating Scale (DRS), Glasgow Outcome Scale, Levels
   of Cognitive Functioning, and Functional Independence Measure. Results:
   Predominant etiology was traumatic; male gender was prevalent in all the
   etiologic groups; patients with traumatic brain injury were younger than
   the patients in the other groups and had shorter rehabilitation
   admission interval, greater functional and cognitive outcomes on all
   considered scales, and a higher frequency of returning home. Patients
   with anoxic brain injury achieved the lowest grade of functional and
   cognitive recovery. Age, etiology, and admission DRS score predicted
   return home. Conclusions: Patients with traumatic brain injury achieved
   greater functional and cognitive improvements than patients with
   cerebrovascular and anoxic ABI. Age, etiology, and admission DRS score
   can assist in predicting discharge destination.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 0885-9701
UT WOS:000316058300007
PM 22333677
ER

PT J
AU Babbitt, Christopher J.
   Halpern, Rebekah
   Liao, Eileen
   Lai, Khanh
TI Hyperglycemia Is Associated With Intracranial Injury in Children Younger
   Than 3 Years of Age
SO PEDIATRIC EMERGENCY CARE
VL 29
IS 3
BP 279
EP 282
DI 10.1097/PEC.0b013e3182850409
PD MAR 2013
PY 2013
AB Objectives: The objective was to see if hyperglycemia in the emergency
   department predicted traumatic intracranial hemorrhage (ICH) for infants
   and young children.
   Methods: A 6-year retrospective chart review was performed on patients
   younger than 3 years. Patients identified from the pediatric intensive
   care unit (PICU) database with ICH on computer tomography were compared
   with those with a history of trauma without ICH identified from a
   radiology database. Subgroup analysis was performed on the ICH group
   comparing abusive head trauma (AHT) and accidental. Primary outcomes
   measured were initial serum glucose level, length of stay, length of
   ventilation, mortality, and disability on discharge.
   Results: Fifty-three patients were admitted to the PICU with traumatic
   ICH with an overall mortality of 7.5%. The average initial glucose in
   the emergency department was significantly higher for the patients with
   ICH than those without (164 vs 99 mg/dL, P < 0.0001). Combining elevated
   serum glucose with any abnormality in Glasgow Coma Scale score yielded
   sensitivity and specificity of 100%. The average presenting glucose was
   higher for AHT compared with accidental injury (190 vs 133 mg/dL, P <
   0.001). Patients with AHT had greater PICU and hospital length of stay
   and more severe disabilities on discharge (P G 0.001).
   Conclusions: Elevated serum glucose is a good marker of ICH in children
   younger than 3 years. When correlated with an abnormal neurological
   examination, it is highly sensitive and specific. Patients with AHT have
   further elevation of serum glucose at presentation. Emergency department
   physicians should consider measuring the serum glucose in children
   younger than 3 years with abnormal neurological examinations and
   obtaining a head computer tomography if it is elevated.
TC 1
ZB 0
Z8 1
ZS 0
Z9 2
SN 0749-5161
UT WOS:000315949000002
PM 23426241
ER

PT J
AU Abu-Kishk, Ibrahim
   Kozer, Eran
   Hod-Feins, Roei
   Anekstein, Yoram
   Mirovsky, Yigal
   Klin, Baruch
   Eshel, Gideon
TI Pediatric scoliosis surgery is postoperative intensive care unit
   admission really necessary?
SO PEDIATRIC ANESTHESIA
VL 23
IS 3
BP 271
EP 277
DI 10.1111/pan.12108
PD MAR 2013
PY 2013
AB Background It is common practice for patients to be admitted to the
   intensive care unit following scoliosis surgery, because of the
   prolonged anesthesia, the need for efficient pain control and the known
   immediate postoperative complications. However, this may be unnecessary
   in many patients. Purpose We aimed to establish possible associations
   between pre- and perioperative parameters and early postoperative
   complication rates, in particular the need for prolonged mechanical
   ventilation (>1day), and the presence of major complications in children
   undergoing primary spinal fusion by thoracolumbar spine instrumentation.
   Methods We conducted a retrospective review of children undergoing
   primary scoliosis surgery at a university-affiliated general hospital
   from 1998 to 2008. Results Surgical approaches were as follows: anterior
   spinal fusion, posterior spinal fusion, and combined anterior and
   posterior fusion. Prior to mid-2005, anesthesia included morphine;
   thereafter, remifentanil was used. Major complications correlated
   significantly with neuromuscular scoliosis (NMS) (OR, 4.94; 95% CI,
   1.0224.05), comorbidity conditions (OR, 3.47; 95% CI, 1.1610.42), and
   anterior or combined fusion (OR, 7.81; 95% CI, 2.1228.57). Late
   extubation correlated significantly with NMS (OR, 31.25; 95% CI,
   1.06100.00) and morphine use during anesthesia (OR, 17.91; 95% CI,
   1.44222.9). Conclusions Relatively young, healthy idiopathic scoliosis
   children receiving intraoperative remifentanil sedation and undergoing
   posterior fusion can be successfully managed in regular wards in the
   immediate postoperative period. However, intensive care unit admission
   should be considered in NMS patients, patients with comorbidity
   conditions, those undergoing anterior or combined spinal fusion, and
   patients whose anesthesia involves long-acting opioids.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1155-5645
UT WOS:000314841000010
PM 23279112
ER

PT J
AU Jethava, Ashif
   Ali, Syed
   Dasanu, Constantin A
TI Primary respiratory failure due to inclusion body myositis: think
   outside the box.
SO Connecticut medicine
VL 77
IS 3
BP 155
EP 8
PD 2013-Mar
PY 2013
AB Inclusion body myositis features a slowly progressive inflammatory
   myopathy characterized by progressive proximal muscle weakness in the
   lower extremities, followed by proximal, upper-extremity weakness and
   later involvement of distal muscles groups. Although the most severely
   affected muscles are those of the limbs, the disease can also involve
   the respiratory, cardiovascular and gastrointestinal system muscles as
   well. We describe a unique patient who presented with acute hypercapnic
   hypoxic respiratory failure secondary to inclusion body myositis. Our
   patient required mechanical ventilation but responded to corticosteroid
   therapy. The diagnosis was delayed in part because of the slowly
   progressive course of the disease and the fact that an extensive
   investigation had not disclosed a cause. We postulate that muscle biopsy
   may be warranted in select patients suffering from a protracted muscle
   weakness.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 0010-6178
UT MEDLINE:23589953
PM 23589953
ER

PT J
AU Mahmoudi, Hosein
   Mohmmadi, Eesa
   Ebadi, Abbas
TI Barriers to nursing care in emergency wards.
SO Iranian journal of nursing and midwifery research
VL 18
IS 2
BP 145
EP 51
PD 2013-Mar
PY 2013
AB BACKGROUND: Caring is the essence of nursing. Since care is influenced
   by cultural, economic, and social factors, various diverse barriers
   exist in the realization of care. The aim of the study was to clarify
   barriers to caring in emergency patients based on experiences of nurses
   and patients and their relatives.
   MATERIALS AND METHODS: A qualitative design of content analysis was used
   to identify the barriers to caring in emergency patients. In-depth
   interviews were conducted with 18 Iranian nurses working in a university
   hospital emergency ward and with seven patients. Participants were
   selected purposefully. Data were analyzed according to qualitative
   content analysis.
   RESULTS: After the classification analyses and integration of codes,
   seven categories were acquired. Finally, following three themes were
   extracted: Identified barriers to nursing care in emergency wards - the
   nature of critical ward, performance weakness of nurses, and deficiency
   in clinical management.
   CONCLUSIONS: According to the results of this study fundamental and
   management education for nurses, empowerment of nurses, principle and
   scientific triage, effective supervision, nurses' support, wage
   increase, and motivation in nurses are important to achieve the research
   purpose.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1735-9066
UT MEDLINE:23983745
PM 23983745
ER

PT J
AU Corner, E. J.
   Wood, H.
   Englebretsen, C.
   Thomas, A.
   Grant, R. L.
   Nikoletou, D.
   Soni, N.
TI The Chelsea Critical Care Physical Assessment Tool (CPAx): validation of
   an innovative new tool to measure physical morbidity in the general
   adult critical care population; an observational proof-of-concept pilot
   study
SO PHYSIOTHERAPY
VL 99
IS 1
BP 33
EP 41
DI 10.1016/j.physio.2012.01.003
PD MAR 2013
PY 2013
AB Objective To develop a scoring system to measure physical morbidity in
   critical care - the Chelsea Critical Care Physical Assessment Tool
   (CPAx).
   Method The development process was iterative involving content validity
   indices (CVI), a focus group and an observational study of 33 patients
   to test construct validity against the Medical Research Council score
   for muscle strength, peak cough flow, Australian Therapy Outcome
   Measures score, Glasgow Coma Scale score, Bloomsbury sedation score,
   Sequential Organ Failure Assessment score, Short Form 36 (SF-36) score,
   days of mechanical ventilation and inter-rater reliability.
   Participants Trauma and general critical care patients from two London
   teaching hospitals.
   Results Users of the CPAx felt that it possessed content validity,
   giving a final CVI of 1.00 (P < 0.05). Construct validation data showed
   moderate to strong significant correlations between the CPAx score and
   all secondary measures, apart from the mental component of the SF-36
   which demonstrated weak correlation with the CPAx score (r = 0.024, P =
   0.720). Reliability testing showed internal consistency of alpha = 0.798
   and inter-rater reliability of kappa = 0.988 (95% confidence interval
   0.791 to 1.000) between five raters.
   Conclusion This pilot work supports proof of concept of the CPAx as a
   measure of physical morbidity in the critical care population, and is a
   cogent argument for further investigation of the scoring system. (C)
   2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All
   rights reserved.
TC 5
ZB 0
Z8 0
ZS 0
Z9 5
SN 0031-9406
UT WOS:000314158000005
PM 23219649
ER

PT J
AU Batt, Jane
   dos Santos, Claudia C.
   Cameron, Jill I.
   Herridge, Margaret S.
TI Intensive Care Unit-acquired Weakness Clinical Phenotypes and Molecular
   Mechanisms
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 187
IS 3
BP 238
EP 246
DI 10.1164/rccm.201205-0954SO
PD FEB 1 2013
PY 2013
AB Intensive care unit acquired weakness (ICUAW) begins within hours of
   mechanical ventilation and may not be completely reversible over time.
   It represents a major functional morbidity of critical illness and is an
   important patient-centered outcome with clear implications for quality
   of life and resumption of prior work and lifestyle. There is
   heterogeneity in functional outcome related to ICUAW across various
   patient populations after an episode of critical illness. This state-of
   the art review argues that this observed heterogeneity may represent a
   clinical spectrum of disability in which there are recognizable clinical
   phenotypes for outcome according to age, burden of comorbid illness, and
   ICU length of stay. It further argues that these functional outcomes are
   modified by mood, cognition, and caregiver physical and mental health.
   This proposed construct of clinical phenotypes will be used as a
   framework for a review of the current literature on the molecular
   biology of muscle and nerve injury. This translational approach for the
   development of models pairing clinical phenotypes for different
   functional outcomes after critical illness with molecular mechanism of
   injury may offer unique insights into the diagnosis and treatment of
   muscle and nerve lesions.
TC 38
ZB 12
Z8 0
ZS 0
Z9 38
SN 1073-449X
UT WOS:000314860700005
PM 23204256
ER

PT J
AU Breilh, Dominique
   Texier-Maugein, Jeannette
   Allaouchiche, Bernard
   Saux, Marie-Claude
   Boselli, Emmanuel
TI Carbapenems
SO JOURNAL OF CHEMOTHERAPY
VL 25
IS 1
BP 1
EP 17
DI 10.1179/1973947812Y.0000000032
PD FEB 2013
PY 2013
AB Objective: To assess the relative strengths and weaknesses of
   carbapenems by considering their microbiological, clinical,
   pharmacokinetics and pharmacokinetic/pharmacodynamic (PK/PD) properties
   and defining optimal conditions of uses of the new generation of
   carbapenems.
   Methods: Literature review.
   Results: Except for ertapenem, the spectrum of activity is similar for
   all carbapenems, with little differences in activities of individual
   agents. The absence or reduced expression of two major porins in
   combination with various beta-lactamases and alteration of some
   penicillin binding proteins have been implicated in carbapenem
   resistance. All carbapenems are not alike, although they have very
   similar pharmacokinetic properties. The most important PK/PD parameter
   predicting bacteriological and clinical efficacy is T-> MIC. There is
   some circumstantial evidence, such as clinical data in severe critically
   ill septic patients, impaired renal function patients and neutropenic
   patients that imipenem has to exceed 66% of T-> MIC to result in good
   clinical outcome. Continuous or extend infusion of carbapenems should
   result in at least equal efficacy to that of intermittent infusion in
   the treatment of infections with susceptible bacteria and appear highly
   appropriate for use in critically ill patients.
   Conclusions: Maximizing clinical outcomes and minimizing antibiotic
   resistance using individualized doses may be best achieved with
   therapeutic drug monitoring of carbapenems.
RI Boselli, Emmanuel/A-9183-2015
OI Boselli, Emmanuel/0000-0002-4949-3518
TC 8
ZB 5
Z8 0
ZS 0
Z9 8
SN 1120-009X
UT WOS:000314773400001
PM 23433439
ER

PT J
AU Cartwright, Michael S.
   Kwayisi, Golda
   Griffin, Leah P.
   Sarwal, Aarti
   Walker, Francis O.
   Harris, Jessica M.
   Berry, Michael J.
   Chahal, Preet S.
   Morris, Peter E.
TI Quantitative neuromuscular ultrasound in the intensive care unit
SO MUSCLE & NERVE
VL 47
IS 2
BP 255
EP 259
DI 10.1002/mus.23525
PD FEB 2013
PY 2013
AB Introduction: Intensive care unit acquired weakness (ICU-AW) results
   from a complex mixture of nerve and muscle pathology, and early
   identification is challenging. This pilot study was designed to examine
   the ultrasonographic changes that occur in muscles during ICU
   hospitalization. Methods: Patients admitted to the ICU for acute
   respiratory failure were enrolled prospectively and underwent serial
   muscle ultrasound for thickness and gray-scale assessment of the
   tibialis anterior, rectus femoris, abductor digiti minimi, biceps, and
   diaphragm muscles over 14 days. Results: Sixteen participants were
   enrolled. The tibialis anterior (P = 0.001) and rectus femoris (P =
   0.041) had significant decreases in gray-scale standard deviation when
   analyzed over 14 days. No muscles showed significant changes in
   thickness. Conclusions: Ultrasound is an informative technique for
   assessing muscles of patients in the ICU, and lower extremity muscles
   demonstrated increased homogeneity during ICU stays. This technique
   should be examined further for diagnosing and tracking those with
   ICU-AW. Muscle Nerve 47: 255-259, 2013
TC 10
ZB 4
Z8 0
ZS 0
Z9 10
SN 0148-639X
UT WOS:000314128700014
PM 23041986
ER

PT J
AU Wang, Kuo-Wei
   Chen, Han-Jung
   Lu, Kang
   Liliang, Po-Chou
   Huang, Chun-Kai
   Tang, Pi-Lien
   Tsai, Yu-Duan
   Wang, Hao-Kuang
   Liang, Cheng-Loong
TI Pneumonia in patients with severe head injury: incidence, risk factors,
   and outcomes
SO JOURNAL OF NEUROSURGERY
VL 118
IS 2
BP 358
EP 363
DI 10.3171/2012.10.JNS127
PD FEB 2013
PY 2013
AB Object. The reported incidence of hospital-acquired bacterial pneumonia
   in critically ill trauma patients varies from as low as 4% to as high as
   87%, with fatality rates varying from 6% to 59%. Clinical studies have
   identified the risk factors for pneumonia. The authors undertook this
   retrospective study to evaluate the incidence, risk factors, and
   outcomes of hospital-acquired bacterial pneumonia in a group of patients
   with severe head injuries.
   Methods. This was a retrospective review of consecutive adult patients
   admitted to the neurosurgical ICU in the authors' hospital because of
   severe head injury (Glasgow Coma Scale scores <= 8) between January 2008
   and December 2010.
   Results. During the study period, 290 patients were admitted to the
   neurosurgical ICU. Multivariate Cox regression analysis showed that age
   (HR 1.01, 95% CI 1.001-1.02), nasogastric tube insertion (BR 4.56, 95%
   CI 1.11-18.64), and hemiplegia or hemiparesis (BR 3.79, 95% CI
   2.01-7.17) were significantly associated with the development of
   pneumonia.
   Conclusions. The authors identified 3 risk factors (age, nasogastric
   tube insertion, and hemiplegia or hemiparesis) associated with the
   development of pneumonia in patients with severe head injury. This
   finding constituted the basis for developing a simple screening tool
   that can be used to assess the risk of occurrence of pneumonia in such
   patients. (http://thejns.org/doi/abs/10.3171/2012.10.JNS127)
TC 4
ZB 1
Z8 0
ZS 0
Z9 4
SN 0022-3085
UT WOS:000313937900020
PM 23157183
ER

PT J
AU Bemis-Dougherty, Anita R.
   Smith, James M.
TI What Follows Survival of Critical Illness? Physical Therapists'
   Management of Patients With Post-Intensive Care Syndrome
SO PHYSICAL THERAPY
VL 93
IS 2
BP 179
EP 185
DI 10.2522/ptj.20110429
PD FEB 2013
PY 2013
AB Historically, the management of patients in the intensive care unit
   (ICU) has involved immobilization and sedation, with care focused on
   physiological impairments and survival. Because more ICU patients are
   now surviving their hospital stay, it is imperative that their ICU care
   be managed with the goal of long-term health, wellness, and functioning.
   The evidence confirms that mobilization and exercise are feasible in the
   ICU and demonstrates that the benefits of early mobilization include
   reduced length of stay in the ICU and hospital. In 2010, the Society of
   Critical Care Medicine (SCCM) invited key stakeholder groups, including
   the American Physical Therapy Association (APTA), to identify strategies
   to improve long-term consequences following ICU discharge, including
   early mobilization in the ICU and integration of the physical therapist
   as a member of the ICU team. This model appears to be successful in some
   institutions, but there is variation among institutions. The SCCM Task
   Force developed major areas of focus that require multidisciplinary
   action to improve long-term outcomes after discharge from an ICU. This
   article describes physical therapist practice in the management of ICU
   survivors, the importance of long-term follow-up after ICU discharge,
   and how APTA is taking steps to address the major areas of focus
   identified by the SCCM Task Force to improve long-term outcomes after
   ICU discharge.
TC 4
ZB 0
Z8 0
ZS 0
Z9 4
SN 0031-9023
UT WOS:000314203400007
PM 22836007
ER

PT J
AU Smith, Barbara K.
   Bleiweis, Mark S.
   Neel, Cimaron R.
   Martin, A. Daniel
TI Inspiratory Muscle Strength Training in Infants With Congenital Heart
   Disease and Prolonged Mechanical Ventilation: A Case Report
SO PHYSICAL THERAPY
VL 93
IS 2
BP 229
EP 236
DI 10.2522/ptj.20110348
PD FEB 2013
PY 2013
AB Background and Purpose. Inspiratory muscle strength training (IMST) has.
   been shown to improve maximal pressures and facilitate ventilator
   weaning in adults with prolonged mechanical ventilation (MV). The
   purposes of this case report are: (1) to describe the rationale for IMST
   in infants with MV dependence and (2) to summarize the device
   modifications used to administer training.
   Case Description. Two infants with congenital heart disease underwent
   corrective surgery and were referred for inspiratory muscle strength
   evaluation after repeated weaning failures. It was determined that IMST
   was indicated due to inspiratory muscle weakness and a rapid, shallow
   breathing pattern. In order to accommodate small tidal volumes of
   infants, 2 alternative training modes were devised. For infant 1, IMST
   consisted of 15-second inspiratory occlusions. Infant 2 received
   10-breath sets of IMST through a modified positive end-expiratory
   pressure valve. Four daily IMST sets separated by 3 to 5 minutes of rest
   were administered 5 to 6 days per week. The infants' IMST tolerance was
   evaluated by vital signs and daily clinical reviews.
   Outcomes. Maximal inspiratory pressure (MIP) and rate of pressure
   development (dP/dt) were the primary outcome measures. Secondary outcome
   measures included the resting breathing pattern and MV weaning. There
   were no adverse events associated with IMST. Infants generated training
   pressures through the adapted devices, with improved MIP, dP/dt, and
   breathing pattern. Both infants weaned from MV to a high-flow nasal
   cannula, and neither required subsequent reintubation during their
   hospitalization.
   Discussion. This case report describes pediatric adaptations of an IMST
   technique used to improve muscle performance and facilitate weaning in
   adults. Training was well tolerated in 2 infants with postoperative
   weaning difficulty and inspiratory muscle dysfunction. Further
   systematic examination will be needed to determine whether IMST provides
   a significant performance or weaning benefit.
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 0031-9023
UT WOS:000314203400012
PM 22466028
ER

PT J
AU Trees, Darin W.
   Smith, James M.
   Hockert, Steven
TI Innovative Mobility Strategies for the Patient With Intensive Care
   Unit-Acquired Weakness: A Case Report
SO PHYSICAL THERAPY
VL 93
IS 2
BP 237
EP 247
DI 10.2522/ptj.20110401
PD FEB 2013
PY 2013
AB Background and Purpose. Although the benefits of early mobilization in
   the intensive care unit (ICU) have been well documented in recent years,
   the decision-making process and customization of treatment strategies
   for patients with ICU-acquired weakness have not been well defined in
   the literature. This case report will describe a patient with
   ICU-acquired weakness in the long-term acute care hospital (LTACH)
   setting and mobilization strategies that include novel devices for
   therapeutic exercise and gait training.
   Case Description. A 73-year-old, active woman underwent a routine
   cardioversion for atrial fibrillation but developed multiple
   complications, including sepsis and respiratory failure. The patient
   spent 3 weeks of limited activity in the ICU and was transferred to our
   LTACH for continued medical intervention and rehabilitation. A 4-phase
   graded mobilization program was initiated in the LTACH ICU. Within that
   program, the physical therapy interventions included partial
   weight-bearing antigravity strength training with a mobile leg press and
   gait training with a hydraulic-assist platform walker.
   Outcome. Before interventions, the patient had severe weakness (Medical
   Research Council [MRC] sum score of 18/60) and displayed complete
   dependence for all functioning. She progressed to being able to ambulate
   150 ft (1 ft=0.3048 m) using a rolling walker with accompanying strength
   increases to an MRC sum score of 52/60.
   Discussion. This case report describes novel mobility strategies for
   managing a patient with ICU-acquired weakness. The application of a
   graded mobilization program using a mobile leg press and a
   hydraulic-assist platform walker was safe and feasible, and appeared to
   expedite the patient's recovery process while decreasing the amount of
   manual lifting for the therapists.
TC 5
ZB 1
Z8 0
ZS 0
Z9 5
SN 0031-9023
UT WOS:000314203400013
PM 22577069
ER

PT J
AU Dyrstad, Dagrunn N.
   Hansen, Britt S.
   Gundersen, Evy M.
TI Factors that influence user satisfaction: tracheotomised home mechanical
   ventilation users' experiences
SO JOURNAL OF CLINICAL NURSING
VL 22
IS 3-4
BP 331
EP 338
DI 10.1111/j.1365-2702.2012.04304.x
PD FEB 2013
PY 2013
AB Aims and objectives To describe the self-reported life situation of
   users totally dependent on home mechanical ventilation (HMV) after
   tracheotomy and to identify factors associated with user satisfaction.
   Background HMV users are a small but growing group in society and among
   the most vulnerable individuals with chronic disabilities. The
   participants in the present study belong to an even more susceptible
   minority of this group, as they require round the clock ventilation at
   home through a tracheostomy, implying the need for continuous care.
   Their testimonies are important for the generation of new knowledge.
   Design A qualitative design using interviews. Methods Individual
   interviews were conducted with six participants and analysed by
   qualitative content analysis. Results The main theme that emerged
   different individual needs require a range of approaches was based on
   three sub-themes: (1) Tailored information (2) Sensitivity in
   decision-making and (3) Building trust and confidence. Information was
   perceived as crucial and participants described different experiences of
   receiving optimal information to not receiving information at all.
   Successful collaboration was perceived when the user was given the
   opportunity to participate in decision-making about her/his treatment
   and care, where to live and how to organise daily life. Trust and
   confidence in the caregivers were important. Conclusion The participants
   highlighted the need for strategies to improve satisfaction. Their
   experiences varied depending on age, where they lived, who they
   encountered in the healthcare system and the level of family support.
   Our findings suggest that patients who perceive themselves as well
   informed at an early stage are more satisfied with treatment, decisions
   about their tracheotomy and their life situation. Relevance to clinical
   practice There is a lack of knowledge among healthcare providers, thus
   tailored, high competence and guidelines are required.
TC 1
ZB 1
Z8 0
ZS 0
Z9 1
SN 0962-1067
UT WOS:000313516800004
PM 23240989
ER

PT J
AU Waak, Karen
   Zaremba, Sebastian
   Eikermann, Matthias
TI Muscle strength measurement in the intensive care unit: Not everything
   that can be counted counts
SO JOURNAL OF CRITICAL CARE
VL 28
IS 1
BP 96
EP 98
DI 10.1016/j.jcrc.2012.08.014
PD FEB 2013
PY 2013
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0883-9441
UT WOS:000312949700015
PM 23102532
ER

PT J
AU Gonzalez Pena, Miriam
   Figuerola Massana, Enric
   Hernandez Gutierrez, Pilar
   Rello Condomines, Jordi
TI Middle ear effusion in mechanically ventilated patients: effects of the
   nasogastric tube.
SO Respiratory care
VL 58
IS 2
BP 273
EP 8
DI 10.4187/respcare.01911
PD 2013-Feb
PY 2013
AB BACKGROUND: Middle ear effusion (MEE) is rare among adults, but has a
   higher incidence among ICU patients. The aim of this study was to
   analyze the effect of nasogastric tube (NGT) on MEE and to assess other
   predisposing factors.
   METHODS: Prospective observational study, carrying out an otoscopic
   examination and tympanometry in 100 mechanically ventilated patients.
   Immittance testing was carried out within 24 hours of ICU admission and
   every 72 hours until ICU discharge. In a case of persisting pathologic
   curve at the moment of discharge from ICU, there was a follow-up
   examination every 3 days until middle ear function was restored. In
   addition to descriptive variables, we recorded placement (left or right
   nostril) and diameter (12, 16, or 18 French) of the NGT. A Cox
   regression analysis was performed, adjusted for the days since ICU
   admission.
   RESULTS: A total of 535 tympanometry studies were carried out, of which
   352 were normal and 183 observations presented MEE. We observed that 12
   and 16 French NGTs were not significantly associated with abnormal
   middle ear function, whereas 18 French NGT was significantly associated
   with MEE (odds ratio 2.54, 95% CI 1.42-4.55; P = .01). Other variables
   independently associated with pathological tympanogram curves were
   Ramsay Sedation Scale score ≥ 4 (odds ratio 2.42, 95% CI 1.65-3.55; P =
   .01) and orotracheal intubation (odds ratio 5.72, 95% CI 3.40-9.60; P =
   .01). No intracranial infection or long-term disabilities were
   identified.
   CONCLUSIONS: MEEs and tympanometric alterations are frequent in
   intubated patients (32% in our study). To prevent these complications,
   they should receive NGTs with a diameter lower than 18 French, when
   feasible.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:22781339
PM 22781339
ER

PT J
AU Winkelman, Chris
TI Mechanisms for muscle health in the critically ill patient.
SO Critical care nursing quarterly
VL 36
IS 1
BP 5
EP 16
DI 10.1097/CNQ.0b013e318275071d
PD 2013 Jan-Mar
PY 2013
AB Human skeletal muscles are continually remodeled to match the function
   required of them. Diameter, strength, and vascular supply are altered
   when a muscle group experiences contraction and resistance. The purpose
   of this article is to describe selected muscle signaling pathways that
   contribute to muscle remodeling. Multiple factors affect the cellular
   and molecular remodeling of muscles and at least 2 of them-exercise and
   protein/calorie delivery-are under the direct care of intensive care
   unit (ICU) clinicians. Activating signaling pathways may promote
   preservation of muscle mass and function. Interventions to prevent
   muscle atrophy have potential to reduce ICU-acquired weakness and
   positively affect quality of life in survivors after ICU
   hospitalization. Exploring information generated by genomic and
   proteomic investigations about muscle signaling pathways can help the
   ICU clinician evaluate the benefits and risks of interventions to
   maintain muscle health early in critical illness.
TC 2
ZB 1
Z8 1
ZS 0
Z9 3
UT MEDLINE:23221437
PM 23221437
ER

PT J
AU Rukstele, Christina D
   Gagnon, Mary M
TI Making strides in preventing ICU-acquired weakness: involving family in
   early progressive mobility.
SO Critical care nursing quarterly
VL 36
IS 1
BP 141
EP 7
DI 10.1097/CNQ.0b013e31827539cc
PD 2013 Jan-Mar
PY 2013
AB As advances in research and technology expand our ability to optimize
   the short-term outcomes in critical illness, survivors are often left
   with long-term functional impairments. The complications of bed rest can
   be nearly as devastating as the illness itself. Prolonged periods of
   immobility during the acute phase of illness have been linked to severe
   weakness, self-care deficits, poor quality of life, and mortality in
   patients up to 5 years after discharge from the intensive care unit.
   Interventions targeted at early, progressive mobility have been shown to
   reduce the burden of these outcomes. Mobilizing the critically ill
   patient, however, requires an integrated approach.Family presence has
   been described in the literature as providing a sense of personhood to
   patients. Involvement of key figures may yield purpose to nursing
   interventions, beyond the pathophysiological rationale. Conversely,
   having a family member in the intensive care unit can be frightening and
   leave a loved one feeling hopeless and helpless. Family engagement has
   been suggested to provide added opportunities for education and tangible
   knowledge about the patient's condition. Such an approach may be the
   fuel in motivating patients and families toward a meaningful recovery.
   Therefore, this article describes the process of incorporating family
   into an intensive care unit early, progressive, mobility protocol.
TC 3
ZB 0
Z8 0
ZS 0
Z9 3
UT MEDLINE:23221450
PM 23221450
ER

PT J
AU Koshy, Kurien
   Zochodne, Douglas W
TI Neuromuscular complications of critical illness.
SO Handbook of clinical neurology
VL 115
BP 759
EP 80
DI 10.1016/B978-0-444-52902-2.00044-8
PD 2013
PY 2013
AB Patients admitted to intensive care units (ICUs) suffer from a wide
   range of neurological disorders. Some develop within the ICU rendering
   weakness and difficulty in weaning patients from ventilator support.
   ICUAW, or ICU acquired weakness, is a broad term that includes several
   more specific neuromuscular problems. After exclusion of other causes of
   weakness, ICUAW includes critical illness polyneuropathy (CIP), first
   described by Charles Bolton, critical illness myopathy (CIM), and
   disorders of neuromuscular junction transmission. This chapter reviews
   the clinical, electrophysiological, and pathological features of these
   conditions and provides clinicians with approaches toward diagnosing and
   investigating ICUAW. 
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0072-9752
UT MEDLINE:23931814
PM 23931814
ER

PT J
AU Mohamed, Ahmad
   Ryan, Monique M
TI Neuromuscular complications of intensive care.
SO Handbook of clinical neurology
VL 113
BP 1481
EP 3
DI 10.1016/B978-0-444-59565-2.00017-4
PD 2013
PY 2013
AB Critical illness polyneuropathy and critical illness myopathy are well
   recognized in adults, in whom they commonly cause generalized weakness
   and muscle wasting, with failure to wean from mechanical ventilation.
   There is significant clinical and neurophysiological overlap between the
   two conditions. Critical illness polyneuropathy and critical illness
   myopathy can cause significant morbidity in critically ill children, but
   they have only occasionally been reported in childhood, and little is
   known of their prevalence or clinical significance in this population.
   These conditions seem to be clinically and electrophysiologically
   similar in children and adults, but prospective studies of these
   entities are required to better characterize their frequency, natural
   history, and clinical significance in pediatric practice.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0072-9752
UT MEDLINE:23622370
PM 23622370
ER

PT J
AU Katsenos, Chrysostomos
   Androulaki, Despoina
   Lyra, Stavroula
   Tsoutsouras, Theodoros
   Mandragos, Costas
TI A 17 year-old girl with a demyelinating disease requiring mechanical
   ventilation: a case report.
SO BMC research notes
VL 6
BP 22
EP 22
DI 10.1186/1756-0500-6-22
PD 2013 Jan 18
PY 2013
AB BACKGROUND: Demyelinating diseases cause destruction of the myelin
   sheath, while axons are relatively spared. Pathologically, demyelination
   can be the result of an inflammatory process, viral infection, acquired
   metabolic derangement and ischemic insult. Three diseases that can cause
   inflammatory demyelination of the CNS are: Multiple sclerosis (MS),
   Acute disseminated encephalomyelitis (ADEM) and Acute hemorrhagic
   leucoencephalitis. Differentiation is not always easy and there is
   considerable overlaping. Data about adults with acute demyelination
   requiring ICU admission is limited.
   CASE PRESENTATION: A 17 year old Greek female was hospitalised in the
   ICU because of acute respiratory failure requiring mechanical
   ventilation. She had a history of febrile disease one month before,
   acute onset of paraplegia, diplopia, progressive arm weakness and
   dyspnea. Her consciousness was not impaired. A demyelinating central
   nervous system (CNS) disease, possibly post infectious encephalomyelitis
   (ADEM) was the underlying condition. The MRI of the brain disclosed
   diffused expanded cerebral lesions involving the optic nerve, basal
   ganglia cerebellum, pons and medulla oblongata. There was also extended
   involvement of the cervical and thoracic part of the spinal cord. CSF
   leukocyte count was elevated with lymphocyte predominance. The patient
   required mechanical ventilation for two months. Then she was transferred
   to a rehabilitation centre. Three years later she remains paraplegic.
   Since then she has not suffered any other demyelination attack.
   CONCLUSIONS: Demyelinating diseases can cause acute respiratory failure
   when the spinal cord is affected. Severe forms of these diseases, making
   necessary ICU admission, is less frequently reported. Intensivists
   should be aware of the features of these rare diseases.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
UT MEDLINE:23331922
PM 23331922
ER

PT J
AU Hind, Charles R K
TI Neurogenic respiratory failure.
SO Handbook of clinical neurology
VL 110
BP 295
EP 302
DI 10.1016/B978-0-444-52901-5.00024-1
PD 2013
PY 2013
AB It is uncommon for the lungs to be primarily involved in neurological
   conditions but severe respiratory problems can arise indirectly. These
   are usually the result of disorders of central ventilatory control,
   respiratory muscle weakness, or bulbar involvement. The effects of those
   disorders can be predicted by an understanding of the nervous control
   mechanisms and mechanical factors that determine effective ventilation.
   Awareness of these potential complications, and the increased
   availability of more advanced diagnostic and monitoring techniques in
   everyday clinical practice, has resulted in the introduction of specific
   treatments to try to reduce consequent morbidity and mortality.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0072-9752
UT MEDLINE:23312649
PM 23312649
ER

PT J
AU Radunovic, Aleksandar
   Annane, Djillali
   Rafiq, Muhammad K
   Mustfa, Naveed
TI Mechanical ventilation for amyotrophic lateral sclerosis/motor neuron
   disease.
SO The Cochrane database of systematic reviews
VL 3
BP CD004427
EP CD004427
DI 10.1002/14651858.CD004427.pub3
PD 2013 Mar 28
PY 2013
AB BACKGROUND: Amyotrophic lateral sclerosis, also known as motor neuron
   disease, is a fatal neurodegenerative disease. Neuromuscular respiratory
   failure is the commonest cause of death, usually within two to five
   years of the disease onset. Supporting respiratory function with
   mechanical ventilation may improve survival and quality of life. This is
   the first update of a review first published in 2009.
   OBJECTIVES: The primary objective of the review is to examine the
   efficacy of mechanical ventilation (tracheostomy and non-invasive
   ventilation) in improving survival in ALS. The secondary objectives are
   to examine the effect of mechanical ventilation on functional measures
   of disease progression and quality of life in people with ALS; and
   assess adverse events related to the intervention.
   SEARCH METHODS: We searched The Cochrane Neuromuscular Disease Group
   Specialized Register (1 May 2012), CENTRAL (2012, Issue 4), MEDLINE
   (January 1966 to April 2012), EMBASE (January 1980 to April 2012),
   CINAHL Plus (January 1937 to April 2012), and AMED (January 1985 to
   April 2012). We also searched for ongoing studies on ClinicalTrials.gov.
   SELECTION CRITERIA: Randomised and quasi-randomised controlled trials
   involving non-invasive or tracheostomy assisted ventilation in
   participants with a clinical diagnosis of amyotrophic lateral sclerosis,
   independent of the reported outcomes. We planned to include comparisons
   with no intervention or the best standard care.
   DATA COLLECTION AND ANALYSIS: For the original review, four authors
   independently selected studies for assessment and two authors reviewed
   searches for this update. All authors extracted data independently from
   the full text of selected studies and assessed the risk of bias in
   studies that met the inclusion criteria. We attempted to obtain missing
   data where possible. We planned to collect adverse event data from
   included studies.
   MAIN RESULTS: For the original Cochrane review, the review authors
   identified and included two randomised controlled trials involving 54
   participants with ALS receiving non-invasive ventilation. There were no
   new randomised or quasi-randomised controlled trials at this first
   update.Incomplete data were published for one study and we contacted the
   trial authors who were not able to provide the missing data. Therefore,
   the results of the review were based on a single study of 41
   participants that compared non-invasive ventilation with standard care.
   It was a well conducted study with low risk of bias.The study showed
   that the overall median survival was significantly different between the
   group treated with non-invasive ventilation and the standard care group.
   The median survival in the non-invasive ventilation group was 48 days
   longer (219 days compared to 171 days for the standard care group
   (estimated 95% CI 12 to 91 days, P = 0.0062)). This survival benefit was
   accompanied by an enhanced quality of life. On subgroup analysis, the
   survival and quality of life benefit was much more in the subgroup with
   normal to moderately impaired bulbar function (20 participants); median
   survival was 205 days longer (216 days in NIV group versus 11 days in
   the standard care group, P = 0.0059). Non-invasive ventilation did not
   prolong survival in participants with poor bulbar function (21
   participants), although it showed significant improvement in the mean
   symptoms domain of the Sleep Apnoea Quality of Life Index but not in the
   Short Form-36 Health Survey Mental Component Summary score. Neither
   trial reported clinical data on intervention related adverse effects.
   AUTHORS' CONCLUSIONS: Evidence from a single randomised trial of
   non-invasive ventilation in 41 participants suggests that it
   significantly prolongs survival and improves or maintains quality of
   life in people with ALS. Survival and some measures of quality of life
   were significantly improved in the subgroup of people with better bulbar
   function, but not in those with severe bulbar impairment. Future studies
   should examine the health economics of NIV and factors influencing
   access to NIV. We need to understand the factors, personal and
   socioeconomic, that determine access to NIV.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:23543531
PM 23543531
ER

PT J
AU Connolly, Bronwen A.
   Jones, Gareth D.
   Curtis, Alexandra A.
   Murphy, Patrick B.
   Douiri, Abdel
   Hopkinson, Nicholas S.
   Polkey, Michael I.
   Moxham, John
   Hart, Nicholas
TI Clinical predictive value of manual muscle strength testing during
   critical illness: an observational cohort study
SO CRITICAL CARE
VL 17
IS 5
AR UNSP R229
DI 10.1186/cc13052
PD 2013
PY 2013
AB Introduction: Impaired skeletal muscle function has important clinical
   outcome implications for survivors of critical illness. Previous studies
   employing volitional manual muscle testing for diagnosing intensive care
   unit-acquired weakness (ICU-AW) during the early stages of critical
   illness have only provided limited data on outcome. This study aimed to
   determine inter-observer agreement and clinical predictive value of the
   Medical Research Council sum score (MRC-SS) test in critically ill
   patients.
   Methods: Study 1: Inter-observer agreement for ICU-AW between two
   clinicians in critically ill patients within ICU (n = 20) was compared
   with simulated presentations (n = 20). Study 2: MRC-SS at awakening in
   an unselected sequential ICU cohort was used to determine the clinical
   predictive value (n = 94) for outcomes of ICU and hospital mortality and
   length of stay.
   Results: Although the intra-class correlation coefficient (ICC) for
   MRC-SS in the ICU was 0.94 (95% CI 0.85-0.98),. statistic for diagnosis
   of ICU-AW (MRC-SS <48/60) was only 0.60 (95% CI 0.25-0.95). Agreement
   for simulated weakness presentations was almost complete (ICC 1.0 (95%
   CI 0.99-1.0), with a. statistic of 1.0 (95% CI 1.0-1.0)). There was no
   association observed between ability to perform the MRC-SS and clinical
   outcome and no association between ICU-AW and mortality. Although ICU-AW
   demonstrated limited positive predictive value for ICU (54.2%; 95% CI
   39.2-68.6) and hospital (66.7%; 95% CI 51.6-79.6) length of stay, the
   negative predictive value for ICU length of stay was clinically
   acceptable (88.2%; 95% CI 63.6-98.5).
   Conclusions: These data highlight the limited clinical applicability of
   volitional muscle strength testing in critically ill patients.
   Alternative non-volitional strategies are required for assessment and
   monitoring of muscle function in the early stages of critical illness.
TC 13
ZB 2
Z8 0
ZS 0
Z9 13
SN 1466-609X
UT WOS:000331540900045
PM 24112540
ER

PT J
AU Denehy, Linda
   Skinner, Elizabeth H.
   Edbrooke, Lara
   Haines, Kimberley
   Warrillow, Stephen
   Hawthorne, Graeme
   Gough, Karla
   Vander Hoorn, Steven
   Morris, Meg E.
   Berney, Sue
TI Exercise rehabilitation for patients with critical illness: a randomized
   controlled trial with 12 months of follow-up
SO CRITICAL CARE
VL 17
IS 4
AR R156
DI 10.1186/cc12835
PD 2013
PY 2013
AB Introduction: The purpose of this trial was to investigate the
   effectiveness of an exercise rehabilitation program commencing during
   ICU admission and continuing into the outpatient setting compared with
   usual care on physical function and health-related quality of life in
   ICU survivors.
   Methods: We conducted a single-center, assessor-blinded, randomized
   controlled trial. One hundred and fifty participants were stratified and
   randomized to receive usual care or intervention if they were in the ICU
   for 5 days or more and had no permanent neurological insult. The
   intervention group received intensive exercises in the ICU and the ward
   and as outpatients. Participants were assessed at recruitment, ICU
   admission, hospital discharge and at 3-, 6- and 12-month follow-up.
   Physical function was evaluated using the Six-Minute Walk Test (6MWT)
   (primary outcome), the Timed Up and Go Test and the Physical Function in
   ICU Test. Patient-reported outcomes were measured using the Short Form
   36 Health Survey, version 2 (SF-36v2) and Assessment of Quality of Life
   (AQoL) Instrument. Data were analyzed using mixed models.
   Results: The a priori enrollment goal was not reached. There were no
   between-group differences in demographic and hospital data, including
   acuity and length of acute hospital stay (LOS) (Acute Physiology and
   Chronic Health Evaluation II score: 21 vs 19; hospital LOS: 20 vs 24
   days). No significant differences were found for the primary outcome of
   6MWT or any other outcomes at 12 months after ICU discharge. However,
   exploratory analyses showed the rate of change over time and mean
   between-group differences in 6MWT from first assessment were greater in
   the intervention group.
   Conclusions: Further research examining the trajectory of improvement
   with rehabilitation is warranted in this population.
TC 26
ZB 5
Z8 0
ZS 0
Z9 26
SN 1466-609X
UT WOS:000331539700030
PM 23883525
ER

PT J
AU Petrof, Basil J.
TI Diaphragmatic dysfunction in the intensive care unit: caught in the
   cross-fire between sepsis and mechanical ventilation
SO CRITICAL CARE
VL 17
IS 4
AR R181
DI 10.1186/cc12864
PD 2013
PY 2013
AB Accumulating evidence indicates that diaphragmatic weakness is common
   and frequently severe in mechanically ventilated patients. Supinski and
   Callahan now report that infection is a major risk factor for
   diaphragmatic weakness in this patient population. Importantly, they
   show that patients with the greatest levels of diaphragmatic dysfunction
   have a much poorer prognosis in terms of more prolonged ventilation as
   well as higher mortality. Mechanical ventilation itself has also been
   found to induce diaphragmatic weakness along with cellular changes
   resembling those found in sepsis. Future studies should be directed at
   understanding the interaction between sepsis and mechanical ventilation,
   and to developing therapeutic approaches that target their common
   cellular pathways implicated in diaphragmatic weakness.
TC 3
ZB 1
Z8 0
ZS 0
Z9 3
SN 1466-609X
UT WOS:000331539700054
PM 23981865
ER

PT J
AU Supinski, Gerald S.
   Callahan, Leigh Ann
TI Diaphragm weakness in mechanically ventilated critically ill patients
SO CRITICAL CARE
VL 17
IS 3
AR R120
DI 10.1186/cc12792
PD 2013
PY 2013
AB Introduction: Studies indicate that mechanically ventilated patients
   develop significant diaphragm muscle weakness, but the etiology of
   weakness and its clinical impact remain incompletely understood. We
   assessed diaphragm strength in mechanically ventilated medical ICU
   patients, correlated the development of diaphragm weakness with multiple
   clinical parameters, and examined the relationship between the level of
   diaphragm weakness and patient outcomes.
   Methods: Transdiaphragmatic twitch pressure (PdiTw) in response to
   bilateral magnetic stimulation of the phrenic nerves was measured.
   Diaphragm weakness was correlated with the presence of infection, blood
   urea nitrogen, albumin, and glucose levels. The relationship of
   diaphragm strength to patient outcomes, including mortality and the
   duration of mechanical ventilation for successfully weaned patients, was
   also assessed.
   Results: We found that infection is a major risk factor for diaphragm
   weakness in mechanically ventilated medical ICU patients. Outcomes for
   patients with severe diaphragm weakness (PdiTw < 10 cmH(2)O) were poor,
   with a markedly increased mortality (49%) compared to patients with
   PdiTw >= 10 cmH(2)O (7% mortality, P = 0.022). In addition, survivors
   with PdiTw < 10 cmH(2)O required a significantly longer duration of
   mechanical ventilation (12.3 +/- 1.7 days) than those with PdiTw >= 10
   cmH(2)O (5.5 +/- 2.0 days, P = 0.016).
   Conclusions: Infection is a major cause of severe diaphragm weakness in
   mechanically ventilated patients. Moreover, diaphragm weakness is an
   important determinant of poor outcomes in this patient population.
TC 14
ZB 3
Z8 0
ZS 0
Z9 14
SN 1466-609X
UT WOS:000329431100037
PM 23786764
ER

PT J
AU Alhazzani, Waleed
   Alshahrani, Mohamed
   Jaeschke, Roman
   Forel, Jean Marie
   Papazian, Laurent
   Sevransky, Jonathan
   Meade, Maureen O.
TI Neuromuscular blocking agents in acute respiratory distress syndrome: a
   systematic review and meta-analysis of randomized controlled trials
SO CRITICAL CARE
VL 17
IS 2
AR R43
DI 10.1186/cc12557
PD 2013
PY 2013
AB Introduction: Randomized trials investigating neuromuscular blocking
   agents in adult acute respiratory distress syndrome (ARDS) have been
   inconclusive about effects on mortality, which is very high in this
   population. Uncertainty also exists about the associated risk of
   ICU-acquired weakness.
   Methods: We conducted a systematic review and meta-analysis. We searched
   the Cochrane (Central) database, MEDLINE, EMBASE, ACP Journal Club, and
   clinical trial registries for randomized trials investigating survival
   effects of neuromuscular blocking agents in adults with ARDS. Two
   independent reviewers abstracted data and assessed methodologic quality.
   Primary study investigators provided additional unpublished data.
   Results: Three trials (431 patients; 20 centers; all from the same
   research group in France) met inclusion criteria for this review. All
   trials assessed 48-hour infusions of cisatracurium besylate. Short-term
   infusion of cisatracurium besylate was associated with lower hospital
   mortality (RR, 0.72; 95% CI, 0.58 to 0.91; P = 0.005; I-2 = 0). This
   finding was robust on sensitivity analyses. Neuromuscular blockade was
   also associated with lower risk of barotrauma (RR, 0.43; 95% CI, 0.20 to
   0.90; P = 0.02; I-2 = 0), but had no effect on the duration of
   mechanical ventilation among survivors (MD, 0.25 days; 95% CI, 5.48 to
   5.99; P = 0.93; I-2 = 49%), or the risk of ICU-acquired weakness (RR,
   1.08; 95% CI, 0.83 to 1.41; P = 0.57; I-2 = 0). Primary studies lacked
   protracted measurements of weakness.
   Conclusions: Short-term infusion of cisatracurium besylate reduces
   hospital mortality and barotrauma and does not appear to increase
   ICU-acquired weakness for critically ill adults with ARDS.
RI Alshahrani, Mohammed /G-1208-2015
OI Alshahrani, Mohammed /0000-0001-5946-2128
TC 20
ZB 2
Z8 1
ZS 0
Z9 21
SN 1466-609X
UT WOS:000327887300008
PM 23497608
ER

PT J
AU Cuthbertson, Brian H.
   Elders, Andrew
   Hall, Sally
   Taylor, Jane
   MacLennan, Graeme
   Mackirdy, Fiona
   Mackenzie, Simon J.
CA Scottish Critical Care Trials Grp
   Scottish Intensive Care Soc Audit
TI Mortality and quality of life in the five years after severe sepsis
SO CRITICAL CARE
VL 17
IS 2
AR R70
DI 10.1186/cc12616
PD 2013
PY 2013
AB Introduction: Severe sepsis is associated with high levels of morbidity
   and mortality, placing a high burden on healthcare resources. We aimed
   to study outcomes in the five years after severe sepsis.
   Methods: This was a cohort study using data from a prospective audit in
   26 adult ICUs in Scotland. Mortality was measured using clinical
   databases and quality of life using Short Form 36 (SF-36) at 3.5 and 5
   years after severe sepsis.
   Results: A total of 439 patients were recruited with a 58% mortality at
   3.5 years and 61% mortality at 5 years. A total of 85 and 67 patients
   responded at 3.5 and 5 years follow-up, respectively. SF-36 physical
   component score (PCS) was low compared to population controls at 3.5
   years (mean 41.8 (SD 11.8)) and at 5 years (mean 44.8 (SD 12.7)). SF-36
   mental component score (MCS) was slightly lower than population controls
   at 3.5 years (mean 47.7 (SD 14.6)) and at 5 years after severe sepsis
   (mean 48.8 (SD 12.6)). The majority of patients were satisfied with
   their current quality of life (QOL) (80%) and all patients would be
   willing to be treated in an ICU again if they become critically ill
   despite many having unpleasant memories (19%) and recall (29%) of ICU
   events.
   Conclusions: Patients with severe sepsis have a high ongoing mortality
   after severe sepsis. They also have a significantly lower physical QOL
   compared to population norms but mental QOL scores were only slightly
   below population norms up to five years after severe sepsis. All
   survivors would be willing to be treated in an ICU again if critically
   ill. Mortality and QOL outcomes were broadly similar to other critically
   ill cohorts throughout the five years of follow-up.
TC 15
ZB 3
Z8 0
ZS 0
Z9 15
SN 1466-609X
UT WOS:000327887300035
PM 23587132
ER

PT J
AU Hodgson, Carol L.
   Berney, Sue
   Harrold, Megan
   Saxena, Manoj
   Bellomo, Rinaldo
TI Clinical review: Early patient mobilization in the ICU
SO CRITICAL CARE
VL 17
IS 1
AR 207
DI 10.1186/cc11820
PD 2013
PY 2013
AB Early mobilization (EM) of ICU patients is a physiologically logical
   intervention to attenuate critical illness-associated muscle weakness.
   However, its long-term value remains controversial. We performed a
   detailed analytical review of the literature using multiple relevant key
   terms in order to provide a comprehensive assessment of current
   knowledge on EM in critically ill patients. We found that the term EM
   remains undefined and encompasses a range of heterogeneous interventions
   that have been used alone or in combination. Nonetheless, several
   studies suggest that different forms of EM may be both safe and feasible
   in ICU patients, including those receiving mechanical ventilation.
   Unfortunately, these studies of EM are mostly single center in design,
   have limited external validity and have highly variable control
   treatments. In addition, new technology to facilitate EM such as cycle
   ergometry, transcutaneous electrical muscle stimulation and video
   therapy are increasingly being used to achieve such EM despite limited
   evidence of efficacy. We conclude that although preliminary low-level
   evidence suggests that EM in the ICU is safe, feasible and may yield
   clinical benefits, EM is also labor-intensive and requires appropriate
   staffing models and equipment. More research is thus required to
   identify current standard practice, optimal EM techniques and
   appropriate outcome measures before EM can be introduced into the
   routine care of critically ill patients.
TC 11
ZB 1
Z8 0
ZS 0
Z9 11
SN 1466-609X
UT WOS:000320161900026
PM 23672747
ER

PT J
AU Wheatley-Smith, Laura
   McGuinness, Siobhan
   Wilson, F. Colin
   Scott, Gareth
   McCann, John
   Caldwell, Sheena
TI Intensive physiotherapy for vegetative and minimally conscious state
   patients: a retrospective audit and analysis of therapy intervention
SO DISABILITY AND REHABILITATION
VL 35
IS 12
BP 1006
EP 1014
DI 10.3109/09638288.2012.720355
PD 2013
PY 2013
AB Purpose: To analyse physiotherapy interventions and evaluate their
   effectiveness in the prevention and management of contracture with
   patients admitted in either vegetative or minimally conscious state in a
   UK Inpatient Regional Acquired Brain Injury Rehabilitation Service.
   Method: Retrospective audit of dependency levels and physiotherapy
   interventions in ten vegetative or minimally conscious state patients
   admitted over a 3-year period (2006-2009). Admission and discharge
   patient dependency status, Wessex Head Injury Matrix data and passive
   range of movement measurements on admission and discharge from
   physiotherapy were recorded. Results: All patients presented with
   hypertonicity including contractures and all initially received a manual
   stretching/passive movement programme. Casting/splinting was employed in
   8 cases and 7 received botulinum toxin injections. Standing regimes were
   initiated for 8 patients. No patient emerged out of either vegetative or
   minimally conscious state. Although they remained fully dependent for
   care needs, carer burden was reduced and all patients were able sustain
   a seating regimen. No minimal clinically important difference was
   observed in 85 out of 120 joint ranges measured (70.8%). Positive
   outcomes were observed in only 14 joints (11.7%) and negative outcomes
   in 21 joints (17.5%). Conclusion: At present, there is a paucity of
   evidence regarding physiotherapy efficacy to inform the management of
   patients in vegetative or minimally conscious state. Clearer agreed
   definitions of clinically important difference in passive range of
   movement are required to allow better interpretation of outcomes.
   Interventions should be aimed at minimising carer burden and developing
   individualised disability management programmes. Further research
   documenting the long-term outcomes in such patients is warranted.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0963-8288
UT WOS:000319064000007
PM 23009212
ER

PT J
AU Radunovic, Aleksandar
   Annane, Djillali
   Rafiq, Muhammad K.
   Mustfa, Naveed
TI Mechanical ventilation for amyotrophic lateral sclerosis/motor neuron
   disease
SO COCHRANE DATABASE OF SYSTEMATIC REVIEWS
IS 3
AR CD004427
DI 10.1002/14651858.CD004427.pub3
PD 2013
PY 2013
AB Background
   Amyotrophic lateral sclerosis, also known as motor neuron disease, is a
   fatal neurodegenerative disease. Neuromuscular respiratory failure is
   the commonest cause of death, usually within two to five years of the
   disease onset. Supporting respiratory function with mechanical
   ventilation may improve survival and quality of life. This is the first
   update of a review first published in 2009.
   Objectives
   The primary objective of the review is to examine the efficacy of
   mechanical ventilation (tracheostomy and non-invasive ventilation) in
   improving survival in ALS. The secondary objectives are to examine the
   effect of mechanical ventilation on functional measures of disease
   progression and quality of life in people with ALS; and assess adverse
   events related to the intervention.
   Search methods
   We searched The Cochrane Neuromuscular Disease Group Specialized
   Register (1 May 2012), CENTRAL (2012, Issue 4), MEDLINE (January 1966 to
   April 2012), EMBASE (January 1980 to April 2012), CINAHL Plus (January
   1937 to April 2012), and AMED (January 1985 to April 2012). We also
   searched for ongoing studies on ClinicalTrials.gov.
   Selection criteria
   Randomised and quasi-randomised controlled trials involving non-invasive
   or tracheostomy assisted ventilation in participants with a clinical
   diagnosis of amyotrophic lateral sclerosis, independent of the reported
   outcomes. We planned to include comparisons with no intervention or the
   best standard care.
   Data collection and analysis
   For the original review, four authors independently selected studies for
   assessment and two authors reviewed searches for this update. All
   authors extracted data independently from the full text of selected
   studies and assessed the risk of bias in studies that met the inclusion
   criteria. We attempted to obtain missing data where possible. We planned
   to collect adverse event data from included studies.
   Main results
   For the original Cochrane review, the review authors identified and
   included two randomised controlled trials involving 54 participants with
   ALS receiving non-invasive ventilation. There were no new randomised or
   quasi-randomised controlled trials at this first update.
   Incomplete data were published for one study and we contacted the trial
   authors who were not able to provide the missing data. Therefore, the
   results of the review were based on a single study of 41 participants
   that compared non-invasive ventilation with standard care. It was a well
   conducted study with low risk of bias.
   The study showed that the overall median survival was significantly
   different between the group treated with non-invasive ventilation and
   the standard care group. The median survival in the non-invasive
   ventilation group was 48 days longer (219 days compared to 171 days for
   the standard care group (estimated 95% CI 12 to 91 days, P = 0.0062)).
   This survival benefit was accompanied by an enhanced quality of life. On
   subgroup analysis, the survival and quality of life benefit was much
   more in the subgroup with normal to moderately impaired bulbar function
   (20 participants); median survival was 205 days longer (216 days in NIV
   group versus 11 days in the standard care group, P = 0.0059).
   Non-invasive ventilation did not prolong survival in participants with
   poor bulbar function (21 participants), although it showed significant
   improvement in the mean symptoms domain of the Sleep Apnoea Quality of
   Life Index but not in the Short Form-36 Health Survey Mental Component
   Summary score. Neither trial reported clinical data on intervention
   related adverse effects.
   Authors' conclusions
   Evidence from a single randomised trial of non-invasive ventilation in
   41 participants suggests that it significantly prolongs survival and
   improves or maintains quality of life in people with ALS. Survival and
   some measures of quality of life were significantly improved in the
   subgroup of people with better bulbar function, but not in those with
   severe bulbar impairment. Future studies should examine the health
   economics of NIV and factors influencing access to NIV. We need to
   understand the factors, personal and socioeconomic, that determine
   access to NIV.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1469-493X
UT WOS:000316887200012
ER

PT J
AU Hannan, Liam M.
   Tan, Siew
   Hopkinson, Kim
   Marchingo, Emma
   Rautela, Linda
   Detering, Karen
   Berlowitz, David J.
   Mcdonald, Christine F.
   Howard, Mark E.
TI Inpatient and long-term outcomes of individuals admitted for weaning
   from mechanical ventilation at a specialized ventilation weaning unit
SO RESPIROLOGY
VL 18
IS 1
BP 154
EP 160
DI 10.1111/j.1440-1843.2012.02266.x
PD JAN 2013
PY 2013
AB Background: Weaning from invasive mechanical ventilation (IMV) in
   specialized weaning units has been demonstrated to be safe and
   cost-effective. Success rates and outcomes vary widely, probably
   relating to patient factors and unit expertise.
   Methods: An audit was undertaken of patients admitted for weaning from
   IMV at the Austin Hospital Ventilation Weaning Unit (VWU) between March
   2002 and January 2008. Weaning success, complications and both
   in-hospital and long-term mortality were examined and regression
   analysis was undertaken to examine factors related to these outcomes.
   Results: Seventy-eight patients were admitted to the VWU after a median
   of 27 days of IMV at their referring centre. Weaning success rate
   (ventilator free or nocturnal non-invasive ventilation only) was 78.2%
   (n = 61). Inpatient mortality was 10.2% (n = 8) and serious
   complications were infrequent. Progressive neuromuscular disease (odds
   ratio 0.10) and sepsis during admission to the VWU(odds ratio 0.09) were
   predictive of weaning failure at discharge. Overall survival at 12
   months following discharge from the VWU was 66.7% (n = 52) with most
   survivors residing in the community. Increasing age (hazard ratio 1.93),
   referral from rural or outer metropolitan centres (hazard ratio 3.57 and
   2.37 respectively) and a diagnosis of chronic obstructive pulmonary
   disease were associated with increased long-term mortality.
   Conclusion: High rates of weaning success with infrequent complications
   and low mortality were achieved in this specialized non-intensive care
   unit-based weaning unit. The VWU may provide a useful template for the
   development of similar units elsewhere.
TC 4
ZB 0
Z8 0
ZS 1
Z9 5
SN 1323-7799
UT WOS:000314116100019
PM 22985330
ER

PT J
AU Lazar, I.
   Cavari, Y.
   Rosenberg, E.
   Knyazer, B.
TI Homer's syndrome in patients admitted to the paediatric intensive care
   unit: epidemiology, diagnosis and clinical practice
SO ANAESTHESIA AND INTENSIVE CARE
VL 41
IS 1
BP 20
EP 23
PD JAN 2013
PY 2013
AB Homer's syndrome appears when the three-neuron sympathetic pathway is
   interrupted anywhere from the posterior-lateral nuclei of the
   hypothalamus through the spinal cord to the eye. In children, Homer's
   syndrome can be either congenital or acquired, but overall it is a rare
   finding. There are several causes of Homer's syndrome, some of
   iatrogenic. Although uncommon in the paediatric population, prompt
   recognition of the syndrome and immediate treatment may prevent
   permanent damage to the neuronal pathway. Awareness of the risk of
   developing iatrogenic Homer's syndrome and early detection of signs are
   recommended to minimise future disability.
RI Knyazer, Boris/D-8969-2014
OI Knyazer, Boris/0000-0002-9246-3226
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0310-057X
UT WOS:000314439200005
PM 23362886
ER

PT J
AU Doorduin, Jonne
   van Hees, Hieronymus W. H.
   van der Hoeven, Johannes G.
   Heunks, Leo M. A.
TI Monitoring of the Respiratory Muscles in the Critically Ill
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 187
IS 1
BP 20
EP 27
DI 10.1164/rccm.201206-1117CP
PD JAN 1 2013
PY 2013
AB Evidence has accumulated that respiratory muscle dysfunction develops in
   critically ill patients and contributes to prolonged weaning from
   mechanical ventilation. Accordingly, it seems highly appropriate to
   monitor the respiratory muscles in these patients. Today, we are only at
   the beginning of routinely monitoring respiratory muscle function.
   Indeed, most clinicians do not evaluate respiratory muscle function in
   critically ill patients at all. In our opinion, however, practical
   issues and the absence of sound scientific data for clinical benefit
   should not discourage clinicians from having a closer look at
   respiratory muscle function in critically ill patients. This perspective
   discusses the latest developments in the field of respiratory muscle
   monitoring and possible implications of monitoring respiratory muscle
   function in critically ill patients.
RI van Hees, Jeroen HWH/A-1276-2011
TC 11
ZB 3
Z8 0
ZS 0
Z9 11
SN 1073-449X
UT WOS:000313606700007
PM 23103733
ER

PT J
AU Poulsen, Jesper B.
   Rose, Martin H.
   Jensen, Bente R.
   Moller, Kirsten
   Perner, Anders
TI Biomechanical and Nonfunctional Assessment of Physical Capacity in Male
   ICU Survivors
SO CRITICAL CARE MEDICINE
VL 41
IS 1
BP 93
EP 101
DI 10.1097/CCM.0b013e31826a3f9e
PD JAN 2013
PY 2013
AB Objectives: ICU admission is associated with decreased physical function
   for years after discharge. The underlying mechanisms responsible for
   this muscle function impairment are undescribed. The aim of this study
   was to describe the biomechanical properties of the quadriceps muscle in
   ICU survivors 12 months after ICU discharge.
   Design: Case-control study with consecutive inclusion of ICU survivors
   and age- and sex-matched controls.
   Setting: Patients were treated at a mixed 18-bed ICU at a tertiary care
   university hospital and tested at a biomechanical university laboratory.
   Patients: We included 16 male ICU patients (Acute Physiology and Chronic
   Health Evaluation II score 20 +/- 7, mean +/- SD), who had stayed in the
   ICU >72 hrs and survived to 12 months and 15 age- and sex-matched
   controls.
   Interventions: None.
   Measurements and Main Results: An extensive battery of biomechanical
   tests, including maximum, fast, and endurance contractions, was
   administered during isometric knee extensions while simultaneously
   recording surface electromyography (quadriceps and hamstrings). Compared
   to controls, ICU survivors had reduced maximal voluntary torque (22%,
   179 +/- 64 Nm vs. 230 +/- 57 Nm, p = 0.03), absolute rate of force
   development (50%, 868 372 Nm/sec vs. 1739 +/- 470 Nm/sec, p < 0.001) and
   relative rate of force development (32%, 512 +/- 260% maximum voluntary
   contraction/sec vs. 754 +/- 189% maximum voluntary contraction/sec, p <
   0.01), and endurance time (40%, 136 +/- 84 sec vs. 226 +/- 111 sec, p <
   0.02). Rate of force development, but not maximal voluntary torque, was
   significantly reduced after adjusting for muscle mass. Electromyography
   data indicated no impairment of motor activation strategy or central
   motor drive. Also, no difference in reaction time was found between
   patients and controls.
   Conclusions: ICU survivors had reduced rate of force development and
   muscular endurance 1 yr after ICU discharge. Our data indicate that the
   functional deficits experienced by ICU survivors originate in muscle
   tissue rather than the nervous system. Also, increased attention to
   velocity-orientated exercise during rehabilitation of ICU patients may
   have the potential to better physical outcome after critical illness.
   (Crit Care Med 2013; 41:93-101)
TC 6
ZB 0
Z8 0
ZS 0
Z9 6
SN 0090-3493
UT WOS:000313150300012
PM 23222267
ER

PT J
AU Kress, John P.
TI Sedation and Mobility Changing the Paradigm
SO CRITICAL CARE CLINICS
VL 29
IS 1
BP 67
EP +
DI 10.1016/j.ccc.2012.10.001
PD JAN 2013
PY 2013
AB A large fraction of intensive care unit (ICU) patients with respiratory
   failure who survive their critical illness leave the hospital with
   substantial neuromuscular weakness. In light of this reality, a shift in
   the approach to critical care management has begun. This viewpoint has
   broadened the perspective of ICU care providers beyond the narrow goal
   of leaving the ICU alive to a broader notion focused on minimizing the
   complications that accompany the inherent noxious nature of ICU care.
   Mobilization of mechanically ventilated patients is feasible, safe, and
   carries the potential for tremendous benefit for our patients.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 0749-0704
UT WOS:000313150200007
PM 23182528
ER

PT J
AU Semmler, Alexander
   Okulla, Torsten
   Kaiser, Markus
   Seifert, Burkhardt
   Heneka, Michael T.
TI Long-term neuromuscular sequelae of critical illness
SO JOURNAL OF NEUROLOGY
VL 260
IS 1
BP 151
EP 157
DI 10.1007/s00415-012-6605-4
PD JAN 2013
PY 2013
AB In this observational study, we analyzed the long-term neuromuscular
   deficits of survivors of critical illness. Intensive care unit-acquired
   muscular weakness (ICU-AW) is a very common complication of critical
   illness. Critical illness polyneuropathy (CIP) and critical illness
   myopathy (CIM) are two main contributors to ICU-AW. ICU-AW is associated
   with an increased mortality and leads to rehabilitation problems.
   However, the long-term outcome of ICU-AW and factors influencing it are
   not well known. We analyzed the medical records of 490 survivors of
   critical illness, aged 18-75 years and located in the area of the study
   center. Intensive care unit (ICU) survivors with comorbidities that
   might influence neuromuscular follow-up examinations, muscle strength,
   or results of nerve conduction studies, such as renal or hepatic
   insufficiency, diabetes mellitus, or vitamin deficiency were excluded. A
   total of 51 patients were finally included in the study. Six to 24
   months after discharge from the ICU, we measured the Medical Research
   Council (MRC) sum score, the Overall Disability Sum score (ODSS), and
   also performed nerve conduction studies and EMG. For all ICU survivors,
   the median MRC sum score was 60 (range 47-60) and the median ODSS score
   was 0 (range 0-8). CIP was diagnosed in 21 patients (41 %). No patient
   was diagnosed with CIM. Patients with diagnosis of CIP showed a higher
   median ODSS scores 1 (range 0-8) versus 0 (range 0-5); p < 0.001 and
   lower median MRC sum scores 56 (range 47-60) versus 60 (range 58-60); p
   < 0.001. The three main outcome variables MRC sum score, ODSS score and
   diagnosis of CIP were not related to age, gender, or diagnosis of
   sepsis. The MRC sum score (r = -0.33; p = 0.02) and the ODSS score (r =
   0.31; p = 0.029) were correlated with the APACHE score. There was a
   trend for an increased APACHE score in patients with diagnosis of CIP 19
   (range 6-33) versus 16.5 (range 6-28); p = 0.065. Patients with the
   diagnosis of CIP had more days of ICU treatment 11 days (range 2-74)
   versus 4 days (range 1-61); p = 0.015, and had more days of ventilator
   support 8 days (range 1-59) versus 2 days (range 1-46); p = 0.006. The
   MRC sum score and the ODSS score were correlated with the days of ICU
   treatment and with the days of ventilator support. The neuromuscular
   long-term consequences of critical illness were not severe in our study
   population. As patients with concomitant diseases and old patients were
   excluded from this study the result of an overall favorable prognosis of
   ICU-acquired weakness may not be true for other patient's case-mix. Risk
   factors for the development of long-term critical illness neuropathy are
   duration of ICU treatment, duration of ventilator support, and a high
   APACHE score, but not diagnosis of sepsis. Although ICU-AW can be
   serious complication of ICU treatment, this should not influence
   therapeutic decisions, given its favorable long-term prognosis, at least
   in relatively young patients with no concomitant diseases.
TC 3
ZB 1
Z8 1
ZS 0
Z9 4
SN 0340-5354
UT WOS:000313007600021
PM 22820684
ER

PT J
AU Van der Starre, Pieter
   Deuse, Tobias
   Pritts, Chad
   Brun, Carlos
   Vogel, Hannes
   Oyer, Philip
TI Late profound muscle weakness following heart transplantation due to
   danon disease
SO MUSCLE & NERVE
VL 47
IS 1
BP 135
EP 137
DI 10.1002/mus.23517
PD JAN 2013
PY 2013
AB Introduction: Postoperative muscle weakness is a serious complication in
   surgical intensive care patients. It is mostly described as critical
   illness polyneuromyopathy. Risk factors include intensive care length of
   stay, sepsis, poor glycemic control, and combined use of corticosteroids
   and neuromuscular blocking agents, malnutrition, and electrolyte
   imbalance. Methods: We report a case of late-progressive, profound
   weakness after heart transplantation for noncompaction cardiomyopathy
   which required prolonged mechanical ventilation. The patient's muscle
   strength recovered completely after prolonged rehabilitation. Results:
   Electromyographic assessment showed myopathy. Muscle biopsy revealed
   Danon disease, a genetic disorder affecting the lysosomal-associated
   membrane protein 2 gene (LAMP2). Conclusions: The finding of this
   genetic disorder was unexpected, because the preoperative
   echocardiographic diagnosis of noncompaction cardiomyopathy has not been
   reported in Danon disease. This report underlines the need for early
   availability of pathology results from the explanted heart, which showed
   the same disorder. Muscle Nerve, 2013
TC 4
ZB 3
Z8 0
ZS 0
Z9 4
SN 0148-639X
UT WOS:000312657200022
PM 23168931
ER

PT J
AU Lipshutz, Angela K. M.
   Gropper, Michael A.
TI Acquired Neuromuscular Weakness and Early Mobilization in the Intensive
   Care Unit
SO ANESTHESIOLOGY
VL 118
IS 1
BP 202
EP 215
DI 10.1097/ALN.0b013e31826be693
PD JAN 2013
PY 2013
AB Survival from critical illness has improved in recent years, leading to
   increased attention to the sequelae of such illness. Neuromuscular
   weakness in the intensive care unit (ICU) is common, persistent, and has
   significant public health implications. The differential diagnosis of
   weakness in the ICU is extensive and includes critical illness
   neuromyopathy. Prolonged immobility and bedrest lead to catabolism and
   muscle atrophy, and are associated with critical illness neuromyopathy
   and ICU-acquired weakness. Early mobilization therapy has been advocated
   as a mechanism to prevent ICU-acquired weakness. Early mobilization is
   safe and feasible in most ICU patients, and improves outcomes.
   Implementation of early mobilization therapy requires changes in ICU
   culture, including decreased sedation and bedrest. Various technologies
   exist to increase compliance with early mobilization programs. Drugs
   targeting muscle pathways to decrease atrophy and muscle-wasting are in
   development. Additional research on early mobilization in the ICU is
   needed.
TC 10
ZB 1
Z8 1
ZS 0
Z9 11
SN 0003-3022
UT WOS:000312536800028
PM 22929731
ER

PT J
AU Mochizuki, Yoko
   Isozaki, Eiji
   Takao, Masaki
   Hashimoto, Tomoyo
   Shibuya, Makoto
   Arai, Makoto
   Hosokawa, Masato
   Kawata, Akihito
   Oyanagi, Kiyomitsu
   Mihara, Ban
   Mizutani, Toshio
TI Familial ALS with FUS P525L mutation: two Japanese sisters with multiple
   systems involvement
SO JOURNAL OF THE NEUROLOGICAL SCIENCES
VL 323
IS 1-2
BP 85
EP 92
DI 10.1016/j.jns.2012.08.016
PD DEC 15 2012
PY 2012
AB We evaluated the clinicopathological features of familial amyotrophic
   lateral sclerosis (ALS) with the fused in sarcoma (FUS) P525L mutation.
   Two sisters and their mother had a similar clinical course, which was
   characterized by the development of limb weakness at a young age with
   rapid disease progression. An elder sister, patient 1, progressed into a
   totally locked-in state requiring mechanical ventilation and died 26
   years after the onset of the disease. In contrast, the younger sister,
   patient 2, died in the early stages of the disease. The patients had
   neuropathological findings that indicated a very active degeneration of
   motor neurons and multiple system degeneration, which led to marked
   brain and spinal cord atrophy in the long term clinical outcome. The
   multiple system degeneration included the frontal lobe, the basal
   ganglia and substantia nigra, cerebellum and related area. Compared with
   previously reported ALS cases, the severe degeneration of the frontal
   lobe and the striatum were the characteristic features in the patient 1
   in this case study. The degeneration spread over multiple systems might
   be caused not only by the appearance of the FUS immunoreactive neuronal
   cytoplasmic inclusions but also by the degeneration of neuronal
   connections from the primary motor cortex and related areas. (C) 2012
   Elsevier B.V. All rights reserved.
TC 8
ZB 3
Z8 0
ZS 0
Z9 8
SN 0022-510X
UT WOS:000311132700015
PM 22980027
ER

PT J
AU Netto, Archana B.
   Kulkarni, Girish Baburao
   Taly, Arun B.
   Rao, G. S. Umamaheshwara
   Periyavan, Sunder
   Rao, Shivaji
TI A comparison of immunomodulation therapies in mechanically ventilated
   patients with Guillain Barre syndrome
SO JOURNAL OF CLINICAL NEUROSCIENCE
VL 19
IS 12
BP 1664
EP 1667
DI 10.1016/j.jocn.2012.04.012
PD DEC 2012
PY 2012
AB A comparison of the effectiveness of immunomodulatory therapies in
   patients with Guillain Barre syndrome (GBS) who require mechanical
   ventilation (MV) is important for patient treatment and cost. We aimed
   to compare the effectiveness of three modes of intervention on the
   outcome of patients with GBS receiving MV: intravenous immunoglobulin
   (IVIgG); small volume plasmapheresis (SVP) and large volume
   plasmapheresis (LVP). Patients with GBS satisfying National Institute of
   Neurological and Communicative Disorders and Stroke 1990 criteria and
   requiring MV between 1997 between 2007 were analyzed. The primary
   outcome parameters evaluated were mortality, duration of MV, hospital
   stay and Hughes scale at discharge from hospital. Of the 173 (Male:
   Female, 118:55) patients who required MV during the study, 106 patients
   received single modality treatment (IVIgG 31, LVP 45, SVP 30) based on
   availability, affordability and feasibility. Patients receiving IVIgG
   had a higher incidence of severe weakness and bulbar involvement. The
   mean duration of MV (p = 0.61), total hospital stay (p = 0.44) and
   Hughes scale at discharge (p = 0.31) did not differ among the three
   groups. Complications were similar in the three treatment groups except
   for hypoalbuminemia and anemia, which were more common in patients in
   the LVP group. In conclusion, the outcome of patients treated with these
   three immunomodulatory treatment modalities did not vary. The beneficial
   effects of SVP in our study warrant further randomized control trials
   especially in resource-constrained settings. (C) 2012 Elsevier Ltd. All
   rights reserved.
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 0967-5868
UT WOS:000312413000011
PM 23036171
ER

PT J
AU Nordon-Craft, Amy
   Moss, Marc
   Quan, Dianna
   Schenkman, Margaret
TI Intensive Care Unit-Acquired Weakness: Implications for Physical
   Therapist Management
SO PHYSICAL THERAPY
VL 92
IS 12
BP 1494
EP 1506
DI 10.2522/ptj.20110117
PD DEC 2012
PY 2012
AB Patients admitted to the intensive care unit (ICU) can develop a
   condition referred to as "ICU-acquired weakness." This condition is
   characterized by profound weakness that is greater than might be
   expected to result from prolonged bed rest. Intensive care unit-acquired
   weakness often is accompanied by dysfunction of multiple organ systems.
   Individuals with ICU-acquired weakness typically have significant
   activity limitations, often requiring physical assistance for even the
   most basic activities associated with bed mobility. Many of these
   individuals have activity limitations months to years after
   hospitalization. The purpose of this article is to review evidence that
   guides physical rehabilitation of people with ICU-acquired weakness.
   Included are diagnostic criteria, medical management, and prognostic
   indicators, as well as criteCria for beginning physical rehabilitation,
   with an emphasis on patient safety. Data are presented indicating that
   rehabilitation can be implemented with very few adverse effects.
   Evidence is provided for appropriate measurement approaches and for
   physical intervention strategies. Finally, some of the key isues are
   summarized that should be investigated to determine the best
   intervention guidelines for individuals with ICU-acquired weakness.
TC 6
ZB 0
Z8 0
ZS 0
Z9 6
SN 0031-9023
UT WOS:000312051900004
PM 22282769
ER

PT J
AU Hopkins, Ramona O.
   Miller, Russell R., III
   Rodriguez, Larissa
   Spuhler, Vicki
   Thomsen, George E.
TI Physical Therapy on the Wards After Early Physical Activity and Mobility
   in the Intensive Care Unit
SO PHYSICAL THERAPY
VL 92
IS 12
BP 1518
EP 1523
DI 10.2522/ptj.20110446
PD DEC 2012
PY 2012
AB Background. Weakness and debilitation are common following critical
   illness. Studies that assess whether early physical activity initiated
   in the intensive care unit (ICU) continues after a patient is
   transferred to a ward are lacking.
   Objective. The purpose of this study was to assess whether physical
   activity and mobility initiated during ICU treatment were maintained
   after patients were discharged from a single ICU to a ward.
   Design. This was a cohort study.
   Methods. Consecutive patients who were diagnosed with respiratory
   failure and admitted to the respiratory ICU (RICU) at LDS Hospital
   underwent early physical activity and mobility as part of usual care.
   Medical data, the number of requests for a physical therapy consultation
   or nursing assistance with ambulation at ICU discharge, and mobility
   data were collected during the first 2 full days on the ward.
   Results. Of the 72 patients who participated in the study, 65 had either
   a physical therapy consultation or a request for nursing assistance with
   ambulation at ward transfer. Activity level decreased in 40 participants
   (55%) on the first full ward day. Of the 61 participants who ambulated
   100 ft (30.48 m) or more on the last full RICU day, 14 did not ambulate,
   22 ambulated less than 100 ft, and 25 ambulated 100 ft or more on the
   first ward day.
   Limitations. Limitations include lack of data regarding why activity was
   not performed on the ward, lack of longitudinal follow-up to assess
   effects of activity, and lack of generalizability to patients not
   transferred to a ward or not treated in an ICU with an early mobility
   program.
   Conclusions. Despite the majority of participants having a physical
   therapy consultation or a request for nursing assistance with ambulation
   at the time of transfer to the medical ward, physical activity levels
   decreased in over half of participants on the first full ward day. The
   data suggest a need for education of ward staff regarding ICU
   debilitation, enhanced communication among care providers, and focus on
   the importance of patient-centered outcomes during and following ICU
   treatment.
TC 4
ZB 0
Z8 0
ZS 0
Z9 4
SN 0031-9023
UT WOS:000312051900006
PM 22491481
ER

PT J
AU Thrush, Aaron
   Rozek, Melanie
   Dekerlegand, Jennifer L.
TI The Clinical Utility of the Functional Status Score for the Intensive
   Care Unit (FSS-ICU) at a Long-Term Acute Care Hospital: A Prospective
   Cohort Study
SO PHYSICAL THERAPY
VL 92
IS 12
BP 1536
EP 1545
DI 10.2522/ptj.20110412
PD DEC 2012
PY 2012
AB Background and Purpose. Long-term acute care hospitals (LTACHs) have
   emerged for patients requiring medical care beyond a short stay. Minimal
   data have been reported on functional outcomes in this setting. The
   purposes of this study were: (1) to measure the clinical utility of the
   Functional Status Score for the Intensive Care Unit (FSS-ICU) in an
   LTACH setting and (2) to explore the association between FSS-ICU score
   and discharge setting.
   Participants. Data were obtained from 101 patients (median age=70 years,
   interquartile range [IQR]=61-78; 39% female, 61% male) who were admitted
   to an LTACH. Participants were categorized into 1 of 5 groups by
   discharge setting: (1) home (n=14), (2) inpatient rehabilitation
   facility (n=26), (3) skilled nursing facility (n=23), (4) long-term
   care/hospice/expired (n=13), or (5) transferred to a short-stay hospital
   (n=25).
   Methods. Data were Prospectively collected from a 38-bed LTACH in the
   United States over 8 months beginning in September 2010. Functional
   status was scored using the FSS-ICU within 4 days of admission and every
   2 weeks until discharge. The FSS-ICU consists of 5 categories: rolling,
   supine-to-sit transfers, unsupported sitting, sit-to-stand transfers,
   and ambulation. Each category was rated from 0 to 7, with a maximum
   cumulative FSS-ICU score of 35.
   Results. Cumulative FSS-ICU scores significantly improved from a median
   (IQR) of 9(3-17) to 14 (5-24) at discharge. Median (IQR) cumulative
   discharge BS-ICU scores were significantly different among the discharge
   categories: home=28 (22-32), inpatient rehabilitation facility=21
   (15-24), skilled nursing facility=14 (8-21), long-term
   care/hospice/expired=5 (0-11), and transfer to a short-stay hospital=4
   (0-7).
   Discussion and Conclusions. Patients receiving therapy at an LTACH
   demonstrate significant improvements from admission to discharge using
   the FSS-ICU. This outcome tool discriminates among discharge settings
   and successfully documents functional improvements of patients in an
   LTACH setting.
TC 8
ZB 0
Z8 0
ZS 0
Z9 8
SN 0031-9023
UT WOS:000312051900008
PM 22956427
ER

PT J
AU Lee, Jeanette J.
   Waak, Karen
   Grosse-Sundrup, Martina
   Xue, Feifei
   Lee, Jarone
   Chipman, Daniel
   Ryan, Cheryl
   Bittner, Edward A.
   Schmidt, Ulrich
   Eikermann, Matthias
TI Global Muscle Strength But Not Grip Strength Predicts Mortality and
   Length of Stay in a General Population in a Surgical Intensive Care Unit
SO PHYSICAL THERAPY
VL 92
IS 12
BP 1546
EP 1555
DI 10.2522/ptj.20110403
PD DEC 2012
PY 2012
AB Background. Paresis acquired in the intensive care unit (ICU) is common
   in patients who are critically ill and independently predicts mortality
   and morbidity. Manual muscle testing (MMT) and handgrip dynamometry
   assessments have been used to evaluate muscle weakness in patients in a
   medical ICU, but similar data for patients in a surgical ICU (SICU) are
   limited.
   Objective. The purpose of this study was to evaluate the predictive
   value of strength measured by MMT and handgrip dynamometry at ICU
   admission for in-hospital mortality, SICU length of stay (LOS), hospital
   LOS, and duration of mechanical ventilation.
   Design. This investigation was a prospective, observational study.
   Methods. One hundred ten patients were screened for eligibility for
   testing in the SICU of a large, academic medical center. The Acute
   Physiology and Chronic Health Evaluation (APACHE) II score, diagnoses,
   and laboratory data were collected. Measurements were obtained by MMT
   quantified with the sum (total) score on the Medical Research Council
   Scale and by handgrip dynamometry. Outcome data, including in-hospital
   mortality, SICU LOS, hospital LOS, and duration of mechanical
   ventilation, were collected for all participants.
   Results. One hundred seven participants were eligible for testing; 89%
   were tested successfully at a median of 3 days (25th-75th
   percentiles=3-6 days) after admission. Sedation was the most frequent
   barrier to testing (70.6%). Manual muscle testing was identified as an
   independent predictor of mortality, SICU LOS, hospital LOS,. and
   duration of mechanical ventilation. Grip strength was not independently
   associated with these outcomes.
   Limitations. This study did not address whether muscle weakness
   translates to functional outcome impairment.
   Conclusions. In contrast to handgrip strength, MMT reliably predicted
   in-hospital mortality, duration of mechanical ventilation, SICU LOS, and
   hospital LOS.
TC 12
ZB 4
Z8 0
ZS 0
Z9 12
SN 0031-9023
UT WOS:000312051900009
PM 22976446
ER

PT J
AU Alison, Jennifer A.
   Kenny, Patricia
   King, Madeleine T.
   McKinley, Sharon
   Aitken, Leanne M.
   Leslie, Gavin D.
   Elliott, Doug
TI Repeatability of the Six-Minute Walk Test and Relation to Physical
   Function in Survivors of a Critical Illness
SO PHYSICAL THERAPY
VL 92
IS 12
BP 1556
EP 1563
DI 10.2522/ptj.20110410
PD DEC 2012
PY 2012
AB Background. The Six-Minute Walk Test (6MWT) is widely used as an outcome
   measure in exercise rehabilitation. However, the repeatability of the
   6MWT performed at home in survivors of a critical illness has not been
   evaluated.
   Objective. The purpose of this study was to evaluate, in survivors of a
   critical illness: (1) the repeatability of the 6MWT performed at home,
   (2) the effect on estimates of change in functional exercise capacity if
   only one 6MWT was performed at follow-up assessments, and (3) the
   relationship between the physical functioning (PF) score of the 36-Item
   Short-Form Health Survey questionnaire (SF-36) and the 6MWT.
   Design. Repeated measures of the 6MWT and SF-36 were obtained.
   Methods. Eligible participants had an intensive care unit (ICU) length
   of stay of >= 48 hours and were mechanically ventilated for >= 24 hours.
   Two 6MWTs and the SF-36 were conducted in participants' homes at weeks
   1, 8, and 26 after hospital discharge.
   Results. One hundred seventy-three participants completed the study. The
   participants had a mean age of 57 years (SD=16), a mean Acute Physiology
   and Chronic Health Evaluation II (APACHE II) score on admission of 19
   (SD=10), a mean ICU length of stay of 9 days (SD=8), and a mean
   mechanical ventilation time of 140 hours (SD=137). Of the 173
   participants, 110 performed two 6MWTs at weeks 1, 8, and 26. There were
   significant mean increases in 6-minute walk distance in the second test
   of 15 m (P<.0001) at week 1, 13 m (P<.0001) at week 8, and 9 m (P=.04)
   at week 26. If only one 6MWT was performed at weeks 8 and 26, the
   estimate of change in 6-minute walk distance from week 1 was 19 m less
   (P<.001) at both weeks 8 and 26. There was a moderate to strong
   correlation between SF-36 PF score and 6-minute walk distance at each
   assessment (week 1: r=.62, P<.001; week 8: r=.55, P<.001; and week 26:
   r=.47, P<.001).
   Limitations. Some study participants were unable to perform a second
   6MWT, and these participants may have differed in important aspects of
   function compared with those individuals who completed two 6MWTs.
   Conclusions. In survivors of a critical illness, the 6MWT in the home
   environment should be performed twice at each assessment to give an
   accurate reflection of change in exercise capacity over time. The SF-36
   PF score was a strong indicator of 6-minute Walk distance in early
   recovery from a critical illness.
TC 8
ZB 2
Z8 0
ZS 0
Z9 9
SN 0031-9023
UT WOS:000312051900010
PM 22577064
ER

PT J
AU Kho, Michelle E.
   Truong, Alexander D.
   Brower, Roy G.
   Palmer, Jeffrey B.
   Fan, Eddy
   Zanni, Jennifer M.
   Ciesla, Nancy D.
   Feldman, Dorianne R.
   Korupolu, Radha
   Needham, Dale M.
TI Neuromuscular Electrical Stimulation for Intensive Care Unit-Acquired
   Weakness: Protocol and Methodological Implications for a Randomized,
   Sham-Controlled, Phase II Trial
SO PHYSICAL THERAPY
VL 92
IS 12
BP 1564
EP 1579
DI 10.2522/ptj.20110437
PD DEC 2012
PY 2012
AB Background. As the population ages and critical care advances, a growing
   number of survivors of critical illness will be at risk for intensive
   care unit (ICU)-acquired weakness. Bed rest, which is common in the ICU,
   causes adverse effects, including muscle weakness. Consequently,
   patients need ICU-based interventions focused on the muscular system.
   Although emerging evidence supports the benefits of early rehabilitation
   during mechanical ventilation, additional therapies may be beneficial.
   Neuromuscular electrical stimulation (NMES), which can provide some
   muscular activity even very early during critical illness, is a
   promising modality for patients in the ICU.
   Objective. The objectives of this article are to discuss the
   implications of bed rest for patients with critical illness, summarize
   recent studies of early rehabilitation and NMES in the ICU, and describe
   a protocol for a randomized, phase II pilot study of NMES in patients
   receiving mechanical ventilation.
   Design. The study was a randomized, sham-controlled, concealed, phase II
   pilot study with caregivers and outcome assessors blinded to the
   treatment allocation.
   Setting. The study setting will be a medical ICU.
   Participants.. The study participants will be patients who are receiving
   mechanical ventilation for 1 day or more, who are expected to stay in
   the ICU for an additional 2 days or more, and who meet no exclusion
   criteria.
   Intervention. The intervention will be NMES (versus a sham [control]
   intervention) applied to the quadriceps, tibialis anterior, and
   gastrocnemius muscles for 60 minutes per day.
   Measurements. Lower-extremity muscle strength at hospital discharge will
   be the primary outcome measure.
   Limitations. Muscle strength is a surrogate measure, not a
   patient-centered outcome. The assessments will not include laboratory,
   genetic, or histological measures aimed at a mechanistic understanding
   of NMES. The optimal duration or dose of NMES is unclear.
   Conclusions. If NMES is beneficial, the results of the study will help
   advance research aimed at reducing the burden of muscular weakness and
   physical disability in survivors of critical illness.
TC 11
ZB 2
Z8 0
ZS 0
Z9 11
SN 0031-9023
UT WOS:000312051900011
PM 22421734
ER

PT J
AU Brummel, Nathan E.
   Jackson, James C.
   Girard, Timothy D.
   Pandharipande, Pratik P.
   Schiro, Elena
   Work, Brittany
   Pun, Brenda T.
   Boehm, Leanne
   Gill, Thomas M.
   Ely, E. Wesley
TI A Combined Early Cognitive and Physical Rehabilitation Program for
   People Who Are Critically III: The Activity and Cognitive Therapy in the
   Intensive Care Unit (ACT-ICU) Trial
SO PHYSICAL THERAPY
VL 92
IS 12
BP 1580
EP 1592
DI 10.2522/ptj.20110414
PD DEC 2012
PY 2012
AB Background. In the coming years, the number of survivors of critical
   illness is expected to increase. These survivors frequently develop
   newly acquired physical and cognitive impairments. Long-term cognitive
   impairment is common following critical illness and has dramatic effects
   on patients' abilities to function autonomously. Neuromuscular weakness
   affects similar proportions of patients and leads to equally profound
   life alterations. As knowledge of these short-term and long-term
   consequences of critical illness has come to light, interventions to
   prevent and rehabilitate these devastating consequences have been
   sought. Physical rehabilitation has been shown to improve functional
   outcomes in people who are critically ill, but subsequent studies of
   physical rehabilitation after hospital discharge have not. Post-hospital
   discharge cognitive rehabilitation is feasible in survivors of critical
   illness and is commonly used in people with other forms of acquired
   brain injury. The feasibility of early cognitive therapy in people who
   are critically ill remains unknown.
   Objective. The purpose of this novel protocol trial will be to determine
   the feasibility of early and sustained cognitive rehabilitation paired
   with physical rehabilitation in patients who are critically ill from
   medical and surgical intensive care units.
   Design. This is a randomized controlled trial.
   Setting. The setting for this trial will be medical and surgical
   intensive care units of a large tertiary care referral center.
   Patients. The participants will be patients who are critically ill with
   respiratory failure or shock.
   Intervention. Patients will be randomized to groups receiving usual
   care, physical rehabilitation, or cognitive rehabilitation plus physical
   rehabilitation. Twice-daily cognitive rehabilitation sessions will be
   performed with patients who are noncomatose and will consist of
   orientation, memory, and attention exercises (eg, forward and reverse
   digit spans, matrix puzzles, letter-number sequences, pattern
   recognition). Daily physical rehabilitation sessions will advance
   patients from passive range of motion exercises through ambulation.
   Patients with cognitive or physical impairment at discharge will undergo
   a 12-week, in-home cognitive rehabilitation program.
   Measurements. A battery of neurocognitive and functional outcomes will
   be measured 3 and 12 months after hospital discharge.
   Conclusions. If feasible, these interventions will lay the groundwork
   for a larger, multicenter trial to determine their efficacy.
TC 15
ZB 0
Z8 2
ZS 1
Z9 18
SN 0031-9023
UT WOS:000312051900012
PM 22577067
ER

PT J
AU Wolfe, Lisa F.
   Joyce, Nanette C.
   McDonald, Craig M.
   Benditt, Joshua O.
   Finder, Jonathan
TI Management of Pulmonary Complications in Neuromuscular Disease
SO PHYSICAL MEDICINE AND REHABILITATION CLINICS OF NORTH AMERICA
VL 23
IS 4
BP 829
EP +
DI 10.1016/j.pmr.2012.08.010
PD NOV 2012
PY 2012
AB Restrictive lung disease occurs commonly in patients with neuromuscular
   disease. The earliest sign of respiratory compromise in the patient with
   neuromuscular disease is nocturnal hypoventilation, which progresses
   over time to include daytime hypoventilation and eventually the need for
   full-time mechanical ventilation. Pulmonary function testing should be
   done during regular follow-up visits to identify the need for assistive
   respiratory equipment and initiate early noninvasive ventilation.
   Initiation of noninvasive ventilation can improve quality of life and
   prolong survival in patients with neuromuscular disease.
TC 1
ZB 1
Z8 0
ZS 0
Z9 1
SN 1047-9651
UT WOS:000311867400007
PM 23137740
ER

PT J
AU O'Brien, Nicole F.
   Mella, Cesar
TI Brain tissue oxygenation-guided management of diabetic ketoacidosis
   induced cerebral edema
SO PEDIATRIC CRITICAL CARE MEDICINE
VL 13
IS 6
BP E383
EP E388
DI 10.1097/PCC.0b013e3182601132
PD NOV 2012
PY 2012
AB Objective: Type 1 diabetes mellitus is the most common chronic disease
   of childhood. Diabetic ketoacidosis is a well-known complication of
   diabetes mellitus and can be associated with devastating cerebral edema
   resulting in severe long-term neurologic disability. Despite the
   significant morbidity and mortality associated with this condition,
   relatively few treatments are recommended for these patients. The
   authors present two patients in which they used both intracranial
   pressure and brain tissue oxygenation monitoring to manage diabetic
   ketoacidosis-associated cerebral edema with favorable neurologic
   outcomes.
   Setting: Pediatric intensive care unit in a tertiary care teaching
   hospital.
   Interventions: Two children presented to the emergency room with vague
   complaints and were found to have diabetic ketoacidosis. During
   treatment, both patients became comatose with head computed tomography
   scans revealing diffuse cerebral edema and herniation syndrome.
   Intracranial pressure and brain tissue oxygenation monitors were placed
   to guide therapy.
   Results: Multiple episodes of brain tissue hypoxia were noted in both
   patients. Intracranial pressure control with intubation, sedation, and
   hyperosmolar therapy improved episodes of decreased brain tissue
   oxygenation associated with intracranial hypertension. Brain tissue
   oxygenation was also noted to be significantly less than the target
   value on several occasions even when intracranial pressure was
   controlled and an age-appropriate cerebral perfusion pressure goal was
   met. Augmentation of cerebral perfusion pressure above age-appropriate
   goal with fluid boluses and inotropic agents increased brain tissue
   oxygenation in these instances. Both children had very low Glasgow Coma
   Scale scores at admission, but ultimately had favorable neurologic
   outcomes.
   Conclusions: Multimodal neuromonitoring of both intracranial pressure
   and brain tissue oxygenation during episodes of clinically apparent
   diabetic ketoacidosis-associated cerebral edema allows for the detection
   and treatment of episodes of elevated intracranial pressure and/or brain
   tissue hypoxia that may be of clinical significance. (Pediatr Crit Care
   Med 2012; 13:e383-e388)
RI O'brien, Nicole/E-3776-2011
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 1529-7535
UT WOS:000310795100008
PM 22895005
ER

PT J
AU Arampatzis, Spyridon
   Frauchiger, Bettina
   Fiedler, Georg-Martin
   Leichtle, Alexander Benedikt
   Buhl, Daniela
   Schwarz, Christoph
   Funk, Georg-Christian
   Zimmermann, Heinz
   Exadaktylos, Aristomenis K.
   Lindner, Gregor
TI Characteristics, Symptoms, and Outcome of Severe Dysnatremias Present on
   Hospital Admission
SO AMERICAN JOURNAL OF MEDICINE
VL 125
IS 11
AR 1125.e1
DI 10.1016/j.amjmed.2012.04.041
PD NOV 2012
PY 2012
AB OBJECTIVE: Dysnatremias are common in critically ill patients and
   associated with adverse outcomes, but their incidence, nature, and
   treatment rarely have been studied systematically in the population
   presenting to the emergency department. We conducted a study in patients
   presenting to the emergency department of the University of Bern.
   METHODS: In this retrospective case series at a university hospital in
   Switzerland, 77,847 patients admitted to the emergency department
   between April 1, 2008, and March 31, 2011, were included. Serum sodium
   was measured in 43,911 of these patients. Severe hyponatremia was
   defined as less than 121 mmol/L, and severe hypernatremia was defined as
   less than 149 mmol/L.
   RESULTS: Hypernatremia (sodium > 145 mmol/L) was present in 2% of
   patients, and hyponatremia (sodium < 135 mmol/L) was present in 10% of
   patients. A total of 74 patients had severe hypernatremia, and 168
   patients had severe hyponatremia. Some 38% of patients with severe
   hypernatremia and 64% of patients with hyponatremia had neurologic
   symptoms. The occurrence of symptoms was related to the absolute
   elevation of serum sodium. Somnolence and disorientation were the
   leading symptoms in hypernatremic patients, and nausea, falls, and
   weakness were the leading symptoms in hyponatremic patients. The rate of
   correction did not differ between symptomatic and asymptomatic patients.
   Patients with symptomatic hypernatremia showed a further increase in
   serum sodium concentration during the first 24 hours after admission.
   Corrective measures were not taken in 18% of hypernatremic patients and
   4% of hyponatremic patients.
   CONCLUSIONS: Dysnatremias are common in the emergency department.
   Hyponatremia and hypernatremia have different symptoms. Contrary to
   recommendations, serum sodium is not corrected more rapidly in
   symptomatic patients. (C) 2012 Elsevier Inc. All rights reserved. The
   American Journal of Medicine (2012) 125, 1125.e1-1125.e7
RI Leichtle, Alexander/C-7262-2011
OI Leichtle, Alexander/0000-0002-6528-9904
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0002-9343
UT WOS:000310432200031
PM 22939097
ER

PT J
AU Shapiro, Mark L
   Baldea, Anthony
   Luchette, Fred A
TI Rhabdomyolysis in the intensive care unit.
SO Journal of intensive care medicine
VL 27
IS 6
BP 335
EP 42
DI 10.1177/0885066611402150
PD 2012 Nov-Dec
PY 2012
AB Rhabdomyolysis is a clinical syndrome defined by muscle breakdown and
   subsequent release of intracellular contents. There are many etiologies
   of rhabdomyolysis, classified here as congenital and acquired;
   compartment syndrome secondary to trauma with reperfusion injury is one
   common precipitating factor. Regardless of the underlying etiology, the
   pathophysiology follows a similar pathway via myocyte destruction and
   release of myoglobin into the systemic circulation.
   Rhabdomyolysis-induced renal failure is caused by the precipitation of
   myoglobin in the renal tubules which is enhanced under acidic
   conditions. A high index of clinical suspicion is required to promptly
   recognize rhabdomyolysis, especially in the unconscious patient.
   Presenting symptoms include tea-colored urine and muscle weakness or
   fatigue. The diagnosis is confirmed most reliably with the finding of
   elevated serum creatine kinase levels. Early, aggressive resuscitation
   with either normal saline or lactated Ringer's solution to maintain an
   adequate urine output is the most important intervention in preventing
   the development of acute renal failure. There is insufficient clinical
   evidence supporting the routine administration of diuretics and
   bicarbonate to protect against the development of acute renal failure.
TC 4
ZB 1
Z8 2
ZS 0
Z9 5
UT MEDLINE:21436168
PM 21436168
ER

PT J
AU Grosse-Sundrup, Martina
   Henneman, Justin P.
   Sandberg, Warren S.
   Bateman, Brian T.
   Uribe, Jose Villa
   Nicole Thuy Nguyen
   Ehrenfeld, Jesse M.
   Martinez, Elizabeth A.
   Kurth, Tobias
   Eikermann, Matthias
TI Intermediate acting non-depolarizing neuromuscular blocking agents and
   risk of postoperative respiratory complications: prospective propensity
   score matched cohort study
SO BRITISH MEDICAL JOURNAL
VL 345
AR e6329
DI 10.1136/bmj.e6329
PD OCT 16 2012
PY 2012
AB Objective To determine whether use of intermediate acting neuromuscular
   blocking agents during general anesthesia increases the incidence of
   postoperative respiratory complications.
   Design Prospective, propensity score matched cohort study.
   Setting General teaching hospital in Boston, Massachusetts, United
   States, 2006-10.
   Participants 18 579 surgical patients who received intermediate acting
   neuromuscular blocking agents during surgery were matched by propensity
   score to 18 579 reference patients who did not receive such agents.
   Main outcome measures The main outcome measures were oxygen desaturation
   after extubation (hemoglobin oxygen saturation <90% with a decrease in
   oxygen saturation after extubation of >3%) and reintubations requiring
   unplanned admission to an intensive care unit within seven days of
   surgery. We also evaluated effects on these outcome variables of
   qualitative monitoring of neuromuscular transmission (train-of-four
   ratio) and reversal of neuromuscular blockade with neostigmine to
   prevent residual postoperative neuromuscular blockade.
   Results The use of intermediate acting neuromuscular blocking agents was
   associated with an increased risk of postoperative desaturation less
   than 90% after extubation (odds ratio 1.36, 95% confidence interval 1.23
   to 1.51) and reintubation requiring unplanned admission to an intensive
   care unit (1.40, 1.09 to 1.80). Qualitative monitoring of neuromuscular
   transmission did not decrease this risk and neostigmine reversal
   increased the risk of postoperative desaturation less than 90% (1.32,
   1.20 to 1.46) and reintubation (1.76, 1.38 to 2.26).
   Conclusion The use of intermediate acting neuromuscular blocking agents
   during anesthesia was associated with an increased risk of clinically
   meaningful respiratory complications. Our data suggest that the
   strategies used in our trial to prevent residual postoperative
   neuromuscular blockade should be revisited.
TC 26
ZB 14
Z8 0
ZS 0
Z9 26
SN 1756-1833
UT WOS:000310140600001
PM 23077290
ER

PT J
AU Lee, Christie M.
   Fan, Eddy
TI ICU-acquired weakness: what is preventing its rehabilitation in
   critically ill patients?
SO BMC MEDICINE
VL 10
AR 115
DI 10.1186/1741-7015-10-115
PD OCT 3 2012
PY 2012
AB Intensive care unit-acquired weakness (ICUAW) has been recognized as an
   important and persistent complication in survivors of critical illness.
   The absence of a consistent nomenclature and diagnostic criteria for
   ICUAW has made research in this area challenging. Although many risk
   factors have been identified, the data supporting their direct
   association have been controversial. Presently, there is a growing body
   of literature supporting the utility and benefit of early mobility in
   reducing the morbidity from ICUAW, but few centers have adopted this
   into their ICU procedures. Ultimately, the implementation of such a
   strategy would require a shift in the knowledge and culture within the
   ICU, and may be facilitated by novel technology and patient care
   strategies. The purpose of this article is to briefly review the
   diagnosis, risk factors, and management of ICUAW, and to discuss some of
   the barriers and novel treatments to improve outcomes for our ICU
   survivors.
TC 9
ZB 3
Z8 0
ZS 0
Z9 9
SN 1741-7015
UT WOS:000312392800002
PM 23033976
ER

PT J
AU Kanwal, Sandeep Kumar
   Yadav, Dinesh
   Chhapola, Viswas
   Kumar, Virendra
TI Post-diphtheritic neuropathy: a clinical study in paediatric intensive
   care unit of a developing country
SO TROPICAL DOCTOR
VL 42
IS 4
BP 195
EP 197
DI 10.1258/td.2012.120293
PD OCT 2012
PY 2012
AB A retrospective study was done on 48 consecutive patients with clinical
   diagnosis of post-diphtheritic neuropathy admitted to the paediatric
   intensive care unit of tertiary care hospital in North India between
   January 2008 and December 2010 to study the clinical profile of
   post-diphtheritic neuropathy in children. The case records were reviewed
   and information regarding personal details, clinical features, recovery
   parameters and outcome was recorded using a predesigned proforma. Median
   age was 4.25 years. All cases were unimmunized. Median latency period
   was 15 days. Of the children, 52% had palatal palsy whereas 48% had limb
   weakness initially. Median duration of progression of weakness was five
   days. Limb muscle weakness was present in 94%. Respiratory muscles were
   involved in 85.4% cases and 60.4% required mechanical ventilation, while
   14.6% had fatal outcome and 10.4% had hypoxic neurological injury. Boys
   were affected more. Median duration of latency was shorter; muscle
   weakness, progression and recovery were faster as compared with
   observational studies in adults.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0049-4755
UT WOS:000315002700004
PM 23146909
ER

PT J
AU Ydemann, Mogens
   Eddelien, Heidi Shil
   Lauritsen, Anne Oberg
TI Treatment of critical illness polyneuropathy and/or myopathy - a
   systematic review
SO DANISH MEDICAL JOURNAL
VL 59
IS 10
AR A4511
PD OCT 2012
PY 2012
AB INTRODUCTION: The objective was to search the literature with a view to
   providing a general description of critical illness
   myopathy/polyneuropathy (CIM/CIP), including its genesis and prevention.
   Furthermore, it was our aim to determine whether new treatments have
   occurred in the past five years.
   METHOD: PubMed, CINAHL and Swedmed+ were searched using the terms CIM,
   CIP and intensive care. The search was narrowed by adding the limits:
   humans, English, Danish, Norwegian, Swedish and, furthermore, articles
   had to have been published in the past five years as we aimed to focus
   on new knowledge.
   RESULTS: A total of 74 articles were found. We excluded articles
   focusing on children and intensive care, tight insulin therapy in
   patients without CIM/CIP and articles focusing on Guillain-Barre
   syndrome, triage, bleeding, alcohol or meningitis. Of the remaining 36
   articles, only five focused on CIM/CIP treatment. Their relevant
   original references were found and used too.
   CONCLUSION: CIM/CIP is the most commonly occurring intensive care unit
   (ICU)-acquired neuromuscular dysfunction, and it is associated with a
   significant increase in length of stay, delayed weaning from mechanical
   ventilation, prolonged rehabilitation and, consequently, more expenses.
   To treat/prevent this condition, it seems reasonable to ensure maximal
   functional status for survivors of an ICU-stay by applying a multimodal
   therapeutic approach that includes intensive insulin therapy, minimal
   sedation and, as suggested by new evidence, early physiotherapy and
   electrical muscle stimulation.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 2245-1919
UT WOS:000312562700010
PM 23158890
ER

PT J
AU Hu, Mei-Hua
   Chen, Chiung-Mei
   Lin, Kuang-Lin
   Wang, Huei-Shyong
   Hsia, Shao-Hsuan
   Chou, Ming-Liang
   Hung, Po-Cheng
   Wu, Chang-Teng
TI Risk Factors of Respiratory Failure in Children with Guillain-Barre
   Syndrome
SO PEDIATRICS AND NEONATOLOGY
VL 53
IS 5
BP 295
EP 299
DI 10.1016/j.pedneo.2012.07.003
PD OCT 2012
PY 2012
AB Background: Respiratory failure is rarely associated with Guillain-Barre
   syndrome (GBS) in children. The aim of the study was to determine the
   risk factors of respiratory failure in children with GBS to advance
   management.
   Methods: In this retrospective study, the variables that lead to
   respiratory failure were investigated in 40 children. The risk factors
   were compared for 4 children with intubation and 36 without. We also
   analyzed the specific treatments, including corticosteroids, intravenous
   immunoglobulin, plasmapheresis, and clinical status at discharge.
   Results: Four (10.0%) of the 40 children with GBS required mechanical
   ventilation. The need for mechanical ventilation was significantly
   related to the Hughes score at nadir (p < 0.001), respiratory distress
   (p < 0.001), and hypotension (p < 0.001). Atypical presentation of
   symptoms such as croup, hoarseness, vomiting, ataxia, consciousness
   disturbance, and previous event of diarrhea were more predominant in
   patients younger than 6 years. Disability grades > 3 at discharge were
   found in 15 patients (37.5%), and there was no mortality in the present
   case series.
   Conclusions: Respiratory failure in childhood GBS was related to the
   Hughes score at nadir, respiratory distress, and hypotension. Atypical
   presentations of symptoms were more predominant in patients younger than
   6 years. The prognosis in our series was good and not related to
   previous events. Understanding the risk factors of severe GBS will
   provide better treatment strategies and improve the outcomes. Copyright
   (C) 2012, Taiwan Pediatric Association. Published by Elsevier Taiwan
   LLC. All rights reserved.
TC 1
ZB 1
Z8 0
ZS 1
Z9 2
SN 1875-9572
UT WOS:000311007400006
PM 23084721
ER

PT J
AU Hsia, Shao-Hsuan
   Lin, Jainn-Jim
   Huang, I-Anne
   Wu, Chang-Teng
TI Outcome of Long-Term Mechanical Ventilation Support in Children
SO PEDIATRICS AND NEONATOLOGY
VL 53
IS 5
BP 304
EP 308
DI 10.1016/j.pedneo.2012.07.005
PD OCT 2012
PY 2012
AB Background: Improved technology and care in recent years have
   significantly improved the prognosis and quality of life for patients on
   long-term mechanical ventilation. This study examined the status of
   children on long-term mechanical ventilation (MV) support in Taiwan.
   Methods: The medical records of patients between January 1998 and
   December 2006 were retrospectively reviewed, and the clinical factors
   were systematically reviewed.
   Results: One hundred and thirty-nine (139) patients aged 3 months to 18
   years, with 53 (38.1%) girls and 86 (61.9%) boys, were enrolled. The
   common underlying disorders included neurologic/neuromuscular diseases
   (n = 100, 71.9%) and airway/lung dysfunction (n = 19, 13.7%). After
   instituting MV, the children returned to the medical center mainly for
   infection (n = 157, 47.7%) and elective surgery or procedures (n = 46,
   13.9%). After long-term follow-up, 37 (26.6%) died, 81 (58.3%) were
   transferred to respiratory care wards in local hospitals, and 21(15.1%)
   received home care support.
   Conclusions: There are now more children on long-term MV support in
   Taiwan and most are in respiratory care wards in local hospitals. The
   shift in underlying diagnoses from pulmonary disease to neurogenic
   respiratory insufficiency affects hospitalization. The main cause of
   respiratory insufficiency is neurologic insult. Copyright (C) 2012,
   Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. All
   rights reserved.
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 1875-9572
UT WOS:000311007400008
PM 23084723
ER

PT J
AU dos Santos, Patricia
   Teixeira, Cassiano
   Savi, Augusto
   Maccari, Jucara Gasparetto
   Neres, Fernanda Santos
   Machado, Andre Sant'Ana
   de Oliveira, Roselaine Pinheiro
   Ribeiro, Marlise
   Rotta, Francisco T.
TI The Critical Illness Polyneuropathy in Septic Patients With Prolonged
   Weaning From Mechanical Ventilation: Is the Diaphragm Also Affected? A
   Pilot Study
SO RESPIRATORY CARE
VL 57
IS 10
BP 1594
EP 1601
DI 10.4187/respcare.01396
PD OCT 2012
PY 2012
AB BACKGROUND: Critical illness myopathy and/or neuropathy (CRIMYNE) is a
   common alteration seen in the ICU. The currently available bedside
   methods of measuring respiratory and peripheral muscle function in
   critically ill patients are somewhat inadequate. The objective of this
   study was to evaluate the presence of diaphragmatic and peripheral
   CRIMYNE in septic patients with prolonged weaning from mechanical
   ventilation (MV). METHODS: Cohort prospective study with an entry period
   of 6 months. In 2 Brazilian medical-surgical ICUs, septic patients >= 18
   years of age, dependent on MV >= 14 days, requiring prolonged weaning
   from MV, awake (Richmond Agitation Sedation Scale >= -2), and with no
   previous history of polyneuropathy or myopathy were included.
   Electrophysiological studies of the limbs and also of the respiratory
   system by phrenic nerve conduction and needle electromyography of the
   diaphragm were performed in all subjects. RESULTS: Twelve subjects were
   enrolled during 6 months of study. The electrophysiological signs of
   peripheral CRIMYNE occurred in 9 subjects, 7 of whom died in the ICU.
   Three subjects developed critical illness polyneuropathy, 4 critical
   illness myopathy, and 2 both. Only one subject who developed peripheral
   CRIMYNE did not present diaphragmatic involvement, whereas no subject
   developed diaphragm involvement alone. Thus, electrophysiological signs
   of diaphragmatic CRIMYNE occurred in 8 of the 9 subjects with peripheral
   CRIMYNE. Upon clinical examination, 8 subjects were not able to moves
   their limbs against gravity, and these findings were related to the
   presence of peripheral and diaphragmatic dysfunction. CONCLUSIONS: Our
   pilot findings suggested that CRIMYNE is common in septic patients with
   prolonged weaning from MV (MV >= 14 d). The inability to move limbs
   against gravity is frequently associated with peripheral and
   diaphragmatic CRIMYNE, and the findings of CRIMYNE in peripheral
   electrophysiological tests are associated with diaphragmatic
   involvement.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0020-1324
UT WOS:000310116200008
ER

PT J
AU MacIntyre, Neil R.
TI Evidence-Based Assessments in the Ventilator Discontinuation Process
SO RESPIRATORY CARE
VL 57
IS 10
BP 1611
EP 1618
DI 10.4187/respcare.02055
PD OCT 2012
PY 2012
AB The ventilator discontinuation process is an essential component of
   overall ventilator management. Undue delay leads to excess stay,
   iatrogenic lung injury, unnecessary sedation, and even higher mortality.
   On the other hand, premature withdrawal can lead to muscle fatigue,
   dangerous gas exchange impairment, loss of airway protection, and also a
   higher mortality. An evidence-based task force has recommended a daily
   discontinuation assessment and management process for most ICU patients
   requiring at least 24 hours of mechanical ventilator support. This
   process focuses on assessments on the causes for ventilator dependence,
   assessments for evidence of disease stability/reversal, use of regular
   spontaneous breathing trials (SBTs) as the primary assessment tool for
   ventilator discontinuation potential, use of separate assessments to
   evaluate the need for an artificial airway in patients tolerating the
   SBT, and the use of comfortable, interactive ventilator modes (that do
   not need to be "weaned") in between regular SBTs. More recent
   developments have focused on the utility of computer decision support to
   guide these processes and the importance of linking sedation reduction
   protocols to ventilator discontinuation protocols. These guidelines are
   standing the test of time, and practice patterns are evolving in
   accordance with them. Nevertheless, there is still room for improvement
   and need for further clinical studies, especially in the patient
   requiring prolonged mechanical ventilation.
CT New Horizons Symposium on Ventilator Liberation Process - A Fresh Look
   at the Evidence at the AARC Congress
CY NOV 05-08, 2011
CL Tampa, FL
SP AARC
TC 6
ZB 0
Z8 1
ZS 1
Z9 8
SN 0020-1324
UT WOS:000310116200010
PM 23013898
ER

PT J
AU Mendez-Tellez, Pedro A.
   Needham, Dale M.
TI Early Physical Rehabilitation in the ICU and Ventilator Liberation
SO RESPIRATORY CARE
VL 57
IS 10
BP 1663
EP 1669
DI 10.4187/respcare.01931
PD OCT 2012
PY 2012
AB Critically ill patients requiring mechanical ventilation are frequently
   subjected to long periods of physical inactivity, leading to skeletal
   muscle atrophy and muscle weakness. Disuse muscle atrophy is the result
   of complex mechanisms, including altered protein turnover and disturbed
   redox signaling. These ICU-acquired complications are associated with
   longer duration of mechanical ventilation, prolonged ICU and hospital
   stays, and poorer functional status at hospital discharge. Similarly,
   there is growing evidence that continuous mandatory ventilation alters
   diaphragmatic structure and contractile function and promotes oxidative
   injury, resulting in a rapid-onset diaphragmatic atrophy and weakness,
   which most likely delays discontinuing mechanical ventilation. Physical
   rehabilitation, when started at the onset of mechanical ventilation, has
   been associated with shorter periods of mechanical ventilation,
   decreased ICU and hospital stay, and improved physical function at
   hospital discharge. This review summarizes the impact of both physical
   inactivity and mechanical ventilation on skeletal and diaphragmatic
   muscles structure and function. Also reviewed is the growing evidence
   demonstrating the feasibility and safety of early physical
   rehabilitation interventions for mechanically ventilated patients, as
   well as their benefit on patient outcomes.
CT New Horizons Symposium on Ventilator Liberation Process - A Fresh Look
   at the Evidence at the AARC Congress
CY NOV 05-08, 2011
CL Tampa, FL
SP AARC
TC 6
ZB 2
Z8 0
ZS 1
Z9 7
SN 0020-1324
UT WOS:000310116200015
PM 23013903
ER

PT J
AU Shively, Sharon
   Scher, Ann I.
   Perl, Daniel P.
   Diaz-Arrastia, Ramon
TI Dementia Resulting From Traumatic Brain Injury What Is the Pathology?
SO ARCHIVES OF NEUROLOGY
VL 69
IS 10
BP 1245
EP 1251
DI 10.1001/archneurol.2011.3747
PD OCT 2012
PY 2012
AB Traumatic brain injury (TBI) is among the earliest illnesses described
   in human history and remains a major source of morbidity and mortality
   in the modern era. It is estimated that 2% of the US population lives
   with long-term disabilities due to a prior TBI, and incidence and
   prevalence rates are even higher in developing countries. One of the
   most feared long-term consequences of TBIs is dementia, as multiple
   epidemiologic studies show that experiencing a TBI in early or midlife
   is associated with an increased risk of dementia in late life. The best
   data indicate that moderate and severe TBIs increase risk of dementia
   between 2- and 4-fold. It is less clear whether mild TBIs such as brief
   concussions result in increased dementia risk, in part because mild head
   injuries are often not well documented and retrospective studies have
   recall bias. However, it has been observed for many years that multiple
   mild TBIs as experienced by professional boxers are associated with a
   high risk of chronic traumatic encephalopathy (CTE), a type of dementia
   with distinctive clinical and pathologic features. The recent
   recognition that CTE is common in retired professional football and
   hockey players has rekindled interest in this condition, as has the
   recognition that military personnel also experience high rates of mild
   TBIs and may have a similar syndrome. It is presently unknown whether
   dementia in TBI survivors is pathophysiologically similar to Alzheimer
   disease, CTE, or some other entity. Such information is critical for
   developing preventive and treatment strategies for a common cause of
   acquired dementia. Herein, we will review the epidemiologic data linking
   TBI and dementia, existing clinical and pathologic data, and will
   identify areas where future research is needed. Arch Neurol.
   2012;69(10):1245-1251. Published online July 9, 2012.
   doi:10.1001/archneurol.2011.3747
TC 32
ZB 24
Z8 0
ZS 0
Z9 32
SN 0003-9942
UT WOS:000309541400002
PM 22776913
ER

PT J
AU Nakamura, Kazuyuki
   Kato, Mitsuhiro
   Sasaki, Ayako
   Shiihara, Takashi
   Hayasaka, Kiyoshi
TI Respiratory syncytial virus-associated encephalopathy complicated by
   congenital myopathy
SO PEDIATRICS INTERNATIONAL
VL 54
IS 5
BP 709
EP 711
DI 10.1111/j.1442-200X.2012.03594.x
PD OCT 2012
PY 2012
AB A 23-month-old Japanese girl with a severe form of congenital fiber type
   disproportion myopathy under mechanical ventilation suffered from
   respiratory syncytial virus (RSV) bronchiolitis, complicated with acute
   encephalopathy. She showed consciousness disturbance and convulsions
   followed by severe brain damage, a rare complication in RSV infection.
   Patients with severe neuromuscular diseases are vulnerable to RSV
   infection. Prophylactic interventions should be recommended.
RI Nakamura, Kazuyuki/B-6247-2012
TC 1
ZB 1
Z8 2
ZS 0
Z9 3
SN 1328-8067
UT WOS:000309234600021
PM 23005904
ER

PT J
AU Davis, Robert T., III
   Bruells, Christian S.
   Stabley, John N.
   McCullough, Danielle J.
   Powers, Scott K.
   Behnke, Bradley J.
TI Mechanical ventilation reduces rat diaphragm blood flow and impairs
   oxygen delivery and uptake
SO CRITICAL CARE MEDICINE
VL 40
IS 10
BP 2858
EP 2866
DI 10.1097/CCM.0b013e31825b933a
PD OCT 2012
PY 2012
AB Objectives: Although mechanical ventilation is a life-saving
   intervention in patients suffering from respiratory failure, prolonged
   mechanical ventilation is often associated with numerous complications
   including problematic weaning. In contracting skeletal muscle,
   inadequate oxygen supply can limit oxidative phosphorylation resulting
   in muscular fatigue. However, whether prolonged mechanical ventilation
   results in decreased diaphragmatic blood flow and induces an oxygen
   supply-demand imbalance in the diaphragm remains unknown.
   Design: We tested the hypothesis that prolonged controlled mechanical
   ventilation results in a time-dependent reduction in rat diaphragmatic
   blood flow and microvascular Po-2 and that prolonged mechanical
   ventilation would diminish the diaphragm's ability to increase blood
   flow in response to muscular contractions.
   Measurements and Main Results: Compared to 30 mins of mechanical
   ventilation, 6 hrs of mechanical ventilation resulted in a 75% reduction
   in diaphragm blood flow (via radiolabeled microspheres), which did not
   occur in the intercostal muscle or high-oxidative hindlimb muscle
   (e.g.,soleus). There was also a time-dependent decline in diaphragm
   microvascular Po-2 (via phosphorescence quenching). Further, contrary to
   30 mins of mechanical ventilation, 6 hrs of mechanical ventilation
   significantly compromised the diaphragm's ability to increase blood flow
   during electrically-induced contractions, which resulted in a similar to
   80% reduction in diaphragm oxygen uptake. In contrast, 6 hrs of
   spontaneous breathing in anesthetized animals did not alter diaphragm
   blood flow or the ability to augment flow during-electrically-induced
   contractions.
   Conclusions: These new and important findings reveal that prolonged
   mechanical ventilation results in a time-dependent decrease in the
   ability of the diaphragm to augment blood flow to match oxygen demand in
   response to contractile activity and could be a key contributing factor
   to difficult weaning. Although additional experiments are required to
   confirm, it is tempting to speculate that this ventilator-induced
   decline in diaphragmatic oxygenation could promote a hypoxia-induced
   generation of reactive oxygen species in diaphragm muscle fibers and
   contribute to ventilator-induced diaphragmatic atrophy and contractile
   dysfunction. (Crit Care Med 2012; 40:2858-2866)
TC 7
ZB 4
Z8 0
ZS 0
Z9 7
SN 0090-3493
UT WOS:000308920600016
PM 22846782
ER

PT J
AU Poulakou, Garyphallia
   Perez, Marcos
   Rello, Jordi
TI Severe acute respiratory infections in the postpandemic era of H1N1
SO CURRENT OPINION IN CRITICAL CARE
VL 18
IS 5
BP 441
EP 450
DI 10.1097/MCC.0b013e32835605f2
PD OCT 2012
PY 2012
AB Purpose of review
   Shortly after the advent of severe acute respiratory syndrome and the
   avian influenza, the emergence of the influenza A(H1N1) 2009 pandemic
   caused significant vibrations to the public health authorities and
   stressed the health systems worldwide. We sought to investigate whether
   this experience has altered our knowledge and our current and future
   practice on the management of severe acute respiratory infections (SARI)
   and community-acquired pneumonia.
   Recent findings
   A changing epidemiology was demonstrated, with obesity and pregnancy
   beyond established risk groups for influenza A, other clinical syndromes
   beyond primary viral pneumonia, possible coinfections by other viral
   beyond bacterial pathogens and a disappointing performance of all
   available severity assessment tools. On the treatment topic,
   accumulating evidence suggesting worse outcomes argues against the use
   of corticosteroids, but some noninvasive ventilating modalities require
   further assessment.
   Summary
   The recent influenza A(H1N1) 2009 pandemic has highlighted our
   weaknesses relating to the diagnosis and assessment of severity of SARI,
   compromising early treatment and ultimate outcomes; further research
   based on this experience will help to improve prognosis and boost our
   future preparedness. An important message is the necessity of
   international collaboration for the rapid dissemination of locally
   acquired knowledge.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 1070-5295
UT WOS:000308671400006
PM 22820154
ER

PT J
AU Hraiech, Sami
   Forel, Jean-Marie
   Papazian, Laurent
TI The role of neuromuscular blockers in ARDS: benefits and risks
SO CURRENT OPINION IN CRITICAL CARE
VL 18
IS 5
BP 495
EP 502
DI 10.1097/MCC.0b013e328357efe1
PD OCT 2012
PY 2012
AB Purpose of review
   Neuromuscular blocking agents (NMBAs) are part of the pharmaceutical
   arsenal employed to treat acute respiratory distress syndrome (ARDS).
   However, their use remains controversial because the potential benefits
   of these agents are counterbalanced by possible adverse effects. This
   review summarizes advantages and risks of NMBAs based on the most recent
   literature.
   Recent findings
   NMBAs have been shown to improve oxygenation during severe ARDS in three
   randomized controlled trials. The most recent results demonstrated that
   NMBAs decrease 90-day in-hospital mortality, particularly in the most
   hypoxaemic patients. NMBAs have not been shown to be an independent risk
   factor of neuromyopathy in most studies.
   Summary
   NMBAs are commonly used in ARDS (25-55% of patients), but the benefits
   and the risks of using these agents are controversial. Recent data
   suggest that a continuous infusion of cisatracurium during the first 48
   h of ARDS, particularly for patients with a PaO2/FiO2 ratio less than
   120, can decrease 90-day in-hospital mortality. NMBAs do not appear to
   be an independent risk factor for ICU-acquired weakness if they are not
   given with corticosteroids or in patients with hyperglycaemia.
TC 3
ZB 1
Z8 0
ZS 0
Z9 3
SN 1070-5295
UT WOS:000308671400012
PM 22941207
ER

PT J
AU Denehy, Linda
   Elliott, Doug
TI Strategies for post ICU rehabilitation
SO CURRENT OPINION IN CRITICAL CARE
VL 18
IS 5
BP 503
EP 508
DI 10.1097/MCC.0b013e328357f064
PD OCT 2012
PY 2012
AB Purpose of review
   As numbers of patients who survive a critical illness increase, often
   within a context of comorbidities and acquired physical, mental or
   cognitive sequelae [postintensive care syndrome (PICS)], identifying
   effective recovery and rehabilitation strategies is paramount. In this
   review, we discuss recent studies that inform our developing
   understanding for improving the recovery trajectory for survivors of a
   critical illness during the postintensive care and posthospital periods.
   Recent findings
   New studies, although at this stage often presented as pilot work,
   provide important beginning messages for improving recovery from a
   critical illness. Some pilot studies demonstrate promise of effective
   interventions, whereas other studies offer useful baseline information
   for improving the power of tested interventions.
   Summary
   Innovative rehabilitation and recovery strategies during the
   postintensive care and posthospital periods are now being published.
   Further research with larger sample sizes, well-documented usual care
   and intervention arms and in different critical illness cohorts is
   required to demonstrate the optimal approaches for screening,
   implementation, outcome assessment and follow-up periods for
   rehabilitation interventions in the postintensive care phase of a
   patient's recovery.
TC 7
ZB 0
Z8 0
ZS 0
Z9 7
SN 1070-5295
UT WOS:000308671400013
PM 22914429
ER

PT J
AU Dos Santos, Claudia C.
   Batt, Jane
TI ICU-acquired weakness: mechanisms of disability
SO CURRENT OPINION IN CRITICAL CARE
VL 18
IS 5
BP 509
EP 517
DI 10.1097/MCC.0b013e328357cb5e
PD OCT 2012
PY 2012
AB Purpose of review
   ICU-acquired weakness (ICUAW) is now recognized as a major complication
   of critical illness. There is no doubt that ICUAW is prevalent - some
   might argue ubiquitous - after critical illness, but its true role, the
   interaction with preexisting nerve and muscle lesions as well as its
   contribution to long-term functional disability, remains to be
   elucidated.
   Recent findings
   In this article, we review the current state-of-the-art of the basic
   pathophysiology of nerve and muscle weakness after critical illness and
   explore the current literature on ICUAW with a special emphasis on the
   most important mechanisms of weakness.
   Summary
   Variable contributions of structural and functional changes likely
   contribute to both early and late myopathy and neuropathy, although the
   specifics of the temporality of both processes, and the influence
   patient comorbidities, age, and nature of the ICU insult have on them,
   remain to be determined.
TC 5
ZB 1
Z8 0
ZS 0
Z9 5
SN 1070-5295
UT WOS:000308671400014
PM 22918258
ER

PT J
AU Johnston, Christopher I.
   O'Leary, Margaret A.
   Brown, Simon G. A.
   Currie, Bart J.
   Halkidis, Lambros
   Whitaker, Richard
   Close, Benjamin
   Isbister, Geoffrey K.
CA ASP Investigators
TI Death Adder Envenoming Causes Neurotoxicity Not Reversed by Antivenom -
   Australian Snakebite Project (ASP-16)
SO PLOS NEGLECTED TROPICAL DISEASES
VL 6
IS 9
AR e1841
DI 10.1371/journal.pntd.0001841
PD SEP 2012
PY 2012
AB Background: Death adders (Acanthophis spp) are found in Australia, Papua
   New Guinea and parts of eastern Indonesia. This study aimed to
   investigate the clinical syndrome of death adder envenoming and response
   to antivenom treatment.
   Methodology/Principal Findings: Definite death adder bites were
   recruited from the Australian Snakebite Project (ASP) as defined by
   expert identification or detection of death adder venom in blood.
   Clinical effects and laboratory results were collected prospectively,
   including the time course of neurotoxicity and response to treatment.
   Enzyme immunoassay was used to measure venom concentrations. Twenty nine
   patients had definite death adder bites; median age 45 yr (5-74 yr); 25
   were male. Envenoming occurred in 14 patients. Two further patients had
   allergic reactions without envenoming, both snake handlers with previous
   death adder bites. Of 14 envenomed patients, 12 developed neurotoxicity
   characterised by ptosis (12), diplopia (9), bulbar weakness (7),
   intercostal muscle weakness (2) and limb weakness (2). Intubation and
   mechanical ventilation were required for two patients for 17 and 83
   hours. The median time to onset of neurotoxicity was 4 hours (0.5-15.5
   hr). One patient bitten by a northern death adder developed myotoxicity
   and one patient only developed systemic symptoms without neurotoxicity.
   No patient developed venom induced consumption coagulopathy. Antivenom
   was administered to 13 patients, all receiving one vial initially. The
   median time for resolution of neurotoxicity post-antivenom was 21 hours
   (5-168). The median peak venom concentration in 13 envenomed patients
   with blood samples was 22 ng/mL (4.4-245 ng/mL). In eight patients where
   post-antivenom bloods were available, no venom was detected after one
   vial of antivenom.
   Conclusions/Significance: Death adder envenoming is characterised by
   neurotoxicity, which is mild in most cases. One vial of death adder
   antivenom was sufficient to bind all circulating venom. The persistent
   neurological effects despite antivenom, suggests that neurotoxicity is
   not reversed by antivenom.
RI Isbister, Geoffrey/G-8052-2015
OI Isbister, Geoffrey/0000-0003-1519-7419
TC 5
ZB 3
Z8 0
ZS 0
Z9 5
SN 1935-2735
UT WOS:000309528100037
PM 23029595
ER

PT J
AU Nardi, Julie
   Prigent, Helene
   Adala, Annie
   Bohic, Mikaelle
   Lebargy, Francois
   Quera-Salva, Maria-Antonia
   Orlikowski, David
   Lofaso, Frederic
TI Nocturnal Oximetry and Transcutaneous Carbon Dioxide in Home-Ventilated
   Neuromuscular Patients
SO RESPIRATORY CARE
VL 57
IS 9
BP 1425
EP 1430
DI 10.4187/respcare.01658
PD SEP 2012
PY 2012
AB BACKGROUND: Pulse oximetry alone has been suggested to determine which
   patients on home mechanical ventilation (MV) require further
   investigation of nocturnal gas exchange. In patients with neuromuscular
   diseases, alveolar hypoventilation (AH) is rarely accompanied with
   ventilation-perfusion ratio heterogeneity, and, therefore, oximetry may
   be less sensitive for detecting All than in patients with lung disease.
   OBJECTIVE: To determine whether pulse oximetry (S-pO2,) and
   transcutaneous carbon dioxide (P-tcCO2) during the same night were
   interchangeable or complementary for assessing home MV efficiency in
   patients with neuromuscular diseases. METHODS: Data were collected
   retrospectively from the charts of 58 patients with chronic
   neuromuscular respiratory failure receiving follow-up at a home MV unit.
   S-PO2 and P-tcCO2 were recorded during a 1-night hospital stay as part
   of standard patient care. We compared AH detection rates by P-tcCO2,
   S-pO2, and both. RESULTS: AH was detected based on P-tcCO2 alone in 24
   (41%) patients, and based on S-pO2 alone with 3 different cutoffs in 3
   (5%), 8 (14%), and 13 (22%) patients, respectively. Using both P-tcCO2
   and S-pO2 showed AH in 25 (43%) patients. CONCLUSIONS: Pulse oximetry
   alone is not sufficient to exclude AH when assessing home MV efficiency
   in patients with neuromuscular diseases. Both P-tcCO2 and S-pO2 should
   be recorded overnight as the first-line investigation in this
   population.
TC 5
ZB 1
Z8 0
ZS 0
Z9 5
SN 0020-1324
UT WOS:000308901700008
PM 22348449
ER

PT J
AU Namachivayam, Poongundran
   Taylor, Anna
   Montague, Terence
   Moran, Karen
   Barrie, Joanne
   Delzoppo, Carmel
   Butt, Warwick
TI Long-stay children in intensive care: Long-term functional outcome and
   quality of life from a 20-yr institutional study
SO PEDIATRIC CRITICAL CARE MEDICINE
VL 13
IS 5
BP 520
EP 528
DI 10.1097/PCC.0b013e31824fb989
PD SEP 2012
PY 2012
AB Objective: Long-stay patients (>= 28 days) in pediatric intensive care
   units consume a disproportionate amount of resources, and very few
   studies have reported their outcome. We determined the long-term outcome
   of these children admitted to intensive care over a 20-yr period
   (January 1, 1989 to December 31, 2008).
   Setting: Pediatric intensive care unit in a university-affiliated
   tertiary pediatric hospital in Melbourne, Australia
   Methods: Demographic and clinical characteristics were compared after
   dividing patients into four groups depending on year of admission
   (1989-1993, 1994-1998, 1999-2003, and 2004-2008). Preadmission health
   status and long- term functional outcome were evaluated by a modified
   Glasgow outcome scale. Quality of life was assessed by using the Health
   Utilities Index Mark 1.
   Results: Over the 20-yr period, 233 long-stay patients had 269 long stay
   admission episodes to the pediatric intensive care unit, accounting for
   1% (269 of 27,536) of all pediatric intensive care unit admissions and
   utilized 18.5% (15,740 of 85,032) of occupied bed days. Bed occupancy of
   long stay patients (as percentage of overall pediatric intensive care
   unit bed occupancy) increased from 8% in 1989 to 21% in 2008 (p = .001).
   Median age at admission was 4.2 months [interquartile range 0.38-41.5]
   and median length of stay was 40 days [interquartile range 32-57]. One
   hundred sixteen of 233 (49.8%) patients had died at the time of
   follow-up. Children who died were younger compared to survivors (median
   3.4 months [interquartile range 0.38-41.5 vs. median 7.6 months,
   interquartile range 0.6-71.1, p = .026], had a higher proportion of
   comorbid illness (91% vs. 80%, p = .026), and 63% had a preexisting
   moderate or severe disability compared to 51% of survivors (p = .215).
   One hundred seventeen of 233 children survived and long-term functional
   outcome was favorable (normal, functionally normal, or mild disability)
   in 27% (63 of 233) and unfavorable (moderate or severe disability) for
   17.2% (40 of 233). Outcome status was not known for 6% (14 of 233).
   Among survivors (n = 117), more than 50% (63 of 117) had favorable
   outcome. The quality of life in patients aged > 2 yrs at follow up was
   good in 21% (40 of 222), moderate in 8% (16 of 222), poor quality in 68%
   (130 of 222, this includes deaths), and very poor in 3% (5 of 222).
   Conclusions: More than two-thirds of children who stay in intensive care
   for >= 28 days have an unfavorable outcome (moderate disability, severe
   disability, or death). Long-stay patients in pediatric intensive care
   utilized a large proportion of resources and this utilization has
   considerably increased with time. Service provision and policy making
   should expect worsening of these trends in the future; its effects on
   critical care bed availability and overall activity levels could be
   substantial. (Pediatr Crit Care Med 2012; 13:520-528)
TC 6
ZB 1
Z8 0
ZS 0
Z9 6
SN 1529-7535
UT WOS:000308537800014
PM 22805156
ER

PT J
AU Mrozek, Segolene
   Jung, Boris
   Petrof, Basil J.
   Pauly, Marion
   Roberge, Stephanie
   Lacampagne, Alain
   Cassan, Cecile
   Thireau, Jerome
   Molinari, Nicolas
   Futier, Emmanuel
   Scheuermann, Valerie
   Constantin, Jean Michel
   Matecki, Stefan
   Jaber, Samir
TI Rapid Onset of Specific Diaphragm Weakness in a Healthy Murine Model of
   Ventilator-induced Diaphragmatic Dysfunction
SO ANESTHESIOLOGY
VL 117
IS 3
BP 560
EP 567
DI 10.1097/ALN.0b013e318261e7f8
PD SEP 2012
PY 2012
AB Background: Controlled mechanical ventilation is associated with
   ventilator-induced diaphragmatic dysfunction, which impedes weaning from
   mechanical ventilation. To design future clinical trials in humans, a
   better understanding of the molecular mechanisms using knockout models,
   which exist only in the mouse, is needed. The aims of this study were to
   ascertain the feasibility of developing a murine model of
   ventilator-induced diaphragmatic dysfunction and to determine whether
   atrophy, sarcolemmal injury, and the main proteolysis systems are
   activated under these conditions.
   Methods: Healthy adult male C57/BL6 mice were assigned to three groups:
   (1) mechanical ventilation with end-expiratory positive pressure of 2-4
   cm H2O for 6 h (n = 6), (2) spontaneous breathing with continuous
   positive airway pressure of 2-4 cm H2O for 6 h (n = 6), and (3) controls
   with no specific intervention (n = 6). Airway pressure and hemodynamic
   parameters were monitored. Upon euthanasia, arterial blood gases and
   isometric contractile properties of the diaphragm and extensor digitorum
   longus were evaluated. Histology and immunoblotting for the main
   proteolysis pathways were performed.
   Results: Hemodynamic parameters and arterial blood gases were comparable
   between groups and within normal physiologic ranges. Diaphragmatic but
   not extensor digitorum longus force production declined in the
   mechanical ventilation group (maximal force decreased by approximately
   40%) compared with the control and continuous positive airway pressure
   groups. No histologic difference was found between groups. In opposition
   with the calpains, caspase 3 was activated in the mechanical ventilation
   group.
   Conclusion: Controlled mechanical ventilation for 6 h in the mouse is
   associated with significant diaphragmatic but not limb muscle weakness
   without atrophy or sarcolemmal injury and activates proteolysis.
TC 18
ZB 11
Z8 0
ZS 0
Z9 18
SN 0003-3022
UT WOS:000307947700016
PM 22766523
ER

PT J
AU Baranowska, Katarzyna
   Juszczyk, Grzegorz
   Dmitruk, Iwona
   Knapp, Malgorzata
   Tycinska, Agnieszka
   Jakubow, Piotr
   Adamczuk, Anna
   Stankiewicz, Adrian
   Hirnle, Tomasz
TI Risk factors of neurological complications in cardiac surgery
SO KARDIOLOGIA POLSKA
VL 70
IS 8
BP 811
EP 818
PD AUG 2012
PY 2012
AB Background: Postoperative complications are integral to cardiac surgery.
   The most serious ones are stroke, which develops in about 7.5% of the
   patients, and postoperative encephalopathy, which affects 10-30% of the
   patients. According to bibliographical data, the number of complications
   is increasing.
   Aim: To analyse the risk factors and the types of neurological
   complications in patients undergoing heart surgery.
   Methods: We assessed retrospectively 323 consecutive patients undergoing
   surgery at the Department of Cardiac Surgery, University Teaching
   Hospital, Medical University of Bialystok, Poland, between July 2007 and
   June 2008. Group 1 comprised patients without neurological complications
   (n = 287; 89%) and Group 2 consisted of patients with neurological
   complications (n = 36; 11%). Our analysis included the following:
   preoperative status (age, sex, co-morbidities), intraoperative course
   (surgery type, duration of cardiopulmonary bypass [CPB], duration of
   aortic cross-clamping, types of medications administered, necessity of
   reinfusion from the cardiotomy reservoir and the necessity of tranexamic
   acid infusion) and the postoperative course (time to regaining
   consciousness, duration of mechanical ventilation, development of
   complications, types of complications). The results were then analysed
   statistically: arithmetic means and standard deviations were calculated
   for quantitative variables and the quantitative and percenage
   distributions were calculated for qualitative variables. The
   between-group comparisons of the quantitative variables were carried out
   using the t-Student test, while the qualitative variables were compared
   using the chi(2) test. The variables that proved significant in the
   univariate comparisons were included in the multivariate model.
   Regression analysis was the final step of the analysis of the risk
   factors for neurological complications. Based on the analysis of the ROC
   curve we calculated the cutoff values for the continuous variables. We
   calculated odds ratios with their 95% confidence intervals. P values of
   less than 0.05 were considered statistically significant.
   Results: Among the 36 patients in Group 2, postoperative encephalopathy
   developed in 22 patients, transient ischaemic attacks in 7 patients,
   ischaemic stroke in 6 patients (associated with right hemisphere damage
   in 3 patients and with left hemisphere damage in 3 patients) and
   haemorrhagic stroke in 1 patient (right hemisphere). Early mortality was
   5% with 2 (0.69%) patients dying in Group 1 and 14 (38.9%) in Group 2.
   Univariate analysis revealed that the preoperative risk factors of
   neurological complications were: age > 68 years (with a cutoff value of
   58.5 years), a history of stroke with paresis, atrial fibrillation (AF)
   and a euroSCORE of > 6 (with a cutoff value of 4.5). The peri- and
   postoperative risk factors included: surgery type (complex coronary and
   valvular surgeries aortic valve surgeries), duration of CPB of > 142
   min, duration of aortic cross-clamping of > 88 min, mean perfusion
   pressure during CPB of < 70 mm Hg, haemodilution manifested by a
   haematocrit (HCT) of < 28%, perfusate supply, time to regaining
   consciousness of > 14.5 h and duration of artificial ventilation of >
   30.5 h. Multivariate analysis revealed the following factors to increase
   the risk of neurological complications: long duration of ventilation, a
   history of stroke with paresis, AF, low HCT values and long duration of
   aortic cross-clamping. The Nagelkerke R-2 coefficient of determination
   was 0.636, the sensitivity was 74.36%, the specificity was 97.545% and
   the accuracy was 94.74%.
   Conclusions: In patients undergoing heart surgery, the independent risk
   factors of neurological complications in the first 30 days include: long
   duration of ventilation, a history of stroke with paresis, AF,
   haemodilution manifested by an HCT of < 28% and long duration of aortic
   cross-clamping. Neurological complications are associated with high
   postoperative mortality.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0022-9032
UT WOS:000309895900008
PM 22933214
ER

PT J
AU Castro, Antonio A. M.
   Cortopassi, Felipe
   Sabbag, Russell
   Torre-Bouscoulet, Luis
   Kuempel, Claudia
   Porto, Elias Ferreira
TI Respiratory Muscle Assessment in Predicting Extubation Outcome in
   Patients With Stroke
SO ARCHIVOS DE BRONCONEUMOLOGIA
VL 48
IS 8
BP 274
EP 279
DI 10.1016/j.arbres.2012.04.010
PD AUG 2012
PY 2012
AB Background: Patients with cerebral infarction often present impaired
   consciousness and unsatisfactory extubation. We aimed to assess the
   respiratory mechanics components that might be associated with the
   success of extubation in stroke patients.
   Methods: Twenty consecutive patients with stroke who needed mechanical
   ventilation support were enrolled. The maximal inspiratory pressure,
   gastric and the esophageal pressure (Pdi/Pdimax), minute volume,
   respiratory rate, static compliance, airway resistance, rapid and
   superficial respiration index (RSRI), inspiratory time/total respiratory
   cycle (Ti/Ttot), and PaO2/FiO(2) were measured.
   Results: The group who presented success to the extubation process
   presented 12.5 +/- 2.2 = days in mechan-ical ventilation and the group
   who failed presented 13.1 +/- 2 = days. The mean Ti/Ttot and Pdi/Pdimax
   for the failure group was 0.4 +/- 0.08 (0.36-0.44) and 0.5 +/- 0.7
   (0.43-0.56), respectively. The Ti/Ttot ratio was 0.37 +/- 0.05
   (0.34-0.41; p=0.0008) and the Pdi/Pdimax was 0.25 +/- 0.05 for the
   success group (0.21-0.28; p < 0.0001). A correlation was found between
   Pdi/Pdimax ratio and the RSRI (r = 0.55; p = 0.009) and PaO2/FiO(2) (r =
   -0.59; p = 0.005). Patients who presented a high RSRI (OR, 3.66; p =
   0.004) and Pdi (OR, 7.3; p = 0.002), and low PaO2/FlO(2) (OR, 4.09; p =
   0.007), Pdi/Pdimax (OR, 4.12; p = 0.002) and RAW (OR, 3.0; p = 0.02)
   developed mechanical ventilation extubation failure.
   Conclusion: Muscular fatigue index is an important predicting variable
   to the extubation process in prolonged mechanical ventilation of stroke
   patients. (C) 2012 SEPAR. Published by Elsevier Espana, S.L. All rights
   reserved.
TC 3
ZB 1
Z8 0
ZS 0
Z9 3
SN 0300-2896
UT WOS:000306989200003
PM 22607984
ER

PT J
AU Kress, John P.
   Herridge, Margaret S.
TI Medical and Economic Implications of Physical Disability of Survivorship
SO SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE
VL 33
IS 4
BP 339
EP 347
DI 10.1055/s-0032-1321983
PD AUG 2012
PY 2012
AB Interventions developed in the last decade have led to impressive rates
   of survival from extreme critical illness. However, surviving an episode
   of critical illness is just the beginning. Discharge from the intensive
   care unit (ICU) is often the start of a long and challenging
   rehabilitation, mood disorders, cognitive impairment, financial
   hardship, and caregiver burden, burnout, and psychological distress. It
   has become increasingly apparent that the majority of patients who
   survive an episode of critical illness will have some degree of
   compromised physical function secondary to ICU Acquired Weakness (ICUAW)
   and a constellation of other physical disabilities. The spectrum of
   muscle, nerve, and brain dysfunction may be permanent and can
   significantly change the disposition for those who were previously
   independent. Furthermore, it may impose a substantial health care cost
   burden and compromise the reserve of even the most resilient family
   members. Important limitations in the current iterature relate to our
   poor understanding of how to risk stratify, how to systematically
   educate and inform our patients and family caregivers about physical
   morbidity and complex patient care in the community, and how to develop,
   test, and implement rehabilitation programs tailored to individual need.
TC 8
ZB 3
Z8 0
ZS 0
Z9 8
SN 1069-3424
UT WOS:000307608600003
PM 22875379
ER

PT J
AU Cox, Christopher E.
   Carson, Shannon S.
TI Medical and Economic Implications of Prolonged Mechanical Ventilation
   and Expedited Post-Acute Care
SO SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE
VL 33
IS 4
BP 357
EP 361
DI 10.1055/s-0032-1321985
PD AUG 2012
PY 2012
AB This article describes the increasingly common phenomenon of prolonged
   mechanical ventilation in the context of the transition between the
   acute care hospital and post-acute care. Prolonged mechanical
   ventilation or chronic critical illness is associated with hospital
   mortality in the range of 20 to 40%, with median hospital length of stay
   ranging from 14 to 60 days. Fewer than 10% of patients are discharged
   home, and most hospital survivors require institutionalized post-acute
   care in the form of long-term acute care, skilled nursing facilities, or
   inpatient rehabilitation. Acute hospital readmission is common. Because
   of prolonged functional disabilities and multiple underlying comorbid
   conditions, overall 1 year mortality for prolonged mechanical
   ventilation patients ranges from 50 to 60%. Survivors experience
   significant functional limitations. The prolonged institutional care and
   poor long-term outcomes of these patients bring into question the
   cost-effectiveness of prolonged mechanical ventilation after acute
   illness, especially for patients with poor long-term prognoses. New
   measures to facilitate assessments of long-term prognosis and improve
   communication with surrogate decision makers may reduce the amount of
   ineffective care for some patients requiring prolonged mechanical
   ventilation.
TC 10
ZB 1
Z8 0
ZS 1
Z9 11
SN 1069-3424
UT WOS:000307608600005
PM 22875381
ER

PT J
AU Confer, Jennifer
   Wolcott, Janet
   Hayes, Robert
TI Critical illness polyneuromyopathy
SO AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY
VL 69
IS 14
BP 1199
EP 1205
DI 10.2146/ajhp110343
PD JUL 15 2012
PY 2012
AB Purpose. The clinical characteristics of and treatment approaches for
   critical illness polyneuromyopathy (CIPNM) are reviewed.
   Summary. CIPNM is an acute axonal sensory-motor polyneuropathy that
   tends to occur after the development of respiratory insufficiency in
   patients with systemic inflammatory response syndrome, sepsis, or
   multiple-organ dysfunction syndrome. Numerous mechanisms have been
   proposed to explain the pathophysiology of CIPNM, most of which are
   complex and not fully understood or proven. While the rate of intensive
   care unit-acquired weakness varies greatly among patients, an estimated
   25-85% of critically ill adult patients will develop neuromuscular
   weakness, most commonly CIPNM, during hospitalization. While no specific
   pharmacologic treatments exist for CIPNM, the outcome for most patients
   is related to the severity of the illness and neuromyopathy, as well as
   early intervention to treat the underlying condition. Electrophysiologic
   studies, such as electromyography, electroneurography, and muscle and
   nerve biopsies, are considered the gold standard for aiding in the
   diagnosis of CIPNM. Preventive measures such as the early provision of
   appropriate nutrition, glucose control, physical rehabilitation, and the
   cautious use of medications such as corticosteroids and neuromuscular
   blocking agents (NMBAs) can help reduce the occurrence of CIPNM.
   Conclusion. CIPNM is an acute axonal sensory-motor polyneuropathy
   commonly seen in critically ill patients with sepsis and multiorgan
   failure. While no specific pharmacologic treatments exist, preventive
   measures such as the early provision of appropriate nutrition, glucose
   control, physical rehabilitation, and the cautious use of medications,
   including corticosteroids and NMBAs, can help reduce the incidence of
   CIPNM. Am J Health-Syst Pharm. 2012; 69:1199-205
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1079-2082
UT WOS:000306582500011
PM 22761073
ER

PT J
AU Bourdin, Gael
   Guerin, Claude
   Leray, Veronique
   Delannoy, Bertrand
   Debord, Sophie
   Bayle, Frederique
   Germain, Michele
   Richard, Jean-Christophe
TI Comparison of Alpha 200 and CoughAssist as Intermittent Positive
   Pressure Breathing Devices: A Bench Study
SO RESPIRATORY CARE
VL 57
IS 7
BP 1129
EP 1136
DI 10.4187/respcare.01344
PD JUL 2012
PY 2012
AB BACKGROUND: Intermittent positive pressure breathing (IPPB) is used in
   non-intubated patients to increase lung volume and to enhance coughing.
   Alpha 200 (Salvia Lifetec, Kronberg, Germany) is a specific IPPB device.
   Cough Assist (Respironics France, Carquefou, France) is a mechanical
   insufflator-exsufflator used to remove secretions in patients with
   inefficient cough. Both can also be used for intubated or tracheotomized
   patients. We assessed the impact of various artificial airways on the
   ability of the Alpha 200 and Cough Assist to generate insufflated
   volume. METHODS: We measured the insufflated volume and pressure at the
   airway opening in a lung model under 2 conditions of compliance (30 or
   60 mL/cm H2O) at single resistance of 5 cm H2O/L/s. The devices were
   used at 2 set pressures: 30 and 40 cm H2O. The Alpha 200 was set at 2
   inflation flows: 0.5 and 1 L/s, whereas Cough Assist was set at its
   highest value of 10 L/s. Measurements were done without (control) and
   with different size endotracheal tubes and tracheostomy cannulae. The
   relationships between insufflated volume and measured pressure were
   analyzed using linear regressions. RESULTS: The slopes and intercepts of
   the control relationship between insufflated volume and pressure were
   significantly greater with Alpha 200 at each set flow than with Cough
   Assist. As artificial airways were used, the insufflated volume did not
   differ from the control with Cough Assist, while with Alpha 200 it
   increased at each flow setting and for all mechanical conditions. The
   largest differences in insufflated volume between the 2 devices were
   observed for the largest endotracheal tubes and tracheostomy cannulas
   and for the lowest inflation flow setting in Alpha 200. These results
   can be explained in terms of how the devices function, as Cough Assist
   adapts by increasing flow, while Alpha 200 adapts by increasing
   inspiratory time. CONCLUSIONS: This bench study has shown that in the
   presence of artificial airways the value of the insufflated volume
   generated by the Cough Assist device was significantly lower than that
   generated by the Alpha 200 device.
RI RICHARD, Jean-Christophe/A-4097-2009
OI RICHARD, Jean-Christophe/0000-0003-1503-3035
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 0020-1324
UT WOS:000306537600011
PM 22494593
ER

PT J
AU Sloan, Sue
   Callaway, Libby
   Winkler, Dianne
   McKinley, Kirsten
   Ziino, Carlo
TI Accommodation Outcomes and Transitions Following Community-Based
   Intervention for Individuals with Acquired Brain Injury
SO BRAIN IMPAIRMENT
VL 13
IS 1
SI SI
BP 24
EP 43
DI 10.1017/BrImp.2012.5
PD JUL 2012
PY 2012
AB Objectives: To explore living situation, support and participation
   outcomes of people with severe acquired brain injury CABO residing in
   either home-like or disability-specific accommodation settings, who were
   provided with 3 years of occupational therapy intervention based on the
   Community Approach to Participation (CAP). To examine transitions for a
   subgroup whose accommodation and support model changed during this
   3-year period and identify factors critical to this change.
   Method: Forty-three participants who had sustained severe to extremely
   severe ABI, and were an average of 6.73 years post-injury, were provided
   with CAP intervention over a 3-year period. Living situation and support
   model, participation levels and accommodation transition data were
   collected at four time points.
   Results: Participants were living in a range of home-like and
   disability-specific accommodation settings at baseline. The
   disability-specific accommodation group had mainly noncompensable
   injuries and required a significantly higher level of daily support at
   all four time points. They also received higher total hours of support,
   which averaged 170.83 hours per week at baseline and did not change
   significantly over the 3 years. In contrast, 86% of the participants
   residing in home-like settings had compensable injuries and received an
   average of 91.46 hours of support per week at baseline. This reduced to
   70.97 hours per week over the 3-year intervention period, a change that
   was statistically significant.
   Conclusion: It is possible to achieve accommodation transitions to more
   independent, home-like situations many years post-injury and regardless
   of injury severity. Home-like settings provide scope to adjust support
   along a continuum to reflect gains in independence, community
   integration and role participation that the fixed models and hours of
   support in disability-specific accommodation do not. Over time, these
   gains can flow into a significant reduction in hours of support.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1443-9646
UT WOS:000305725200004
ER

PT J
AU Mendez-Tellez, Pedro A
   Nusr, Rasha
   Feldman, Dorianne
   Needham, Dale M
TI Early Physical Rehabilitation in the ICU: A Review for the
   Neurohospitalist.
SO The Neurohospitalist
VL 2
IS 3
BP 96
EP 105
DI 10.1177/1941874412447631
PD 2012-Jul
PY 2012
AB Advances in critical care have resulted in improved intensive care unit
   (ICU) mortality. However, improved ICU survival has resulted in a
   growing number of ICU survivors living with long-term sequelae of
   critical illness, such as impaired physical function and quality of life
   (QOL). In addition to critical illness, prolonged bed rest and
   immobility may lead to severe physical deconditioning and loss of muscle
   mass and muscle weakness. ICU-acquired weakness is associated with
   increased duration of mechanical ventilation and weaning, longer ICU and
   hospital stay, and increased mortality. These physical impairments may
   last for years after ICU discharge. Early Physical Medicine and
   Rehabilitation (PM&R) interventions in the ICU may attenuate or prevent
   the weakness and physical impairments occurring during critical illness.
   This article reviews the evidence regarding safety, feasibility,
   barriers, and benefits of early PM&R interventions in ICU patients and
   discusses the limited existing data on early PM&R in the neurological
   ICU and future directions for early PM&R in the ICU. 
TC 4
ZB 1
Z8 0
ZS 0
Z9 4
SN 1941-8744
UT MEDLINE:23983871
PM 23983871
ER

PT J
AU Rajabally, Yusuf A.
   Uncini, Antonino
TI Outcome and its predictors in Guillain-Barre syndrome
SO JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY
VL 83
IS 7
BP 711
EP 718
DI 10.1136/jnnp-2011-301882
PD JUL 2012
PY 2012
AB Despite the use of plasma exchanges and intravenous immunoglobulins,
   Guillain-Barre syndrome (GBS) still carries non-negligible morbidity and
   mortality. Furthermore, the psychosocial consequences of GBS may persist
   longer than expected. Various aetiological, clinical,
   electrophysiological and immunological factors may carry prognostic
   predictive value. The objective of this article was to perform a summary
   of the current knowledge-base on outcome and its determinants in
   adequately-treated adult-onset GBS. Relevant prospective literature was
   reviewed through a Medline search of English-language articles published
   between 1966 and March 2012. GBS causes severe persistent disability in
   14% of patients at 1 year. Loss of full strength, persistent pain and
   need for professional change occurs in about 40%. Mortality is of about
   4% within the first year. Analysis of prognostic predictors consistently
   demonstrates the negative impact of higher age, preceding diarrhoea,
   greater disability/weaker muscles at admission, short interval between
   symptom-onset and admission, mechanical ventilation and absent/low
   amplitude compound muscle action potentials. Further outcome studies
   will soon be underway and may in future contribute to adequately
   integrate all potential factors in more reliable predictive models.
TC 18
ZB 7
Z8 0
ZS 1
Z9 19
SN 0022-3050
UT WOS:000304907500010
PM 22566597
ER

PT J
AU Rodriguez, Pablo O.
   Setten, Mariano
   Maskin, Luis P.
   Bonelli, Ignacio
   Vidomlansky, Silvana Romero
   Attie, Shiry
   Frosiani, Silvana L.
   Kozima, Shigeru
   Valentini, Ricardo
TI Muscle weakness in septic patients requiring mechanical ventilation:
   Protective effect of transcutaneous neuromuscular electrical stimulation
SO JOURNAL OF CRITICAL CARE
VL 27
IS 3
AR 319.e1
DI 10.1016/j.jcrc.2011.04.010
PD JUN 2012
PY 2012
AB Purpose: The aim of this study was to evaluate the effect of
   transcutaneous neuromuscular electrical stimulation (NMES) on muscle
   strength in septic patients requiring mechanical ventilation (MV).
   Methods: Sixteen septic patients requiring MV and having 1 or more organ
   failure other than respiratory dysfunction were enrolled within 48 hours
   from admission to the intensive care unit. Neuromuscular electrical
   stimulation was administered twice a day on brachial biceps and vastus
   medialis (quadriceps) of 1 side of the body until MV withdrawal. Blinded
   investigators measured arm and thigh circumferences, biceps thickness by
   ultrasonography, and muscle strength after awakening with Medical
   Research Council scale.
   Results: Two patients died before strength evaluation and were excluded
   from the analysis. Neuromuscular electrical stimulation was applied for
   13 days (interquartile range, 7-30 days). Biceps (P = .005) and
   quadriceps (P = .034) strengths were significantly higher on the
   stimulated side at the last day of NMES. Improvement was mainly observed
   in more severe and weaker patients. Circumference of the nonstimulated
   arm decreased at the last day of NMES (P = .015), whereas no other
   significant differences in limb circumferences or biceps thickness were
   observed.
   Conclusion: Neuromuscular electrical stimulation was associated with an
   increase in strength of the stimulated muscle in septic patients
   requiring MV. Neuromuscular electrical stimulation may be useful to
   prevent muscle weakness in this population. (C) 2012 Elsevier Inc. All
   rights reserved.
TC 1
ZB 1
Z8 1
ZS 0
Z9 2
SN 0883-9441
UT WOS:000304872000030
PM 21715139
ER

PT J
AU Fan, Eddy
TI Critical Illness Neuromyopathy and the Role of Physical Therapy and
   Rehabilitation in Critically Ill Patients
SO RESPIRATORY CARE
VL 57
IS 6
BP 933
EP 946
DI 10.4187/respcare.01634
PD JUN 2012
PY 2012
AB Neuromuscular complications of critical illness are common, and can be
   severe and persistent, with substantial impairment in physical function
   and long-term quality of life. While the etiology of ICU-acquired
   weakness (ICUAW) is multifactorial, both direct (ie, critical illness
   neuromyopathy) and indirect (ie, immobility/disuse atrophy)
   complications of critical illness contribute to it. ICUAW is often
   difficult to diagnose clinically during the acute phase of critical
   illness, due to the frequent use of deep sedation, encephalopathy, and
   delirium, which impair physical examination for patient strength.
   Despite its limitations, physical examination is the starting point for
   identification of ICUAW in the cooperative patient. Given the relative
   cost, invasiveness, and need for expertise, electrophysiological testing
   and/or muscle biopsy may be reserved for weak patients with slower than
   expected improvement on serial clinical examination. Currently there are
   limited interventions to prevent or treat ICUAW, with tight glycemic
   control having the greatest supporting evidence. There is a paucity of
   clinical trials evaluating the specific role of early rehabilitation in
   the chronic critically ill. However, a number of studies support the
   benefit of intensive rehabilitation in patients receiving chronic
   mechanical ventilation. Furthermore, emerging data demonstrate the
   safety, feasibility, and potential benefit of early mobility in
   critically ill patients, with the need for multicenter randomized trials
   to evaluate potential short- and long-term benefits of early mobility,
   including the potential to prevent the need for prolonged mechanical
   ventilation and/or the development of chronic critical illness, and
   other novel treatments on patients' muscle strength, physical function,
   quality of life, and resource utilization. Finally, the barriers,
   feasibility, and efficacy of early mobility in both medical and other
   ICUs (eg, surgical, neurological, pediatric), as well as in the chronic
   critically ill, have not been formally evaluated and require exploration
   in future clinical trials.
CT 49th Respiratory Care Journal Conference on Chronically Critically Ill
   Patient
CY SEP 09-10, 2011
CL St Petersburg, FL
SP Amer Resp Care Fdn
TC 11
ZB 3
Z8 1
ZS 0
Z9 12
SN 0020-1324
UT WOS:000305047600008
PM 22663968
ER

PT J
AU Peterson-Carmichael, Stacey L.
   Cheifetz, Ira M.
TI The Chronically Critically Ill Patient: Pediatric Considerations
SO RESPIRATORY CARE
VL 57
IS 6
BP 993
EP 1003
DI 10.4187/respcare.01738
PD JUN 2012
PY 2012
AB Whether defined as chronically critically ill, long-term mechanical
   ventilator dependent (or otherwise chronically medically supported), or
   medically fragile, a population of infants and children with chronic
   illness clearly exists. Infants and children with chronic healthcare
   needs are at an increased risk for physical, developmental, behavioral,
   and/or emotional conditions and generally require healthcare services of
   a type or amount beyond that of a general pediatric or adult population.
   This review will focus on the specific management and psychosocial needs
   associated with the healthcare of this subgroup of infants and children
   with chronic illness. Attention will be paid to defining the population,
   describing trends over time, reviewing their special needs, and
   discussing outcomes. Increased focus and an increasing quantity of
   resources for this subgroup of infants and children are needed, as the
   number of such pediatric patients continues to grow.
CT 49th Respiratory Care Journal Conference on Chronically Critically Ill
   Patient
CY SEP 09-10, 2011
CL St Petersburg, FL
SP Amer Resp Care Fdn
TC 6
ZB 1
Z8 0
ZS 0
Z9 6
SN 0020-1324
UT WOS:000305047600012
PM 22663972
ER

PT J
AU Nelson, W. Bradley
   Smuder, Ashley J.
   Hudson, Matthew B.
   Talbert, Erin E.
   Powers, Scott K.
TI Cross-talk between the calpain and caspase-3 proteolytic systems in the
   diaphragm during prolonged mechanical ventilation
SO CRITICAL CARE MEDICINE
VL 40
IS 6
BP 1857
EP 1863
DI 10.1097/CCM.0b013e318246bb5d
PD JUN 2012
PY 2012
AB Objective: Diaphragmatic weakness, due to both atrophy and contractile
   dysfunction, is a well-documented response following prolonged
   mechanical ventilation. Evidence indicates that activation of the
   proteases calpain and caspase-3 is essential for mechanical
   ventilation-induced diaphragmatic weakness to occur. We tested the
   hypothesis that a regulatory cross-talk exists between calpain and
   caspase-3 in the diaphragm during prolonged mechanical ventilation. To
   test this prediction, we determined whether selective pharmacological
   inhibition of calpain would prevent activation of caspase-3 and
   conversely whether selective inhibition of caspase-3 would abate calpain
   activation.
   Design: Animal study.
   Setting: University Research Laboratory.
   Subjects: Female Sprague-Dawley rats.
   Interventions: Animals were randomly divided into control or one of
   three 12-hr mechanical ventilation groups that were treated with/without
   a selective pharmacological protease inhibitor: 1) control, 2)
   mechanical ventilation, 3) mechanical ventilation with a selective
   caspase-3 inhibitor, and 4) mechanical ventilation with a selective
   calpain inhibitor.
   Measurements and Main Results: Compared to control, mechanical
   ventilation resulted in calpain and caspase-3 activation in the
   diaphragm accompanied by atrophy of type I, type IIa, and type IIx/IIb
   fibers. Independent inhibition of either calpain or caspase-3 prevented
   this mechanical ventilation-induced atrophy. Pharmacological inhibition
   of calpain prevented mechanical ventilation-induced activation of
   diaphragmatic caspase-3 and inhibition of caspase-3 prevented activation
   of diaphragmatic calpain. Furthermore, calpain inhibition also prevented
   the activation of caspase-9 and caspase-12, along with the cleavage of
   Bid to tBid, all upstream signals for caspase-3 activation. Lastly,
   caspase-3 inhibition prevented the mechanical ventilation-induced
   degradation of the endogenous calpain inhibitor, calpastatin.
   Conclusions: Collectively, these results indicate that mechanical
   ventilation-induced diaphragmatic atrophy is dependent on the activation
   of both calpain and caspase-3. Importantly, these findings provide the
   first experimental evidence in diaphragm muscle that calpain inhibition
   prevents the activation of caspase-3 and vice versa and caspase-3
   inhibition prevents the activation of calpain. These findings support
   our hypothesis that a regulatory calpain/caspase-3 cross-talk exists
   whereby calpain can promote caspase-3 activation and active caspase-3
   can enhance calpain activity in diaphragm muscle during prolonged
   mechanical ventilation. (Crit Care Med 2012; 40:1857-1863)
RI Hudson, Matthew/E-4246-2010
TC 24
ZB 20
Z8 1
ZS 0
Z9 25
SN 0090-3493
UT WOS:000304335600023
PM 22487998
ER

PT J
AU Andrews, Bree
   Lagatta, Joanne
   Chu, Alison
   Plesha-Troyke, Susan
   Schreiber, Michael
   Lantos, John
   Meadow, William
TI The nonimpact of gestational age on neurodevelopmental outcome for
   ventilated survivors born at 23-28 weeks of gestation
SO ACTA PAEDIATRICA
VL 101
IS 6
BP 574
EP 578
DI 10.1111/j.1651-2227.2012.02609.x
PD JUN 2012
PY 2012
AB Aim: It has long been known that survival of preterm infants strongly
   depends upon birth weight and gestational age. This study addresses a
   different question whether the gestational maturity improves
   neurodevelopmental outcomes for ventilated infants born at 2328 weeks
   who survive to neonatal intensive care unit (NICU) discharge. Methods:
   We performed a prospective cohort study of 199 ventilated infants born
   between 23 and 28 weeks of gestation. Neurodevelopmental impairment was
   determined using the Bayley Scales of Infant Development-II at 24
   months. Results: As expected, when considered as a ratio of all births,
   both survival and survival without neurodevelopmental impairment were
   strongly dependent on gestational age. However, the percentage of
   surviving infants who displayed neurodevelopmental impairment did not
   vary with gestational age for any level of neurodevelopmental impairment
   (MDI or PDI <50, <60, <70). Moreover, as a higher percentage of
   ventilated infants survived to NICU discharge at higher gestational
   ages, but the percentage of neurodevelopmental impairment in NICU
   survivors was unaffected by gestational age, the percentage of all
   ventilated births who survived with neurodevelopmental impairment rose
   not fell with increasing gestation age. Conclusion: For physicians,
   parents and policy-makers whose primary concern is the presence of
   neurodevelopmental impairment in infants who survive the NICU, reliance
   on gestational age appears to be misplaced.
TC 8
ZB 6
Z8 0
ZS 0
Z9 8
SN 0803-5253
UT WOS:000303237900015
PM 22277021
ER

PT J
AU Archambault, Patrick M.
   St-Onge, Maude
TI Invasive and Noninvasive Ventilation in the Emergency Department
SO EMERGENCY MEDICINE CLINICS OF NORTH AMERICA
VL 30
IS 2
BP 421
EP +
DI 10.1016/j.emc.2011.10.008
PD MAY 2012
PY 2012
AB This article reviews invasive and noninvasive ventilation for emergency
   physicians. It presents an overview of respiratory physiology principles
   that will help emergency physicians adapt their ventilation strategies
   to any clinical situation. The basic modes of ventilation are
   summarized. The advantages and limitations of certain novel modes of
   ventilation are presented. This review highlights a variety of
   ventilation strategies to be used for patients with normal lung
   mechanics and gas exchange, acute hypoxemic respiratory failure,
   decreased lung compliance, airflow obstruction, and weakness or
   restriction of the chest wall. This article will help clinicians
   prevent, recognize, and treat complications of mechanical ventilation.
RI St-Onge, Maude/B-3066-2015
OI St-Onge, Maude/0000-0001-5157-1442
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 0733-8627
UT WOS:000303945000011
PM 22487113
ER

PT J
AU Paulides, Fleur M.
   Plotz, Frans B.
   Verweij-van den Oudenrijn, Laura P.
   van Gestel, Josephus P. J.
   Kampelmacher, Mike J.
TI Thirty years of home mechanical ventilation in children: escalating need
   for pediatric intensive care beds
SO INTENSIVE CARE MEDICINE
VL 38
IS 5
BP 847
EP 852
DI 10.1007/s00134-012-2545-9
PD MAY 2012
PY 2012
AB To describe trends in pediatric home mechanical ventilation (HMV) and
   their impact on the use of pediatric intensive care unit (PICU) beds.
   Review of all children who had started HMV in a single center for HMV.
   Between 1979 and 2009, HMV was started in 197 patients [100 (51 %) with
   invasive and 97 with noninvasive ventilation], with a median age of 14.7
   (range 0.5-17.9) years. Most patients (77 %) were males with a
   neuromuscular disorder (66 %). The number of children receiving HMV
   increased from 8 in the 1979-1988 period to 122 in the 1999-2008 period.
   This increase occurred foremost in patients aged 0-5 years and was
   accompanied by a sharp rise in the use of PICU beds. In 150 patients (76
   %), HMV was initiated on an ICU with a total of 12,440 admission days,
   of which 10,385 days (83 %) could be attributed to 67 patients who
   started non-electively with invasive HMV. Of the latter, 52 patients had
   been admitted to a PICU with a total of 9,335 admission days. At the end
   of the study, 134 patients (68 %) were still being ventilated, 43
   patients (22 %) had died, 11 patients (6 %) were weaned from HMV, 4
   patients (2 %) did not want to continue HMV and 5 patients (3 %) were
   lost to follow-up.
   Over time, there was an impressive increase in the application of HMV in
   children. This increase was most obvious in the youngest age group with
   invasive HMV, and these children had very long stays in the PICU.
TC 8
ZB 2
Z8 0
ZS 0
Z9 8
SN 0342-4642
UT WOS:000303453200014
PM 22476447
ER

PT J
AU Puthucheary, Zudin
   Rawal, Jaikirty
   Ratnayake, Gamunu
   Harridge, Stephen
   Montgomery, Hugh
   Hart, Nicholas
TI Neuromuscular Blockade and Skeletal Muscle Weakness in Critically Ill
   Patients Time to Rethink the Evidence?
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 185
IS 9
BP 911
EP 917
DI 10.1164/rccm.201107-1320OE
PD MAY 1 2012
PY 2012
AB Neuromuscular blocking agents are commonly used in critical care.
   However, concern after observational reports of a causal relationship
   with skeletal muscle dysfunction and intensive care-acquired weakness
   (ICU-AW) has resulted n a cautionary and conservative approach to their
   use. This integrative review, interpreted in the context of our current
   understanding of the pathophysiology of ICU-AW and integrated into our
   current conceptual framework of clinical practice, challenges the
   established clinical view of an adverse relationship between the use of
   neuromuscular blocking agents and skeletal muscle weakness. In addition
   to discussing data, this review identifies potential con founders and
   alternative etiological factors responsible for ICU-AW and provides
   evidence that neuromuscular blocking agents may not be a major cause of
   weakness in a 21st century critical care setting.
TC 12
ZB 6
Z8 0
ZS 0
Z9 12
SN 1073-449X
UT WOS:000303182700005
PM 22550208
ER

PT J
AU Files, D. Clark
   D'Alessio, Franco R.
   Johnston, Laura F.
   Kesari, Priya
   Aggarwal, Neil R.
   Garibaldi, Brian T.
   Mock, Jason R.
   Simmers, Jessica L.
   DeGorordo, Antonio
   Murdoch, Jared
   Willis, Monte S.
   Patterson, Cam
   Tankersley, Clarke G.
   Messi, Maria L.
   Liu, Chun
   Delbono, Osvaldo
   Furlow, J. David
   Bodine, Sue C.
   Cohn, Ronald D.
   King, Landon S.
   Crow, Michael T.
TI A Critical Role for Muscle Ring Finger-1 in Acute Lung Injury-associated
   Skeletal Muscle Wasting
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 185
IS 8
BP 825
EP 834
DI 10.1164/rccm.201106-1150OC
PD APR 15 2012
PY 2012
AB Rationale: Acute lung injury (ALI) is a debilitating condition
   associated with severe skeletal muscle weakness that persists in humans
   long after lung injury has resolved. The molecular mechanisms underlying
   this condition are unknown.
   Objectives: To identify the muscle-specific molecular mechanisms
   responsible for muscle wasting in a mouse model of ALI.
   Methods: Changes in skeletal muscle weight, fiber size, in vivo
   contractile performance, and expression of mRNAs and proteins encoding
   muscle atrophy associated genes for muscle ring finger-1 (MuRF1) and
   atrogin1 were measured. Genetic inactivation of MuRF1 or
   electroporation-mediated transduction of miRNA-based short hairpin RNAs
   targeting either MuRF1 or atrogin1 were used to identify their role in
   ALI-associated skeletal muscle wasting.
   Measurements and Main Results: Mice with All developed profound muscle
   atrophy and preferential loss of muscle contractile proteins associated
   with reduced muscle function in vivo. Although mRNA expression of the
   muscle-specific ubiquitin ligases, MuRF1 and atrogin1, was increased in
   ALI mice, only MuRF1 protein levels were up-regulated. Consistent with
   these changes, suppression of MuRF1 by genetic or biochemical approaches
   prevented muscle fiber atrophy, whereas suppression of atrogin1
   expression was without effect. Despite resolution of lung injury and
   down-regulation of MuRF1 and atrogin1, force generation in ALI mice
   remained suppressed.
   Conclusions: These data show that MuRF1 is responsible for mediating
   muscle atrophy that occurs during the period of active lung injury in
   ALI mice and that, as in humans, skeletal muscle dysfunction persists
   despite resolution of lung injury.
TC 20
ZB 14
Z8 0
ZS 0
Z9 20
SN 1073-449X
UT WOS:000302766300011
PM 22312013
ER

PT J
AU Bloch, S.
   Polkey, M. I.
   Griffiths, M.
   Kemp, P.
TI Molecular mechanisms of intensive care unit-acquired weakness
SO EUROPEAN RESPIRATORY JOURNAL
VL 39
IS 4
BP 1000
EP 1011
DI 10.1183/09031936.00090011
PD APR 2012
PY 2012
AB Intensive care unit-acquired weakness (ICUAW) is an increasingly
   recognised and important clinical consequence of critical illness. It is
   associated with significant morbidity and mortality. The aetiology of
   this disease is not well understood. The purpose of this article is to
   review our understanding of the molecular pathogenesis of ICUAW in the
   context of current knowledge of clinical risk factors and aetiology.
   Key features of the disease are loss of muscle mass resulting from a
   shift in the dynamic balance of muscle protein synthesis and breakdown
   and a reduction in force-generating capacity. These alternations are
   secondary to neuropathy, disruption of the myofilament structure and
   function, a disrupted sarcoplasmic reticulum, electrical inexcitability
   and bioenergenetic failure.
   As knowledge and understanding of ICUAW grows, potential therapeutic
   targets will be identified, hopefully leading to multiple strategies for
   prevention and treatment of this important condition.
TC 10
ZB 3
Z8 0
ZS 0
Z9 10
SN 0903-1936
UT WOS:000302354900030
PM 21965224
ER

PT J
AU Karakurt, Zuhal
   Fanfulla, Francesco
   Ceriana, Piero
   Carlucci, Annalisa
   Grassi, Mario
   Colombo, Roberto
   Karakurt, Sait
   Nava, Stefano
TI Physiologic determinants of prolonged mechanical ventilation in patients
   after major surgery
SO JOURNAL OF CRITICAL CARE
VL 27
IS 2
AR 221.e9
DI 10.1016/j.jcrc.2011.08.009
PD APR 2012
PY 2012
AB Purpose: The aim of the study was to evaluate the physiologic
   determinants of ventilator dependency in patients who underwent major
   surgery.
   Materials and Methods: In this observational study, 43 stable
   tracheostomized patients undergoing prolonged ventilation (>14 days)
   were evaluated. Diaphragmatic muscle function was assessed invasively by
   the tension-time index of the diaphragm (TTdi), an indicator of
   diaphragm endurance time. The TTdi was calculated as transdiaphragmatic
   pressure/maximum transdiaphragmatic pressure x inspiratory time/total
   respiratory time and was recorded either when weaning from mechanical
   ventilation had finally been successful (n = 28 patients) or at the end
   of the fifth week in those patients in whom weaning failed (FW) (n =
   15). Furthermore, the characteristics of survivors (n = 33) were
   compared with those of nonsurvivors (n = 10).
   Results: Successfully weaned patients had a lower breathing
   frequency/tidal volume or rapid shallow breathing index compared with FW
   patients (93.9 +/- 45.5 vs 142.4 +/- 60.3, respectively; P < .005). The
   TTdi was significantly higher in FW than in successfully weaned patients
   (0.107 +/- 0.050 vs 0.148 +/- 0.059; P < .023) and in nonsurvivors than
   in survivors (0.106 +/- 0.046 vs 0.174 +/- 0.058, P < .0001,
   respectively). A transdiaphragmatic pressure/maximum transdiaphragmatic
   pressure ratio of more than 40% was an independent predictor of
   mortality, whereas an increased frequency/tidal volume ratio and TTdi
   were independent predictors of weaning failure.
   Conclusions: Difficult-to-wean patients after major surgery have overall
   a limited diaphragm endurance time, in particular, FW breathe very close
   to the fatigue threshold, and they adopt a rapid shallow breathing
   respiratory pattern to avoid crossing this threshold. (C) 2012 Elsevier
   Inc. All rights reserved.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0883-9441
UT WOS:000302291300023
PM 22033055
ER

PT J
AU Tiruvoipati, Ravindranath
   Botha, John
   Peek, Giles
TI Effectiveness of extracorporeal membrane oxygenation when conventional
   ventilation fails: Valuable option or vague remedy?
SO JOURNAL OF CRITICAL CARE
VL 27
IS 2
BP 192
EP 198
DI 10.1016/j.jcrc.2011.04.003
PD APR 2012
PY 2012
AB The mortality and morbidity of patients with severe acute respiratory
   distress syndrome (ARDS) remains high despite the advances in intensive
   care practice. The low-tidal-volume ventilation strategy (ARDS net
   protocol) has been shown to be effective in improving survival.
   Unfortunately, however, some patients have such severe ARDS that they
   cannot be managed with the ARDS net strategy. In these patients, rescue
   therapies such as high-frequency ventilation, prone ventilation, nitric
   oxide, and extracorporeal membrane oxygenation (ECMO) are considered.
   The CESAR trial has shown that an ECMO-based protocol improved survival
   without severe disability as compared with conventional ventilation. The
   recent increased incidence of severe respiratory failure due to H1N1
   influenza pandemic has led to an increased use of ECMO. Although several
   reports showed ECMO use to be encouraging, some scepticism remains. In
   this article, we reviewed the usefulness of ECMO in patients with severe
   ARDS in the light of current evidence. Crown Copyright (C) 2012
   Published by Elsevier Inc. All rights reserved.
TC 11
ZB 5
Z8 2
ZS 0
Z9 13
SN 0883-9441
UT WOS:000302291300013
PM 21703814
ER

PT J
AU van Hees, Hieronymus W. H.
   Schellekens, Willem-Jan M.
   Acuna, Gilberto L. Andrade
   Linkels, Marianne
   Hafmans, Theo
   Ottenheijm, Coen A. C.
   Granzier, Henk L.
   Scheffer, Gert-Jan
   van der Hoeven, Johannes G.
   Dekhuijzen, P. N. Richard
   Heunks, Leo M. A.
TI Titin and diaphragm dysfunction in mechanically ventilated rats
SO INTENSIVE CARE MEDICINE
VL 38
IS 4
BP 702
EP 709
DI 10.1007/s00134-012-2504-5
PD APR 2012
PY 2012
AB Diaphragm weakness induced by mechanical ventilation may contribute to
   difficult weaning from the ventilator. For optimal force generation the
   muscle proteins myosin and titin are indispensable. The present study
   investigated if myosin and titin loss or dysfunction are involved in
   mechanical ventilation-induced diaphragm weakness.
   Male Wistar rats were either assigned to a control group (n = 10) or
   submitted to 18 h of mechanical ventilation (MV, n = 10). At the end of
   the experiment, diaphragm and soleus muscle were excised for functional
   and biochemical analysis.
   Maximal specific active force generation of muscle fibers isolated from
   the diaphragm of MV rats was lower than controls (128 +/- A 9 vs. 165
   +/- A 13 mN/mm(2), p = 0.02) and was accompanied by a proportional
   reduction of myosin heavy chain concentration in these fibers. Passive
   force generation upon stretch was significantly reduced in diaphragm
   fibers from MV rats by ca. 35%. Yet, titin content was not significantly
   different between control and MV diaphragm. In vitro pre-incubation with
   phosphatase-1 decreased passive force generation upon stretch in
   diaphragm fibers from control, but not from MV rats. Mechanical
   ventilation did not affect active or passive force generation in the
   soleus muscle.
   Mechanical ventilation leads to impaired diaphragm fiber active
   force-generating capacity and passive force generation upon stretch.
   Loss of myosin contributes to reduced active force generation, whereas
   reduced passive force generation is likely to result from a decreased
   phosphorylation status of titin. These impairments were not discernable
   in the soleus muscle of 18 h mechanically ventilated rats.
RI van Hees, Jeroen HWH/A-1276-2011; Dekhuijzen, P.N.R./H-8024-2014; Scheffer, G.J./H-8086-2014
TC 9
ZB 6
Z8 0
ZS 0
Z9 9
SN 0342-4642
UT WOS:000301777900021
PM 22327561
ER

PT J
AU Jackson, James C.
   Ely, E. Wesley
   Morey, Miriam C.
   Anderson, Venice M.
   Denne, Laural B.
   Clune, Jennifer
   Siebert, Carol S.
   Archer, Kristin R.
   Torres, Renee
   Janz, David
   Schiro, Elena
   Jones, Julie
   Shintani, Ayumi K.
   Levine, Brian
   Pun, Brenda T.
   Thompson, Jennifer
   Brummel, Nathan E.
   Hoenig, Helen
TI Cognitive and physical rehabilitation of intensive care unit survivors:
   Results of the RETURN randomized controlled pilot investigation
SO CRITICAL CARE MEDICINE
VL 40
IS 4
BP 1088
EP 1097
DI 10.1097/CCM.0b013e3182373115
PD APR 2012
PY 2012
AB Background: Millions of patients who survive medical and surgical
   general intensive care unit care every year experience newly acquired
   long-term cognitive impairment and profound physical and functional
   disabilities. To overcome the current reality in which patients receive
   inadequate rehabilitation, we devised a multifaceted, in-home,
   telerehabilitation program implemented using social workers and
   psychology technicians with the goal of improving cognitive and
   functional outcomes.
   Methods: This was a single-site, feasibility, pilot, randomized trial of
   21 general medical/surgical intensive care unit survivors (8 controls
   and 13 intervention patients) with either cognitive or functional
   impairment at hospital discharge. After discharge, study controls
   received usual care (sporadic rehabilitation), whereas intervention
   patients received a combination of in-home cognitive, physical, and
   functional rehabilitation over a 3-month period via a social worker or
   master's level psychology technician utilizing telemedicine to allow
   specialized multidisciplinary treatment. Interventions over 12 wks
   included six in-person visits for cognitive rehabilitation and six
   televisits for physical/functional rehabilitation. Outcomes were
   measured at the completion of the rehabilitation program (i.e., at 3
   months), with cognitive functioning as the primary outcome. Analyses
   were conducted using linear regression to examine differences in 3-month
   outcomes between treatment groups while adjusting for baseline scores.
   Results: Patients tolerated the program with only one adverse event
   reported. At baseline both groups were well-matched. At 3-month
   follow-up, intervention group patients demonstrated significantly
   improved cognitive executive functioning on the widely used and
   well-normed Tower test (for planning and strategic thinking) vs.
   controls (median [interquartile range], 13.0 [11.5-14.0] vs. 7.5
   [4.0-8.5]; adjusted p < .01). Intervention group patients also reported
   better performance (i.e., lower score) on one of the most frequently
   used measures of functional status (Functional Activities Questionnaire
   at 3 months vs. controls, 1.0 [0.0 -3.0] vs. 8.0 [6.0-11.8], adjusted p
   = .04).
   Conclusions: A multicomponent rehabilitation program for intensive care
   unit survivors combining cognitive, physical, and functional training
   appears feasible and possibly effective in improving cognitive
   performance and functional outcomes in just 3 months. Future
   investigations with a larger sample size should be conducted to build on
   this pilot feasibility program and to confirm these results, as well as
   to elucidate the elements of rehabilitation contributing most to
   improved outcomes. (Crit Care Med 2012; 40:1088-1097)
RI Levine,  Brian/G-4328-2010
OI Levine,  Brian/0000-0003-4343-811X
TC 43
ZB 5
Z8 1
ZS 0
Z9 44
SN 0090-3493
UT WOS:000301813700006
PM 22080631
ER

PT J
AU Kasotakis, George
   Schmidt, Ulrich
   Perry, Dana
   Grosse-Sundrup, Martina
   Benjamin, John
   Ryan, Cheryl
   Tully, Susan
   Hirschberg, Ronald
   Waak, Karen
   Velmahos, George
   Bittner, Edward A.
   Zafonte, Ross
   Cobb, J. Perren
   Eikermann, Matthias
TI The surgical intensive care unit optimal mobility score predicts
   mortality and length of stay
SO CRITICAL CARE MEDICINE
VL 40
IS 4
BP 1122
EP 1128
DI 10.1097/CCM.0b013e3182376e6d
PD APR 2012
PY 2012
AB Objectives: To test if the surgical intensive care unit optimal mobility
   score predicts mortality and intensive care unit and hospital length of
   stay.
   Design: Prospective single-center cohort study.
   Setting: Surgical intensive care unit of the Massachusetts General
   Hospital.
   Patients:One hundred thirteen consecutive patients admitted to the
   surgical intensive care unit.
   Investigations: We tested the hypotheses that the surgical intensive
   care unit optimal mobility score independent of comorbidity index, Acute
   Physiology and Chronic Health Evaluation II, creatinine, hypotension,
   hypernatremia, acidosis, hypoxia, and hypercarbia predicts hospital
   mortality, surgical intensive care unit and total hospital length of
   stay.
   Measurements and Main Results: Two nurses independently predicted the
   patients' mobilization capacity by using the surgical intensive care
   unit optimal mobility score the morning after admission, whereas a third
   nurse recorded the achieved mobilization levels of patients at the end
   of the day. A multidisciplinary expert team measured patients' grip
   strength and assessed their predicted mobilization capacity
   independently. Multivariate analysis revealed that the surgical
   intensive care unit optimal mobility score was the only independent
   predictor of mortality. Surgical intensive care unit optimal mobility
   score, hypotension, and hypernatremia (>144 mmol/L) independently
   predicted intensive care unit length of stay, whereas the surgical
   intensive care unit optimal mobility score and hypernatremia predicted
   total hospital length of stay. The Acute Physiology and Chronic Health
   Evaluation II score was not identified in the multivariate analysis. The
   surgical intensive care unit optimal mobility score was also a reliable
   and valid instrument in predicting achieved mobilization levels of
   patients.
   Conclusions: In surgical critically ill patients presenting without
   preexisting impairment of functional mobility, the surgical intensive
   care unit optimal mobility score is a reliable and valid tool to predict
   mortality and intensive care unit and hospital length of stay. (Crit
   Care Med 2012; 40:1122-1128)
TC 22
ZB 7
Z8 0
ZS 0
Z9 22
SN 0090-3493
UT WOS:000301813700010
PM 22067629
ER

PT J
AU Hudson, Matthew B.
   Smuder, Ashley J.
   Nelson, W. Bradley
   Bruells, Christian S.
   Levine, Sanford
   Powers, Scott K.
TI Both high level pressure support ventilation and controlled mechanical
   ventilation induce diaphragm dysfunction and atrophy
SO CRITICAL CARE MEDICINE
VL 40
IS 4
BP 1254
EP 1260
DI 10.1097/CCM.0b013e31823c8cc9
PD APR 2012
PY 2012
AB Objectives: Previous workers have demonstrated that controlled
   mechanical ventilation results in diaphragm inactivity and elicits a
   rapid development of diaphragm weakness as a result of both contractile
   dysfunction and fiber atrophy. Limited data exist regarding the impact
   of pressure support ventilation, a commonly used mode of mechanical
   ventilation that permits partial mechanical activity of the diaphragm on
   diaphragm structure and function. We carried out the present study to
   test the hypothesis that high-level pressure support ventilation
   decreases the diaphragm pathology associated with CMV.
   Methods: Sprague-Dawley rats were randomly assigned to one of the
   following five groups:1) control (no mechanical ventilation); 2) 12 hrs
   of controlled mechanical ventilation (12CMV); 3) 18 hrs of controlled
   mechanical ventilation (18CMV); 4) 12 hrs of pressure support
   ventilation (12PSV); or 5) 18 hrs of pressure support ventilation
   (18PSV).
   Measurements and Main Results: We carried out the following measurements
   on diaphragm specimens: 4-hydroxynonenal-a marker of oxidative stress,
   active caspase-3 (casp-3), active calpain-1 (calp-1), fiber type
   cross-sectional area, and specific force (sp F). Compared with the
   control, both 12PSV and 18PSV promoted a significant decrement in
   diaphragmatic specific force production, but to a lesser degree than
   12CMV and 18CMV. Furthermore, 12CMV, 18PSV, and 18CMV resulted in
   significant atrophy in all diaphragm fiber types as well as significant
   increases in a biomarker of oxidative stress (4-hydroxynonenal) and
   increased proteolytic activity (20S proteasome, calpain-1, and
   caspase-3). Furthermore, although no inspiratory effort occurs during
   controlled mechanical ventilation, it was observed that pressure support
   ventilation resulted in large decrement, approximately 96%, in
   inspiratory effort compared with spontaneously breathing animals.
   Conclusions: High levels of prolonged pressure support ventilation
   promote diaphragmatic atrophy and contractile dysfunction. Furthermore,
   similar to controlled mechanical ventilation, pressure support
   ventilation-induced diaphragmatic atrophy and weakness are associated
   with both diaphragmatic oxidative stress and protease activation. (Crit
   Care Med 2012; 40:1254-1260)
RI Hudson, Matthew/E-4246-2010
TC 34
ZB 16
Z8 1
ZS 0
Z9 35
SN 0090-3493
UT WOS:000301813700028
PM 22425820
ER

PT J
AU Luetz, Alawi
   Goldmann, Anton
   Weber-Carstens, Steffen
   Spies, Claudia
TI Weaning from mechanical ventilation and sedation
SO CURRENT OPINION IN ANESTHESIOLOGY
VL 25
IS 2
BP 164
EP 169
DI 10.1097/ACO.0b013e32834f8ce7
PD APR 2012
PY 2012
AB Purpose of review
   Guidelines for weaning from sedation and weaning from ventilator gained
   increasing interest in recent years. This includes patients with acute
   respiratory distress syndrome, as well as other mechanically ventilated
   patients. This review will give an overview of the current literature
   and practice guidelines in ventilator and sedation weaning.
   Recent findings
   Sedation and ventilator weaning are closely linked. Weaning protocols
   for both sedation and ventilator weaning should be implemented in daily
   routine. The essential element of such algorithm should be a daily
   spontaneous awakening trial and spontaneous breathing trial.
   Furthermore, regularly monitoring for deepness of sedation and delirium
   should be implemented. Too deep sedation, as well as prolonged delirium
   is associated with higher mortality.
   Summary
   The most important conclusion we come to from recent randomized
   controlled trials is that only using an integrative algorithm for
   sedation and ventilator weaning can improve survival of ICU patients.
TC 7
ZB 1
Z8 0
ZS 0
Z9 7
SN 0952-7907
UT WOS:000301286100007
PM 22246460
ER

PT J
AU Bissett, Bernie
   Leditschke, I Anne
   Green, Margot
TI Specific inspiratory muscle training is safe in selected patients who
   are ventilator-dependent: a case series.
SO Intensive & critical care nursing : the official journal of the British
   Association of Critical Care Nurses
VL 28
IS 2
BP 98
EP 104
DI 10.1016/j.iccn.2012.01.003
PD 2012-Apr
PY 2012
AB BACKGROUND: Mechanical ventilation of intensive care patients results in
   inspiratory muscle weakness. Inspiratory muscle training may be useful,
   but no studies have specifically described the physiological response to
   training.
   RESEARCH QUESTIONS: Is inspiratory muscle training with a threshold
   device safe in selected ventilator-dependent patients? Does inspiratory
   muscle strength increase with high-intensity inspiratory muscle training
   in ventilator-dependent patients?
   DESIGN: Prospective cohort study of 10 medically stable
   ventilator-dependent adult patients.
   SETTING: Tertiary adult intensive care unit.
   METHODS: Inspiratory muscle training 5-6 days per week with a threshold
   device attached to the tracheostomy without supplemental oxygen.
   OUTCOME MEASURES: Physiological response to training (heart rate, mean
   arterial pressure, oxygen saturation and respiratory rate), adverse
   events, training pressures.
   RESULTS: No adverse events were recorded in 195 sessions studied. For
   each patient's second training session, no significant changes in heart
   rate (Mean Difference 1.3 bpm, 95% CI -2.7 to 5.3), mean arterial
   pressure (Mean Difference -0.9 mmHg, 95% CI -6.4 to 4.6), respiratory
   rate (Mean Difference 1.2 bpm, 95% CI -1.1 to 3.5 bpm) or oxygen
   saturation (Mean Difference 1.2%, 95% CI -0.6 to 3.0) were detected
   Training pressures increased significantly (Mean Difference 18.6
   cmH(2)O, 95% CI 11.8-25.3).
   CONCLUSION: Threshold-based inspiratory muscle training can be delivered
   safely in selected ventilator-dependent patients without supplemental
   oxygen. Inspiratory muscle training is associated with increased muscle
   strength, which may assist ventilatory weaning.
TC 5
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Z9 5
UT MEDLINE:22340987
PM 22340987
ER

PT J
AU Rosen, Beth A
TI Guillain-Barre syndrome.
SO Pediatrics in review / American Academy of Pediatrics
VL 33
IS 4
BP 164
EP 70; quiz 170-1
DI 10.1542/pir.33-4-164
PD 2012-Apr
PY 2012
AB Based on strong research evidence, in countries where poliomyelitis has
   been eliminated, GBS is the most common cause of acquired paralysis in
   children. (9)  Based on strong research evidence, GBS describes a
   spectrum of disorders caused by an autoimmune reaction against
   peripheral nerve components, including the myelin sheath and the axon.
   (10)(11)  Based on strong research evidence, GBS usually is preceded by
   a bacterial or viral infection, less likely by vaccination in the 1 to 4
   weeks before onset. The strongest relationship is with infection by C
   jejuni. (12)(13)  Based on strong research evidence, GBS in children
   most often presents with symmetrical ascending paralysis, diminished or
   absent reflexes, and often severe pain. Pain may lead to a delay in
   diagnosis. (2) (3)(9)(14)  Based on strong research evidence, the
   progressive phase peaks in 7 to 14 days and can lead to various levels
   of weakness, from abnormal gait to total paralysis, cranial nerve
   weakness, pain, respiratory compromise, and autonomic instability. (2) 
   Based on some research evidence and consensus, children require
   hospitalization and often intensive care until their condition
   stabilizes because of significant risk of respiratory compromise and
   autonomic instability. (15)  Based on strong research evidence in adults
   and some research evidence in children, IVIG and plasma exchange hasten
   recovery from GBS in patients with impaired ability to ambulate. (4)(6) 
   Based primarily on consensus, IVIG is the treatment of choice in
   children with GBS. (6)(9)(15)  Based on strong research evidence, the
   prognosis for full functional recovery in childhood GBS is excellent.
   (2)(8)(9).
TC 3
ZB 3
Z8 1
ZS 0
Z9 4
UT MEDLINE:22474113
PM 22474113
ER

PT J
AU Jensen, Gordon L.
   Wheeler, Dara
TI A new approach to defining and diagnosing malnutrition in adult critical
   illness
SO CURRENT OPINION IN CRITICAL CARE
VL 18
IS 2
BP 206
EP 211
DI 10.1097/MCC.0b013e328351683a
PD APR 2012
PY 2012
AB Purpose of review
   This review will highlight a new approach to defining malnutrition
   syndromes for critically ill adults that incorporates a modern
   understanding of the contributions of inflammatory response. A
   systematic approach to nutrition assessment is described to help support
   diagnosis.
   Recent findings
   Recent findings suggest that varying degrees of acute or chronic
   inflammation are key contributing factors in the pathogenesis of
   malnutrition in the setting of disease or injury. Newly proposed
   malnutrition syndromes include: 'starvation-associated malnutrition',
   when there is chronic starvation without inflammation; 'chronic
   disease-associated malnutrition', when inflammation is chronic and of
   mild to moderate degree; and 'acute disease or injury-associated
   malnutrition', when inflammation is acute and of severe degree.
   Summary
   Inflammation and malnutrition have an intimate interplay; the presence
   of inflammation contributes to the development of malnutrition and often
   limits the effectiveness of nutritional interventions. In turn, the
   associated malnutrition may blunt the effectiveness of medical
   therapies. A new approach to defining and diagnosing malnutrition
   syndromes can help to guide intervention and expected outcomes.
TC 13
ZB 4
Z8 0
ZS 0
Z9 13
SN 1070-5295
UT WOS:000301286400014
PM 22322266
ER

PT J
AU Dominelli, Paolo B.
   Sheel, A. William
TI Experimental approaches to the study of the mechanics of breathing
   during exercise
SO RESPIRATORY PHYSIOLOGY & NEUROBIOLOGY
VL 180
IS 2-3
BP 147
EP 161
DI 10.1016/j.resp.2011.10.005
PD MAR 15 2012
PY 2012
AB This review describes the methodology and analysis of respiratory
   mechanics as it pertains to dynamic exercise. Underlying physical
   principles governing respiratory mechanics and commonly used measuring
   instruments will be discussed. We explain the physiological basis behind
   respiration, along with the dynamics of pulmonary ventilation. This
   review will outline the theoretical framework behind several forms of
   analysis along with their specific pitfalls, advantages and assumptions.
   Particular attention will be given to the techniques used to estimate
   the mechanical work of breathing. Specifically, we detail the different
   styles of work of breathing analysis and their inherent limitations as
   well as common sources of error often encountered. Finally, recent
   technological advancements that contribute to the understanding of
   respiratory mechanics are explained. (C) 2011 Elsevier B.V. All rights
   reserved.
TC 5
ZB 4
Z8 0
ZS 0
Z9 5
SN 1569-9048
UT WOS:000301016200001
PM 22019486
ER

PT J
AU Paul, Birinder S.
   Bhatia, Rohit
   Prasad, Kameshwar
   Padma, M. V.
   Tripathi, Manjari
   Singh, M. B.
TI Clinical predictors of mechanical ventilation in Guillain-Barre syndrome
SO NEUROLOGY INDIA
VL 60
IS 2
BP 150
EP 153
DI 10.4103/0028-3886.96383
PD MAR-APR 2012
PY 2012
AB Background: Patients with Guillain-Barre syndrome (GBS) require assisted
   ventilation frequently. However, no single factor can predict ventilator
   requirement. Aims: To identify clinical variables which could predict
   the need for mechanical ventilation in GBS. Settings and Design:
   Tertiary hospital-based retrospective and prospective study. Materials
   and Methods: One hundred and thirty-eight GBS patients studied were
   divided into two groups ventilated (Group 1) and non-ventilated (Group
   2). Parameters assessed included age, gender, associated illness(es),
   antecedent events, first symptom at onset, time from onset to bulbar
   involvement, confinement to bed and peak disability, upper limb power
   and reflexes at nadir, presence of facial weakness, neck muscle weakness
   and autonomic dysfunction. Statistical Analysis: Multivariate predictors
   of ventilation were assessed using logistic regression analysis.
   Results: There were 53 patients in Group 1 and 85 in Group 2. The mean
   age in the two groups was comparable. On bivariate analysis,
   simultaneous weakness of upper (UL) and lower (LL) limbs as the initial
   symptom (P<0.001); UL power less than Grade 3/5 at nadir (P<0.001);
   presence of neck and bulbar weakness (P<0.001); shorter duration from
   onset to bulbar weakness and confinement to bed (P=0.001) and bilateral
   facial involvement (P<0.01) were more frequently associated with the
   need for ventilation. Preserved reflexes in UL at nadir was
   significantly associated with absence of the need for mechanical
   ventilation (P<0.01). On multivariate analysis, factors independently
   associated with the need for mechanical ventilation included
   simultaneous motor weakness in UL and LL as the initial symptom
   (P=0.02), UL power <3/5 (Medical Research Council grade) at nadir
   (P=0.013) and presence of bulbar weakness (P<0.001). Preserved reflexes
   in the UL at nadir was independently associated with a lesser need for
   ventilation (P=0.001). Conclusions: Comprehensive assessment of clinical
   features may predict the need for mechanical ventilation in patients of
   GBS.
TC 3
ZB 1
Z8 0
ZS 0
Z9 3
SN 0028-3886
UT WOS:000304604200003
PM 22626694
ER

PT J
AU Chen, Da-Wei
   Chen, Jin-Wen
   Xu, Wei
   Liu, Wei
   Du, Wen-Jin
   Li, Hua-Jun
TI A Pilot Study for Reliability and Validity of Mini-Physical Performance
   Test for Chinese Male Elders
SO INTERNATIONAL JOURNAL OF GERONTOLOGY
VL 6
IS 1
BP 16
EP 19
DI 10.1016/j.ijge.2011.09.022
PD MAR 2012
PY 2012
AB Background and purpose: Physical frailty may predict many adverse
   events, and it is important to identify a stable and easy clinical
   measurement to assess physical function for Chinese elders.
   Methods: We modified the mini-Physical Performance Test (PPT) of Wilkins
   et al by adding one-leg standing test and simulating the 15 meters timed
   walk with a 6 meters timed walk to construct the Chinese version
   mini-PPT (CM-PPT). A total of 170 elderly individuals were tested by
   CM-PPT and mini-mental state examination (MMSE). Twenty-three randomly
   chosen individuals were tested again by the same rater and another rater
   in a week, and the 15 meters timed walk and the Barthel index (BI) were
   also evaluated.
   Results: The Cronbach's coefficient of CM-PPT was 0.868, and the
   test-retest and inter-rater reliability were 0.96 and 0.99, respectively
   (p < 0.001). When the diseases influencing PPT other than cognitive
   disorders were excluded, CM-PPT was associated with MMSE (r=0.420, p <
   0.01) and age (r=-0.649, p < 0.001) in 47 participants. CM-PPT was also
   correlated with BI (r=0.667, p < 0.001), while 65% of the participants
   acquired full marks for BI and only 9% of the participants did so for
   CM-PPT. Of the 170 participants, 31 had different results between tandem
   and one-leg positions (p < 0.001). Of these participants, 90% were only
   able to do tandem position and 10% were only able to do one-leg
   position. There was no difference between the scores in 6- and 15 meters
   timed walk (p=0.49).
   Conclusion: CM-PPT is a stable test and more sensitive than the BI. It
   is moderately associated with MMSE in the elderly without diseases
   influencing PPT other than cognitive disorders. Copyright (C) 2012,
   Taiwan Society of Geriatric Emergency & Critical Care Medicine.
   Published by Elsevier Taiwan LLC. All rights reserved.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 1873-9598
UT WOS:000303370100004
ER

PT J
AU Bissett, B.
   Leditschke, I. A.
   Paratz, J. D.
   Boots, R. J.
TI Respiratory dysfunction in ventilated patients: can inspiratory muscle
   training help?
SO ANAESTHESIA AND INTENSIVE CARE
VL 40
IS 2
BP 236
EP 246
PD MAR 2012
PY 2012
AB Respiratory muscle dysfunction is associated with prolonged and
   difficult weaning from mechanical ventilation. This dysfunction in
   ventilator-dependent patients is multifactorial: there is evidence that
   inspiratory muscle weakness is partially explained by disuse atrophy
   secondary to ventilation, and positive end-expiratory pressure can
   further reduce muscle strength by negatively shifting the length-tension
   curve of the diaphragm. Polyneuropathy is also likely to contribute to
   apparent muscle weakness in critically ill patients, and nutritional and
   pharmaceutical effects may further compound muscle weakness. Moreover,
   psychological influences, including anxiety, may contribute to
   difficulty in weaning. There is recent evidence that inspiratory muscle
   training is safe and feasible in selected ventilator-dependent patients,
   and that this training can reduce the weaning period and improve overall
   weaning success rates. Extrapolating from evidence in sports medicine,
   as well as the known effects of inspiratory muscle training in chronic
   lung disease, a theoretical model is proposed to describe how
   inspiratory muscle training enhances weaning and recovery from
   mechanical ventilation. Possible mechanisms include increased protein
   synthesis (both Type 1 and Type 2 muscle fibres), enhanced limb
   perfusion via dampening of a sympathetically-mediated metaboreflex,
   reduced lactate levels and modulation of the perception of exertion,
   resulting in less dyspnoea and enhanced exercise capacity.
RI Boots, Robert/G-2209-2010; Boots, Rob/K-1159-2013
OI Boots, Robert/0000-0002-3901-4077; 
TC 5
ZB 2
Z8 0
ZS 0
Z9 5
SN 0310-057X
UT WOS:000301998600005
PM 22417017
ER

PT J
AU Cabrera Serrano, M.
   Rabinstein, A. A.
TI Usefulness of pulmonary function tests and blood gases in acute
   neuromuscular respiratory failure
SO EUROPEAN JOURNAL OF NEUROLOGY
VL 19
IS 3
BP 452
EP 456
DI 10.1111/j.1468-1331.2011.03539.x
PD MAR 2012
PY 2012
AB Background and purpose: Define the usefulness of pulmonary function
   tests (PFT) and arterial blood gases (ABG) in patients admitted to the
   ICU with acute neuromuscular respiratory failure (NMRF).
   Methods: We reviewed 76 patients admitted to an ICU at Mayo Clinic
   (Rochester) between 2003 and 2009 with acute NMRF defined as need for
   mechanical ventilation (MV) because of primary impairment of the
   peripheral nervous system. Poor functional outcome was defined as a
   modified Rankin score > 3.
   Results: Median age was 65 years. The most frequent diagnosis was
   myasthenia gravis (25 patients); 54% of patients had no known
   neuromuscular diagnosis before admission, and 11% had no specific
   diagnosis at discharge. Median MV time was 16 days; 14% of patients died
   during hospitalization, and 63% were severely disabled at discharge.
   Maximal expiratory pressure <= 30 cm H2O and maximal inspiratory
   pressure (MIP) worse than) 28 cm H2O before MV were associated with need
   for invasive MV for longer than 7 days (P = 0.02). Indicators of chronic
   respiratory acidosis (low pH, high pCO(2), and high HCO3) before MV were
   associated with in- hospital death and poor functional outcome, but
   mostly in patients with progressive, untreatable neuromuscular
   diagnoses.
   Conclusions: In patients with primary acute NMRF, bedside PFT and ABG
   before MV can be used to predict evolution and outcome. Lower MIP and
   MEP portend prolonged MV and are more useful than forced vital capacity.
   Presentation with chronic respiratory acidosis is associated with high
   risk of in- hospital mortality and severe disability, especially in
   patients without treatable diagnoses.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1351-5101
UT WOS:000300505800019
PM 21974753
ER

PT J
AU Navi, Babak B.
   Kamel, Hooman
   McCulloch, Charles E.
   Nakagawa, Kazuma
   Naravetla, Bharath
   Moheet, Asma M.
   Wong, Christine
   Johnston, S. Claiborne
   Hemphill, J. Claude, III
   Smith, Wade S.
TI Accuracy of Neurovascular Fellows' Prognostication of Outcome After
   Subarachnoid Hemorrhage
SO STROKE
VL 43
IS 3
BP 702
EP +
DI 10.1161/STROKEAHA.111.639161
PD MAR 2012
PY 2012
AB Background and Purpose-The purpose of this study was to determine the
   accuracy and optimal timing of physician prognostication in patients
   with subarachnoid hemorrhage, a prototypical neurological disease
   characterized by variable outcomes and frequent disability.
   Methods-From October 2009 to April 2010, treating neurologists at a
   tertiary care academic medical center made daily predictions of the
   modified Rankin Scale at 6 months for consecutive patients with
   subarachnoid hemorrhage. Actual functional outcomes at 6 months were
   determined by phone interview and dichotomized into good (modified
   Rankin Scale 0-2) and poor (modified Rankin Scale 3-6) outcomes.
   Descriptive statistics were used to assess the accuracy of
   prognostications. Multiple logistic regression and generalized
   estimating equations were used to assess changes in prognostication
   accuracy over time and the relationship between prognostication accuracy
   and clinical factors.
   Results-Physicians made 648 prognostications for 66 patients. Overall
   accuracy ranged from 78% to 88%. Among patients predicted to have a good
   outcome, 81% (95% CI, 71%-92%) actually had a good outcome, whereas 88%
   (95% CI, 77%-99%) of patients predicted to do poorly had poor outcomes.
   No significant trends were seen in prognostication accuracy over time
   during the hospital course (P = 0.72). Increasing age, infection,
   mechanical ventilation, hydrocephalus, and seizures all significantly
   worsened physician accuracy.
   Conclusions-Neurologists were generally but not perfectly accurate in
   their prognostications of functional outcomes. The accuracy of prognoses
   did not correlate with the hospital day on which they were made but was
   affected by clinical factors that can cloud the neurological
   examination. (Stroke. 2012; 43: 702-707.)
TC 12
ZB 6
Z8 0
ZS 0
Z9 12
SN 0039-2499
UT WOS:000300639400023
PM 22223238
ER

PT J
AU Oh, Jae K.
   Pellikka, Patricia A.
   Panza, Julio A.
   Biernat, Jolanta
   Attisano, Tiziana
   Manahan, Barbara G.
   Wiste, Heather J.
   Lin, Grace
   Lee, Kerry
   Miller, Fletcher A.
   Stevens, Susanna
   Sopko, George
   She, Lilin
   Velazquez, Eric J.
CA STICH Trial Investigators
TI Core Lab Analysis of Baseline Echocardiographic Studies in the STICH
   Trial and Recommendation for Use of Echocardiography in Future Clinical
   Trials
SO JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY
VL 25
IS 3
BP 327
EP 336
DI 10.1016/j.echo.2011.12.002
PD MAR 2012
PY 2012
AB Background: The Surgical Treatment for Ischemic Heart Failure (STICH)
   randomized trial was designed to identify an optimal management strategy
   for patients with ischemic cardiomyopathy. Baseline echocardiographic
   examinations were required for all patients. The primary aim of this
   report is to describe the baseline STICH Echocardiography Core
   Laboratory data. The secondary aim is to provide recommendations
   regarding how echocardiography should be used in clinical practice and
   research on the basis of the experience gained from echocardiography in
   STICH.
   Methods: Between September 2002 and January 2006, 2,136 patients with
   ejection fractions (EFs)<= 35% and coronary artery disease amenable to
   coronary artery bypass grafting were enrolled. Echocardiography was
   acquired by 122 clinical enrolling sites, and measurements were
   performed by the Echocardiography Core Laboratory after a certification
   process for all clinical sites.
   Results: Echocardiography was available for analysis in 2,006 patients
   (93.9%); 1,734 (86.4%) were men, and the mean age was 60.9 +/- 9.5
   years. The mean left ventricular end-systolic volume index, measureable
   in 72.8%, was 84.0 +/- 30.9 mL/m(2), and the mean EF was 28.9 +/- 8.3%,
   with 18.5% of patients having EFs > 35%. Single-plane measurements of
   left ventricular and left atrial volumes were similar to their volumes
   by biplane measurement (r = 0.97 and r = 0.92, respectively). Mitral
   regurgitation severity by visual assessment was associated with a wide
   range of effective regurgitant orifice area, while effective regurgitant
   orifice area >= 0.2 cm(2) indicated at least moderate mitral
   regurgitation by visual assessment. Deceleration time of mitral inflow
   velocity had a weak correlation with EF (r = 0.25) but was inversely
   related to estimated pulmonary artery systolic pressure (r = -0.49).
   Conclusions: In STICH patients with ischemic cardiomyopathy,
   Echocardiography Core Laboratory analysis of baseline echocardiographic
   findings demonstrated a wide spectrum of left ventricular shape,
   function, and hemodynamics, as well as the feasibility and limitations
   of obtaining essential echocardiographic measurements. It is critical
   that the use of echocardiographic parameters in clinical practice and
   research balance the strengths and weaknesses of the technique. (J Am
   Soc Echocardiogr 2012;25:327-36.)
TC 16
ZB 4
Z8 0
ZS 0
Z9 16
SN 0894-7317
UT WOS:000300633200015
PM 22227341
ER

PT J
AU Peters, Jay I.
   Stupka, J. Eric
   Singh, Harjinder
   Rossrucker, Jill
   Angel, Luis F.
   Melo, Jairo
   Levine, Stephanie M.
TI Status asthmaticus in the medical intensive care unit: A 30-year
   experience
SO RESPIRATORY MEDICINE
VL 106
IS 3
BP 344
EP 348
DI 10.1016/j.rmed.2011.11.015
PD MAR 2012
PY 2012
AB Objectives: To investigate the characteristics, trends in management
   (permissive hypercapnia; mechanical ventilation (MV); neuromuscular
   blockade) and their impact on complications and outcomes in Status
   Asthmaticus (SA).
   Methods: We performed a retrospective observational study of subjects
   admitted with SA to a single multidisciplinary MICU over a 30-year
   period. All laboratory, radiologic, respiratory care, physician notes
   and orders were extracted from an electronic medical record (EMR)
   maintained during the entire duration of the study.
   Results: Two hundred and twenty-seven subjects were admitted with 280
   episodes of SA. While subjects reflected our regional population (52%
   Hispanic), African Americans were over-represented (22%) and Caucasians
   under-represented (21%). Thirty-eight percent reported childhood asthma,
   27% were steroid dependent (10% in the last 10 years), and 18% had a
   recent steroid taper. One hundred and thirty-nine (61.2%) required
   intubation. The duration of hospitalization was similar between
   mechanically ventilated and non-ventilated subjects (5.8 +/- 4.41 vs.
   6.8 +/- 7.22 days; p = 0.07). The overall complication rate remained low
   irrespective of the use of permissive hypercapnia or mode of mechanical
   ventilation (overall mortality 0.4%; pneumothorax 2.5%; pneumonia 2.9%).
   The frequency of SA declined significantly in the last 10 years of the
   study (12.4 vs. 3.2 cases/year).
   Conclusions: Despite the frequent use of mechanical ventilation,
   mortality/complication rates remained extremely low. MV did not
   significantly increase the duration of hospitalization. At our
   institution, the frequency of SA significantly decreased despite an
   increase in emergency room visits for asthma. Published by Elsevier Ltd.
TC 13
ZB 2
Z8 1
ZS 0
Z9 14
SN 0954-6111
UT WOS:000300127300004
PM 22188845
ER

PT J
AU Thomas, Cameron W.
   Meinzen-Derr, Jareen
   Hoath, Steven B.
   Narendran, Vivek
TI Neurodevelopmental Outcomes of Extremely Low Birth Weight Infants
   Ventilated with Continuous Positive Airway Pressure vs. Mechanical
   Ventilation
SO INDIAN JOURNAL OF PEDIATRICS
VL 79
IS 2
BP 218
EP 223
DI 10.1007/s12098-011-0535-5
PD FEB 2012
PY 2012
AB Objective To compare continuous positive airway pressure (CPAP) vs.
   traditional mechanical ventilation (MV) at 24 h of age as predictors of
   neurodevelopmental (ND) outcomes in extremely low birth weight (ELBW)
   infants at 18-22 mo corrected gestational age (CGA).
   Methods Infants <= 1000 g birth weight born from January 2000 through
   December 2006 at two hospitals at the Cincinnati site of the National
   Institute of Child Health and Human Development Neonatal Research
   Network were evaluated comparing CPAP (n=198) vs. MV (n=109). Primary
   outcomes included the Bayley Score of Infant Development Version II
   (BSID-II), presence of deafness, blindness, cerebral palsy,
   bronchopulmonary dysplasia and death.
   Results Ventilatory groups were similar in gender, rates of preterm
   prolonged rupture of membranes, antepartum hemorrhage, use of antenatal
   antibiotics, steroids, and tocolytics. Infants receiving CPAP weighed
   more, were older, were more likely to be non-Caucasian and from a
   singleton pregnancy. Infants receiving CPAP had better BSID-II scores,
   and lower rates of BPD and death.
   Conclusions After adjusting for acuity differences, ventilatory strategy
   at 24 h of age independently predicts long-term neurodevelopmental
   outcome in ELBW infants.
TC 8
ZB 5
Z8 1
ZS 0
Z9 9
SN 0019-5456
UT WOS:000302360700009
PM 21853318
ER

PT J
AU Bengmark, Stig
TI Pro- and Synbiotics to Prevent Sepsis in Major Surgery and Severe
   Emergencies
SO NUTRIENTS
VL 4
IS 2
BP 91
EP 111
DI 10.3390/nu4020091
PD FEB 2012
PY 2012
AB Septic morbidity associated with advanced surgical and medical
   treatments is unacceptably high, and so is the incidence of
   complications occurring in connection with acute emergencies such as
   severe trauma and severe acute pancreatitis. Only considering the US, it
   will annually affect approximately (app) 300 million (mill) of a
   population of almost one million inhabitants and cause the death of more
   than 200,000 patients, making sepsis the tenth most common cause of
   death in the US. Two major factors affect this, the lifestyle-associated
   increased weakness of the immune defense systems, but more than this the
   artificial environment associated with modern treatments such as
   mechanical ventilation, use of tubes, drains, intravascular lines,
   artificial nutrition and extensive use of synthetic chemical drugs,
   methods all known to reduce or eliminate the human microbiota and impair
   immune functions and increase systemic inflammation. Attempts to
   recondition the gut by the supply of microorganisms have sometimes shown
   remarkably good results, but too often failed. Many factors contribute
   to the lack of success: unsuitable choice of probiotic species, too low
   dose, but most importantly, this bio-ecological treatment has never been
   given the opportunity to be tried as an alternative treatment. Instead
   it has most often been applied as complementary to all the other
   treatments mentioned above, including antibiotic treatment. The
   supplemented lactic acid bacteria have most often been killed already
   before they have reached their targeted organs.
TC 2
ZB 1
Z8 1
ZS 0
Z9 3
SN 2072-6643
UT WOS:000300718900003
PM 22413064
ER

PT J
AU Smuder, Ashley J.
   Min, Kisuk
   Hudson, Matthew B.
   Kavazis, Andreas N.
   Kwon, Oh-Sung
   Nelson, W. Bradley
   Powers, Scott K.
TI Endurance exercise attenuates ventilator-induced diaphragm dysfunction
SO JOURNAL OF APPLIED PHYSIOLOGY
VL 112
IS 3
BP 501
EP 510
DI 10.1152/japplphysiol.01086.2011
PD FEB 2012
PY 2012
AB Smuder AJ, Min K, Hudson MB, Kavazis AN, Kwon OS, Nelson WB, Powers SK.
   Endurance exercise attenuates ventilator-induced diaphragm dysfunction.
   J Appl Physiol 112: 501-510, 2012. First published November 10, 2011;
   doi: 10.1152/japplphysiol.01086.2011.-Controlled mechanical ventilation
   (MV) is a life-saving measure for patients in respiratory failure.
   However, MV renders the diaphragm inactive leading to diaphragm weakness
   due to both atrophy and contractile dysfunction. It is now established
   that oxidative stress is a requirement for MV-induced diaphragmatic
   proteolysis, atrophy, and contractile dysfunction to occur. Given that
   endurance exercise can elevate diaphragmatic antioxidant capacity and
   the levels of the cellular stress protein heat shock protein 72 (HSP72),
   we hypothesized that endurance exercise training before MV would protect
   the diaphragm against MV-induced oxidative stress, atrophy, and
   contractile dysfunction in female Sprague-Dawley rats. Our results
   confirm that endurance exercise training before MV increased both HSP72
   and the antioxidant capacity in the diaphragm. Importantly, compared
   with sedentary animals, exercise training before MV protected the
   diaphragm against MV-induced oxidative damage, protease activation,
   myofiber atrophy, and contractile dysfunction. Further, exercise
   protected diaphragm mitochondria against MV-induced oxidative damage and
   uncoupling of oxidative phosphorylation. These results provide the first
   evidence that exercise can provide protection against MV-induced
   diaphragm weakness. These findings are important and establish the need
   for future experiments to determine the mechanism(s) responsible for
   exercise-induced diaphragm protection.
RI Hudson, Matthew/E-4246-2010
TC 13
ZB 6
Z8 0
ZS 0
Z9 13
SN 8750-7587
UT WOS:000300408300022
PM 22074717
ER

PT J
AU Benington, Steve
   McWilliams, David
   Eddleston, Jane
   Atkinson, Dougal
TI Exercise testing in survivors of intensive care-is there a role for
   cardiopulmonary exercise testing?
SO JOURNAL OF CRITICAL CARE
VL 27
IS 1
BP 89
EP 94
DI 10.1016/j.jcrc.2011.07.080
PD FEB 2012
PY 2012
AB Purpose: The aims of this study were to assess the feasibility of
   cardiopulmonary exercise testing (CPET) for the early assessment of
   cardiorespiratory fitness in general adult intensive care unit (ICU)
   survivors and to characterize the pathophysiology of exercise limitation
   in this population.
   Methods: Fifty general ICU survivors (ventilated for >= 5 days)
   performed a maximal cycle ergometer CPET within 6 weeks of hospital
   discharge. Health-related quality of life was measured by the Medical
   Outcome Study Short Form 36 version 2.0 questionnaire.
   Results: Fifty patients (median age, 57 years; median Acute Physiology
   And Chronic Health Evaluation II score, 16) completed a CPET 24 +/- 14
   days after hospital discharge with no adverse events. Significant
   exercise limitation was present with peak VO2 56% +/- 16% predicted and
   anaerobic threshold (AT) 41% +/- 13% of peak predicted VO2.
   Prospectively stratified subgroup comparison showed that patients
   ventilated for 14 days or more had a significantly lower AT and peak VO2
   than those ventilated for 5 to 14 days (AT: 9.6 vs 11.7 mL/kg per minute
   O-2, P = .009; peak VO2: 12.9 vs 15.3 mL/kg per minute O-2, P = .022).
   At peak exercise, heart rate reserve was 25% +/- 14%, breathing reserve
   was 47% +/- 19%, and the respiratory exchange ratio was 0.96 +/- 0.11.
   Ventilatory equivalents for CO2 (EqCO(2)) were 39 +/- 9.
   Conclusions: Significant exercise limitation is evident in patients who
   have had critical illness. Etiology of exercise limitation appears
   multifactorial, with general deconditioning and muscle weakness as major
   contributory factors. Early CPET appears a practical method of assessing
   exercise capacity in ICU survivors. Cardiopulmonary exercise testing
   could be used to select patients who may benefit most from a targeted
   physical rehabilitation program, aid in exercise prescription, and help
   assess the response to intervention. (C) 2012 Elsevier Inc. All rights
   reserved.
TC 6
ZB 1
Z8 0
ZS 0
Z9 6
SN 0883-9441
UT WOS:000300771600014
PM 21958985
ER

PT J
AU Ramadan, Ghada
   Paul, Nicola
   Morton, Margaret
   Peacock, Janet L.
   Greenough, Anne
TI Outcome of ventilated infants born at term without major congenital
   abnormalities
SO EUROPEAN JOURNAL OF PEDIATRICS
VL 171
IS 2
BP 331
EP 336
DI 10.1007/s00431-011-1549-8
PD FEB 2012
PY 2012
AB The longer-term outcome of term-born infants without congenital
   anomalies requiring ventilation in the first 24 h after birth has rarely
   been reported. Our aims were to determine the mortality and long-term
   morbidity of such infants and identify risk factors for adverse outcome.
   The outcomes of 43 of 45 infants born at term consecutively requiring
   mechanical ventilation were reviewed. The infants had: meconium
   aspiration syndrome (n=11), hypoxic ischaemic encephalopathy (HIE)
   (n=11), respiratory depression (n=12), sepsis (n=5), persistent
   pulmonary hypertension of the newborn (n=3) and middle cerebral artery
   infarction (n=1). Eleven infants developed seizures (26%), 13 (30%) had
   abnormal electroencephalograms and 11 (26%) had abnormal MRI scans; 26%
   had an adverse outcome: six died, and five had severe neurodisability at
   2 years. The infants with congenital toxoplasmosis and a middle cerebral
   artery infarction were excluded from the prediction analysis. In the
   remaining 41 patients, requirement for anticonvulsants (relative risk,
   RR=4.44, 95% CI=1.48 to 12.70; p=0.014) and prolonged ventilation
   (longer than 3 days) (RR 4.83, 95% CI 1.51 to 15.64) predicted adverse
   outcome. Infants with HIE had an increased risk of adverse outcome
   (relative risk 5.45, 95% CI 1.01 to 33.85), but an adverse outcome
   occurred in infants with other diagnoses. Conclusion: Mortality and
   neurodisability at follow-up were common in infants born at term without
   major congenital anomalies who required mechanical ventilation in the
   first 24 h after birth, particularly in those who developed seizures
   requiring treatment and prolonged ventilation.
TC 2
ZB 2
Z8 1
ZS 0
Z9 3
SN 0340-6199
UT WOS:000300669500017
PM 21833494
ER

PT J
AU Bierbrauer, Jeffrey
   Koch, Susanne
   Olbricht, Claudio
   Hamati, Jida
   Lodka, Doerte
   Schneider, Joanna
   Luther-Schroeder, Anja
   Kleber, Christian
   Faust, Katharina
   Wiesener, Solveigh
   Spies, Claudia D.
   Spranger, Joachim
   Spuler, Simone
   Fielitz, Jens
   Weber-Carstens, Steffen
TI Early type II fiber atrophy in intensive care unit patients with
   nonexcitable muscle membrane
SO CRITICAL CARE MEDICINE
VL 40
IS 2
BP 647
EP 650
DI 10.1097/CCM.0b013e31823295e6
PD FEB 2012
PY 2012
AB Objective: Intensive care unit-acquired weakness indicates increased
   morbidity and mortality. Nonexcitable muscle membrane after direct
   muscle stimulation develops early and predicts intensive care
   unit-acquired weakness in sedated, mechanically ventilated patients. A
   comparison of muscle histology at an early stage in intensive care
   unit-acquired weakness has not been done. We investigated whether
   nonexcitable muscle membrane indicates fast-twitch myofiber atrophy
   during the early course of critical illness.
   Design: Prospective observational study.
   Setting: Two intensive care units at Charite University Medicine,
   Berlin.
   Patients: Patients at increased risk for development of intensive care
   unit-acquired weakness, indicated by Sepsis-related Organ Failure
   Assessment scores >= 8 on 3 of 5 consecutive days within their first
   week in the intensive care unit.
   Interventions: None.
   Measurements and Main Results: Electrophysiological compound muscle
   action potentials after direct muscle stimulation and muscle biopsies
   were obtained at median days 7 and 5, respectively. Patients with
   nonexcitable muscle membranes (n = 15) showed smaller median type II
   cross-sectional areas (p <. 05), whereas type I muscle fibers did not
   compared with patients with preserved muscle membrane excitability
   (compound muscle action potentials after direct muscle stimulation >=
   3.0 mV; n = 9). We also observed decreased mRNA transcription levels of
   myosin heavy chain isoform IIa and a lower densitometric ratio of
   fast-to-slow myosin heavy chain protein content.
   Conclusion: We suggest that electrophysiological nonexcitable muscle
   membrane predicts preferential type II fiber atrophy in intensive care
   unit patients during early critical illness. (Crit Care Med 2012;
   40:647-650)
TC 16
ZB 6
Z8 0
ZS 0
Z9 16
SN 0090-3493
UT WOS:000299313500038
PM 21963579
ER

PT J
AU Babb, Tony
   Levine, Benjamin
   Philley, Julie
TI ICU-Acquired Weakness: An Extension of the Effects of Bed Rest
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 185
IS 2
BP 230
EP 231
PD JAN 15 2012
PY 2012
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1073-449X
UT WOS:000299311500023
PM 22246709
ER

PT J
AU Hodgson, Carol L.
   Hayes, Kate
   Everard, Tori
   Nichol, Alistair
   Davies, Andrew R.
   Bailey, Michael J.
   Tuxen, David V.
   Cooper, David J.
   Pellegrino, Vin
TI Long-term quality of life in patients with acute respiratory distress
   syndrome requiring extracorporeal membrane oxygenation for refractory
   hypoxaemia
SO CRITICAL CARE
VL 16
IS 5
AR R202
DI 10.1186/cc11811
PD 2012
PY 2012
AB Introduction: The purpose of the study was to assess the long term
   outcome and quality of life of patients with acute respiratory distress
   syndrome (ARDS) receiving extracorporeal membrane oxygenation (ECMO) for
   refractory hypoxemia.
   Methods: A retrospective observational study with prospective health
   related quality of life (HRQoL) assessment was conducted in ARDS
   patients who had ECMO as a rescue therapy for reversible refractory
   hypoxemia from January 2009 until April 2011 in a tertiary Australian
   centre. Survival and long-term quality of life assessment, using the
   Short-Form 36 (SF-36) and the EuroQol health related quality of life
   questionnaire (EQ5D) were assessed and compared to international data
   from other research groups.
   Results: Twenty-one patients (mean age 36.3 years) with ARDS receiving
   ECMO for refractory hypoxemia were studied. Eighteen (86%) patients were
   retrieved from external intensive care units (ICUs) by a dedicated ECMO
   retrieval team. Eleven (55%) had H1N1 influenza A-associated
   pneumonitis. Eighteen (86%) patients survived to hospital discharge. Of
   the 18 survivors, ten (56%) were discharged to other hospitals and 8
   (44%) were discharged directly home. Sequelae and health related quality
   of life were evaluated for 15 of the 18 (71%) long-term survivors
   (assessment at median 8 months). Mean SF-36 scores were significantly
   lower across all domains compared to age and sex matched Australian
   norms. Mean SF-36 scores were lower (minimum important difference at
   least 5 points) than previously described ARDS survivors in the domains
   of general health, mental health, vitality and social function. One
   patient had long-term disability as a result of ICU acquired weakness.
   Only 26% of survivors had returned to previous work levels at the time
   of follow-up.
   Conclusions: This ARDS cohort had a high survival rate (86%) after use
   of ECMO support for reversible refractory hypoxemia. Long term survivors
   had similar physical health but decreased mental health, general health,
   vitality and social function compared to other ARDS survivors and an
   unexpectedly poor return to work.
RI Cooper, D. James/G-7961-2013
OI Cooper, D. James/0000-0002-5872-9051
TC 13
ZB 4
Z8 0
ZS 0
Z9 15
SN 1466-609X
UT WOS:000317499900039
PM 23082772
ER

PT J
AU Parry, Selina M.
   Berney, Sue
   Koopman, Rene
   Bryant, Adam
   El-Ansary, Doa
   Puthucheary, Zudin
   Hart, Nicholas
   Warrillow, Stephen
   Denehy, Linda
TI Early rehabilitation in critical care (eRiCC): functional electrical
   stimulation with cycling protocol for a randomised controlled trial
SO BMJ OPEN
VL 2
IS 5
AR e001891
DI 10.1136/bmjopen-2012-001891
PD 2012
PY 2012
AB Introduction: Intensive care-acquired weakness is a common problem,
   leads to significant impairment in physical functioning and muscle
   strength, and is prevalent in individuals with sepsis. Early
   rehabilitation has been shown to be safe and feasible; however,
   commencement is often delayed due to a patient's inability to
   co-operate. An intervention that begins early in an intensive care unit
   (ICU) admission without the need for patient volition may be beneficial
   in attenuating muscle wasting. The eRiCC (early rehabilitation in
   critical care) trial will investigate the effectiveness of functional
   electrical stimulation-assisted cycling and cycling alone, compared to
   standard care, in individuals with sepsis.
   Methods and analysis: This is a single centre randomised controlled
   trial. Participants (n=80) aged >= 18 years, with a diagnosis of sepsis
   or severe sepsis, who are expected to be mechanically ventilated for >=
   48 h and remain in the intensive care >= 4 days will be randomised
   within 72 h of admission to (1) standard care or (2) intervention where
   participants will receive functional electrical muscle
   stimulation-assisted supine cycling on one leg while the other leg
   undergoes cycling alone. Primary outcome measures include: muscle mass
   (quadriceps ultrasonography; bioelectrical impedance spectroscopy);
   muscle strength (Medical Research Council Scale; hand-held dynamometry)
   and physical function (Physical Function in Intensive Care Test;
   Functional Status Score in intensive care; 6 min walk test). Blinded
   outcome assessors will assess measures at baseline, weekly, at ICU
   discharge and acute hospital discharge. Secondary measures will be
   evaluated in a nested subgroup (n=20) and will consist of
   biochemical/histological analyses of collected muscle, urine and blood
   samples at baseline and at ICU discharge.
   Ethics and dissemination: Ethics approval has been obtained from the
   relevant institution, and results will be published to inform clinical
   practice in the care of patients with sepsis to optimise rehabilitation
   and physical function outcomes.
TC 8
ZB 1
Z8 0
ZS 0
Z9 8
SN 2044-6055
UT WOS:000315053900119
ER

PT J
AU Connolly, Bronwen
   Denehy, Linda
   Brett, Stephen
   Elliott, Doug
   Hart, Nicholas
TI Exercise rehabilitation following hospital discharge in survivors of
   critical illness: an integrative review
SO CRITICAL CARE
VL 16
IS 3
AR 226
DI 10.1186/cc11219
PD 2012
PY 2012
AB Although clinical trials have shown benefit from early rehabilitation
   within the ICU, rehabilitation of patients following critical illness is
   increasingly acknowledged as an area of clinical importance. However,
   despite recommendations from published guidelines for rehabilitation to
   continue following hospital discharge, there is limited evidence to
   underpin practice during this intermediate stage of recovery. Those
   patients with ICU-acquired weakness on discharge from the ICU are most
   likely to benefit from ongoing rehabilitation. Despite this, screening
   based on strength alone may fail to account for the associated level of
   physical functioning, which may not correlate with muscle strength, nor
   address non-physical complications of critical illness. The aim of this
   review was to consider which patients are likely to require
   rehabilitation following critical illness and to perform an integrative
   review of the available evidence of content and nature of exercise
   rehabilitation programmes for survivors of critical illness following
   hospital discharge. Literature databases and clinical trials registries
   were searched using appropriate terms and groups of terms. Inclusion
   criteria specified the reporting of rehabilitation programmes for
   patients following critical illness post-hospital discharge. Ten items,
   including data from published studies and protocols from trial
   registries, were included. Because of the variability in study
   methodology and inadequate level of detail of reported exercise
   prescription, at present there can be no clear recommendations for
   clinical practice from this review. As this area of clinical practice
   remains in its relative infancy, further evidence is required both to
   identify which patients are most likely to benefit and to determine the
   optimum content and format of exercise rehabilitation programmes for
   patients following critical illness post-hospital discharge.
TC 14
ZB 1
Z8 0
ZS 0
Z9 14
SN 1466-609X
UT WOS:000313197500061
PM 22713336
ER

PT J
AU Tedde, Miguel L.
   Vasconcelos Filho, Paulo
   Hajjar, Ludhmila Abrahao
   de Almeida, Juliano Pinheiro
   Flora, Gustavo Fagundes
   Okumura, Erica Mie
   Osawa, Eduardo A.
   Fukushima, Julia Tizue
   Teixeira, Manoel Jacobsen
   Barbosa Gomes Galas, Filomena Regina
   Jatene, Fabio Biscegli
   Costa Auler, Jose Otavio, Jr.
TI Diaphragmatic pacing stimulation in spinal cord injury: anesthetic and
   perioperative management
SO CLINICS
VL 67
IS 11
BP 1265
EP 1269
DI 10.6061/clinics/2012(11)07
PD 2012
PY 2012
AB OBJECTIVE: The standard therapy for patients with high-level spinal cord
   injury is long-term mechanical ventilation through a tracheostomy.
   However, in some cases, this approach results in death or disability.
   The aim of this study is to highlight the anesthetics and perioperative
   aspects of patients undergoing insertion of a diaphragmatic pacemaker.
   METHODS: Five patients with quadriplegia following high cervical
   traumatic spinal cord injury and ventilator-dependent chronic
   respiratory failure were implanted with a laparoscopic diaphragmatic
   pacemaker after preoperative assessments of their phrenic nerve function
   and diaphragm contractility through transcutaneous nerve stimulation.
   ClinicalTrials.gov:NCT01385384.
   RESULTS: The diaphragmatic pacemaker placement was successful in all of
   the patients. Two patients presented with capnothorax during the
   perioperative period, which resolved without consequences. After six
   months, three patients achieved continuous use of the diaphragm pacing
   system, and one patient could be removed from mechanical ventilation for
   more than 4 hours per day.
   CONCLUSIONS: The implantation of a diaphragmatic phrenic system is a new
   and safe technique with potential to improve the quality of life of
   patients who are dependent on mechanical ventilation because of spinal
   cord injuries. Appropriate indication and adequate perioperative care
   are fundamental to achieving better results.
TC 3
ZB 0
Z8 2
ZS 2
Z9 6
SN 1807-5932
UT WOS:000311534900007
PM 23184201
ER

PT J
AU Pham, Julius Cuong
   Aswani, Monica S.
   Rosen, Michael
   Lee, HeeWon
   Huddle, Matthew
   Weeks, Kristina
   Pronovost, Peter J.
BE Caskey, CT
   Austin, CP
   Hoxie, JA
TI Reducing Medical Errors and Adverse Events
SO ANNUAL REVIEW OF MEDICINE, VOL 63
SE Annual Review of Medicine
VL 63
BP 447
EP 463
DI 10.1146/annurev-med-061410-121352
PD 2012
PY 2012
AB Medical errors account for similar to 98,000 deaths per year in the
   United States. They increase disability and costs and decrease
   confidence in the health care system. We review several important types
   of medical errors and adverse events. We discuss medication errors,
   healthcare-acquired infections, falls, handoff errors, diagnostic
   errors, and surgical errors. We describe the impact of these errors,
   review causes and contributing factors, and provide an overview of
   strategies to reduce these events. We also discuss teamwork/safety
   culture, an important aspect in reducing medical errors.
TC 28
ZB 6
Z8 0
ZS 0
Z9 28
SN 0066-4219
BN 978-0-8243-0563-5
UT WOS:000301838400030
PM 22053736
ER

PT J
AU Pasquina, Patrick
   Adler, Dan
   Farr, Pamela
   Bourqui, Pascale
   Bridevaux, Pierre Olivier
   Janssens, Jean-Paul
TI What Does Built-In Software of Home Ventilators Tell Us? An
   Observational Study of 150 Patients on Home Ventilation
SO RESPIRATION
VL 83
IS 4
BP 293
EP 299
DI 10.1159/000330598
PD 2012
PY 2012
AB Background: Recent home ventilators are equipped with built-in software
   which provides data such as compliance, estimations of leaks, tidal
   volume, minute ventilation, respiratory rate, apnea and apnea-hypopnea
   indexes, and percentage of inspirations triggered by the patient (or
   ventilator). However, for many of these variables, there is neither
   consensus nor documentation as to what is to be expected in a population
   of stable patients under noninvasive ventilation (NIV). Objectives: To
   document the values and distribution of specific items downloaded from
   ventilator monitoring software, by diagnostic category. Methods:
   Analysis of data downloaded from home ventilators in clinically stable
   patients under long-term NIV, during elective home visits by specialized
   nurses. Results: Data were collected from home ventilators of 150
   patients with chronic obstructive pulmonary disease (n = 32), overlap
   syndrome (n = 29), obesity-hypoventilation (n = 38), neuromuscular
   disorders (n = 19), restrictive disorders (n = 21), and central sleep
   apnea syndrome (n = 11). On average, leaks were low, being lowest in
   patients with facial masks (vs. nasal masks), and increased with older
   age. Compliance was excellent in all groups. Patients with neuromuscular
   diseases triggered their ventilators less and tended to be 'captured',
   while other groups triggered at least half of inspiratory cycles. Most
   patients had a respiratory rate just slightly above the back-up rate.
   Residual apneas and hypopneas were highest in patients with central
   apneas. Conclusions: Built-in software of home ventilators provides the
   clinician with new parameters, some of which are a useful adjunct to
   recommended tools for monitoring NIV and may contribute to a better
   understanding of residual hypoventilation and/or desaturations. However,
   an independent validation of the accuracy of this information is
   mandatory. Copyright (C) 2011 S. Karger AG, Basel
TC 8
ZB 1
Z8 0
ZS 0
Z9 8
SN 0025-7931
UT WOS:000302134200002
PM 21952176
ER

PT J
AU Beckham, J. David
   Tyler, Kenneth L.
TI Neuro-Intensive Care of Patients with Acute CNS Infections
SO NEUROTHERAPEUTICS
VL 9
IS 1
BP 124
EP 138
DI 10.1007/s13311-011-0086-5
PD JAN 2012
PY 2012
AB Infections in the central nervous system (CNS) are caused by a wide
   range of microorganisms resulting in distinct clinical syndromes
   including meningitis, encephalitis, and pyogenic infections, such as
   empyema and brain abscess. Bacterial and viral infections in the CNS can
   be rapidly fatal and can result in severe disability in survivors.
   Appropriate identification and acute management of these infections
   often occurs in a critical care setting and is vital to improving
   outcomes in this group of patients. This review of diagnosis and
   management of acute bacterial and viral infections in the CNS provides a
   general approach to patients with a suspected CNS infection and also
   provides a more detailed review of the diagnosis and management of
   patients with suspected bacterial meningitis, viral encephalitis, brain
   abscess, and subdural empyema.
TC 5
ZB 3
Z8 0
ZS 0
Z9 5
SN 1933-7213
UT WOS:000300187900012
PM 22102180
ER

PT J
AU Chakravorty, Subarna
   Roberts, Irene
TI How I manage neonatal thrombocytopenia
SO BRITISH JOURNAL OF HAEMATOLOGY
VL 156
IS 2
BP 155
EP 162
DI 10.1111/j.1365-2141.2011.08892.x
PD JAN 2012
PY 2012
AB Although neonatal thrombocytopenia (platelet count < 150 x 109/l) is a
   common finding in hospital practice, a careful clinical history and
   examination of the blood film is often sufficient to establish the
   diagnosis and guide management without the need for further
   investigations. In preterm neonates, early-onset thrombocytopenia (<72
   h) is usually secondary to antenatal causes, has a characteristic
   pattern and resolves without complications or the need for treatment. By
   contrast, late-onset thrombocytopenia in preterm neonates (>72 h) is
   nearly always due to post-natally acquired bacterial infection and/or
   necrotizing enterocolitis, which rapidly leads to severe
   thrombocytopenia (platelet count < 50 x 109/l). Thrombocytopenia is much
   less common in term neonates and the most important cause is neonatal
   alloimmune thrombocytopenia (NAIT), which confers a high risk of
   perinatal intracranial haemorrhage and long-term neurological
   disability. Prompt diagnosis and transfusion of human platelet
   antigen-compatible platelets is key to the successful management of
   NAIT. Recent studies suggest that more than half of neonates with severe
   thrombocytopenia receive platelet transfusion(s) based on consensus
   national or local guidelines despite little evidence of benefit. The
   most pressing problem in management of neonatal thrombocytopenia is
   identification of safe, effective platelet transfusion therapy and
   controlled trials are urgently needed.
TC 15
ZB 9
Z8 1
ZS 0
Z9 16
SN 0007-1048
UT WOS:000298480000001
PM 21950766
ER

PT J
AU Blichfeldt-Lauridsen, L.
   Hansen, B. D.
TI Anesthesia and myasthenia gravis
SO ACTA ANAESTHESIOLOGICA SCANDINAVICA
VL 56
IS 1
BP 17
EP 22
DI 10.1111/j.1399-6576.2011.02558.x
PD JAN 2012
PY 2012
AB Myasthenia gravis (MG) is a disease affecting the nicotinic
   acetylcholine receptor of the post-synaptic membrane of the
   neuromuscular junction, causing muscle fatigue and weakness. The
   myasthenic patient can be a challenge to anesthesiologists, and the
   post-surgical risk of respiratory failure has always been a matter of
   concern. The incidence and prevalence of MG have been increasing for
   decades and the disease is underdiagnosed. This makes it important for
   the anesthesiologist to be aware of possible signs of the disease and to
   be properly updated on the optimal perioperative anesthesiological
   management of the myasthenic patient. The review is based on electronic
   searches on PubMed and a review of the references of the articles. The
   following keywords were used: myasthenia gravis AND neuromuscular
   blocking agents, myasthenia gravis AND sevoflurane, myasthenia gravis
   AND epidural, myasthenia gravis AND neuromuscular blockade reversal and
   myasthenia gravis AND pyridostigmine. The articles included were from
   reviews and clinical trials written in English. MG patients can easily
   be anesthetized without need for post-surgery mechanical ventilation
   whether it is general anesthesia or peripheral nerve block. Volatile
   anesthesia or the use of an epidural for the patient makes it possible
   to avoid the use of neuromuscular blocking agents, and when used, it
   should be in smaller doses and the patient should be carefully
   monitored. This review shows that with thorough pre-operative
   evaluation, continuing the daily pyridostigmine and careful monitoring
   the MG patient can be managed safely.
TC 13
ZB 9
Z8 0
ZS 1
Z9 15
SN 0001-5172
UT WOS:000297918400003
PM 22091897
ER

PT J
AU Doorduin, Jonne
   Sinderby, Christer A.
   Beck, Jennifer
   Stegeman, Dick F.
   van Hees, Hieronymus W. H.
   van der Hoeven, Johannes G.
   Heunks, Leo M. A.
TI The Calcium Sensitizer Levosimendan Improves Human Diaphragm Function
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 185
IS 1
BP 90
EP 95
DI 10.1164/rccm.201107-1268OC
PD JAN 1 2012
PY 2012
AB Rationale: Acquired diaphragm muscle weakness is a key feature in
   several chronic conditions, including chronic obstructive pulmonary
   disease, congestive heart failure, and difficult weaning from mechanical
   ventilation. No drugs are available to improve respiratory muscle
   function in these patients. Recently, we have shown that the calcium
   sensitizer levosimendan enhances the force-generating capacity of
   isolated diaphragm fibers.
   Objectives: To investigate the effects of the calcium sensitizer
   levosimendan on in vivo human diaphragm function.
   Methods: In a double-blind, randomized, crossover design, 30 healthy
   subjects performed two identical inspiratory loading tasks. After the
   first loading task, subjects received levosimendan (40 mu g/kg bolus
   followed by 0.1/0.2 mu g/kg/min continuous infusion) or placebo.
   Transdiaphragmatic pressure, diaphragm electrical activity, and their
   relationship (neuromechanical efficiency) were measured during loading.
   Magnetic phrenic nerve stimulation was performed before the first
   loading task and after bolus administration to assess twitch
   contractility. Center frequency of diaphragm electrical activity was
   evaluated to study the effects of levosimendan on muscle fiber
   conduction velocity.
   Measurements and Main Results: The placebo group showed a 9% (P = 0.01)
   loss of twitch contractility after loaded breathing, whereas no loss in
   contractility was observed in the levosimendan group. Neuromechanical
   efficiency of the diaphragm during loading improved by 21% (P < 0.05) in
   the levosimendan group. Baseline center frequency of diaphragm
   electrical activity was reduced after levosimendan administration (P <
   0.05).
   Conclusions: The calcium sensitizer levosimendan improves
   neuromechanical efficiency and contractile function of the human
   diaphragm. Our findings suggest a new therapeutic approach to improve
   respiratory muscle function in patients with respiratory failure.
RI Stegeman, Dick/E-4952-2012; van Hees, Jeroen HWH/A-1276-2011
TC 14
ZB 7
Z8 0
ZS 0
Z9 14
SN 1073-449X
UT WOS:000298806600019
PM 21960535
ER

PT J
AU Needham, Craig J.
   Brindley, Peter G.
TI The role of neuromuscular blocking drugs in early severe acute
   respiratory distress syndrome
SO CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE
VL 59
IS 1
BP 105
EP 108
DI 10.1007/s12630-011-9615-2
PD JAN 2012
PY 2012
AB Acute respiratory distress syndrome (ARDS) is defined as severe
   hypoxemic respiratory failure resulting from diffuse lung injury and
   secondary to direct and indirect insults. Despite advances, mortality
   remains as high as 40-60%. Neuromuscular blocking agents (NMBAs) are
   used to facilitate mechanical ventilation in patients with ARDS and have
   been shown to improve arterial partial pressure of oxygen. However, the
   association between NMBAs and mortality is unclear. Furthermore,
   morbidity concerns exist, particularly regarding a putative role in
   intensive care unit (ICU)-acquired weakness.
   The purpose of this study was to compare survival in adult patients with
   early ARDS who were randomized to receive either a 48-hr infusion of the
   NMBA, cisatracurium, or a placebo.
   This study was a multicentre double-blinded randomized controlled trial
   involving 20 ICUs in France from March 2006 to March 2008.
   Eligible patients were > 18 yr with an intubated trachea and ventilated
   lungs for acute hypoxemic respiratory failure. Their PaO(2)/F (i) O(2)
   ratio was < 150 at a tidal volume of 6-8 mL center dot kg(-1) ideal body
   weight and a positive end-expiratory pressure (PEEP) a parts per
   thousand yen 5 cm H(2)O for < 48 hr. Additional inclusion criteria were
   radiographic evidence of bilateral pulmonary infiltrates and the absence
   of left atrial hypertension. Exclusion criteria included patients
   already receiving NMBA at enrolment; those who had increased
   intracranial pressure, severe chronic respiratory disease, or severe
   chronic liver disease; those who had received a bone marrow transplant
   or had chemotherapy-induced neutropenia; those who had a pneumothorax;
   and those who were expected to require mechanical ventilation for < 48
   hr or were enrolled in another trial within 30 days.
   Three hundred twenty-six patients were screened, and 340 of these
   underwent randomization in blocks of four and received either a 48-hr
   infusion of cisatracurium (15 mg bolus followed by 37.5 mg center dot
   hr(-1)) or a volume equivalent placebo. One hundred and seventy-eight
   patients received a cisatracurium infusion, and one patient withdrew
   leaving 177 patients included in the analysis. One hundred and sixty-two
   patients received the placebo infusion. Prior to either infusion,
   patients were sedated to a Ramsay sedation score of 6. Patients' lungs
   were ventilated by a volume assist-controlled mode according to the ARDS
   Clinical Network Mechanical Ventilation Protocol (<ExternalRef>
   <RefSource>http://www.ardsnet.org/</RefSource> <RefTarget
   Address="http://www.ardsnet.org/" TargetType="URL"/> </ExternalRef>)
   with the goal SpO(2) of 88-95% (or PaO(2) 55-80 mmHg) and goal plateau
   pressure a parts per thousand currency sign 35 cm H(2)O. Open-label
   boluses of cisatracurium 20 mg (maximum of two per 24-hr period) were
   allowed if plateau pressures remained > 32 cm H(2)O despite increased
   sedation and despite decreased PEEP and decreased tidal volumes.
   Monitoring of paralysis via peripheral nerve stimulation was not
   permitted.
   The primary outcome was death before hospital discharge and within 90
   days of study enrolment. It was determined a priori that this would be
   adjusted for imbalance in key risk factors at baseline, as derived from
   Cox regression. Secondary outcomes included 28-day mortality, number of
   ventilator-free days, number of days outside of ICU, number of days
   without organ system failure, rate of barotrauma, and rate of
   ICU-acquired paresis (as defined by a Medical Research Council [MRC]
   score < 48) on day 28 and at ICU discharge.
   With regard to the primary outcome, crude 90-day mortality was 31.6% in
   the cisatracurium group vs 40.7% in the placebo group. This outcome did
   not reach statistical significance (P = 0.08). However, post hoc
   analysis found a reduction in 90-day mortality in the cisatracurium
   group compared with placebo (95% confidence interval 0.48 to 0.98; P =
   0.04). Results suggest that the reduction in 90-day mortality in the
   cisatracurium group was confined to those patients with a PaO(2)/F (i)
   O(2) ratio < 120. Additionally, 28-day mortality was significantly lower
   in the cisatracurium group (absolute difference -9.6%; P = 0.05). The
   cisatracurium group also had significantly more ventilator-free days,
   more days outside of the ICU, and more days free of organ-failure.
   Similarly, pneumothorax developed more often and earlier in the placebo
   group than in the cisatracurium group. The rate of ICU-acquired weakness
   at day 28 or at ICU discharge did not differ significantly between the
   two groups.
   Treatment in early severe ARDS with the NMBA, cisatracurium, for 48 hr
   was associated with lower adjusted 90-day mortality. It was also
   associated with decreased morbidity, which included increased
   ventilator-free days, increased ICU-free days, and increased organ
   failure-free days. These benefits occurred without increasing the
   incidence of ICU-acquired weakness.
TC 9
ZB 0
Z8 2
ZS 0
Z9 11
SN 0832-610X
UT WOS:000298608000012
PM 22042702
ER

PT J
AU Derde, Sarah
   Hermans, Greet
   Derese, Inge
   Guiza, Fabian
   Hedstrom, Yvette
   Wouters, Pieter J.
   Bruyninckx, Frans
   D'Hoore, Andre
   Larsson, Lars
   Van den Berghe, Greet
   Vanhorebeek, Ilse
TI Muscle atrophy and preferential loss of myosin in prolonged critically
   ill patients
SO CRITICAL CARE MEDICINE
VL 40
IS 1
BP 79
EP 89
DI 10.1097/CCM.0b013e31822d7c18
PD JAN 2012
PY 2012
AB Objective: Muscle weakness contributes to prolonged rehabilitation and
   adverse outcome of critically ill patients. Distinction between a
   neurogenic and/or myogenic underlying problem is difficult using routine
   diagnostic tools. Preferential loss of myosin has been suggested to
   point to a myogenic component. We evaluated markers of muscle atrophy
   and denervation, and the myosin/actin ratio in limb and abdominal wall
   skeletal muscle of prolonged critically ill patients and matched
   controls in relation to insulin therapy and known risk factors for
   intensive care unit-acquired weakness.
   Design: Secondary analysis of two large, prospective, single-center
   randomized clinical studies.
   Setting: University hospital surgical and medical intensive care unit.
   Patients: Critically ill patients and matched controls.
   Interventions: Intensive care unit patients had been randomized to blood
   glucose control to 80-110 mg/dL with insulin infusion or conventional
   glucose management, where insulin was only administered when glucose
   levels rose above 215 mg/dL.
   Measurements and Main Results: As compared with controls, rectus
   abdominis and vastus lateralis muscle of critically ill patients showed
   smaller myofiber size, decreased mRNA levels for myofibrillar proteins,
   increased proteolytic enzyme activities, and a lower myosin/actin ratio,
   virtually irrespective of insulin therapy. Increased forkhead box 01
   action may have played a role. Most alterations were more severe in
   patients treated with corticosteroids. Duration of corticosteroid
   treatment, independent of duration of intensive care unit stay or other
   risk factors, was a dominant risk factor for a low myosin/actin ratio.
   The immature acetylcholine receptor subunit gamma messenger RNA
   expression was elevated in vastus lateralis, independent of the
   myosin/actin ratio.
   Conclusions: Both limb and abdominal wall skeletal muscles of prolonged
   critically ill patients showed downregulation of protein synthesis at
   the gene expression level as well as increased proteolysis. This
   affected myosin to a greater extent than actin, resulting in a decreased
   myosin/actin ratio. Muscle atrophy was not ameliorated by intensive
   insulin therapy, but possibly aggravated by corticosteroids. (Crit Care
   Med 2012; 40:79-89)
TC 29
ZB 9
Z8 1
ZS 0
Z9 30
SN 0090-3493
UT WOS:000298379800012
PM 21926599
ER

PT J
AU Hermans, Greet
   Clerckx, Beatrickx
   Vanhullebusch, Tine
   Segers, Johan
   Vanpee, Goele
   Robbeets, Christophe
   Casaer, Michael Paul
   Wouters, Pieter
   Gosselink, Rik
   Van Den Berghe, Greet
TI Interobserver agreement of medical research council sum-score and
   handgrip strength in the intensive care unit
SO MUSCLE & NERVE
VL 45
IS 1
BP 18
EP 25
DI 10.1002/mus.22219
PD JAN 2012
PY 2012
AB Introduction: Muscle weakness often complicates critical illness and is
   associated with devastating short- and long-term consequences. For
   interventional studies, reliable measurements of muscle force in the
   intensive care unit (ICU) are needed. Methods: To examine interobserver
   agreement, two observers independently measured Medical Research Council
   (MRC) sum-score (n = 75) and handgrip strength (n = 46) in a
   cross-sectional ICU sample. Results: The intraclass correlation
   coefficient (ICC) for MRC sum-score was 0.95 (0.920.97). The kappa
   coefficient for identifying significant weakness (MRC sum-score <48, MRC
   subtotal upper limbs <24) and severe weakness (MRC sum-score <36) was
   0.68 +/- 0.09, 0.88 +/- 0.07, and 0.93 +/- 0.07, respectively. The ICC
   for left and right handgrip strength was 0.97 (0.940.98) and 0.93
   (0.860.97), respectively. Conclusions: Interobserver agreement on MRC
   sum-score and handgrip strength in the ICU was very good. Agreement on
   severe weakness (MRC sum-score <36) was excellent and supports its use
   in interventional studies. Agreement on significant weakness (MRC
   sum-score <48) was good, but even better using the equivalent cut-off in
   the upper limbs. It remains to be determined whether this may serve as a
   substitute. Muscle Nerve 45: 1825, 2012
TC 27
ZB 9
Z8 0
ZS 0
Z9 27
SN 0148-639X
UT WOS:000298477000005
PM 22190301
ER

PT J
AU Vasconcelos, Alexandra
   Abecasis, Francisco
   Monteiro, Rita
   Camilo, Cristina
   Vieira, Marisa
   de Carvalho, Mamede
   Correia, Manuela
TI A 3-month-old baby with H1N1 and Guillain-Barre syndrome.
SO BMJ case reports
VL 2012
DI 10.1136/bcr.12.2011.5462
PD 2012 Mar 27
PY 2012
AB Majority of children with pandemic influenza A (H1N1)pdm09 experience
   mild illness with full recovery without treatment. A previously healthy
   two and a half month-old girl was admitted to our paediatric intensive
   care unit because of severe respiratory failure with A (H1N1)pdm09
   infection. Despite initial clinical improvement all attempts to extubate
   to non-invasive ventilation were unsuccessful and 2 to 3 weeks after
   symptom onset she started periods of cardiovascular instability and a
   progressive neurological deterioration with distal symmetrical
   progressive motor weakness and areflexia. All investigations were normal
   except elevated liver enzymes and cerebrospinal fluid examination that
   revealed elevated protein without pleocytosis. A possible diagnosis of
   Guillain-Barre syndrome (GBS) was considered and electromyogram was
   compatible with axonal form of GBS. To our knowledge this is the
   youngest case of GBS acquired postnatally and the first in children
   associated with H1N1 virus.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:22605827
PM 22605827
ER

PT J
AU Parry, Selina M
   Berney, Sue
   Koopman, Rene
   Bryant, Adam
   El-Ansary, Doa
   Puthucheary, Zudin
   Hart, Nicholas
   Warrillow, Stephen
   Denehy, Linda
TI Early rehabilitation in critical care (eRiCC): functional electrical
   stimulation with cycling protocol for a randomised controlled trial.
SO BMJ open
VL 2
IS 5
DI 10.1136/bmjopen-2012-001891
PD 2012 Sep 13
PY 2012
AB INTRODUCTION: Intensive care-acquired weakness is a common problem,
   leads to significant impairment in physical functioning and muscle
   strength, and is prevalent in individuals with sepsis. Early
   rehabilitation has been shown to be safe and feasible; however,
   commencement is often delayed due to a patient's inability to
   co-operate. An intervention that begins early in an intensive care unit
   (ICU) admission without the need for patient volition may be beneficial
   in attenuating muscle wasting. The eRiCC (early rehabilitation in
   critical care) trial will investigate the effectiveness of functional
   electrical stimulation-assisted cycling and cycling alone, compared to
   standard care, in individuals with sepsis.
   METHODS AND ANALYSIS: This is a single centre randomised controlled
   trial. Participants (n=80) aged ≥18 years, with a diagnosis of sepsis or
   severe sepsis, who are expected to be mechanically ventilated for ≥48 h
   and remain in the intensive care ≥4 days will be randomised within 72 h
   of admission to (1) standard care or (2) intervention where participants
   will receive functional electrical muscle stimulation-assisted supine
   cycling on one leg while the other leg undergoes cycling alone. Primary
   outcome measures include: muscle mass (quadriceps ultrasonography;
   bioelectrical impedance spectroscopy); muscle strength (Medical Research
   Council Scale; hand-held dynamometry) and physical function (Physical
   Function in Intensive Care Test; Functional Status Score in intensive
   care; 6 min walk test). Blinded outcome assessors will assess measures
   at baseline, weekly, at ICU discharge and acute hospital discharge.
   Secondary measures will be evaluated in a nested subgroup (n=20) and
   will consist of biochemical/histological analyses of collected muscle,
   urine and blood samples at baseline and at ICU discharge.
   ETHICS AND DISSEMINATION: Ethics approval has been obtained from the
   relevant institution, and results will be published to inform clinical
   practice in the care of patients with sepsis to optimise rehabilitation
   and physical function outcomes.
   TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry
   ACTRN12612000528853.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:22983782
PM 22983782
ER

PT J
AU Adler, Dan
   Gottfried, Stewart B.
   Bautin, Nathalie
   Mirkovic, Tomislav
   Schmidt, Matthieu
   Raux, Mathieu
   Pavlovic, Dragan
   Similowski, Thomas
   Demoule, Alexandre
TI Repetitive magnetic stimulation of the phrenic nerves for diaphragm
   conditioning: a normative study of feasibility and optimal settings
SO APPLIED PHYSIOLOGY NUTRITION AND METABOLISM-PHYSIOLOGIE APPLIQUEE
   NUTRITION ET METABOLISME
VL 36
IS 6
BP 1001
EP 1008
DI 10.1139/H11-095
PD DEC 2011
PY 2011
AB Electrical stimulation can enhance muscle function. We applied
   repetitive cervical magnetic phrenic stimulation (rCMS) to induce
   diaphragm contractions in 7 healthy subjects (800 ms trains;
   transdiaphragmatic pressure (Pdi) measurements; tolerance ratings). Each
   rCMS train produced a sustained diaphragm contraction. Sixty-five
   percent of the maximal available output at 15 Hz proved the best
   compromise between Pdi and discomfort with nonfatiguing contractions.
   rCMS appears feasible and should be investigated for diaphragm
   conditioning in appropriate clinical populations.
TC 3
ZB 1
Z8 0
ZS 0
Z9 3
SN 1715-5312
UT WOS:000299777200025
PM 22014178
ER

PT J
AU Aare, Sudhakar
   Ochala, Julien
   Norman, Holly S.
   Radell, Peter
   Eriksson, Lars I.
   Goransson, Hanna
   Chen, Yi-Wen
   Hoffman, Eric P.
   Larsson, Lars
TI Mechanisms underlying the sparing of masticatory versus limb muscle
   function in an experimental critical illness model
SO PHYSIOLOGICAL GENOMICS
VL 43
IS 24
BP 1334
EP 1350
DI 10.1152/physiolgenomics.00116.2011
PD DEC 2011
PY 2011
AB Aare S, Ochala J, Norman HS, Radell P, Eriksson LI, Goransson H, Chen
   YW, Hoffman EP, Larsson L. Mechanisms underlying the sparing of
   masticatory versus limb muscle function in an experimental critical
   illness model. Physiol Genomics 43: 1334-1350, 2011. First published
   October 18, 2011; doi:10.1152/physiolgenomics.00116.2011.-Acute
   quadriplegic myopathy (AQM) is a common debilitating acquired disorder
   in critically ill intensive care unit (ICU) patients that is
   characterized by tetraplegia/generalized weakness of limb and trunk
   muscles. Masticatory muscles, on the other hand, are typically spared or
   less affected, yet the mechanisms underlying this striking
   muscle-specific difference remain unknown. This study aims to evaluate
   physiological parameters and the gene expression profiles of masticatory
   and limb muscles exposed to factors suggested to trigger AQM, such as
   mechanical ventilation, immobilization, neuromuscular blocking agents,
   corticosteroids (CS), and sepsis for 5 days by using a unique porcine
   model mimicking the ICU conditions. Single muscle fiber cross-sectional
   area and force-generating capacity, i.e., maximum force normalized to
   fiber cross-sectional area (specific force), revealed maintained
   masseter single muscle fiber cross-sectional area and specific-force
   after 5 days' exposure to all triggering factors. This is in sharp
   contrast to observations in limb and trunk muscles, showing a dramatic
   decline in specific force in response to 5 days' exposure to the
   triggering factors. Significant differences in gene expression were
   observed between craniofacial and limb muscles, indicating a highly
   complex and muscle-specific response involving transcription and growth
   factors, heat shock proteins, matrix metalloproteinase inhibitor,
   oxidative stress responsive elements, and sarcomeric proteins underlying
   the relative sparing of cranial vs. spinal nerve innervated muscles
   during exposure to the ICU intervention.
TC 12
ZB 8
Z8 1
ZS 0
Z9 13
SN 1094-8341
UT WOS:000298403600002
PM 22010006
ER

PT J
AU Schweickert, William D.
   Kress, John P.
TI Implementing Early Mobilization Interventions in Mechanically Ventilated
   Patients in the ICU
SO CHEST
VL 140
IS 6
BP 1612
EP 1617
DI 10.1378/chest.10-2829
PD DEC 2011
PY 2011
AB As ICU survival continues to improve, clinicians are faced with short-
   and long-term consequences of critical illness. Deconditioning and
   weakness have become common problems in survivors of critical illness
   requiring mechanical ventilation. Recent literature, mostly from a
   medical population of patients in the ICU, has challenged the patient
   care model of prolonged bed rest. Instead, the feasibility, safety, and
   benefits of early mobilization of mechanically ventilated ICU patients
   have been reported in recent publications. The benefits of early
   mobilization include reductions in length of stay in the ICU and
   hospital as well as improvements in strength and functional status. Such
   benefits can be accomplished with a remarkably acceptable patient safety
   profile. The importance of interactions between mind and body are
   highlighted by these studies, with improvements in patient awareness and
   reductions in ICU delirium being noted. Future research to address the
   benefits of early mobilization in other patient populations is needed.
   In addition, the potential for early mobilization to impact long-term
   outcomes in ICU survivors requires further study. CHEST 2011;
   140(6):1612-1617
TC 24
ZB 4
Z8 0
ZS 0
Z9 24
SN 0012-3692
UT WOS:000297966500033
PM 22147819
ER

PT J
AU Alia, Inmaculada
   de la Cal, Miguel A.
   Esteban, Andres
   Abella, Ana
   Ferrer, Ricard
   Molina, Francisco J.
   Torres, Antoni
   Gordo, Federico
   Elizalde, Jose J.
   de Pablo, Raul
   Huete, Alejandro
   Anzueto, Antonio
TI Efficacy of Corticosteroid Therapy in Patients With an Acute
   Exacerbation of Chronic Obstructive Pulmonary Disease Receiving
   Ventilatory Support
SO ARCHIVES OF INTERNAL MEDICINE
VL 171
IS 21
BP 1939
EP 1946
PD NOV 28 2011
PY 2011
AB Background: Randomized trials assessing the effect of systemic
   corticosteroids on chronic obstructive pulmonary disease (COPD)
   exacerbations excluded patients who were mechanically ventilated or
   admitted to the intensive care unit (ICU). Critically ill patients
   constitute a population of persons who are prone to develop
   complications that are potentially associated with the use of
   corticosteroids (eg, infections, hyperglycemia, ICU-acquired paresis)
   that could prolong the duration of mechanical ventilation and even
   increase mortality.
   Methods: A double-blind placebo-controlled trial was conducted to
   evaluate the efficacy and safety of systemic corticosteroid treatment in
   patients with an exacerbation of COPD who were receiving ventilatory
   support (invasive or noninvasive mechanical ventilation). A total of 354
   adult patients who were admitted to the ICUs of 8 hospitals in 4
   countries from July 2005 through July 2009 were screened, and 83 were
   randomized to receive intravenous methylprednisolone (0.5 mg/kg every 6
   hours for 72 hours, 0.5 mg/kg every 12 hours on days 4 through 6, and
   0.5 mg/kg/d on days 7 through 10) or placebo. The main outcome measures
   were duration of mechanical ventilation, length of ICU stay, and need
   for intubation in patients treated with noninvasive mechanical
   ventilation.
   Results: There were no significant differences between the groups in
   demographics, severity of illness, reasons for COPD exacerbation, gas
   exchange variables, and corticosteroid rescue treatment. Corticosteroid
   treatment was associated with a significant reduction in the median
   duration of mechanical ventilation (3 days vs 4 days; P=.04), a trend
   toward a shorter median length of ICU stay (6 days vs 7 days; P=.09),
   and significant reduction in the rate of NIV failure (0% vs 37%; P=.04).
   Conclusion: Systemic corticosteroid therapy in patients with COPD
   exacerbations requiring mechanical ventilation is associated with a
   significant increase in the success of noninvasive mechanical
   ventilation and a reduction in the duration of mechanical ventilation
TC 18
ZB 5
Z8 0
ZS 0
Z9 18
SN 0003-9926
UT WOS:000297423000013
PM 22123804
ER

PT J
AU Brodie, Daniel
   Bacchetta, Matthew
TI Extracorporeal Membrane Oxygenation for ARDS in Adults
SO NEW ENGLAND JOURNAL OF MEDICINE
VL 365
IS 20
BP 1905
EP 1914
DI 10.1056/NEJMct1103720
PD NOV 17 2011
PY 2011
AB A 41-year-old woman presents with severe community-acquired pneumococcal
   pneumonia. Chest radiography reveals diffuse bilateral infiltrates, and
   hypoxemic respiratory failure develops despite appropriate antibiotic
   therapy. She is intubated and mechanical ventilation is initiated with a
   volume- and pressure-limited approach for the acute respiratory distress
   syndrome (ARDS). Over the ensuing 24 hours, her partial pressure of
   arterial oxygen (PaO(2)) decreases to 40 mm Hg, despite ventilatory
   support with a fraction of inspired oxygen (FIO(2)) of 1.0 and a
   positive end-expiratory pressure (PEEP) of 20 cm of water. She is placed
   in the prone position and a neuromuscular blocking agent is
   administered, without improvement in her PaO(2). An intensive care
   specialist recommends the initiation of extracorporeal membrane
   oxygenation (ECMO).
TC 131
ZB 37
Z8 9
ZS 1
Z9 141
SN 0028-4793
UT WOS:000297041900009
PM 22087681
ER

PT J
AU Wallis, C.
   Paton, J. Y.
   Beaton, S.
   Jardine, E.
TI Children on long-term ventilatory support: 10 years of progress
SO ARCHIVES OF DISEASE IN CHILDHOOD
VL 96
IS 11
BP 998
EP 1002
DI 10.1136/adc.2010.192864
PD NOV 2011
PY 2011
AB Objectives To identify the number and current location of all children
   receiving long-term ventilation (LTV) in the UK, and to establish their
   underlying diagnoses and ventilatory requirements.
   Design Single time-point census completed by members of the UK LTV
   working party using an electronic-based questionnaire
   Subjects All children in the UK at home or in hospital who, when
   medically stable, continue to need a mechanical aid for breathing
   following a failure to wean beyond a 3-month period.
   Results 933 children under the age of 17 years in 30 regional centres
   were identified as receiving LTV. 88 children (9.5%) required continuous
   positive pressure ventilation by tracheostomy over 24 h, while 658
   received ventilation while asleep only. Most children are ventilated by
   a non-invasive mask (n=704; 75%) or tracheostomy (n=206; 22%).
   Underlying conditions included neuromuscular disease (n=402; 43%),
   chronic respiratory (n=343; 37%) and central nervous system conditions
   (n=168; 18%). 129 (14%) children were aged 16 or over. 844 (91%)
   children were cared for at home with only 49 children listed as being in
   acute hospital units (n=34) or paediatric intensive care units/high
   dependency units (n=15).
   Conclusions The last 10 years has seen a very significant increase in
   the number of children requiring LTV in the UK with an increasing number
   cared for at home. This reflects both improving technology and
   increasing clinical expertise in paediatric non-invasive ventilatory
   support, and a continuing change in attitude towards long-term support,
   particularly in children with neuromuscular diseases. There are a
   substantial number of children who soon will require transition to adult
   services, yet few such services currently exist.
RI Paton, James/B-9541-2008
TC 16
ZB 7
Z8 2
ZS 0
Z9 18
SN 0003-9888
UT WOS:000296153800003
PM 21109507
ER

PT J
AU Lamontagne, Marie-Eve
   Swaine, Bonnie R.
   Lavoie, Andre
   Careau, Emmanuelle
TI Analysis of the strengths, weaknesses, opportunities and threats of the
   network form of organization of traumatic brain injury service delivery
   systems
SO BRAIN INJURY
VL 25
IS 12
BP 1188
EP 1197
DI 10.3109/02699052.2011.608211
PD NOV 2011
PY 2011
AB Networks are an increasingly popular way to deal with the lack of
   integration of traumatic brain injury (TBI) care. Knowledge of the
   stakes of the network form of organization is critical in deciding
   whether or not to implement a TBI network to improve the continuity of
   TBI care.
   Goals of the study: To report the strengths, weaknesses, opportunities,
   and threats of a TBI network and to consider these elements in a
   discussion about whether networks are a suitable solution to fragmented
   TBI care.
   Methods: In-depth interviews with 12 representatives of network
   organization members. Interviews were qualitatively analyzed using the
   EGIPSS model of performance.
   Results: The majority of elements reported were related to the network's
   adaptation to its environment and more precisely to its capacity to
   acquire resources. The issue of value maintenance also received
   considerable attention from participants.
   Discussion: The network form of organization seems particularly
   sensitive to environmental issues, such as resource acquisition and
   legitimacy. The authors suggest that the network form of organization is
   a suitable way to increase the continuity of TBI care if the following
   criteria are met: (1) expectations toward network effectiveness to
   increase continuity of care are moderate and realistic; (2) sufficient
   resources are devoted to the design, implementation, and maintenance of
   the network; (3) a network's existence and actions are deemed legitimate
   by community and organization member partners; and (4) there is a good
   collaborative climate between the organizations.
TC 2
ZB 2
Z8 0
ZS 0
Z9 2
SN 0269-9052
UT WOS:000295615200005
PM 21939374
ER

PT J
AU Shilo, Yael
   Pypendop, Bruno H.
   Barter, Linda S.
   Epstein, Steven E.
TI Thymoma removal in a cat with acquired myasthenia gravis: a case report
   and literature review of anesthetic techniques
SO VETERINARY ANAESTHESIA AND ANALGESIA
VL 38
IS 6
BP 603
EP 613
DI 10.1111/j.1467-2995.2011.00648.x
PD NOV 2011
PY 2011
AB History and presentation A 12 year old, 4.2 kg, domestic long hair,
   castrated male cat was presented with regurgitation, inability to
   retract the claws, general weakness, cervical ventroflexion and weight
   loss. A thymic mass was evident on radiographs. Acetylcholine receptor
   antibody titer was positive for acquired myasthenia gravis (MG).
   Thymectomy via midline sternotomy was scheduled.
   Anesthetic management Oxymorphone and atropine were administered
   subcutaneously as premedication, and anesthesia was induced with
   etomidate and diazepam given intravenously to effect. The cat's trachea
   was intubated and anesthesia was maintained with isoflurane in oxygen,
   and continuous infusions of remifentanil and ketamine. Epidural
   analgesia with preservative-free morphine was administered prior to
   surgery. Postoperative analgesia was provided by oxymorphone
   subcutaneously, interpleural bupivacaine, and fentanyl infusion.
   Postoperative complications included airway obstruction, hypoxemia and
   hypercapnia.
   Follow-up The cat was discharged 3 days after surgery. Discharge
   medications included pyridostigmine and prednisone. Nine days after
   surgery, the cat had a significant increase in its activity level, and
   medications were discontinued. Histopathologically, the mass was
   consistent with a thymoma. Approximately 6 weeks later the cat became
   weak again and pyridostigmine and prednisone administration was resumed.
   Conclusion The perioperative management of patients with MG for
   transsternal thymectomy is a complex task. The increased potential for
   respiratory compromise requires the anesthesiologist to be familiar with
   the underlying disease state, and the interaction of anesthetic and
   non-anesthetic drugs with MG. Careful monitoring of ventilation and
   oxygenation is indicated postoperatively.
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 1467-2987
UT WOS:000295834300012
PM 21988817
ER

PT J
AU Feng, Xue-wei
   Zhou, Xiao-ming
   Qu, Wen-xiu
   Li, Yu
   Li, Shi-yu
   Zhao, Li
TI [Retrospective analysis of related factors for patients with weaning
   difficulties in medical intensive care unit].
SO Zhonghua yi xue za zhi
VL 91
IS 38
BP 2688
EP 91
PD 2011-Oct-18
PY 2011
AB OBJECTIVE: To explore the related factors of difficult-to-wean patients
   in medical intensive care unit (MICU).
   METHODS: A retrospective analysis was performed for 112 patients placed
   on mechanical ventilation. There were 63 males and 49 females with a
   mean age of (58 ± 26) years. Their primary diseases included acute
   exacerbation of chronic obstructive pulmonary disease (AECOPD) (n = 27),
   pneumonia (n = 20), asthma (n = 12) and neuromuscular diseases (n = 8).
   Basic admission profiles, underlying diseases, accompanying diseases and
   pre-weaning changes in physiological indicators were recorded. They were
   divided into 2 groups: successfully-weaned group and different-to-wean
   group. Logistic regression analysis was used to analyze the risk factors
   correlated with the difficult withdrawal of mechanical ventilation.
   RESULTS: There were 27 (24.1%) difficult-to-wean patients on mechanical
   ventilation in MICU. Some underlying diseases had statistical
   significance in both groups, including AECOPD (chi(2) = 6.238, P =
   0.028), idiopathic pulmonary fibrosis (chi(2) = 5.232, P = 0.025) and
   neuromuscular disease (chi(2) = 14.635, P = 0.007). The ratios of
   difficult-to-wean patients were 9/27, 2/6 and 6/8 respectively. There
   was statistical significance of pre-admission and pre-weaning
   oxygenation index between two groups (t = 2.183, 2.162, P < 0.05).
   Zubrod score at pre-weaning was also significantly different between two
   groups (t = 9.037, P < 0.05). Logistic regression indicated that the
   patients with severe heart failure (OR = 5.781), psychological disorders
   (OR = 4.654), obstructive sleep apnea (OR = 4.012), AECOPD (OR = 3.617)
   and neuromuscular diseases (OR = 2.885) were more vulnerable to weaning
   difficulties.
   CONCLUSION: The major risk factors of difficult-to-wean patients in MICU
   include severe heart failure, psychological diseases, obstructive sleep
   apnea, neuromuscular disease and AECOPD. And oxygenation and self-care
   capability may also affect weaning significantly.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0376-2491
UT MEDLINE:22321978
PM 22321978
ER

PT J
AU Asehnoune, Karim
   Roquilly, Antoine
   Sebille, Veronique
CA Corti-TC Trial Grp
TI Corticotherapy for traumatic brain-injured Patients - The Corti-TC
   trial: study protocol for a randomized controlled trial
SO TRIALS
VL 12
AR 228
DI 10.1186/1745-6215-12-228
PD OCT 14 2011
PY 2011
AB Background: Traumatic brain injury (TBI) is a main cause of severe
   prolonged disability of young patients. Hospital acquired pneumonia
   (HAP) add to the morbidity and mortality of traumatic brain-injured
   patients. In one study, hydrocortisone for treatment of
   traumatic-induced corticosteroid insufficiency (CI) in multiple injured
   patients has prevented HAP, particularly in the sub-group of patients
   with severe TBI. Fludrocortisone is recommended in severe brain-injured
   patients suffering from acute subarachnoid hemorrhage. Whether an
   association of hydrocortisone with fludrocortisone protects from HAP and
   improves neurological recovery is uncertain. The aim of the current
   study is to compare corticotherapy to placebo for TBI patients with CI.
   Methods: The CORTI-TC (Corticotherapy in traumatic brain-injured
   patients) trial is a multicenter, randomized, placebo controlled,
   double-blind, two-arms study. Three hundred and seventy six patients
   hospitalized in Intensive Care Unit with a severe traumatic brain injury
   (Glasgow Coma Scale <= 8) are randomized in the first 24 hours following
   trauma to hydrocortisone (200 mg. day(-1) for 7 days, 100 mg on days 8-9
   and 50 mg on day-10) with fludrocortisone (50 mu g for 10 days) or
   double placebo. The treatment is stopped if patients have an appropriate
   adrenal response. The primary endpoint is HAP on day-28. The endpoint of
   the ancillary study is the neurological status on 6 and 12 months.
   Discussion: The CORTI-TC trial is the first randomized controlled trial
   powered to investigate whether hydrocortisone with fludrocortisone in
   TBI patients with CI prevent HAP and improve long term recovery.
TC 5
ZB 1
Z8 0
ZS 0
Z9 5
SN 1745-6215
UT WOS:000297420700001
PM 21999663
ER

PT J
AU Rutter, Christine R.
   Rozanski, Elizabeth A.
   Sharp, Claire R.
   Powell, Lisa L.
   Kent, Marc
TI Outcome and medical management in dogs with lower motor neuron disease
   undergoing mechanical ventilation: 14 cases (2003-2009)
SO JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE
VL 21
IS 5
BP 531
EP 541
DI 10.1111/j.1476-4431.2011.00669.x
PD OCT 2011
PY 2011
AB Objective - To describe the application of intermittent positive
   pressure ventilation (IIPV) in dogs with lower motor neuron disease
   (LMND).
   Design - Multi-institutional, retrospective study (2003-2009).
   Setting - Intensive care units at multiple university teaching
   hospitals.
   Animals - Fourteen dogs with LMND that underwent IIPV.
   Interventions - None.
   Measurements and Main Results - The ventilatory logs of 4 teaching
   hospitals were searched for dogs undergoing IIPV in association with a
   diagnosis of acute LMND. The medical records were evaluated for
   signalment, specific LMND, ventilatory management and duration,
   complications associated with ventilation, duration of hospitalization,
   and outcome. Descriptive statistics were used as indicated. Fifteen
   records were evaluated, 1 dog was excluded since it experienced
   cardiopulmonary arrest (CPA) before commencement of IIPV. The median age
   was 7.0 years (range 10 mo to 12 y). There were 5 Labrador retrievers, 4
   mixed breeds, and 5 other breeds were each represented once. Five dogs
   were diagnosed with myasthenia gravis, 4 dogs with polyradiculoneuritis,
   and 5 dogs had an undetermined LMND. Clinical signs of weakness before
   ventilation were present for a median of 36 hours (range 6 h to 14 d).
   Dogs were ventilated for a median of 109 hours (range 5-261 h). Nine
   dogs had temporary tracheostomies performed, and 8 dogs received
   nutritional support. Five dogs developed ventilator associated
   pneumonia. Six dogs were successfully weaned from the ventilator with a
   median ventilatory time of 49 hours (range 25-192 h). Three dogs
   survived to discharge. No single LMND was associated with a better
   outcome.
   Conclusions - High euthanasia rates and iatrogenic complications limit
   the ability to accurately prognosticate for affected dogs in this
   retrospective study, but in dogs with LMND that is severe enough to
   require IIPV, support may be required days to weeks.
TC 6
ZB 4
Z8 0
ZS 0
Z9 6
SN 1479-3261
UT WOS:000296378900009
PM 22316200
ER

PT J
AU Latronico, Nicola
   Bolton, Charles F.
TI Critical illness polyneuropathy and myopathy: a major cause of muscle
   weakness and paralysis
SO LANCET NEUROLOGY
VL 10
IS 10
BP 931
EP 941
PD OCT 2011
PY 2011
AB Critical illness polyneuropathy (CIP) and myopathy (CIM) are
   complications of critical illness that present with muscle weakness and
   failure to wean from the ventilator. In addition to prolonging
   mechanical ventilation and hospitalisation, CIP and CIM increase
   hospital mortality in patients who are critically ill and cause chronic
   disability in survivors of critical illness. Structural changes
   associated with CIP and CIM include axonal nerve degeneration, muscle
   myosin loss, and muscle necrosis. Functional changes can cause
   electrical inexcitability of nerves and muscles with reversible muscle
   weakness. Microvascular changes and cytopathic hypoxia might disrupt
   energy supply and use. An acquired sodium channelopathy causing reduced
   muscle membrane and nerve excitability is a possible unifying mechanism
   underlying CIP and CIM. The diagnosis of CIP, CIM, or combined CIP and
   CIM relies on clinical, electrophysiological, and muscle biopsy
   investigations. Control of hyperglycaemia might reduce the severity of
   these complications of critical illness, and early rehabilitation in the
   intensive care unit might improve the functional recovery and
   independence of patients.
RI Latronico, Nicola/F-1557-2010
OI Latronico, Nicola/0000-0002-2521-5871
TC 94
ZB 30
Z8 3
ZS 0
Z9 96
SN 1474-4422
UT WOS:000295814600014
PM 21939902
ER

PT J
AU Rousseau, Marie-Christine
   Pietra, Stephane
   Blaya, Jose
   Catala, Anne
TI Quality of life of ALS and LIS patients with and without invasive
   mechanical ventilation
SO JOURNAL OF NEUROLOGY
VL 258
IS 10
BP 1801
EP 1804
DI 10.1007/s00415-011-6018-9
PD OCT 2011
PY 2011
AB There are very few studies where quality of life (QOL) is assessed in
   patients with complete physical and functional disability and dependence
   to invasive mechanical ventilation (IV). We compared QOL of amyotrophic
   lateral sclerosis (ALS) and locked-in-syndrome (LIS) patients with
   invasive mechanical ventilation to ALS and LIS patients without
   mechanical invasive ventilation. Thirty-four patients, 27 with ALS and
   seven with LIS (vascular or tumoral aetiology) were included in the
   study. Twelve had invasive ventilation, 22 had non-invasive ventilation,
   and in the non-invasive ventilation group, five of them had ventilation
   via mask. The following scales were used for patients: ALS Functional
   Rating Scale (ALSFRS), McGILL, Short-Form 36 (SF36), Beck Depression
   Inventory-II, the Toronto Alexithymia Scale and the anxiety inventory of
   Spielberger. Mean ALSFRS scores were significantly lower in the invasive
   ventilation group (IV) than in the non-invasive ventilation group.
   McGILL and SF36 were not significantly different between the IV group
   and the non-invasive ventilation group; there were no significant
   differences between the two groups for others scales either. Comparison
   between IV group and LIS without invasive mechanical ventilation
   revealed no significant difference for SF36 and McGILL QOL scores. QOL
   was not significantly different between the IV and not invasively
   ventilated patients, but ALSFRS was significantly lower in the IV group,
   and comparison of QOL scores between non-ventilated LIS patients who had
   the same score of dependence that invasively ventilated patients did not
   show any difference. Invasive mechanical ventilation for patients who
   accept tracheotomy allows life prolongation and their QOL is not
   affected; medical teams should be aware of that.
TC 13
ZB 3
Z8 0
ZS 0
Z9 13
SN 0340-5354
UT WOS:000295534400007
PM 21461685
ER

PT J
AU Chong, Hyon Su
   Moon, Eun Su
   Park, Jin Oh
   Kim, Do Yeon
   Kho, Phillip Anthony B.
   Lee, Hwan Mo
   Moon, Sung Hwan
   Kim, Yong Sang
   Kim, Hak Sun
TI Value of Preoperative Pulmonary Function Test in Flaccid Neuromuscular
   Scoliosis Surgery
SO SPINE
VL 36
IS 21
BP E1391
EP E1394
DI 10.1097/BRS.0b013e31820cd489
PD OCT 1 2011
PY 2011
AB Study Design. Retrospective study.
   Objective. To evaluate the prognostic value of preoperative pulmonary
   function test (PFT) for postoperative pulmonary complications and to
   identify the operability associated with severely decreased forced vital
   capacity (FVC) (<30%) status in flaccid neuromuscular scoliosis.
   Summary of Background Data. The preoperative PFT, especially more than
   30% FVC, is known as a critical factor for the operability of flaccid
   neuromuscular scoliosis. But only one study reported that patients with
   pre-existing respiratory failure on nocturnal noninvasive ventilation
   can undergo an operation for deformity correction without mortality and
   severe complications.
   Methods. A total of 74 patients (45 male and 29 female) presented with
   flaccid neuromuscular scoliosis. For all patients, preoperative PFTs
   were evaluated and subdivided into three groups (< 30% FVC, 30%-50% FVC,
   and >50% FVC). Then postoperative pulmonary complications, pneumothorax,
   pneumonia, atelectasis, prolonged ventilator care in the intensive care
   unit (more than 72 hours), and postoperative tracheostomy were
   evaluated.
   Results. Among these patients, 59 had muscular dystrophy; 5, spinal
   muscular atrophy; 2, cerebral palsy; and 8, others. The mean age at
   surgery was 16.8 years (range, 5-32 years). The mean preoperative Cobb
   angle was 54.6 degrees (16 degrees-135 degrees). The overall
   postoperative pulmonary complication rate was 31% (23 complications in
   74 patients). The less than 30% FVC group had 6 complications among 18
   patients; the 30% to 50% FVC group had 7 complications among 18
   patients; and the more than 50% FVC group had 10 complications among 38
   patients. There were no deaths during the perioperative period. There is
   no statistical difference between the three groups (P = 0.6195).
   Conclusion. Patients with flaccid neuromuscular scoliosis can undergo an
   operation for deformity correction regardless of the severely decreased
   pulmonary function.
TC 4
ZB 1
Z8 0
ZS 0
Z9 4
SN 0362-2436
UT WOS:000295318000004
PM 21311396
ER

PT J
AU Tan, Sheng
   Chen, Jian
   Chen, Rui-qing
   Liu, Hui
   Guo, Yang
   Li, Can
   Zhang, Ma-hui
   Chen, Zhen-zhou
TI [Critical illness polyneuropathy in a patient with Parkinson disease: a
   case report and review of the literature].
SO Nan fang yi ke da xue xue bao = Journal of Southern Medical University
VL 31
IS 10
BP 1792
EP 4
PD 2011-Oct
PY 2011
AB OBJECTIVE: To report a case of critical illness polyneuropathy (CIP)
   with Parkinson disease and discuss the development, clinical features
   and early diagnosis of this condition.
   METHODS: The clinical data of a patient with CIP and Parkinson's disease
   and the relevant literature were reviewed.
   RESULTS: This case showed no typical disease course of sepsis, and the
   condition exacerbated rapidly. The patient presented initially with
   abnormal homeostasis, followed by rapid onset of respiratory muscle
   weakness to require mechanical ventilation, but no limb weaknesses were
   detected. Intravenous antibiotics and aggressive treatment of sepsis did
   not produce any positive responses to wean from mechanical ventilation.
   Examinations of creatine kinase and cerebrospinal fluid showed no
   abnormalities. Electromyography and nerve conduction studies
   demonstrated declined nerve conduction velocity and decreased sensory
   and motor muscle action potentials, suggesting the possibility of CIP.
   CONCLUSION: In patients with Parkinson disease, the occurrence of sepsis
   with prolonged mechanical ventilation and limb weakness indicates the
   necessity of neurophysiological examination, muscle biopsies and
   laboratory tests, which may help detect CIP in the early phase. Proper
   interventions of sepsis may reduce the likeliness of CIP. Elimination of
   the risk factors and aggressive management of sepsis can be effective
   measures for preventing CIP.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1673-4254
UT MEDLINE:22027794
PM 22027794
ER

PT J
AU Nordon-Craft, Amy
   Schenkman, Margaret
   Ridgeway, Kyle
   Benson, Alexander
   Moss, Marc
TI Physical Therapy Management and Patient Outcomes Following ICU-Acquired
   Weakness: A Case Series
SO JOURNAL OF NEUROLOGIC PHYSICAL THERAPY
VL 35
IS 3
BP 133
EP 140
DI 10.1097/NPT.0b013e3182275905
PD SEP 2011
PY 2011
AB Background and Purpose: Individuals with critical illness experience
   dysfunction of many body systems including the neuromuscular system.
   Neuromuscular impairments result in a syndrome referred to as intensive
   care unit (ICU)-acquired weakness, which may lead to difficulty with
   activities and participation. The purposes of this case series were to
   (1) describe safety and feasibility of physical intervention in
   individuals with ICU-acquired weakness mechanically ventilated for at
   least 7 days and (2) characterize physical therapist management and
   patient outcomes.
   Case Description: Nineteen patients with ICU-acquired weakness who
   required mechanical ventilation for at least 7 days were enrolled over a
   1-year period.
   Intervention: Physical therapy (PT) was provided 5 d/wk for 30 minutes
   per session.
   Outcomes: Outcome measures included manual muscle tests and item scores
   from the Functional Independence Measure. Participants completed 170 PT
   sessions. Only 20 sessions (12%) were stopped before 30 minutes.
   Seventeen participants survived to discharge; no PT-related adverse
   events occurred. At discharge, participants who went home showed a trend
   toward greater independence and strength than those who were discharged
   to another level of care. Median total hospital days was 28 for those
   discharged to home and 22 for those discharged to other level of care.
   Discussion: This case series demonstrates safety and feasibility of PT
   intervention for patients with ICU-acquired weakness requiring
   mechanical ventilation for at least 7 days. The examination and
   intervention procedures are described and could be implemented with
   other similar individuals in the hospital setting. Future studies should
   investigate frequency and duration of physical intervention, both during
   hospitalization and postdischarge, and how these factors influence
   outcomes.
TC 14
ZB 4
Z8 0
ZS 0
Z9 15
SN 1557-0576
UT WOS:000300182800006
PM 21934375
ER

PT J
AU Warr, Julia
   Thiboutot, Zoe
   Rose, Louise
   Mehta, Sangeeta
   Burry, Lisa D.
TI Current Therapeutic Uses, Pharmacology, and Clinical Considerations of
   Neuromuscular Blocking Agents for Critically III Adults
SO ANNALS OF PHARMACOTHERAPY
VL 45
IS 9
BP 1116
EP 1126
DI 10.1345/aph.1Q004
PD SEP 2011
PY 2011
AB OBJECTIVE: To summarize literature describing use of neuromuscular
   blocking agents (NMBAs) for common critical care indications and provide
   a review of NMBA pharmacology, pharmacokinetics, dosing, drug
   interactions, monitoring, complications, and reversal.
   DATA SOURCES: Searches of MEDLINE (1975-May 2011), EMBASE (1980-May
   2011), and Cumulative Index to Nursing and Allied Health Literature
   (1981-May 2011) were conducted to identify observational and
   interventional studies evaluating the efficacy or safety of NMBAs for
   management of acute lung injury (ALI)/acute respiratory distress
   syndrome (ARDS), status asthmaticus, elevated intracranial pressure
   (ICP), and therapeutic hypothermia.
   STUDY SELECTION AND DATA EXTRACTION: We excluded case reports, animal-
   Or laboratory-based studies, trials describing NMBA use during rapid
   sequence intubation or in the operating room, and studies published in
   languages other than English or French.
   DATA SYNTHESIS: Clinical applications of NMBAs in intensive care
   include, but are not limited to, immobilizing patients for procedural
   interventions, decreasing oxygen consumption, facilitating mechanical
   ventilation, reducing intracranial pressure, preventing shivering, and
   management of tetanus. Recent data on ARDS demonstrated that early
   application of NMBAs improved adjusted 90-day survival for patients with
   severe lung injury. These results may lead to increased use of these
   drugs. While emerging data support the use of cisatracurium in select
   patients with ALI/ARDS, current literature does not support the use of
   one NMBA over another for other critical care indications. Cisatracurium
   may be kinetically preferred for patients with organ dysfunction. Close
   monitoring with peripheral nerve stimulation is recommended with
   sustained use of NMBAs to avoid drug accumulation and minimize the risk
   for adverse drug events. Reversal of paralysis is achieved by
   discontinuing therapy or, rarely, the use of anticholinesterases.
   CONCLUSIONS: NMBAs are high-alert medications used to manage critically
   ill patients. New data are available regarding the use of these agents
   for treatment of ALI/ARDS and status asthmaticus, management of elevated
   ICP, and provision of therapeutic hypothermia after cardiac arrest. To
   improve outcomes and promote patient safety, intensive care unit team
   members should have a thorough knowledge of this class of medications.
RI Charbonneau-Smith, Renee/F-2705-2012
TC 9
ZB 1
Z8 1
ZS 0
Z9 10
SN 1060-0280
UT WOS:000295250000009
PM 21828347
ER

PT J
AU Newman, Julie Bapp
   DeBastos, Angela Gustafson
   Batton, Daniel
   Raz, Sarah
TI Neonatal Respiratory Dysfunction and Neuropsychological Performance at
   the Preschool Age: A Study of Very Preterm Infants With Bronchopulmonary
   Dysplasia
SO NEUROPSYCHOLOGY
VL 25
IS 5
BP 666
EP 678
DI 10.1037/a0023895
PD SEP 2011
PY 2011
AB Objective: The neuropsychological outcome of chronic lung disease (CLD)
   in the very preterm (VP) infant may be determined by a process involving
   chronic hypoxia, with superimposed acute hypoxic episodes, in the
   developing brain. We wished to study the differences in quality of
   outcome between VP preschoolers with and without history of the most
   common form of CLD in the preterm infant, bronchopulmonary dysplasia
   (BPD). We also examined the strength of association between BPD severity
   and neuropsychological outcome, with degree of severity defined
   according to the National Institute of Child Health and Human
   Development (NICHD) National Heart, Lung and Blood Institute (NHLBI)
   Workshop categorical ranking scheme (Jobe & Bancalari, 2001) or in
   accord with dimensional views of severity of respiratory illness.
   Method: We evaluated the intellectual, language, and motor outcomes of
   156, predominantly middle-class preschoolers with history of VP birth,
   with (n = 80) or without (n = 76) BPD. We used supplemental oxygen
   requirement or need for mechanical ventilation as indirect indexes of
   respiratory dysfunction. Results: Following adjustment for potentially
   confounding sociodemographic variables and perinatal medical risk
   factors, we found no group differences in neuropsychological outcome
   based on categorical ranking of BPD severity. However, continuous
   measures of BPD severity accounted for a unique portion of the variance
   in fine motor performance (n(p)(2) = .05), while patent ductus
   arteriosus, a risk mark-er or antecedent of BPD, explained a unique
   portion of the variance in both receptive language (n(p)(2) = .048), and
   gross motor (n(p)(2) = .061) function. Conclusion: A significant, yet
   circumscribed, association was demonstrated between neonatal hypoxic
   risk, in the VP infant, and neuropsychological outcome assessed in the
   preschool years.
TC 5
ZB 3
Z8 0
ZS 0
Z9 5
SN 0894-4105
UT WOS:000294523600012
PM 21639640
ER

PT J
AU Netto, Archana B
   Taly, Arun B
   Kulkarni, Girish Baburao
   Uma Maheshwara Rao, G S
   Rao, Shivaji
TI Prognosis of patients with Guillain-Barre syndrome requiring mechanical
   ventilation.
SO Neurology India
VL 59
IS 5
BP 707
EP 11
DI 10.4103/0028-3886.86545
PD 2011 Sep-Oct
PY 2011
AB INTRODUCTION: Severe Guillain-Barre syndrome (GBS) is associated with
   significant morbidity and also mortality. Identification of modifiable
   risk factors may help in reducing the morbidity and mortality.
   OBJECTIVE: To study the prognostic factors in a selected cohort of
   mechanically ventilated GBS patients.
   MATERIALS AND METHODS: Case records of GBS patients requiring mechanical
   ventilation admitted between 1997 and 2007 were analyzed. All patients
   satisfied the National Institute of Neurological and Communicative
   Disorders and Stroke (NINCDS) criteria for GBS. Primary outcome
   parameters included mortality and GBS disability (Hughes) scale score at
   discharge.
   RESULTS: During the study period, 173 (118 men and 55 women; mean age of
   33.5 ± 21 years) GBS patients were mechanically ventilated. A history of
   antecedent events was present in 83 (48%) patients. In addition to motor
   weakness, In all facial palsy was present in 106 (61%), bulbar palsy in
   91 (53%), sensory involvement in 74 (43%), and symptomatic autonomic
   dysfunction in 27 (16%). The overall mortality was 10.4%. On univariate
   analysis the risk factors for mortality included elderly age (P =
   0.014), autonomic dysfunction (P = 0.002), pulmonary complications (P =
   0.011), hypokalemia (P = 0.011), and bleeding (P = 0.026). All these
   factors were significant in multivariate analysis except for bleeding
   from any site and hypokalemia. In univariate analysis factors associated
   with Hughes scale score ≤ 3 at discharge included younger age (P =
   0.02), presence of bulbar symptoms (P = 0.03) and less severe weakness
   at admission (P = 0.02), slower evolution of disease over more than 3
   days (P = 0.01), electrodiagnostic evidence of demyelinating neuropathy
   (P = 0.00), and absence of sepsis (P = 0.01), hyperkalemia (P = 0.0001),
   and anemia (P = 0.02). In multivariate analysis age was the only
   significant factor.
   CONCLUSIONS: Early identification of modifiable risk factors, such as
   pulmonary involvement, autonomic dysfunction, hypokalemia, sepsis,
   bleeding, and nutritional complications, may reduce the mortality and
   morbidity associated with GBS.
TC 0
ZB 0
Z8 1
ZS 0
Z9 1
SN 0028-3886
UT MEDLINE:22019655
PM 22019655
ER

PT J
AU Lagatta, Joanne
   Andrews, Bree
   Caldarelli, Leslie
   Schreiber, Michael
   Plesha-Troyke, Susan
   Meadow, William
TI Early Neonatal Intensive Care Unit Therapy Improves Predictive Power for
   the Outcomes of Ventilated Extremely Low Birth Weight Infants
SO JOURNAL OF PEDIATRICS
VL 159
IS 3
BP 384
EP U238
DI 10.1016/j.jpeds.2011.02.014
PD SEP 2011
PY 2011
AB Objective To assess the predictive value of early therapy for ventilated
   extremely low birth weight (ELBW) infants beyond information available
   at delivery.
   Study design Prospective, single-center cohort analysis of 177
   ventilated ELBW infants. We collected information known at delivery
   (gestational age, birth weight, singleton, sex, antenatal steroids) and
   additional information while infants were mechanically ventilated (head
   ultrasound scanning, clinician intuitions of death before discharge). An
   adverse outcome was defined as mortality or Bayley Mental Developmental
   Index or Psychomotor Developmental Index <70 at 2 years. We compared the
   predictive ability of clinical variables separately, in combination, and
   in addition to information available at delivery.
   Results A total of 77% of infants survived to follow-up; 56% of
   survivors had Bayley Mental Developmental Index and Psychomotor
   Developmental Index >= 70. A total of 95% of infants with both abnormal
   head ultrasound scanning results and predicted death before discharge
   had an adverse outcome, independent of gestational age. Conversely, 40%
   of infants with normal head ultrasound scanning results and no predicted
   death before discharge had an adverse outcome, independent of
   gestational age. After adjusting for variables known at birth, predicted
   death before discharge and abnormal head ultrasound scanning results
   added significantly to the ability to predict outcomes.
   Conclusion Information gained early in the neonatal intensive care unit
   improves prediction of mortality or neuro-developmental impairment in
   ventilated ELBW infants beyond information available in the delivery
   room. (J Pediatr 2011; 159: 384-91).
TC 9
ZB 7
Z8 0
ZS 0
Z9 9
SN 0022-3476
UT WOS:000294054200009
PM 21429509
ER

PT J
AU Thevis, Mario
   Thomas, Andreas
   Moeller, Ines
   Geyer, Hans
   Dalton, James T.
   Schaenzer, Wilhelm
TI Mass spectrometric characterization of urinary metabolites of the
   selective androgen receptor modulator S-22 to identify potential targets
   for routine doping controls
SO RAPID COMMUNICATIONS IN MASS SPECTROMETRY
VL 25
IS 15
BP 2187
EP 2195
DI 10.1002/rcm.5100
PD AUG 15 2011
PY 2011
AB Drugs that promote anabolic processes with limited undesirable effects
   are of considerable therapeutic interest; some notable examples include
   those for the treatment of cancer cachexia and muscle-wasting diseases.
   Anabolic properties are not only therapeutically beneficial to
   critically ill and debilitated patients, but are also desirable to
   athletes seeking artificial enhancements in endurance, strength and
   accelerated recovery. The use of anabolic agents in the clinical setting
   is being reconsidered with the emergence of a new class of drugs
   referred to as SARMs (selective androgen receptor modulators). SARMs
   have the potential to complement or even replace anabolic androgenic
   steroidal use with the benefit of a reduction of the undesirable side
   effects associated with steroid administration alone.
   Arylpropionamide-based SARMs such as andarine (S-4) and S-22 have shown
   promising therapeutic properties and have attracted the interest of
   elite and amateur athletes despite the absence of clinical approval, and
   evidence for trafficking and misuse in sport has been obtained by doping
   control authorities.
   In this communication, the elucidation of urinary metabolites of the
   SARM drug candidate S-22 is compared with earlier in vitro metabolism
   studies. Following oral administration of illicit S-22, urine samples
   were collected after 62 and 135 h and analyzed for the active drug and
   its major metabolic products. Liquid chromatography interfaced with
   high-resolution/high-accuracy (tandem) mass spectrometry was used to
   identify and/or confirm the predicted target analytes for sports drug
   testing purposes. S-22 was detected in both specimens accompanied by its
   glucuronic acid conjugate. This was the B-ring hydroxylated derivative
   of S-22 plus the corresponding glucuronide (with the phase-II
   metabolites being the more abundant analytes). In addition, the samples
   collected 62 h post-administration also contained the phase-I metabolite
   hydroxylated at the methyl residue (C-20) and the B-ring depleted
   degradation product ('dephenylated' S-22) together with the
   corresponding carboxy analog that was previously reported for canine
   metabolism. The obtained data supports future efforts to effectively
   screen for and confirm the misuse of the non-approved S-22 drug
   candidate in doping controls. Copyright (C) 2011 John Wiley & Sons, Ltd.
TC 15
ZB 12
Z8 0
ZS 0
Z9 15
SN 0951-4198
UT WOS:000292552800009
PM 21710598
ER

PT J
AU Mirzaie, Masoud
   Fatehpur, Sheila
   Friedrich, Martin
   Sossalla, Samuel
   Sohns, Christian
   Schoendube, Friedrich A.
   Schmitto, Jan D.
TI Complex Reconstruction of Supraaortic Branches
SO ANNALS OF THORACIC AND CARDIOVASCULAR SURGERY
VL 17
IS 4
BP 347
EP 351
DI 10.5761/atcs.oa.09.01432
PD AUG 2011
PY 2011
AB Objective: The present paper exemplary describes several severe stenoses
   of supraaortic branches with its symptoms and operative treatments.
   Methods: Eight patients, two female (68 +/- 5 y), six male (73 +/- 4 y),
   were retrospectively evaluated. Patients showed neurological signs as
   followed: recurring attacks of vertigo (80%), temporary paresis of
   extremity (20%), speech disorders (20%) and subclavian and/or
   carotic-steel-syndrome (15%). Seven patients have already been
   previously treated with revascularization of the supraaortic branches in
   the past. The surgical techniques used were thrombendarterectomy of the
   internal carotid artery, carotid-subclavian bypass and complex
   aortotruncal, aorto-carotid and aorto-subclavian-bypass.
   Results: One patient died nine days postoperatively due to myocardial
   infarction. Mean duration of stay on intensive care unit was 1.5 days.
   Mean duration of postoperative ventilation was six hours. Average
   duration of stay on normal ward was nine days.
   Conclusion: This study presents several complex reconstructions of
   supraaortic branches, which were indicated in cases with severe stenoses
   of supraaortic branches. Even though treatment strategies were complex
   the peri- and postoperative complication rates are quite low. These
   therapeutic strategies were necessary to avoid severe neurological
   complications in these patients.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1341-1098
UT WOS:000294510200005
PM 21881320
ER

PT J
AU Guerin, Claude
   Bourdin, Gael
   Leray, Veronique
   Delannoy, Bertrand
   Bayle, Frederique
   Germain, Michele
   Richard, Jean-Christophe
TI Performance of the Cough Assist Insufflation-Exsufflation Device in the
   Presence of an Endotracheal Tube or Tracheostomy Tube: A Bench Study
SO RESPIRATORY CARE
VL 56
IS 8
BP 1108
EP 1114
DI 10.4187/respcare.01121
PD AUG 2011
PY 2011
AB BACKGROUND: The Cough Assist is a mechanical insufflator-exsufflator
   designed to assist airway secretion clearance in patients with
   ineffective cough. The device may benefit intubated and tracheotomized
   patients. We assessed the impact of various artificial airways on peak
   expiratory flow (PEF) with the Cough Assist. METHODS: We measured PEF
   and pressure at the airway opening in a lung model during
   insufflation-exsufflation with the Cough Assist, at 3 set pressures:
   30/-30, 401-40, and 50/-50 cm H(2)O, first without (control), and then
   with different sizes (6.5 to 8.5 mm inner diameter) of endotracheal tube
   (ETT) and tracheostomy tube (6, 7, and 8 mm inner diameter), compliance
   settings of 30 and 60 mL/cm H(2)O, and resistance settings of 0 and 5 cm
   H(2)O/L/s). We analyzed the relationship between PEF and pressure with
   linear regression. RESULTS: With compliance of 30 mL/cm H(2)O and 0
   resistance the slope of the control relationship between PEF and
   pressure was statistically significantly greater than during any
   conditions with ETT or tracheostomy tube. Therefore, in comparison to
   the control, the relationship of PEF to pressure significantly went in
   the direction from top to bottom as the ETT or tracheostomy tube became
   narrower. The findings were the same with compliance of 30 mL/cm H(2)O
   and resistance of 5 cm H(2)O/L/s. With compliance of 60 mL/cm H(2)O the
   highest set pressure values were not achieved and some relationships
   departed from linearity. The control slope of the relationship between
   PEF and pressure with compliance of 60 mL/cm H(2)O and 0 resistance did
   not significantly differ with any ETT or tracheostomy tube. CONCLUSIONS.
   The artificial airways significantly reduced PEF during
   insufflation-exsufflation with Cough Assist; the narrower the inner
   diameter of the artificial airway, the lower the PEF for a given
   expiratory pressure.
RI RICHARD, Jean-Christophe/A-4097-2009
OI RICHARD, Jean-Christophe/0000-0003-1503-3035
TC 8
ZB 0
Z8 1
ZS 0
Z9 9
SN 0020-1324
UT WOS:000293868500005
PM 21801577
ER

PT J
AU Lin, Yusen E.
   Stout, Janet E.
   Yu, Victor L.
TI Prevention of hospital-acquired legionellosis
SO CURRENT OPINION IN INFECTIOUS DISEASES
VL 24
IS 4
BP 350
EP 356
DI 10.1097/QCO.0b013e3283486c6e
PD AUG 2011
PY 2011
AB Purpose of review
   The incidence of hospital-acquired legionellosis appears to be
   increasing. Presence of Legionella in the hospital drinking water is the
   only risk factor known with certainty to be predictive of risk for
   contracting Legionnaires' disease.
   Recent findings
   Given the high frequency of infection by nonpneumophila and nonserogroup
   1 species, both Legionella respiratory culture on selective media and
   urine antigen testing should be available in the hospital clinical
   microbiology laboratory. If the drinking water is contaminated by
   nonpneumophila or nonserogroup 1 species, Legionella culture on
   selective media must be available for patients with hospital-acquired
   pneumonia. The impact of PCR application for environmental water
   specimen remains to be elucidated. Its advantage is that it is a rapid
   test and its weakness is its low specificity. Copper-silver ionization
   disinfection and point-of-use ( POU) filters have proved effective.
   Chlorine dioxide and monochloramine are under evaluation and their
   ultimate role remains to be elucidated. Routine Legionella cultures in
   concert with disinfectant levels are the best indicators for ensuring
   long-term efficacy. Percentage distal site positivity for Legionella in
   drinking water is accurate in predicting risk. Quantitative criteria
   (CFU/ml) have proven inaccurate and should be abandoned.
   Summary
   Infection control professionals, not healthcare facility personnel or
   engineers, should play the leadership role in selecting and evaluating
   the specific disinfection modality. Proactive measures of routine
   environmental cultures for hospital water and disinfection modalities
   allow for effective prevention of this high-profile hospital-acquired
   infection.
TC 10
ZB 6
Z8 1
ZS 0
Z9 11
SN 0951-7375
UT WOS:000292185700008
PM 21666459
ER

PT J
AU Herridge, Margaret S.
TI Recovery and Long-Term Outcome in Acute Respiratory Distress Syndrome
SO CRITICAL CARE CLINICS
VL 27
IS 3
BP 685
EP +
DI 10.1016/j.ccc.2011.04.003
PD JUL 2011
PY 2011
AB Interest in longer-term outcomes after acute respiratory distress
   syndrome (ARDS) and the understanding of patterns of recovery have
   increased enormously over the past 10 years. This article highlights
   important advances in outcomes after ARDS and describes pulmonary
   outcomes, the most recent data on functional and neuropsychological
   disability in patients, health care cost, family caregivers, and early
   models of rehabilitation and intervention.
TC 8
ZB 3
Z8 0
ZS 0
Z9 9
SN 0749-0704
UT WOS:000293306400016
PM 21742223
ER

PT J
AU Flandreau, Ghislain
   Bourdin, Gael
   Leray, Veronique
   Bayle, Frederique
   Wallet, Florent
   Delannoy, Bertrand
   Durante, Gerard
   Vincent, Bernard
   Barbier, Jack
   Burle, Jean-Francois
   Passant, Sandrine
   Richard, Jean-Christophe
   Guerin, Claude
TI Management and Long-Term Outcome of Patients With Chronic Neuromuscular
   Disease Admitted to the Intensive Care Unit for Acute Respiratory
   Failure: A Single-Center Retrospective Study
SO RESPIRATORY CARE
VL 56
IS 7
BP 953
EP 960
DI 10.4187/respcare.00862
PD JUL 2011
PY 2011
AB BACKGROUND: Patients with chronic neuromuscular disease represent less
   than 10% of those receiving mechanical ventilation in the intensive care
   unit (ICU). Little has been reported regarding either ICU management of
   acute respiratory failure (ARF) in the era of noninvasive mechanical
   ventilation (NIV) or long-term outcomes. OBJECTIVE: To describe the
   respiratory management of patients with chronic neuromuscular diseases
   admitted to our university hospital ICU for ARF, and the long-term
   outcomes. METHODS: We retrospectively analyzed patients with chronic
   neuromuscular diseases admitted to our ICU for a first episode of ARF
   between January 1, 1996, and February 27, 2007. We assessed severity of
   illness on ICU admission, respiratory management during ICU stay, and
   outcomes on June 15, 2008. RESULTS: During the study period, 87 patients
   (44 with hereditary and 43 with acquired neuromuscular diseases) had
   their first ARF episode that required ICU admission. In the
   hereditary-diseases group and the acquired-diseases group, respectively,
   the rates of NIV use during the ICU stay were 82% and 63% (P = .040),
   the intubation rates were 30% and 56% (P = .02), and the tracheotomy
   rates were 9% and 12% (difference not significant). At the final
   assessment (median 3 years) the mortality rate was 58%, and mortality
   was not significantly related to the type of neuromuscular disease. At
   final assessment, 46% of the patients were on NIV and 29% had
   tracheotomy. CONCLUSIONS: In our ICU, chronic neuromuscular disease is
   an uncommon cause of ARF, for which we often use NIV. These patients had
   a low probability of death in the ICU. Long-term outcome was independent
   of the type of neuromuscular disease.
RI RICHARD, Jean-Christophe/A-4097-2009
OI RICHARD, Jean-Christophe/0000-0003-1503-3035
TC 6
ZB 0
Z8 0
ZS 0
Z9 6
SN 0020-1324
UT WOS:000293049200005
PM 21740726
ER

PT J
AU Brown, Carlos V. R.
   Daigle, Jacob B.
   Foulkrod, Kelli H.
   Brouillette, Brandee
   Clark, Adam
   Czysz, Clea
   Martinez, Marnie
   Cooper, Hassie
TI Risk Factors Associated With Early Reintubation in Trauma Patients: A
   Prospective Observational Study
SO JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE
VL 71
IS 1
BP 37
EP 41
DI 10.1097/TA.0b013e31821e0c6e
PD JUL 2011
PY 2011
AB Background: After mechanical ventilation, extubation failure is
   associated with poor outcomes and prolonged hospital and intensive care
   unit (ICU) stays. We hypothesize that specific and unique risk factors
   exist for failed extubation in trauma patients. The purpose of this
   study was to identify the risk factors in trauma patients.
   Methods: We performed an 18-month (January 2008-June 2009) prospective,
   cohort study of all adult (8 years or older) trauma patients admitted to
   the ICU who required mechanical ventilation. Failure of extubation was
   defined as reintubation within 24 hours of extubation. Patients who
   failed extubation (failed group) were compared with those who were
   successfully extubated (successful group) to identify independent risk
   factors for failed extubation.
   Results: A total of 276 patients were 38 years old, 76% male, 84%
   sustained blunt trauma, with an mean Injury Severity Score = 21, Glasgow
   Coma Scale (GCS) score = 7, and systolic blood pressure = 125 mm Hg.
   Indications for initial intubation included airway (4%), breathing
   (13%), circulation (2%), and neurologic disability (81%). A total of 17
   patients (6%) failed extubation and failures occurred a mean of 15 hours
   after extubation. Independent risk factors to fail extubation included
   spine fracture, airway intubation, GCS at extubation, and delirium
   tremens. Patients who failed extubation spent more days in the ICU (11
   vs. 6, p = 0.006) and hospital (19 vs. 11, p = 0.002). Mortality was 6%
   (n = 1) in the failed group and 0.4% (n = 1) in the successful
   extubation group.
   Conclusions: Independent risk factors for trauma patients to fail
   extubation include spine fracture, initial intubation for airway, GCS at
   extubation, and delirium tremens. Trauma patients with these four risk
   factors should be observed for 24 hours after extubation, because the
   mean time to failure was 15 hours. In addition, increased complications,
   extended need for mechanical ventilation, and prolonged ICU and hospital
   stays should be expected for trauma patients who fail extubation.
CT 40th Annual Meeting of the Western-Trauma-Association
CY FEB 28-MAR 07, 2010
CL Telluride, CO
SP Western Trauma Assoc; Novo Nordisk A/S
TC 9
ZB 2
Z8 0
ZS 0
Z9 9
SN 0022-5282
UT WOS:000292607400014
PM 21818012
ER

PT J
AU Powers, Scott K.
   Hudson, Matthew B.
   Nelson, W. Bradley
   Talbert, Erin E.
   Min, Kisuk
   Szeto, Hazel H.
   Kavazis, Andreas N.
   Smuder, Ashley J.
TI Mitochondria-targeted antioxidants protect against mechanical
   ventilation-induced diaphragm weakness
SO CRITICAL CARE MEDICINE
VL 39
IS 7
BP 1749
EP 1759
DI 10.1097/CCM.0b013e3182190b62
PD JUL 2011
PY 2011
AB Background: Mechanical ventilation is a life-saving intervention used to
   provide adequate pulmonary ventilation in patients suffering from
   respiratory failure. However, prolonged mechanical ventilation is
   associated with significant diaphragmatic weakness resulting from both
   myofiber atrophy and contractile dysfunction. Although several signaling
   pathways contribute to diaphragm weakness during mechanical ventilation,
   it is established that oxidative stress is required for diaphragmatic
   weakness to occur. Therefore, identifying the site(s) of mechanical
   ventilation-induced reactive oxygen species production in the diaphragm
   is important.
   Objective: These experiments tested the hypothesis that elevated
   mitochondrial reactive oxygen species emission is required for
   mechanical ventilation-induced oxidative stress, atrophy, and
   contractile dysfunction in the diaphragm.
   Design: Cause and effect was determined by preventing mechanical
   ventilation-induced mitochondrial reactive oxygen species emission in
   the diaphragm of rats using a novel mitochondria-targeted antioxidant
   (SS-31).
   Interventions: None.
   Measurements and Main Results: Compared to mechanically ventilated
   animals treated with saline, animals treated with SS-31 were protected
   against mechanical ventilation-induced mitochondrial dysfunction,
   oxidative stress, and protease activation in the diaphragm. Importantly,
   treatment of animals with the mitochondrial antioxidant also protected
   the diaphragm against mechanical ventilation-induced myofiber atrophy
   and contractile dysfunction.
   Conclusions: These results reveal that prevention of mechanical
   ventilation-induced increases in diaphragmatic mitochondrial reactive
   oxygen species emission protects the diaphragm from mechanical
   ventilation-induced diaphragmatic weakness. This important new finding
   indicates that mitochondria are a primary source of reactive oxygen
   species production in the diaphragm during prolonged mechanical
   ventilation. These results could lead to the development of a
   therapeutic intervention to impede mechanical ventilation-induced
   diaphragmatic weakness. (Crit Care Med 2011; 39: 1749-1759)
RI Hudson, Matthew/E-4246-2010
TC 55
ZB 38
Z8 1
ZS 0
Z9 56
SN 0090-3493
UT WOS:000291721800018
PM 21460706
ER

PT J
AU Levine, Sanford
   Budak, Murat T.
   Dierov, Jamil
   Singhal, Sunil
TI Inactivity-induced diaphragm dysfunction and mitochondria-targeted
   antioxidants: New concepts in critical care medicine
SO CRITICAL CARE MEDICINE
VL 39
IS 7
BP 1844
EP 1845
DI 10.1097/CCM.0b013e31821e85ca
PD JUL 2011
PY 2011
RI Budak, Murat/I-8358-2013
OI Budak, Murat/0000-0002-5059-9651
TC 4
ZB 2
Z8 0
ZS 0
Z9 4
SN 0090-3493
UT WOS:000291721800043
PM 21685759
ER

PT J
AU Edberg, M.
   Furebring, M.
   Sjolin, J.
   Enblad, P.
TI Neurointensive care of patients with severe community-acquired
   meningitis
SO ACTA ANAESTHESIOLOGICA SCANDINAVICA
VL 55
IS 6
BP 732
EP 739
DI 10.1111/j.1399-6576.2011.02460.x
PD JUL 2011
PY 2011
AB Background: Reports about neurointensive care of severe
   community-acquired meningitis are few. The aims of this retrospective
   study were to review the acute clinical course, management and outcome
   in a series of bacterial meningitis patients receiving neurointensive
   care.
   Methods: Thirty patients (median age 51, range 1-81) admitted from a
   population of 2 million people during 7 years were studied. The
   neurointensive care protocol included escalated stepwise treatment with
   mild hyperventilation, cerebrospinal fluid (CSF) drainage, continuous
   thiopentotal infusion and decompressive craniectomy. Clinical outcome
   was assessed using the Glasgow outcome scale.
   Results: Twenty-eight patients did not respond to commands on arrival,
   five were non-reacting and five had dilated pupils. Twenty-two patients
   had positive CSF cultures: Streptococcus pneumoniae (n=18), Neisseria
   meningitidis (n=2), beta-streptococcus group A (n=1) and Staphylococcus
   aureus (n=1). Thirty-five patients were mechanically ventilated.
   Intracranial pressure (ICP) was monitored in 28 patients
   (intraventricular catheter=26, intracerebral transducers=2). CSF was
   drained in 15 patients. Three patients received thiopentothal. Increased
   ICP (>20 mm Hg) was observed in 7/26 patients with available ICP data.
   Six patients died during neurointensive care: total brain infarction
   (n=4), cardiac arrest (n=1) and treatment withdrawal (n=1). Seven
   patients died after discharge, three due to meningitis complications. At
   follow-up, 14 patients showed good recovery, six moderate disability,
   two severe disability and 13 were dead.
   Conclusion: Patients judged to have severe meningitis should be admitted
   to neurointensive care units without delay for ICP monitoring and
   management according to modern neurointensive care principles.
TC 6
ZB 3
Z8 0
ZS 0
Z9 6
SN 0001-5172
UT WOS:000292100800016
PM 21615347
ER

PT J
AU Montagnani, Giulia
   Vagheggini, Guido
   Vlad, Eugenia Panait
   Berrighi, Daniele
   Pantani, Luca
   Ambrosino, Nicolino
TI Use of the Functional Independence Measure in People for Whom Weaning
   From Mechanical Ventilation Is Difficult
SO PHYSICAL THERAPY
VL 91
IS 7
BP 1109
EP 1115
DI 10.2522/ptj.20100369
PD JUL 2011
PY 2011
AB Background. The Functional Independence Measure (FIM) has been proposed
   as an outcome measure for people receiving pulmonary rehabilitation
   after an acute exacerbation of chronic obstructive pulmonary disease.
   Objective. The purpose of this study was to examine the clinical utility
   of the FIM after a weaning program in people for whom weaning from
   mechanical ventilation is difficult.
   Design. This was a retrospective observational study.
   Methods. People who had had a tracheostomy, for whom weaning from
   mechanical ventilation was difficult, and who were participating in a
   weaning program (WP group) were retrospectively evaluated. People
   receiving pulmonary rehabilitation after an acute exacerbation of
   chronic obstructive pulmonary disease (PR group) were included as a
   validated control group. The scores on the FIM questionnaire and the
   Medical Research Council dyspnea scores were assessed at admission to
   and at discharge from the programs.
   Results. Admission and discharge data from 56 participants in the WP
   group and 63 participants in the PR group were compared. At admission,
   according to the FIM, 5 participants in the WP group (7.7%) were defined
   as functionally independent, 34 (52.3%) were defined as partially
   dependent, and 26 (40.0%) were defined as completely dependent. At
   discharge, the mean FIM global score was significantly improved, from
   47.9 (SD = 22.8) to 62.6 (SD = 30.0). For participants in the WP group,
   changes in the FIM score were significantly inversely related to the
   admission Acute Physiology and Chronic Health Evaluation (R = -.286) and
   Simplified Acute Physiology (R = -.293) scores and directly related to
   the admission FIM score (R =.355). At admission, 46 participants in the
   PR group (67.7%) were defined as functionally independent, 19 (27.9%)
   were defined as partially dependent, and 3 (4.4%) were defined as
   completely dependent. After pulmonary rehabilitation, the mean FIM
   global score was significantly improved, from 97.4 (SD = 27.5) to 102.5
   (SD = 25.7).
   Limitations. The study was not randomized and involved a relatively
   small sample size.
   Conclusions. The FIM can be used as a functional status outcome measure
   in people for whom weaning from mechanical ventilation is difficult.
TC 8
ZB 0
Z8 0
ZS 1
Z9 9
SN 0031-9023
UT WOS:000292288700014
PM 21596958
ER

PT J
AU Ochala, Julien
   Ahlbeck, Karsten
   Radell, Peter J.
   Eriksson, Lars I.
   Larsson, Lars
TI Factors Underlying the Early Limb Muscle Weakness in Acute Quadriplegic
   Myopathy Using an Experimental ICU Porcine Model
SO PLOS ONE
VL 6
IS 6
AR e20876
DI 10.1371/journal.pone.0020876
PD JUN 14 2011
PY 2011
AB The basic mechanisms underlying acquired generalized muscle weakness and
   paralysis in critically ill patients remain poorly understood and may be
   related to prolonged mechanical ventilation/immobilization (MV) or to
   other triggering factors such as sepsis, systemic corticosteroid (CS)
   treatment and administration of neuromuscular blocking agents (NMBA).
   The present study aims at exploring the relative importance of these
   factors by using a unique porcine model. Piglets were all exposed to MV
   together with different combinations of endotoxin-induced sepsis, CS and
   NMBA for five days. Peroneal motor nerve conduction velocity and
   amplitude of the compound muscle action potential (CMAP) as well as
   biceps femoris muscle biopsy specimens were obtained immediately after
   anesthesia on the first day and at the end of the 5-day experimental
   period. Results showed that peroneal nerve motor conduction velocity is
   unaffected whereas the size of the CMAP decreases independently of the
   type of intervention, in all groups after 5 days. Otherwise, despite a
   preserved size, muscle fibre specific force (maximum force normalized to
   cross-sectional area) decreased dramatically for animals exposed to MV
   in combination with CS or/and sepsis. These results suggest that the
   rapid declines in CMAP amplitude and in force generation capacity are
   triggered by independent mechanisms with significant clinical and
   therapeutic implications.
TC 15
ZB 10
Z8 0
ZS 0
Z9 15
SN 1932-6203
UT WOS:000291682300017
PM 21695079
ER

PT J
AU Emeriaud, Guillaume
   Pettersen, Geraldine
   Ozanne, Bruno
TI Pediatric traumatic brain injury: an update
SO CURRENT OPINION IN ANESTHESIOLOGY
VL 24
IS 3
BP 307
EP 313
DI 10.1097/ACO.0b013e3283466b6b
PD JUN 11 2011
PY 2011
AB Purpose of review
   The developing brain is particularly vulnerable to traumatic brain
   injury (TBI), leading to frequent disability or death. This article is
   an update of the pediatric specificities of TBI management.
   Recent findings
   We review the evidences with regards to general management and
   therapeutic goals to prevent secondary injuries in pediatric TBI
   patients. Recent controversies in neurocritical care, such as multimodal
   neuromonitoring, hyperventilation, barbiturate coma, hypothermia, and
   decompressive surgery, are also highlighted.
   Summary
   Many therapeutic modalities in pediatric TBI have a low level of
   evidence. Further research is needed to establish clear resuscitation
   goals. Universal objectives may not be suitable for all patients;
   intensive neuromonitoring may help in identifying individual therapeutic
   goals and guiding the selection of treatments.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 0952-7907
UT WOS:000289974800011
PM 21494129
ER

PT J
AU Dawson, Deborah
   Endacott, Ruth
TI Implementing quality initiatives using a bundled approach.
SO Intensive & critical care nursing : the official journal of the British
   Association of Critical Care Nurses
VL 27
IS 3
BP 117
EP 20
DI 10.1016/j.iccn.2011.03.006
PD 2011-Jun
PY 2011
AB Critical care has been criticised for its inconsistency in implementing
   and evaluating evidence based practice both at national and
   international level. A review of the critical care literature by
   Berenholtz et al. (2002) identified interventions that might help
   prevent morbidity or mortality in the intensive care unit; from this
   four elements were developed into the initial ventilator care bundle.
   The aim of this bundle was to improve the quality of care for
   mechanically ventilated patients by improving compliance with relevant
   evidence based practice; implementation of this or an adapted cluster of
   interventions has been shown consistently to reduce the incidence of
   ventilator-associated pneumonias across countries. There are now
   numerous care bundles and the bundle approach to quality improvement has
   been proven to be effective across a number of problems, international
   boundaries and in a wide variety of ICU's. The bundle approach
   recognises that core clinical interventions, are not always consistently
   applied across all appropriate patients, the range of interventions
   within a bundle tackles the problem from a variety of different angles.
   Other strengths include its adaptability to the wide variety of
   environments and working practices of intensive care units across the
   world. The bundle and the method of implementation can be adapted to
   suit individual teams and units; however, this can also be a weakness of
   this approach as it limits comparability across centres. The bundle
   approach to quality improvement requires significant multidisciplinary
   engagement and resources to be effective.
RI Endacott, Ruth/B-1333-2013
TC 4
ZB 0
Z8 0
ZS 0
Z9 4
UT MEDLINE:21511476
PM 21511476
ER

PT J
AU Lacomis, David
TI Neuromuscular disorders in critically ill patients: review and update.
SO Journal of clinical neuromuscular disease
VL 12
IS 4
BP 197
EP 218
DI 10.1097/CND.0b013e3181b5e14d
PD 2011-Jun
PY 2011
AB Neuromuscular disorders that are diagnosed in the intensive care unit
   (ICU) usually cause substantial limb weakness and contribute to
   ventilatory dysfunction. Although some lead to ICU admission,
   ICU-acquired disorders, mainly critical illness myopathy (CIM) and
   critical illness polyneuropathy (CIP), are more frequent and are
   associated with considerable morbidity. Approximately 25% to 45% of
   patients admitted to the ICU develop CIM, CIP, or both. Their clinical
   features often overlap; therefore, nerve conduction studies and
   electromyography are particularly helpful diagnostically, and more
   sophisticated electrodiagnostic studies and histopathologic evaluation
   are required in some circumstances. A number of prospective studies have
   identified risk factors for CIP and CIM, but their limitations often
   include the inability to separate CIM from CIP. Animal models reveal
   evidence of a channelopathy in both CIM and CIP, and human studies also
   identified axonal degeneration in CIP and myosin loss in CIM. Outcomes
   are variable. They tend to be better with CIM, and some patients have
   longstanding disabilities. Future studies of well-characterized patients
   with CIP and CIM should refine our understanding of risk factors,
   outcomes, and pathogenic mechanisms, leading to better interventions.
TC 8
ZB 4
Z8 1
ZS 0
Z9 8
UT MEDLINE:22361518
PM 22361518
ER

PT J
AU Racca, F.
   Berta, G.
   Sequi, M.
   Bignamini, E.
   Capello, E.
   Cutrera, R.
   Ottonello, G.
   Ranieri, V. M.
   Salvo, I.
   Testa, R.
   Wolfler, A.
   Bonati, M.
CA LTV Pediat Italian Network
TI Long-Term Home Ventilation of Children in Italy: A National Survey
SO PEDIATRIC PULMONOLOGY
VL 46
IS 6
BP 566
EP 572
DI 10.1002/ppul.21401
PD JUN 2011
PY 2011
AB Background: Improved technology, as well as professional and parental
   awareness, enable many ventilator-dependent children to live at home.
   However, the profile of this growing population, the quality and
   adequacy of home care, and patients' needs still require thorough
   assessment. Objectives: To define the characteristics of Italian
   children receiving long-term home mechanical ventilation (HMV) in Italy.
   Methods: A detailed questionnaire was sent to 302 National Health
   Service hospitals potentially involved in the care of HVM in children
   (aged < 17 years). Information was collected on patient characteristics,
   type of ventilation, and home respiratory care. Results: A total of 362
   HMV children was identified. The prevalence was 4.2 per 100,000 (95% CI:
   3.8-4.6), median age was 8 years (interquartile range 4-14), median age
   at starting mechanical ventilation was 4 years (1-11), and 56% were
   male. The most frequent diagnostic categories were neuromuscular
   disorders (49%), lung and upper respiratory tract diseases (18%),
   hypoxic (ischemic) encephalopathy (13%), and abnormal ventilation
   control (12%). Medical professionals with nurses (for 62% of children)
   and physiotherapists (20%) participated in the patients' discharge from
   hospital, though parents were the primary care giver, and in 47% of
   cases, the sole care giver. Invasive ventilation was used in 41% and was
   significantly related to young age, southern regional residence, longer
   time spent under mechanical ventilation, neuromuscular disorders, or
   hypoxic (ischemic) encephalopathy. Conclusions: Care and technical
   assistance of long-term HMV children need assessment, planning, and
   resources. A wide variability in pattern of HMV was found throughout
   Italy. An Italian national ventilation program, as well as a national
   registry, could be useful in improving the care of these often
   critically ill children. Pediatr Pulmonol. 2011; 46:566-572. (C) 2010
   Wiley-Liss, Inc.
RI Cutrera, Renato/E-9894-2012
TC 9
ZB 4
Z8 0
ZS 0
Z9 9
SN 8755-6863
UT WOS:000290453300006
PM 21560263
ER

PT J
AU Corey, G. Ralph
   Stryjewski, Martin E.
TI New Rules for Clinical Trials of Patients With Acute Bacterial Skin and
   Skin-Structure Infections: Do Not Let the Perfect Be the Enemy of the
   Good
SO CLINICAL INFECTIOUS DISEASES
VL 52
BP S469
EP S476
DI 10.1093/cid/cir162
SU 7
PD JUN 1 2011
PY 2011
AB Over the past decade, the United States has witnessed an epidemic of
   acute bacterial skin and skin-structure infections (ABSSSIs) caused
   primarily by community-acquired methicillin-resistant Staphylococcus
   aureus. To address this medical need as well as the ongoing threat of
   increasing resistance, new antibiotics are being developed. Clinical
   trials involving patients with complicated ABSSSI are being implemented
   to understand the efficacy and safety of these new antibiotic agents.
   Because antibiotics clearly have an effect on the resolution of the
   majority of these infections, placebo-controlled trials have been
   replaced by noninferiority studies. However, to conduct noninferiority
   trials a noninferiority margin must be determined on the basis of the
   effect size of the comparator antibiotic. The lack of modern-day
   placebo-controlled studies of ABSSSI makes determining effect
   size/noninferiority margin-and as a result, trial design-challenging.
   The US Food and Drug Administration (FDA) in collaboration with the
   Foundation for the National Institutes of Health (FNIH) have been
   working hard to resolve these issues and develop a new guidance to aid
   investigators in the conduct of these trials. In this article, we first
   review the 1998 guidance and its shortcomings. Next, we address the
   ongoing discussion of the new 2010 guidance as we understand it, along
   with its perceived strengths and weaknesses. Throughout this process, we
   wish to emphasize that the continued development of antibiotics is
   essential. Thus, we hope that as the FDA and FNIH move forward they will
   strike a balance between "The Perfect" statistical solution and "The
   Good" practical clinical realities.
TC 13
ZB 6
Z8 0
ZS 0
Z9 13
SN 1058-4838
UT WOS:000290319300002
PM 21546623
ER

PT J
AU Wieske, Luuk
   Harmsen, Robin E.
   Schultz, Marcus J.
   Horn, Janneke
TI Is Critical Illness Neuromyopathy and Duration of Mechanical Ventilation
   Decreased by Strict Glucose Control?
SO NEUROCRITICAL CARE
VL 14
IS 3
BP 475
EP 481
DI 10.1007/s12028-011-9507-x
PD JUN 2011
PY 2011
AB Strict glycemic control (SGC) is reported to have a beneficial effect on
   critical illness polyneuropathy/myopathy (CINM) and the duration of
   mechanical ventilation. The methodology used to diagnose CINM differs
   substantially in studies on this topic. This may influence the reported
   treatment effect. We reviewed literature on the effect of SGC on CINM
   and duration of ventilation by conducting a OVID Medline systematic
   electronic search of literature describing effects of SGC on occurrence
   of CINM and the effect of SGC on the duration of mechanical ventilation.
   A beneficial effect of SGC on CINM, diagnosed by needle myography, was
   reported in three studies. One of these studies showed that the
   incidence of weakness or failure to wean did not decrease by SGC, as the
   number of electrophysiological studies (EMG) ordered for these problems
   remained the same. Another study reported no improvement of muscle
   strength due to SGC. SGC reduced the duration of mechanical ventilation
   in three studies while six other studies did not report this beneficial
   effect. SGC seems to have a beneficial effect on CINM, but the reported
   risk reduction is likely to be an overestimation of the treatment effect
   due to the diagnostic methods used. Duration of mechanical ventilation
   may not be a reliable surrogate marker for CINM and a beneficial effect
   of SGC on this parameter has not been proven. We propose to use the
   recently developed diagnostic criteria for ICU-acquired weakness and
   critical illness neuromyopathy in future studies.
RI Schultz, Marcus/K-6147-2012
TC 6
ZB 3
Z8 1
ZS 0
Z9 6
SN 1541-6933
UT WOS:000290226800025
PM 21267673
ER

PT J
AU Needham, Dale M.
   Feldman, Dorianne R.
   Kho, Michelle E.
TI The Functional Costs of ICU Survivorship Collaborating to Improve
   Post-ICU Disability
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 183
IS 8
BP 962
EP 964
DI 10.1164/rccm.201012-2042ED
PD APR 15 2011
PY 2011
TC 19
ZB 4
Z8 0
ZS 0
Z9 19
SN 1073-449X
UT WOS:000289955600004
PM 21498817
ER

PT J
AU Barnato, Amber E.
   Albert, Steven M.
   Angus, Derek C.
   Lave, Judith R.
   Degenholtz, Howard B.
TI Disability among Elderly Survivors of Mechanical Ventilation
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 183
IS 8
BP 1037
EP 1042
DI 10.1164/rccm.201002-0301OC
PD APR 15 2011
PY 2011
AB Rationale: Studies of long-term functional outcomes of elderly survivors
   of mechanical ventilation (MV) are limited to local samples and biased
   retrospective, proxy-reported preadmission functional status.
   Objectives: To assess the impact on disability of hospitalization with
   MV, compared with hospitalization without MV, accounting for
   prospectively assessed prior functional status.
   Methods: Retrospective population-based longitudinal cohort study of
   Medicare beneficiaries age 65 and older enrolled in the Medicare Current
   Beneficiary Survey, 1996-2003.
   Measurements and Main Results: Premeasures and postmeasures of
   disability included mobility difficulty and weighted activities of daily
   living disability scores ranging from 0 (not disabled) to 100
   (completely disabled) based on self-reported health and functional
   status collected 1 year apart. Among 54,771 person-years (PY) of
   observation over 7 calendar years of data, 42,890 PY involved no
   hospitalization, 11,347 PY involved a hospitalization without MV, and
   534 PY included a hospitalization with MV. Mortality at 1 year was 8.9%,
   23.9%, and 72.5%, respectively. The level of disability at the
   post-assessment was substantially higher for a prototypical patient who
   survived after hospitalization with MV (adjusted activities of daily
   living disability score [95% confidence interval] 14.9 [12.2-17.7];
   adjusted mobility difficulty score [95% confidence interval] 25.4
   [22.4-28.4]) compared with an otherwise identical patient who survived
   hospitalization without MV (11.5 [11.1-11.9] and 22.3 [21.8-22.9]) or
   who was not hospitalized (8.0 [7.9-8.1] and 13.4 [13.3-13.6]).
   Conclusions: The greater marginal increase in disability among survivors
   of MV compared with survivors of hospitalization without MV is larger
   than would be predicted from prior functional status.
RI Angus, Derek/E-9671-2012
TC 44
ZB 6
Z8 0
ZS 0
Z9 44
SN 1073-449X
UT WOS:000289955600018
PM 21057004
ER

PT J
AU Ochala, Julien
   Gustafson, Ann-Marie
   Diez, Monica Llano
   Renaud, Guillaume
   Li, Meishan
   Aare, Sudhakar
   Qaisar, Rizwan
   Banduseela, Varuna C.
   Hedstrom, Yvette
   Tang, Xiaorui
   Dworkin, Barry
   Ford, G. Charles
   Nair, K. Sreekumaran
   Perera, Sue
   Gautel, Mathias
   Larsson, Lars
TI Preferential skeletal muscle myosin loss in response to mechanical
   silencing in a novel rat intensive care unit model: underlying
   mechanisms
SO JOURNAL OF PHYSIOLOGY-LONDON
VL 589
IS 8
BP 2007
EP 2026
DI 10.1113/jphysiol.2010.202044
PD APR 15 2011
PY 2011
AB Non-technical summary
   Wasting and severely impaired function of skeletal muscle is frequently
   observed in critically ill intensive care unit (ICU) patients, with
   negative consequences for recovery and quality of life. An experimental
   rat ICU model has been used to study the mechanisms underlying this
   unique wasting condition in neuromuscularly blocked and mechanically
   ventilated animals at durations varying between 6 h and 2 weeks. The
   complete 'mechanical silencing' of skeletal muscle (removal of both
   weight bearing and activation) resulted in a specific myopathy
   frequently observed in ICU patients and characterized by a preferential
   loss of the motor protein myosin. A highly complex and coordinated
   protein synthesis and degradation system was observed in the
   time-resolved analyses. It is suggested the 'mechanical silencing' of
   skeletal muscle is a dominating factor triggering the specific myopathy
   associated with the ICU intervention, and strongly supporting the
   importance of interventions counteracting the complete unloading in ICU
   patients.The muscle wasting and impaired muscle function in critically
   ill intensive care unit (ICU) patients delay recovery from the primary
   disease, and have debilitating consequences that can persist for years
   after hospital discharge. It is likely that, in addition to pernicious
   effects of the primary disease, the basic life support procedures of
   long-term ICU treatment contribute directly to the progressive
   impairment of muscle function. This study aims at improving our
   understanding of the mechanisms underlying muscle wasting in ICU
   patients by using a unique experimental rat ICU model where animals are
   mechanically ventilated, sedated and pharmacologically paralysed for
   duration varying between 6 h and 14 days. Results show that the ICU
   intervention induces a phenotype resembling the severe muscle wasting
   and paralysis associated with the acute quadriplegic myopathy (AQM)
   observed in ICU patients, i.e. a preferential loss of myosin,
   transcriptional down-regulation of myosin synthesis, muscle atrophy and
   a dramatic decrease in muscle fibre force generation capacity. Detailed
   analyses of protein degradation pathways show that the ubiquitin
   proteasome pathway is highly involved in this process. A sequential
   change in localisation of muscle-specific RING finger proteins 1/2
   (MuRF1/2) observed during the experimental period is suggested to play
   an instrumental role in both transcriptional regulation and protein
   degradation. We propose that, for those critically ill patients who
   develop AQM, complete mechanical silencing, due to pharmacological
   paralysis or sedation, is a critical factor underlying the preferential
   loss of the molecular motor protein myosin that leads to impaired muscle
   function or persisting paralysis.
TC 39
ZB 28
Z8 0
ZS 0
Z9 39
SN 0022-3751
UT WOS:000289527200018
PM 21320889
ER

PT J
AU Griffiths, Richard D.
   Jones, Christina
TI Recovering Lives The Follow-Up of ICU Survivors
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 183
IS 7
BP 833
EP 834
DI 10.1164/rccm.201012-1988ED
PD APR 1 2011
PY 2011
TC 3
ZB 1
Z8 0
ZS 0
Z9 3
SN 1073-449X
UT WOS:000289318800001
PM 21471071
ER

PT J
AU Misak, Cheryl J.
TI ICU-Acquired Weakness Obstacles and Interventions for Rehabilitation
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 183
IS 7
BP 845
EP 846
DI 10.1164/rccm.201007-1110OE
PD APR 1 2011
PY 2011
TC 14
ZB 2
Z8 1
ZS 0
Z9 15
SN 1073-449X
UT WOS:000289318800009
PM 20971828
ER

PT J
AU Ciesla, Nancy
   Dinglas, Victor
   Fan, Eddy
   Kho, Michelle
   Kuramoto, Jill
   Needham, Dale
TI Manual Muscle Testing: A Method of Measuring Extremity Muscle Strength
   Applied to Critically Ill Patients
SO JOVE-JOURNAL OF VISUALIZED EXPERIMENTS
IS 50
AR e2632
DI 10.3791/2632
PD APR 2011
PY 2011
AB Survivors of acute respiratory distress syndrome (ARDS) and other causes
   of critical illness often have generalized weakness, reduced exercise
   tolerance, and persistent nerve and muscle impairments after hospital
   discharge.(1-6) Using an explicit protocol with a structured approach to
   training and quality assurance of research staff, manual muscle testing
   (MMT) is a highly reliable method for assessing strength, using a
   standardized clinical examination, for patients following ARDS, and can
   be completed with mechanically ventilated patients who can tolerate
   sitting upright in bed and are able to follow two-step commands.(7, 8)
   This video demonstrates a protocol for MMT, which has been taught to >=
   43 research staff who have performed >800 assessments on >280 ARDS
   survivors. Modifications for the bedridden patient are included. Each
   muscle is tested with specific techniques for positioning,
   stabilization, resistance, and palpation for each score of the 6-point
   ordinal Medical Research Council scale.(7,9-11) Three upper and three
   lower extremity muscles are graded in this protocol: shoulder abduction,
   elbow flexion, wrist extension, hip flexion, knee extension, and ankle
   dorsiflexion. These muscles were chosen based on the standard approach
   for evaluating patients for ICU-acquired weakness used in prior
   publications.(1,2).
TC 3
ZB 0
Z8 0
ZS 0
Z9 3
SN 1940-087X
UT WOS:000209214700026
ER

PT J
AU Masud, Faisal
   Vykoukal, Daynene
TI Preventing healthcare-associated infections in cardiac surgical patients
   as a hallmark of excellence.
SO Methodist DeBakey cardiovascular journal
VL 7
IS 2
BP 48
EP 50
PD 2011 Apr-Jun
PY 2011
AB Healthcare-associated infections (HAI) are the tenth-leading cause of
   death in the United States. The Centers for Disease Control and
   Prevention (CDC) estimate that HAIs annually account for 1.7 million
   infections, 99,000 associated deaths, and a cost of approximately $30
   billion. Nonreimbursement of some of these HAIs by the Centers for
   Medicare and Medicaid Services, public reporting of data (currently in
   27 states), and the statistics listed above are driving quality
   initiatives to reduce or eliminate HAIs. However, a 2009 report from the
   Agency for Healthcare Research & Quality showed that little progress has
   been made towards eliminating HAIs. Reducing the risk of
   healthcare-associated infections is the Joint Commission's National
   Patient Safety Goal Number 7. Cardiac surgery has always been at the
   leading edge of innovation and quality care. Improvements in this field
   have been brought about by the needs of critically ill patients who are
   at high risk of death and by leaders such as Dr. Michael DeBakey who
   were driven to provide excellence in patient care. One of the prime
   examples of quality initiatives in cardiac surgery has been the
   development of the Society of Thoracic Surgeons (STS) National Database.
   This has helped to develop benchmarks by which different institutions
   are measured. The STS database will lead another initiative by providing
   public presentation of hospital- and surgeon-specific data in the near
   future. Even so, cardiac surgery patients are at especially high risk of
   developing HAIs. Use of invasive devices such as central lines, urinary
   catheters, ventilators, etc. - all of which are commonly utilized in the
   care of cardiac surgical patients - is one of the most significant risk
   factors for acquiring HAIs. Cardiac patients also have significant
   co-morbidities such as diabetes, obesity, increasing frailty, advanced
   age, and multiple redo-operations. This combination makes our patients
   more vulnerable to HAIs. Accordingly, in 2010 the Society of
   Cardiovascular Anesthesiologists (SCA) Foundation launched the FOCUS
   (Flawless Operative Cardiovascular Unified Systems) Cardiac Surgery
   Patient Safety Initiative to help eliminate infections in cardiac
   surgery patients, especially catheter-related infections. This
   publication will briefly discuss the four most common infections and
   strategies to reduce HAIs and will touch on some of the
   infection-control experiences from the Methodist DeBakey Heart &
   vascular Center (MDHVC).
TC 1
ZB 1
Z8 0
ZS 0
Z9 1
SN 1947-6094
UT MEDLINE:21685849
PM 21685849
ER

PT J
AU Qin, Ying-Zhi
TI [Pay close attention to intensive care unit-acquired weakness].
SO Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine =
   Zhongguo weizhongbing jijiuyixue
VL 23
IS 4
BP 193
EP 4
PD 2011-Apr
PY 2011
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1003-0603
UT MEDLINE:21473817
PM 21473817
ER

PT J
AU Banerjee, Arna
   Girard, Timothy D.
   Pandharipande, Pratik
TI The complex interplay between delirium, sedation, and early mobility
   during critical illness: applications in the trauma unit
SO CURRENT OPINION IN ANESTHESIOLOGY
VL 24
IS 2
BP 195
EP 201
DI 10.1097/ACO.0b013e3283445382
PD APR 2011
PY 2011
AB Purpose of review
   Critically ill patients are prescribed sedatives and analgesics to
   decrease pain and anxiety, improve patient-ventilator dyssynchrony and
   ensure patient safety. These medications may themselves lead to delirium
   and ICU-acquired weakness, which are associated with worse clinical
   outcomes. This review will focus on the epidemiology of these two
   disease processes and discuss strategies aimed at reducing these
   devastating complications of critical illness.
   Recent findings
   Delirium and ICU-acquired weakness are associated with longer hospital
   stay, increased cost and decreased quality of life after discharge from
   the ICU. Delirium has also shown to be associated with increased
   mortality. Strategies aimed at reducing sedative exposure through
   protocols and coordination of daily sedation and ventilator cessation
   trials, avoiding benzodiazepines in favor of alternative sedative
   regimens and early mobilization of patients have all shown to
   significantly improve patient outcomes.
   Summary
   Delirium and ICU-acquired weakness are complications of critical illness
   associated with worse clinical outcomes and functional decline in
   survivors. An evidence-based approach based on the following tenets -
   minimization of sedative medication, particularly benzodiazepines,
   delirium monitoring and management and early mobilization may mitigate
   these complications.
TC 17
ZB 3
Z8 0
ZS 0
Z9 17
SN 0952-7907
UT WOS:000288154100013
PM 21386669
ER

PT J
AU Sligl, Wendy I.
   Majumdar, Sumit R.
TI How important is age in defining the prognosis of patients with
   community-acquired pneumonia?
SO CURRENT OPINION IN INFECTIOUS DISEASES
VL 24
IS 2
BP 142
EP 147
DI 10.1097/QCO.0b013e328343b6f8
PD APR 2011
PY 2011
AB Purpose of review
   Given that the population is increasing in age, a better understanding
   of the relationship between chronological age and health-related
   outcomes (especially mortality) is needed, for both chronic diseases (e.
   g. diabetes) and acute illnesses (e. g. pneumonia). Our purpose was to
   review the impact of age on the prognosis of patients with
   community-acquired pneumonia (CAP).
   Recent findings
   Many studies in patients with CAP have suggested that chronological age
   is not necessarily independently associated with mortality. Poorer
   outcomes in the elderly with CAP have been related to severity of
   disease, comorbid disease burden, functional status, and frailty, but
   not to age alone. However, many of these studies suffer from
   'over-adjustment' due to the use of unmodified severity scores such as
   the Pneumonia Severity Index or Acute Physiology and Chronic Health
   Evaluation II (that already include age) in multivariable analyses.
   Studies accounting for this over-adjustment suggest that age is, in
   fact, independently associated with mortality in hospitalized patients
   with CAP. Other outcomes including hospitalization and readmission
   rates, hospital length of stay, and cost of care are similarly
   associated with increasing age. Residual confounding is still a problem
   in many of the observational studies reviewed.
   Summary
   Contrary to conventional wisdom, chronological age is independently
   associated with adverse outcomes in patients with CAP. Until better
   methods (or more clinically-rich datasets) for observational studies are
   developed that can avoid over-adjustment and better deal with residual
   confounding, physicians should take into account both a patient's
   overall health status and his or her chronological age.
TC 8
ZB 6
Z8 1
ZS 0
Z9 10
SN 0951-7375
UT WOS:000287693500010
PM 21252659
ER

PT J
AU Berney, Susan
   Elliot, Doug
   Denehy, Linda
TI ICU-acquired weakness - a call to arms (and legs)
SO CRITICAL CARE AND RESUSCITATION
VL 13
IS 1
BP 3
EP 4
PD MAR 2011
PY 2011
TC 4
ZB 0
Z8 0
ZS 0
Z9 4
SN 1441-2772
UT WOS:000295819000001
PM 21355821
ER

PT J
AU Laghi, Franco
   Jubran, Amal
TI Treating the septic muscle with electrical stimulations
SO CRITICAL CARE MEDICINE
VL 39
IS 3
BP 585
EP 586
DI 10.1097/CCM.0b013e31820e2f6f
PD MAR 2011
PY 2011
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 0090-3493
UT WOS:000287480000026
PM 21330856
ER

PT J
AU Scheuringer, M.
   Grill, E.
   Boldt, C.
   Stucki, G.
TI Latent Class Factor Analysis of the Functional Independence Measure
   confirmed four distinct dimensions in patients undergoing neurological
   rehabilitation
SO EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
VL 47
IS 1
BP 25
EP 34
PD MAR 2011
PY 2011
AB Aim. The FIM (TM) instrument is broadly applied in varying
   rehabilitation services for outcome assessment. Thus, it is important to
   examine its applicability for services which may differ from the
   situations and patients for which it was originally developed. The aims
   of the present study were to examine 1) whether the four FIM (TM)
   dimensions "activities of daily living", "sphincter management",
   "mobility", and "executive function" can be retrieved by Latent Class
   Factor Analysis (LCFA); and 2) whether the four dimensions show floor
   effects in patients with acquired brain injuries undergoing intensive
   post-acute rehabilitation.
   Methods. We analyzed the FIM (TM) data of 269 patients with acquired
   brain injuries undergoing intensive post-acute rehabilitation. To
   examine the dimensional structure of the FIM (TM) instrument we carried
   out LCFA. Cronbach's alpha was used to measure the internal consistency.
   We examined the distribution of the dimension scores to identify floor
   effects.
   Results. LCFA confirmed the postulated four dimensions. The explained
   variance of items assigned to the four dimensions ranged from 46% to
   89%. Cronbach's alpha coefficients of the four subscales ranged from
   0.94 to 0.96. The percentage of patients scoring the minimum possible
   score in each of the retrieved dimensions ranged from 22.3% to 47.9%.
   Conclusion. When applying the FIM (TM) instrument to patients undergoing
   intensive neurological rehabilitation its dimensionality should be kept
   in mind. For some patients this outcome measure might not be
   discriminative enough due to floor effects.
RI Grill, Eva/D-1875-2010
OI Grill, Eva/0000-0002-0273-7984
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 1973-9087
UT WOS:000289595300004
PM 20827255
ER

PT J
AU Kobr, J.
   Pizingerova, K.
   Fremuth, J.
   Sasek, L.
   Kocova, J.
   Hes, O.
   Racek, J.
   Topolcan, O.
TI Signaling Molecules for Early Detection of Adverse Interactions during
   Mechanical Ventilation in Animal Models
SO IN VIVO
VL 25
IS 2
BP 209
EP 217
PD MAR-APR 2011
PY 2011
AB Aim: The early identification of adverse interactions during mechanical
   ventilation, investigated by multiplexed immunoanalysis. Materials and
   Methods: Twenty piglets (average age 7 weeks, weight 23 kg) were
   intubated and divided into groups: A, spontaneously breathing; B,
   protectively ventilated; C, ventilated with injurious strategy; D,
   ventilated with lung disability. At the 1st hour (time-1) and 12th hour
   (time-2) of the study, brain natriuretic peptide (BNP), intercellular
   cell adhesion molecules (ICAM-I), vascular cell adhesion molecules
   (VCAM-I), tumor necrosis factor-alpha (TNF-alpha), and interleukin-6
   (Il-6) were analyzed in the blood. Results: The injurious ventilated
   group C exhibited an increase in both cell adhesion molecules (p <
   0.01), TNF-alpha and BNP (p < 0.05) at time-1, and at time-2 farther
   increases (p < 0.05). In group D, an increase in ICAM-I and BNP (p <
   0.05) at time-1, and increases in II-6 and ICAM-I (p < 0.05) at time-2,
   with notable decreases in urine output were observed. Overall, the lung
   damage correlated with TNT-alpha (r=0.904), Il-6 (r=0.740), and ICAM-I
   (r=0.756) levels. Conclusion: All five monitored molecules quickly and
   reliably signaled adverse interactions.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0258-851X
UT WOS:000289322500010
PM 21471537
ER

PT J
AU Shroufi, Amir
   Chowdhury, Rajiv
   Aston, Louise M.
   Pashayan, Nora
   Franco, Oscar H.
TI Measuring health: A practical challenge with a philosophical solution?
SO MATURITAS
VL 68
IS 3
SI SI
BP 210
EP 216
DI 10.1016/j.maturitas.2010.11.019
PD MAR 2011
PY 2011
AB "It is health that is real wealth and not pieces of gold and silver."
   Mohandas Karamchand Gandhi (1869-1948).
   With the current demographic shift being experienced by populations
   globally, almost linear increases in life expectancy have been seen and
   can be expected. However, increases in healthy life expectancy may not
   keep pace. Among older populations the proportion of time spent in less
   than full health tends to increase. As a result, the accurate valuation
   of life spent in states less than full health will become increasingly
   important. Different techniques and approaches have been used to measure
   health in populations. The use of summary measures of population health
   such as DALYs (Disability Adjusted Life Years) has become common, and is
   widely used to compare health between populations and to evaluate the
   potential impact of interventions in economic analyses. Most of the
   commonly used summary measures of health express some measure of life
   lived in full health and life lived with disability or in a state of
   sub-optimal health. Critical to the construction of summary health
   measures are values assigned to health states. Current tools used in
   determining these values include the standard gamble, time trade off,
   person trade off, and the visual analogue scale. However, these
   techniques all have the disadvantage of incorporating individual biases
   (derived from particular characteristics specific to individuals or
   populations) into the process through which health state valuations are
   derived. As a consequence health states are often not directly
   comparable between populations, since characteristics such as
   nationality and ethnicity can influence how health states are valued.
   Furthermore, health can be judged differently by those of different
   ages, with the young often assigning a lower value to life lived at less
   than full health compared to older people.
   The challenge of obtaining opinions which are not influenced by an
   individual's own circumstances is not new. This issue was encountered
   and described by the American philosopher John Rawls in 'A Theory of
   Justice' (1971), in which he employed a thought experiment called 'the
   veil of ignorance' as a means of overcoming this problem. In this
   thought experiment an individual is asked to make decisions about
   distributive justice by imagining they are behind a 'veil of ignorance',
   whereby they are unaware of their own position in society.
   Here we discuss how current methods for deriving health state values may
   incorporate a veil of ignorance approach, and how this may benefit the
   comparability of the health state valuations produced. We also propose
   how such methods may be operationalised.
   Considering these issues, we propose that a new society with new needs
   and a progressively growing interest in maintaining adequate health
   requires appropriate measures of health. These measures should
   facilitate derivation of objective measures of health that are
   comparable to those acquired in other populations, irrespective of age,
   gender, disease status, ethnicity and geographical location. Promoting
   and improving health demands adequate measures of health and the
   application of the Rawlsian veil of ignorance approach could be an
   effective alternative. (C) 2010 Elsevier Ireland Ltd. All rights
   reserved.
TC 4
ZB 2
Z8 0
ZS 1
Z9 5
SN 0378-5122
UT WOS:000288630300003
PM 21216114
ER

PT J
AU Wilkinson, Dominic
TI The Window of Opportunity for Treatment Withdrawal
SO ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE
VL 165
IS 3
BP 211
EP 215
DI 10.1001/archpediatrics.2011.4
PD MAR 2011
PY 2011
AB Physicians sometimes refer to a "window of opportunity" for withdrawing
   life-sustaining treatment in patients with acute severe brain injury.
   There is a period of critical illness and physiological instability when
   treatment withdrawal is likely to be followed by death but prognosis is
   uncertain. If decisions are delayed, greater prognostic certainty can be
   achieved, but with the risk that the patient is no longer dependent on
   life support and survives with very severe disability. In this article I
   draw on the example of birth asphyxia and highlight the role that the
   window of opportunity sometimes plays in decisions about life-sustaining
   treatment in intensive care. I outline the potential arguments in favor
   of and against taking the window into account. I argue that it is, at
   least sometimes, ethical and appropriate for physicians and parents to
   be influenced by the window of opportunity in their decisions about
   life-sustaining treatment. Arch Pediatr Adolesc Med. 2011;165(3):211-215
RI Wilkinson, Dominic/G-1380-2012
TC 10
ZB 3
Z8 0
ZS 0
Z9 10
SN 1072-4710
UT WOS:000288087900005
PM 21383270
ER

PT J
AU Saeed, Tahir
   Patel, Sonal
TI Use of non invasive ventilation to avoid Re-Intubation in Myasthenia
   Gravis; a case report and review of literature
SO JOURNAL OF THE PAKISTAN MEDICAL ASSOCIATION
VL 61
IS 3
BP 293
EP 295
PD MAR 2011
PY 2011
AB Myasthenia Gravis (MG) in the elderly is an uncommon finding, especially
   when it is not related to thymoma. A case is presented with late onset
   Myasthenia Gravis treated with steroids, immunosuppressives and
   mechanical ventilation.
   This 61 year Asian hypertensive lady clinically diagnosed as MG
   presented to emergency room with difficulty in swallowing liquid,
   diplopia, drooping of eyelids and generalized weakness. Within 24 hours
   in the ward developed respiratory distress and CO(2) narcosis, for which
   she was immediately intubated and shifted to ICU and managed by invasive
   ventilation and inotropic support. After stabilization and extubation
   BiPAP was applied successfully.
   BiPAP use is an established, non invasive ventilation technique for
   Myasthenia Gravis. Its application to avoid re-intubation has not been
   thoroughly investigated. We intend to highlight this area for further
   research as it may change the total length of ICU and hospital stay and
   more importantly the outcome for this subset of patients.
TC 2
ZB 0
Z8 1
ZS 1
Z9 3
SN 0030-9982
UT WOS:000287297300024
PM 21465951
ER

PT J
AU Hardiman, Orla
TI Management of respiratory symptoms in ALS
SO JOURNAL OF NEUROLOGY
VL 258
IS 3
BP 359
EP 365
DI 10.1007/s00415-010-5830-y
PD MAR 2011
PY 2011
AB Respiratory insufficiency is a frequent feature of ALS and is present in
   almost all cases at some stage of the illness. It is the commonest cause
   of death in ALS. FVC is used as important endpoint in many clinical
   trials, and in decision-making events for patients with ALS, although
   there are limitations to its predictive utility. There are multiple
   causes of respiratory muscle failure, all of which act to produce a
   progressive decline in pulmonary function. Diaphragmatic fatigue and
   weakness, coupled with respiratory muscle weakness, lead to reduced lung
   compliance and atelectasis. Increased secretions increase the risk of
   aspiration pneumonia, which further compromises respiratory function.
   Bulbar dysfunction can lead to nutritional deficiency, which in turn
   increases the fatigue of respiratory muscles. Early recognition of
   respiratory decline and symptomatic intervention, including non-invasive
   ventilation can significantly enhance both quality of life and life
   expectancy in ALS. Patients with respiratory failure should be advised
   to consider an advance directive to avoid emergency mechanical
   ventilation.
TC 17
ZB 6
Z8 0
ZS 0
Z9 17
SN 0340-5354
UT WOS:000287924200002
PM 21082322
ER

PT J
AU Koch, Susanne
   Spuler, Simone
   Deja, Maria
   Bierbrauer, Jeffrey
   Dimroth, Anna
   Behse, Friedrich
   Spies, Claudia D.
   Wernecke, Klaus-D
   Weber-Carstens, Steffen
TI Critical illness myopathy is frequent: accompanying neuropathy protracts
   ICU discharge
SO JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY
VL 82
IS 3
BP 287
EP 293
DI 10.1136/jnnp.2009.192997
PD MAR 2011
PY 2011
AB Objectives Neuromuscular dysfunction in critically ill patients is
   attributed to either critical illness myopathy (CIM) or critical illness
   polyneuropathy (CIP) or a combination of both. However, it is unknown
   whether differential diagnosis has an impact on prognosis. This study
   investigates whether there is an association between the early
   differentiation of CIM versus CIP and clinical prognosis.
   Methods The authors included mechanically ventilated patients who
   featured a Simplified Acute Physiology Score II (SAPS-II) >= 20 on three
   consecutive days within the first week after intensive care unit (ICU)
   admission. Fifty-three critically ill patients were enrolled and
   examined by conventional nerve-conduction studies and direct muscle
   stimulation (184 examinations in total). The first examination was
   conducted within the first week after admission to the ICU.
   Results In this cohort of critically ill patients, CIM was more frequent
   (68%) than CIP (38%). Electrophysiological signs of CIM preceded
   electrophysiological signs of CIP (median at day 7 in CIM patients vs
   day 10 in CIP patients, p<0.001). Most patients with CIP featured
   concomitant CIM. At discharge from ICU, 25% of patients with isolated
   CIM showed electrophysiological signs of recovery and significantly
   lower degrees of weakness. Recovery could not be observed in patients
   with combined CIM/CIP, even though the ICU length of stay was
   significantly longer (mean 35 days in CIM/CIP vs mean 19 days in CIM,
   p<0.001).
   Conclusion Prognoses of patients differ depending on
   electrophysiological findings during early critical illness: early
   electrophysiological differentiation of ICU acquired neuromuscular
   disorder enhances the evaluation of clinical prognosis during critical
   illness.
TC 29
ZB 14
Z8 1
ZS 0
Z9 30
SN 0022-3050
UT WOS:000287351900012
PM 20802220
ER

PT J
AU Murphy, Timothy W. G.
   Smith, Jon H.
   Ranger, Michael R. B.
   Haynes, Simon R.
TI General Anesthesia for Children With Severe Heart Failure
SO PEDIATRIC CARDIOLOGY
VL 32
IS 2
BP 139
EP 144
DI 10.1007/s00246-010-9832-4
PD FEB 2011
PY 2011
AB Severe heart failure in children is uncommon. The anesthetic management
   of children with this condition is challenging. The authors aimed to
   identify the frequency with which anesthesia for short noncardiac
   surgical procedures or investigations was complicated by
   life-threatening hemodynamic instability and to describe the anesthetic
   techniques used. This study retrospectively reviewed the anesthetic
   charts and notes of children admitted acutely with a diagnosis of severe
   heart failure (fractional shortening of 15% or less) who received
   general anesthesia for noncardiac surgical or diagnostic interventions
   during the 3-year period from September 2005 to September 2008. In this
   study, 21 children received a total of 28 general anesthetics. Two
   patients (10%) experienced a cardiac arrest, and both required unplanned
   admission to the authors' pediatric intensive care unit (PICU)
   postoperatively. A variety of anesthetic techniques was used. In 27
   (96%) of the 28 cases, perioperative inotropic support was required.
   General anesthesia for children with severe heart failure is associated
   with a significant complication rate and should be administered by
   anesthetists familiar with managing all aspects of circulatory support
   for children in an appropriate setting.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0172-0643
UT WOS:000288562400003
PM 21140261
ER

PT J
AU Kallet, Richard H.
TI Patient-Ventilator Interaction During Acute Lung Injury, and the Role of
   Spontaneous Breathing: Part 1: Respiratory Muscle Function During
   Critical Illness
SO RESPIRATORY CARE
VL 56
IS 2
SI SI
BP 181
EP 189
DI 10.4187/respcare.00964
PD FEB 2011
PY 2011
AB Since the early 1970s there has been an ongoing debate regarding the
   wisdom of promoting unassisted spontaneous breathing throughout the
   course of critical illness in patients with severe respiratory failure,.
   The basis of this debate has focused on the clinical relevance of
   opposite problems. Historically, the term "disuse atrophy" has described
   a situation wherein sustained inactivity of the respiratory muscles (ie,
   passive ventilation) results in deconditioning and weakness. More
   recently it has been referred to as "ventilator-induced diaphragmatic
   dysfunction." In contrast, "use atrophy" describes a situation where
   chronic high-tension inspiratory work causes structural damage to the
   diaphragm and weakness. Both laboratory and clinical studies
   demonstrated that relatively brief periods of complete respiratory
   muscle inactivity, as well as intense muscle loading, result in acute
   inflammation, loss of muscle mass, and weakness. Yet in critical illness
   other factors also affect respiratory muscle function, including
   prolonged use of neuromuscular blocking agents, administration of
   corticosteroids, and sepsis. This makes the attribution of acquired
   respiratory muscle weakness and ventilator-dependence to either
   ventilator-induced diaphragmatic dysfunction or loaded breathing
   extremely difficult. Regardless, the clinical implications of this
   research strongly suggest that passive mechanical ventilation should be
   avoided whenever possible. However, promotion of unassisted spontaneous
   breathing in the acute phase of critical illness also may carry a
   substantial risk of respiratory muscle injury and weakness. Use of
   mechanical ventilation modes in a manner that induces spontaneous
   breathing effort, while simultaneously reducing the work load on the
   respiratory muscles, is probably sufficient to minimize both problems.
TC 9
ZB 2
Z8 1
ZS 0
Z9 10
SN 0020-1324
UT WOS:000287958700010
PM 21333178
ER

PT J
AU Ottenheijm, Coen A. C.
   van Hees, Hieronymus W. H.
   Heunks, Leo M. A.
   Granzier, Henk
TI Titin-based mechanosensing and signaling: role in diaphragm atrophy
   during unloading?
SO AMERICAN JOURNAL OF PHYSIOLOGY-LUNG CELLULAR AND MOLECULAR PHYSIOLOGY
VL 300
IS 2
BP L161
EP L166
DI 10.1152/ajplung.00288.2010
PD FEB 2011
PY 2011
AB Ottenheijm CA, van Hees HW, Heunks LM, Granzier H. Titin-based
   mechanosensing and signaling: role in diaphragm atrophy during
   unloading? Am J Physiol Lung Cell Mol Physiol 300: L161-L166, 2011.
   First published November 12, 2010; doi:10.1152/ajplung.00288.2010.-The
   diaphragm, the main muscle of inspiration, is constantly subjected to
   mechanical loading. One of the very few occasions during which diaphragm
   loading is arrested is during controlled mechanical ventilation in the
   intensive care unit. Recent animal studies indicate that the diaphragm
   is extremely sensitive to unloading, causing rapid muscle fiber atrophy:
   unloading-induced diaphragm atrophy and the concomitant diaphragm
   weakness has been suggested to contribute to the difficulties in weaning
   patients from ventilatory support. Little is known about the molecular
   triggers that initiate the rapid unloading atrophy of the diaphragm,
   although proteolytic pathways and oxidative signaling have been shown to
   be involved. Mechanical stress is known to play an important role in the
   maintenance of muscle mass. Within the muscle's sarcomere titin is
   considered to play an important role in the stress-response machinery.
   Titin is the largest protein known to date and acts as a mechanosensor
   that regulates muscle protein expression in a sarcomere strain-dependent
   fashion. Thus, titin is an attractive candidate for sensing the sudden
   mechanical arrest of the diaphragm when patients are mechanically
   ventilated, leading to changes in muscle protein expression. Here, we
   provide a novel perspective on how titin, and its biomechanical sensing
   and signaling, might be involved in the development of mechanical
   unloading-induced diaphragm weakness.
RI van Hees, Jeroen HWH/A-1276-2011
TC 7
ZB 4
Z8 0
ZS 0
Z9 7
SN 1040-0605
UT WOS:000286800300002
PM 21075826
ER

PT J
AU Jaber, Samir
   Petrof, Basil J.
   Jung, Boris
   Chanques, Gerald
   Berthet, Jean-Philippe
   Rabuel, Christophe
   Bouyabrine, Hassan
   Courouble, Patricia
   Koechlin-Ramonatxo, Christelle
   Sebbane, Mustapha
   Similowski, Thomas
   Scheuermann, Valerie
   Mebazaa, Alexandre
   Capdevila, Xavier
   Mornet, Dominique
   Mercier, Jacques
   Lacampagne, Alain
   Philips, Alexandre
   Matecki, Stefan
TI Rapidly Progressive Diaphragmatic Weakness and Injury during Mechanical
   Ventilation in Humans
SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
VL 183
IS 3
BP 364
EP 371
DI 10.1164/rccm.201004-0670OC
PD FEB 1 2011
PY 2011
AB Rationale. Diaphragmatic function is a major determinant of the ability
   to successfully wean patients from mechanical ventilation (MV).
   Paradoxically, MV itself results in a rapid loss of diaphragmatic
   strength in animals. However, very little is known about the time course
   or mechanistic basis for such a phenomenon in humans.
   Objectives: To determine in a prospective fashion the time course for
   development of diaphragmatic weakness during MV; and the relationship
   between MV duration and diaphragmatic injury or atrophy, and the status
   of candidate cellular pathways implicated in these phenomena.
   Methods: Airway occlusion pressure (TwPtr) generated by the diaphragm
   during phrenic nerve stimulation was measured in short-term (0.5 h; n =
   6) and long-term (>5 d; n = 6) MV groups. Diaphragmatic biopsies
   obtained during thoracic surgery (MV for 2-3 h; n = 10) and from
   brain-dead organ donors (MV for 24-249 h; n = 15) were analyzed for
   ultrastructural injury, atrophy, and expression of proteolysis-related
   proteins (ubiquitin, nuclear factor-kappa B, and calpains).
   Measurements and Main Results: TwPtr decreased progressively during MV,
   with a mean reduction of 32 +/- 6% after 6 days. Longer periods of MV
   were associated with significantly greater ultrastructural fiber injury
   (26.2 +/- 4.8 vs. 4.7 +/- 0.6% area), decreased cross-sectional area of
   muscle fibers (1,904 +/- 220 vs. 3,100 +/- 329 mu m(2)), an increase of
   ubiquitinated proteins (+19%), higher expression of p65 nuclear
   factor-kappa B (+77%), and greater levels of the calcium-activated
   proteases calpain-1, -2, and -3 (+104%, +432%, and +266%, respectively)
   in the diaphragm.
   Conclusions: Diaphragmatic weakness, injury, and atrophy occur rapidly
   in critically ill patients during MV, and are significantly correlated
   with the duration of ventilator support.
TC 107
ZB 44
Z8 1
ZS 0
Z9 110
SN 1073-449X
UT WOS:000287294300013
PM 20813887
ER

PT J
AU Morandi, Alessandro
   Brummel, Nathan E.
   Ely, E. Wesley
TI Sedation, delirium and mechanical ventilation: the 'ABCDE' approach
SO CURRENT OPINION IN CRITICAL CARE
VL 17
IS 1
BP 43
EP 49
DI 10.1097/MCC.0b013e3283427243
PD FEB 2011
PY 2011
AB Purpose of review
   Delirium and ICU-acquired weakness are frequent in critically ill
   mechanically ventilated patients. The number of mechanically ventilated
   patients is increasing, placing more patients at risk for these adverse
   outcomes. Sedation is given to ensure comfort and to minimize distress,
   but is linked to delirium and immobility. We review recent findings on
   the management of mechanically ventilated patients focusing on
   strategies that may improve neurologic and functional outcomes in
   critically ill patients.
   Recent findings
   We present the evidence-based 'ABCDE' bundle, an integrated and
   interdisciplinary approach to the management of mechanically ventilated
   patients. Spontaneous awakening and breathing trials have been combined
   into 'awake and breathing coordination', shortening the duration of
   mechanical ventilation, ICU and hospital length of stay and improving
   survival. The choice of alpha-2 agonists reduces ICU delirium and
   duration of mechanical ventilation. Delirium monitoring improves
   recognition of this disorder, but data on pharmacologic treatment are
   mixed. Early mobility and exercise may reduce physical dysfunction and
   delirium rates.
   Summary
   Outcomes of critically ill patients can be improved by applying
   evidence-based therapies for the 'liberation' from mechanical
   ventilation and sedation, and the 'animation' through early
   mobilization. Clinicians should be aware of organizational approaches
   such as the 'ABCDE' bundle to improve the management of mechanically
   ventilated patients.
TC 57
ZB 11
Z8 5
ZS 0
Z9 64
SN 1070-5295
UT WOS:000285726000008
PM 21169829
ER

PT J
AU Hill, Neil
   Fallowfield, Joanne
   Price, Susan
   Wilson, Duncan
TI Military nutrition: maintaining health and rebuilding injured tissue
SO PHILOSOPHICAL TRANSACTIONS OF THE ROYAL SOCIETY B-BIOLOGICAL SCIENCES
VL 366
IS 1562
BP 231
EP 240
DI 10.1098/rstb.2010.0213
PD JAN 27 2011
PY 2011
AB Food and nutrition are fundamental to military capability. Historical
   examples demonstrate that a failure to supply adequate nutrition to
   armies inevitably leads to disaster; however, innovative measures to
   overcome difficulties in feeding reap benefits, and save lives. In
   barracks, UK Armed Forces are currently fed according to the relatively
   new Pay As You Dine policy, which has attracted criticism from some
   quarters. The recently introduced Multi-Climate Ration has been
   developed specifically to deal with issues arising from Iraq and the
   current conflict in Afghanistan. Severely wounded military personnel are
   likely to lose a significant amount of their muscle mass, in spite of
   the best medical care. Nutritional support is unable to prevent this,
   but can ameliorate the effects of the catabolic process. Measuring and
   quantifying nutritional status during critical illness is difficult. A
   consensus is beginning to emerge from studies investigating the effects
   of nutritional interventions on how, what and when to feed patients with
   critical illness. The Ministry of Defence is currently undertaking
   research to address specific concerns related to nutrition as well as
   seeking to promote healthy eating in military personnel.
TC 5
ZB 4
Z8 0
ZS 0
Z9 6
SN 0962-8436
UT WOS:000285241400010
PM 21149358
ER

PT J
AU Macht, Madison
   Wimbish, Tim
   Clark, Brendan J.
   Benson, Alexander B.
   Burnham, Ellen L.
   Williams, Andre
   Moss, Marc
TI Postextubation dysphagia is persistent and associated with poor outcomes
   in survivors of critical illness
SO CRITICAL CARE
VL 15
IS 5
AR R231
DI 10.1186/cc10472
PD 2011
PY 2011
AB Introduction: Dysphagia is common among survivors of critical illness
   who required mechanical ventilation during treatment. The risk factors
   associated with the development of postextubation dysphagia, and the
   effects of dysphagia on patient outcomes, have been relatively
   unexplored.
   Methods: We conducted a retrospective, observational cohort study from
   2008 to 2010 of all patients over 17 years of age admitted to a
   university hospital ICU who required mechanical ventilation and
   subsequently received a bedside swallow evaluation (BSE) by a speech
   pathologist.
   Results: A BSE was performed after mechanical ventilation in 25% (630 of
   2,484) of all patients. After we excluded patients with stroke and/or
   neuromuscular disease, our study sample size was 446 patients. We found
   that dysphagia was present in 84% of patients (n = 374) and classified
   dysphagia as absent, mild, moderate or severe in 16% (n = 72), 44% (n =
   195), 23% (n = 103) and 17% (n = 76), respectively. In univariate
   analyses, we found that statistically significant risk factors for
   severe dysphagia included long duration of mechanical ventilation and
   reintubation. In multivariate analysis, after adjusting for age, gender
   and severity of illness, we found that mechanical ventilation for more
   than seven days remained independently associated with moderate or
   severe dysphagia (adjusted odds ratio (AOR) = 2.84 [interquartile range
   (IQR) = 1.78 to 4.56]; P < 0.01). The presence of severe postextubation
   dysphagia was significantly associated with poor patient outcomes,
   including pneumonia, reintubation, in-hospital mortality, hospital
   length of stay, discharge status and surgical placement of feeding
   tubes. In multivariate analysis, we found that the presence of moderate
   or severe dysphagia was independently associated with the composite
   outcome of pneumonia, reintubation and death (AOR = 3.31 [IQR = 1.89 to
   5.90]; P < 0.01).
   Conclusions: In a large cohort of critically ill patients, long duration
   of mechanical ventilation was independently associated with
   postextubation dysphagia, and the development of postextubation
   dysphagia was independently associated with poor patient outcomes.
TC 20
ZB 6
Z8 0
ZS 0
Z9 20
SN 1466-609X
UT WOS:000303048200027
PM 21958475
ER

PT J
AU van Hees, Hieronymus W. H.
   Schellekens, Willem-Jan M.
   Linkels, Marianne
   Leenders, Floris
   Zoll, Jan
   Donders, Rogier
   Dekhuijzen, P. N. Richard
   van der Hoeven, Johannes G.
   Heunks, Leo M. A.
TI Plasma from septic shock patients induces loss of muscle protein
SO CRITICAL CARE
VL 15
IS 5
AR R233
DI 10.1186/cc10475
PD 2011
PY 2011
AB Introduction: ICU-acquired muscle weakness commonly occurs in patients
   with septic shock and is associated with poor outcome. Although atrophy
   is known to be involved, it is unclear whether ligands in plasma from
   these patients are responsible for initiating degradation of muscle
   proteins. The aim of the present study was to investigate if plasma from
   septic shock patients induces skeletal muscle atrophy and to examine the
   time course of plasma-induced muscle atrophy during ICU stay.
   Methods: Plasma was derived from septic shock patients within 24 hours
   after hospital admission (n = 21) and healthy controls (n = 12). From
   nine patients with septic shock plasma was additionally derived at two,
   five and seven days after ICU admission. These plasma samples were added
   to skeletal myotubes, cultured from murine myoblasts. After incubation
   for 24 hours, myotubes were harvested and analyzed on myosin content,
   mRNA expression of E3-ligase and Nuclear Factor Kappa B (NF kappa B)
   activity. Plasma samples were analyzed on cytokine concentrations.
   Results: Myosin content was approximately 25% lower in myotubes exposed
   to plasma from septic shock patients than in myotubes exposed to plasma
   from controls (P < 0.01). Furthermore, patient plasma increased
   expression of E3-ligases Muscle RING Finger protein-1 (MuRF-1) and
   Muscle Atrophy F-box protein (MAFbx) (P < 0.01), enhanced NF kappa B
   activity (P < 0.05) and elevated levels of ubiquitinated myosin in
   myotubes. Myosin loss was significantly associated with elevated plasma
   levels of interleukin (IL)-6 in septic shock patients (P < 0.001).
   Addition of antiIL-6 to septic shock plasma diminished the loss of
   myosin in exposed myotubes by approximately 25% (P < 0.05). Patient
   plasma obtained later during ICU stay did not significantly reduce
   myosin content compared to controls.
   Conclusions: Plasma from patients with septic shock induces loss of
   myosin and activates key regulators of proteolysis in skeletal myotubes.
   IL-6 is an important player in sepsis-induced muscle atrophy in this
   model. The potential to induce atrophy is strongest in plasma obtained
   during the early phase of human sepsis.
RI van Hees, Jeroen HWH/A-1276-2011; Dekhuijzen, P.N.R./H-8024-2014
TC 17
ZB 8
Z8 0
ZS 0
Z9 17
SN 1466-609X
UT WOS:000303048200029
PM 21958504
ER

PT J
AU Elliott, Doug
   Denehy, Linda
   Berney, Sue
   Alison, Jennifer A.
TI Assessing physical function and activity for survivors of a critical
   illness: A review of instruments
SO AUSTRALIAN CRITICAL CARE
VL 24
IS 3
BP 155
EP 166
DI 10.1016/j.aucc.2011.05.002
PD 2011
PY 2011
AB Background: Functional outcomes and health-related quality of life are
   important measures for survivors of a critical illness. Studies have
   demonstrated debilitating physical effects for a significant proportion
   of surviving patients, particularly those with intensive care
   unit-acquired weakness. Contemporary practice changes include a focus on
   the continuum of critical illness, with less sedation and more physical
   activity including mobility while in ICU, and post-ICU and
   post-hospitalisation activities to support optimal recovery. How to best
   assess the physical function of patients at different phases of their
   recovery and rehabilitation is therefore important.
   Purpose: This narrative review paper examined observational and
   functional assessment instruments used for assessing patients across the
   in-ICU, post-ICU and post-hospital continuum of critical illness.
   Methods: Relevant papers were identified from a search of bibliographic
   databases and a review of the reference list of selected articles. The
   clinimetric properties of physical function and HRQOL measures and their
   relevance and utility in ICU were reported in narrative format.
   Findings: The review highlighted many different instruments used to
   measure function in survivors of ICU including muscle strength testing,
   functional tests and walk tests, and patient centred outcomes such as
   health related quality of life. In general, the sensitivity and validity
   of these instruments for use with survivors of a critical illness has
   not yet been established.
   Conclusion: Based on findings from the review, screening of patients
   using reliable and valid instruments for ICU patients is recommended to
   inform both practice and future studies of interventions aimed at
   improving recovery and rehabilitation. (C) 2011 Australian College of
   Critical Care Nurses Ltd. Published by Elsevier Australia (a division of
   Reed International Books Australia Pty Ltd). All rights reserved.
RI Alison, Jennifer/B-6250-2012
TC 17
ZB 2
Z8 0
ZS 0
Z9 17
SN 1036-7314
UT WOS:000294195200005
PM 21723143
ER

PT J
AU Brennan, David M
   Lum, Peter S
   Uswatte, Gitendra
   Taub, Edward
   Gilmore, Brendan M
   Barman, Joydip
TI A telerehabilitation platform for home-based automated therapy of arm
   function.
SO Conference proceedings : ... Annual International Conference of the IEEE
   Engineering in Medicine and Biology Society. IEEE Engineering in
   Medicine and Biology Society. Annual Conference
VL 2011
BP 1819
EP 22
DI 10.1109/IEMBS.2011.6090518
PD 2011
PY 2011
AB Constraint-Induced Movement Therapy (CI therapy) has been shown to be an
   effective approach for improving arm function in stroke survivors with
   mild to severe hemiparesis. Given the time-intensive nature of the
   intervention, and the inherent costs and travel required to receive
   in-clinic treatment, the accessibility and availability of CI therapy is
   limited. To facilitate home-based CI therapy, a telerehabilitation
   platform has been developed. It consists of a table-top workstation
   configured with a range of physical task devices (e.g. pegboard, object
   flipping, threading, vertical reaching). A desktop PC is used to acquire
   data from sensors embedded in the task devices; display visual
   instructions, stimuli, and feedback to the patient during tasks; and
   provide videoconferencing and remote connection capabilities so the
   therapist can interact with and monitor the patient during at-home
   therapy sessions. This system has potential to greatly expand access to
   CI therapy and make it a more realistic option for a larger number of
   stroke survivors with upper extremity impairment.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 1557-170X
UT MEDLINE:22254682
PM 22254682
ER

PT J
AU Hermans, Greet
   Gosselink, Rik
TI Should we abandon manual muscle strength testing in the ICU?
SO CRITICAL CARE
VL 15
IS 2
AR 127
DI 10.1186/cc10038
PD 2011
PY 2011
AB Intensive-care-unit-acquired weakness is a major complication in
   critically ill patients. The paper by Hough and coworkers suggests that
   the current method of manual muscle strength testing with the Medical
   Research Council sum score is of limited value in the intensive care
   unit. However, their results raise a number of questions and provide
   important lessons for implementation of such evaluations in the
   intensive care unit.
TC 6
ZB 1
Z8 1
ZS 0
Z9 7
SN 1466-609X
UT WOS:000292506000044
PM 21371345
ER

PT J
AU Hough, Catherine L.
   Lieu, Binh K.
   Caldwell, Ellen S.
TI Manual muscle strength testing of critically ill patients: feasibility
   and interobserver agreement
SO CRITICAL CARE
VL 15
IS 1
AR R43
DI 10.1186/cc10005
PD 2011
PY 2011
AB Introduction: It has been proposed that intensive care unit
   (ICU)-acquired weakness (ICUAW) should be assessed using the sum of
   manual muscle strength test scores in 12 muscle groups (the sum score).
   This approach has been tested in patients with Guillain-Barre syndrome,
   yet little is known about the feasibility or test characteristics in
   other critically ill patients. We studied the feasibility and
   interobserver agreement of this sum score in a mixed cohort of
   critically ill and injured patients.
   Methods: We enrolled patients requiring more than 3 days of mechanical
   ventilation. Two observers performed systematic strength assessments of
   each patient. The primary outcome measure was interobserver agreement of
   weakness as a binary outcome (ICUAW is sum score less than 48; "no
   ICUAW" is a sum score greater than or equal to 48) using the Cohen's
   kappa statistic.
   Results: We identified 135 patients who met the inclusion criteria. Most
   were precluded from study participation by altered mental status or
   polytrauma. Thirty-four participants were enrolled, and 30 of these
   individuals completed assessments conducted by both observers. Six met
   the criteria for ICUAW recorded by at least one observer. The observers
   agreed on the diagnosis of ICUAW for 93% of participants (Cohen's kappa
   = 0.76; 95% confidence interval (CI), 0.44 to 1.0). Observer agreement
   was fair in the ICU (Cohen's kappa = 0.38), and agreement was perfect
   after ICU discharge (Cohen's kappa = 1.0). Absolute values of sum scores
   were similar between observers (intraclass correlation coefficient 0.83;
   95% CI, 0.67 to 0.91), but they differed between observers by six points
   or more for 23% of the participants.
   Conclusions: Manual muscle testing (MMT) during critical illness was not
   possible for most patients because of coma, delirium and/or injury.
   Among patients who were able to participate in testing, we found that
   interobserver agreement regarding ICUAW was good, particularly when
   evaluated after ICU discharge. MMT is insufficient for early detection
   of ICU-acquired neuromuscular dysfunction in most patients and may be
   unreliable during critical illness.
TC 40
ZB 7
Z8 1
ZS 0
Z9 41
SN 1466-609X
UT WOS:000288961900043
PM 21276225
ER

PT J
AU McDermid, Robert C.
   Stelfox, Henry T.
   Bagshaw, Sean M.
TI Frailty in the critically ill: a novel concept
SO CRITICAL CARE
VL 15
IS 1
AR 301
DI 10.1186/cc9297
PD 2011
PY 2011
AB The concept of frailty has been defined as a multidimensional syndrome
   characterized by the loss of physical and cognitive reserve that
   predisposes to the accumulation of deficits and increased vulnerability
   to adverse events. Frailty is strongly correlated with age, and overlaps
   with and extends aspects of a patient's disability status (that is,
   functional limitation) and/or burden of comorbid disease. The frail
   phenotype has more specifically been characterized by adverse changes to
   a patient's mobility, muscle mass, nutritional status, strength and
   endurance. We contend that, in selected circumstances, the critically
   ill patient may be analogous to the frail geriatric patient. The
   prevalence of frailty amongst critically ill patients is currently
   unknown; however, it is probably increasing, based on data showing that
   the utilization of intensive care unit (ICU) resources by older people
   is rising. Owing to the theoretical similarities in frailty between
   geriatric and critically ill patients, this concept may have clinical
   relevance and may be predictive of outcomes, along with showing
   important interaction with several factors including illness severity,
   comorbid disease, and the social and structural environment. We believe
   studies of frailty in critically ill patients are needed to evaluate how
   it correlates with outcomes such as survival and quality of life, and
   how it relates to resource utilization, such as length of mechanical
   ventilation, ICU stay and duration of hospitalization. We hypothesize
   that the objective measurement of frailty may provide additional support
   and reinforcement to clinicians confronted with end-of-life decisions on
   the appropriateness of ICU support and/or withholding of life-sustaining
   therapies.
TC 26
ZB 7
Z8 1
ZS 1
Z9 27
SN 1466-609X
UT WOS:000288961900106
PM 21345259
ER

PT J
AU Onders, Raymond P.
   Ponsky, Todd A.
   Elmo, MaryJo
   Lidsky, Karen
   Barksdale, Edward
TI First reported experience with intramuscular diaphragm pacing in
   replacing positive pressure mechanical ventilators in children
SO JOURNAL OF PEDIATRIC SURGERY
VL 46
IS 1
BP 72
EP 76
DI 10.1016/j.jpedsurg.2010.09.071
PD JAN 2011
PY 2011
AB Purpose: Diaphragm pacing (DP) has been shown to successfully replace
   mechanical ventilators for adult tetraplegic patients with chronic
   respiratory insufficiency. This is the first report of DP in
   ventilator-dependent children.
   Methods: This was a prospective interventional experience under
   institutional review board approval. Diaphragm pacing involves
   outpatient laparoscopic diaphragm motor point mapping to identify the
   site where stimulation causes maximum diaphragm contraction with
   implantation of 4 percutaneous intramuscular electrodes. Diaphragm
   conditioning ensues to wean the child from the ventilator.
   Results: Six children were successfully implanted ranging from 5 to 17
   years old with the smallest 15 kg in weight. Length of time on
   mechanical ventilation ranged from 11 days to 7.6 years with an average
   of 3.2 years. In all patients, DP provided tidal volumes above basal
   needs. Five of the patients underwent a home-based weaning program,
   whereas one patient who was implanted only 11 days post spinal cord
   injury never returned to the ventilator with DP use. Another patient was
   weaned from the ventilator full time but died of complications of his
   underlying brain stem tumor. The remaining patients weaned from the
   ventilator for over 14 hours a day and/or are actively conditioning
   their diaphragms.
   Conclusion: Diaphragm pacing successfully replaced mechanical
   ventilators, which improves quality of life. (C) 2011 Elsevier Inc. All
   rights reserved.
RI Ponsky, Todd/J-1214-2014
OI Ponsky, Todd/0000-0001-7195-1493
TC 7
ZB 3
Z8 0
ZS 0
Z9 7
SN 0022-3468
UT WOS:000286194200021
PM 21238643
ER

PT J
AU Ciesla, Nancy
   Dinglas, Victor
   Fan, Eddy
   Kho, Michelle
   Kuramoto, Jill
   Needham, Dale
TI Manual muscle testing: a method of measuring extremity muscle strength
   applied to critically ill patients.
SO Journal of visualized experiments : JoVE
IS 50
DI 10.3791/2632
PD 2011 Apr 12
PY 2011
AB Survivors of acute respiratory distress syndrome (ARDS) and other causes
   of critical illness often have generalized weakness, reduced exercise
   tolerance, and persistent nerve and muscle impairments after hospital
   discharge. Using an explicit protocol with a structured approach to
   training and quality assurance of research staff, manual muscle testing
   (MMT) is a highly reliable method for assessing strength, using a
   standardized clinical examination, for patients following ARDS, and can
   be completed with mechanically ventilated patients who can tolerate
   sitting upright in bed and are able to follow two-step commands. (7, 8)
   This video demonstrates a protocol for MMT, which has been taught to ≥
   43 research staff who have performed >800 assessments on >280 ARDS
   survivors. Modifications for the bedridden patient are included. Each
   muscle is tested with specific techniques for positioning,
   stabilization, resistance, and palpation for each score of the 6-point
   ordinal Medical Research Council scale. Three upper and three lower
   extremity muscles are graded in this protocol: shoulder abduction, elbow
   flexion, wrist extension, hip flexion, knee extension, and ankle
   dorsiflexion. These muscles were chosen based on the standard approach
   for evaluating patients for ICU-acquired weakness used in prior
   publications. (1,2).
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:21505416
PM 21505416
ER

PT J
AU Sassoon, Catherine S. H.
   Zhu, Ercheng
   Fang, Liwei
   Ramar, Kannan
   Jiao, Guang-Yu
   Caiozzo, Vincent J.
TI INTERACTIVE EFFECTS OF CORTICOSTEROID AND MECHANICAL VENTILATION ON
   DIAPHRAGM MUSCLE FUNCTION
SO MUSCLE & NERVE
VL 43
IS 1
BP 103
EP 111
DI 10.1002/mus.21821
PD JAN 2011
PY 2011
AB Information on the interactive effects of methylprednisolone, controlled
   mechanical ventilation (CMV), and assisted mechanical ventilation (AMV)
   on diaphragm function is sparse. Sedated rabbits received 2 days of CMV,
   AMV, and spontaneous breathing (SB), with either methylprednisolone (MP;
   60 mg/kg/day intravenously) or saline. There was also a control group.
   In vitro diaphragm force, myofibril ultrastructure, alpha II-spectrin
   proteins, insulin-like growth factor-1 (IGF-1), and muscle atrophy F-box
   (MAF-box) mRNA were measured. Maximal tetanic tension (P(o)) decreased
   significantly with CMV. Combined MP plus CMV did not decrease P(o)
   further. With AMV, P(o) was similar to SB and controls. Combined MP plus
   AMV or MP plus SB decreased P(o) substantially. Combined MP plus CMV, MP
   plus AMV, or MP plus SB induced myofibrillar disruption that correlated
   with the reduced P(o). alpha II-spectrin increased, IGF-1 decreased, and
   MAF-box mRNA increased in both the CMV group and MP plus CMV group.
   Short-term, high-dose MP had no additive effects on CMV-induced
   diaphragm dysfunction. Combined MP plus AMV impaired diaphragm function,
   but AMV alone did not. We found that acute, high-dose MP produces
   diaphragm dysfunction depending on the mode of mechanical ventilation.
   Muscle Nerve 43: 103-111, 2011
TC 6
ZB 5
Z8 2
ZS 0
Z9 8
SN 0148-639X
UT WOS:000285980000016
PM 21171101
ER

PT J
AU Sassoon, Catherine S. H.
TI Triggering of the Ventilator in Patient-Ventilator Interactions
SO RESPIRATORY CARE
VL 56
IS 1
SI SI
BP 39
EP 48
DI 10.4187/respcare.01006
PD JAN 2011
PY 2011
AB With current ventilator triggering design, in initiating ventilator
   breaths patient effort is only a small fraction of the total effort
   expended to overcome the inspiratory load. Similarly, advances in
   ventilator pressure or flow delivery and inspiratory flow termination
   improve patient effort or inspiratory muscle work during mechanical
   ventilation. Yet refinements in ventilator design do not necessarily
   allow optimal patient-ventilator interactions, as the clinician is key
   in managing patient factors and selecting appropriate ventilator factors
   to maintain patient-ventilator synchrony. In patient-ventilator
   interactions, unmatched patient flow demand by ventilator flow delivery
   results in flow asynchrony, whereas mismatches between mechanical
   inspiratory time (mechanical T(I)) and neural T(I) produce timing
   asynchrony. Wasted efforts are an example of timing asynchrony. In the
   triggering phase, trigger thresholds that are set too high or the type
   of triggering methods induces wasted efforts. Wasted efforts can be
   aggravated by respiratory muscle weakness or other conditions that
   reduce respiratory drive. In the post-triggering phase, ventilator
   factors play an important role in patient-ventilator interaction; this
   role includes the assistance level, set inspiratory flow rate, T(I),
   pressurization rate, and cycling-off threshold, and to some extent,
   applied PEEP. This paper proposes an algorithm that clinicians can use
   to adjust ventilator settings with the goal to eliminate or reduce
   patients' wasted efforts.
CT Conference on Patient - Ventilator Interaction
CY MAR 19-21, 2010
CL Cancun, MEXICO
TC 24
ZB 4
Z8 0
ZS 0
Z9 25
SN 0020-1324
UT WOS:000286575700007
PM 21235837
ER

PT J
AU MacIntyre, Neil R.
TI Patient-Ventilator Interactions: Optimizing Conventional Ventilation
   Modes
SO RESPIRATORY CARE
VL 56
IS 1
SI SI
BP 73
EP 81
DI 10.4187/respcare.00953
PD JAN 2011
PY 2011
AB Assisted (interactive) breathing is generally preferred to controlled
   breaths in patients on mechanical ventilators. Assisted breaths allow
   the patient's respiratory muscles to be used, and ventilatory muscle
   atrophy can be prevented. Moreover, the respiratory drive of the patient
   does not have to be aggressively blunted. However, interactive breaths
   need to be synchronized with the patient's efforts during the trigger,
   the flow delivery, and the cycling phases. Asynchrony during any of
   these can put an intolerable load on the respiratory muscles, leading to
   fatigue and the need for a high level of sedation or even paralysis.
   Current ventilation modes have a number of features that can monitor and
   enhance synchrony, including adjustment of the trigger variable, the use
   of pressure-targeted versus fixed-flow-targeted breaths, and
   manipulations of the cycle variable. Clinicians need to know how to use
   these ventilation mode and monitor them properly, especially
   understanding the airway pressure and flow graphics. The clinical
   challenge is synchronizing ventilator gas delivery with patient effort.
CT Conference on Patient - Ventilator Interaction
CY MAR 19-21, 2010
CL Cancun, MEXICO
TC 11
ZB 3
Z8 0
ZS 0
Z9 11
SN 0020-1324
UT WOS:000286575700013
PM 21235840
ER

PT J
AU Fiorenza, Domenico
   Vitacca, Michele
   Bianchi, Luca
   Gabbrielli, Luciano
   Ambrosino, Nicolino
TI Lung function and disability in neuromuscular patients at first
   admission to a respiratory clinic
SO RESPIRATORY MEDICINE
VL 105
IS 1
BP 151
EP 158
DI 10.1016/j.rmed.2010.09.018
PD JAN 2011
PY 2011
AB Background: Respiratory failure is the most common cause of morbidity
   and mortality in patients with neuromuscular diseases (NMD).
   Non-invasive mechanical ventilation is considered highly effective for
   treating chronic respiratory failure. Perception and knowledge of risks
   associated with respiratory derangements may be underestimated.
   Objective: The aim of our study was to evaluate the association among
   respiratory function, general clinical disability and need of home
   mechanical ventilation (HMV) in patients with slowly progressive NMD
   admitted for the first time to dedicated respiratory outpatient clinics.
   Methods: Anthropometrics, lung function, respiratory muscle function,
   daytime blood gases data, and general clinical disability assessed by
   means of a clinical interview were recorded. Indication for HMV was an
   arterial CO(2) tension >45 mmHg and/or a vital capacity <50% predicted,
   and/or maximal inspiratory pressure <60 cmH(2)O.
   Results: Two out of 5 patients complained of dyspnoea during daily
   activity and dysphagia, while more than 1/3 had ineffective cough and
   speech difficulties. Two-third of the whole group were considered to
   need HMV. By applying one or more criteria for NMD diagnosis, great
   variability was found for indication to HMV. Clinical disability was
   inversely related to dynamic and static lung volumes, and to respiratory
   muscle function.
   Conclusions: About two-third of NMD patients admitted to a respiratory
   clinic is a candidate for home mechanical ventilation being their
   clinical derangement inversely related with respiratory function. The
   use of a simple dedicated clinical disability interview may reduce
   underestimation of HMV need. (C) 2010 Elsevier Ltd. All rights reserved.
TC 5
ZB 2
Z8 0
ZS 0
Z9 5
SN 0954-6111
UT WOS:000286863500023
PM 20965709
ER

PT J
AU Burks, Tyesha N
   Cohn, Ronald D
TI Role of TGF-beta signaling in inherited and acquired myopathies.
SO Skeletal muscle
VL 1
IS 1
BP 19
EP 19
DI 10.1186/2044-5040-1-19
PD 2011 May 04
PY 2011
AB The transforming growth factor-beta (TGF-beta) superfamily consists of a
   variety of cytokines expressed in many different cell types including
   skeletal muscle. Members of this superfamily that are of particular
   importance in skeletal muscle are TGF-beta1, mitogen-activated protein
   kinases (MAPKs), and myostatin. These signaling molecules play important
   roles in skeletal muscle homeostasis and in a variety of inherited and
   acquired neuromuscular disorders. Expression of these molecules is
   linked to normal processes in skeletal muscle such as growth,
   differentiation, regeneration, and stress response. However, chronic
   elevation of TGF-beta1, MAPKs, and myostatin is linked to various
   features of muscle pathology, including impaired regeneration and
   atrophy. In this review, we focus on the aberrant signaling of TGF-beta
   in various disorders such as Marfan syndrome, muscular dystrophies,
   sarcopenia, and critical illness myopathy. We also discuss how the
   inhibition of several members of the TGF-beta signaling pathway has been
   implicated in ameliorating disease phenotypes, opening up novel
   therapeutic avenues for a large group of neuromuscular disorders.
TC 38
ZB 32
Z8 1
ZS 0
Z9 39
UT MEDLINE:21798096
PM 21798096
ER

PT J
AU Ishikawa, Y.
   Bach, J. R.
TI Physical medicine respiratory muscle aids to avert respiratory
   complications of pediatric chest wall and vertebral deformity and muscle
   dysfunction
SO EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
VL 46
IS 4
BP 581
EP 597
PD DEC 2010
PY 2010
AB The purpose of this article was to describe the use of noninvasive
   inspiratory and expiratory muscle aids to prevent chest wall deformities
   including pectus excavatum, to prevent respiratory complications of
   vertebral surgery, to prevent acute and long-term ventilatory
   insufficiency and failure in children with paralytic disorders who
   develop these deformities, and to permit the extubation and tracheostomy
   tube decanulation of "unweanable" patients. Noninvasive airway pressure
   aids can provide up to continuous ventilator support for patients with
   little or no vital capacity and can provide for effective cough flows
   for patients with severely dysfunctional expiratory muscles. An April
   2010 consensus of clinicians from 20 centers in 14 countries reported
   over 1 500 spinal muscular atrophy type 1 (SMA1), Duchenne muscular
   dystrophy (DMD), and amyotrophic lateral sclerosis (ALS) patients who
   survived using continuous ventilatory support without tracheostomy
   tubes. Four of the centers routinely extubated unweanable DMD patients
   so that none of their over 250 such patients has undergone tracheotomy.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 1973-9087
UT WOS:000286687600014
PM 21224790
ER

PT J
AU Schefold, Joerg C.
   Bierbrauer, Jeffrey
   Weber-Carstens, Steffen
TI Intensive care unit-acquired weakness (ICUAW) and muscle wasting in
   critically ill patients with severe sepsis and septic shock
SO JOURNAL OF CACHEXIA SARCOPENIA AND MUSCLE
VL 1
IS 2
BP 147
EP 157
DI 10.1007/s13539-010-0010-6
PD DEC 2010
PY 2010
AB Sepsis presents a major health care problem and remains one of the
   leading causes of death within the intensive care unit (ICU).
   Therapeutic approaches against severe sepsis and septic shock focus on
   early identification. Adequate source control, administration of
   antibiotics, preload optimization by fluid resuscitation and further
   hemodynamic stabilisation using vasopressors whenever appropriate are
   considered pivotal within the early-golden-hours of sepsis. However,
   organ dysfunction develops frequently in and represents a significant
   comorbidity of sepsis. A considerable amount of patients with sepsis
   will show signs of severe muscle wasting and/or ICU-acquired weakness
   (ICUAW), which describes a frequently observed complication in
   critically ill patients and refers to clinically weak ICU patients in
   whom there is no plausible aetiology other than critical illness. Some
   authors consider ICUAW as neuromuscular organ failure, caused by
   dysfunction of the motor unit, which consists of peripheral nerve,
   neuromuscular junction and skeletal muscle fibre. Electrophysiologic
   and/or biopsy studies facilitate further subclassification of ICUAW as
   critical illness myopathy, critical illness polyneuropathy or critical
   illness myoneuropathy, their combination. ICUAW may protract weaning
   from mechanical ventilation and impede rehabilitation measures,
   resulting in increased morbidity and mortality. This review provides an
   insight on the available literature on sepsis-mediated muscle wasting,
   ICUAW and their potential pathomechanisms.
TC 22
ZB 7
Z8 5
ZS 0
Z9 27
SN 2190-5991
UT WOS:000208768100003
ER

PT J
AU Raghig, Hakim
   Young, G. Bryan
   Hammond, Robert
   Nicolle, Michael
TI A Comparison of EMG and Muscle Biopsy in ICU Weakness
SO NEUROCRITICAL CARE
VL 13
IS 3
BP 326
EP 330
DI 10.1007/s12028-010-9431-5
PD DEC 2010
PY 2010
AB Patients can become weak in ICU from various etiologies and mechanisms.
   Establishing the diagnosis is invaluable for prognostic determination
   and specific management. We evaluated the relative contributions of
   clinical, laboratory, electomyographic studies (EMG), and percutaneous
   muscle biopsy (MB) in determining the cause of muscular weakness that
   developed in a series of patients while in ICU. The principal objective
   is to determine the concordance between results of the EMG and MB
   studies in patients with ICU-acquired weakness.
   We retrospectively reviewed hospital charts for clinical features, and
   results of laboratory investigations, EMG studies, and MB results in 11
   consecutive patients who underwent both EMG and MB while in ICU. We
   excluded patients with previously diagnosed muscular weakness or
   neurological conditions prior to ICU admission.
   Electomyographic studies suggested axonal neuropathy in three cases; MB
   confirmed this in one case, but showed myopathic features in two. EMG
   showed myopathic features in two cases; MB confirmed this in both cases.
   EMG suggested neuromyopathy in four cases, confirmed by MB in one case
   only. One patient, subsequently diagnosed with myasthenia gravis with
   decrement on repetitive nerve stimulation and positive
   anti-acetylcholine receptor antibodies, had non-specific findings on MB.
   EMG and MB are complementary investigations. They agreed completely in
   four cases but in the rest of the cases there was uncertainty as to the
   primary process based on the results of electrophysiological studies. In
   only one case was there a clear discordance between electrophysiological
   studies and muscle biopsy. We suggest that muscle biopsy should be
   performed more frequently as it establishes the diagnosis and thus the
   prognosis with more certainty than EMG in some patients. EMG is much
   more difficult in the ICU and more susceptible to confounding technical
   factors, but remains indispensable for the diagnosis of neuromuscular
   transmission defects.
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 1541-6933
UT WOS:000284653800006
PM 20717748
ER

PT J
AU Smit, Gerwin
   Plettenburg, Dick H.
TI Efficiency of voluntary closing hand and hook prostheses
SO PROSTHETICS AND ORTHOTICS INTERNATIONAL
VL 34
IS 4
BP 411
EP 427
DI 10.3109/03093646.2010.486390
PD DEC 2010
PY 2010
AB The Delft Institute of Prosthetics and Orthotics has started a research
   program to develop an improved voluntary closing, body-powered hand
   prosthesis. Five commercially available voluntary closing terminal
   devices were mechanically tested: three hands [Hosmer APRL VC hand,
   Hosmer Soft VC Male hand, Otto Bock 8K24] and two hooks [Hosmer APRL VC
   hook, TRS Grip 2S]. The test results serve as a design guideline for
   future prostheses. A test bench was used to measure activation cable
   forces and displacements, and the produced pinch forces. The
   measurements show that the hands require higher activation forces than
   the hooks and 1.5-8 times more mechanical work. The TRS hook requires
   the smallest activation force (33 N for a 15 N pinch force) and has the
   lowest energy dissipation (52 Nmm). The Hosmer Soft hand requires the
   largest activation force (131 N for a 15 N pinch force) and has the
   highest energy dissipation (1409 Nmm). The main recommendations for
   future prostheses are the following: (1) Required activation forces
   should be below the critical muscle force (similar to 18% of maximum),
   to enable continuous activation without muscle fatigue; and (2)
   hysteresis of mechanism and glove should be lowered, to increase
   efficiency and controllability.</.
RI Smit, Gerwin/B-9994-2012
OI Smit, Gerwin/0000-0002-8160-3238
TC 10
ZB 0
Z8 0
ZS 0
Z9 10
SN 0309-3646
UT WOS:000284360400005
PM 20849359
ER

PT J
AU Divo, Miguel J.
   Murray, Susan
   Cortopassi, Felipe
   Celli, Bartolome R.
TI Prolonged Mechanical Ventilation in Massachusetts: The 2006 Prevalence
   Survey
SO RESPIRATORY CARE
VL 55
IS 12
BP 1693
EP 1698
PD DEC 2010
PY 2010
AB BACKGROUND: Prolonged mechanical ventilation and home ventilation impose
   unique challenges on patients, families, and the heathcare system. In
   the absence of a centralized database to track prolonged and home
   ventilation, there has been a paucity of prevalence studies, and what is
   known is outdated. We surveyed respiratory care managers working in the
   state of Massachusetts to estimate the prevalence and locations of
   prolonged and home ventilation in 2006. METHODS: We invited 113
   respiratory care managers practicing in acute-care hospitals, long-term
   acute-care facilities (also known as weaning units, step-down units, and
   long-term-ventilation units), and home-care companies to participate in
   a Web-based survey. We matched the responses to their respective
   institutions and analyzed the results according to hospital size,
   location (urban or suburban), and whether the institution was a teaching
   institution. RESULTS: In December of 2006 there were 817 ventilated
   patients, of whom 460 met the criteria for prolonged ventilation (> 21 d
   for at least 6 h/d) and 221 met the criteria for home ventilation
   (ventilation for any period of time at home). Of the 239 patients not at
   home, 64 were in acute-care hospitals, 175 in long-term acute-care
   facilities, and 221 at home. The survey response rate was 86% for
   acute-care hospitals with >= 400 beds, 48% for acute-care hospitals with
   < 400 beds, 65% for long-term acute-care facilities, and 67% for
   home-care companies. The non-respondents were primarily smaller,
   suburban, non-teaching hospitals, which have a low prevalence of
   prolonged-ventilation patients. Among the home-ventilation patients, the
   majority had neuromuscular diseases, were < 65 years old, and were
   ventilated via tracheostomy tube. The most important limitations to
   transitioning prolonged-ventilation patients to home ventilation
   appeared to be lack of family and/or economic support. CONCLUSIONS: In
   Massachusetts, the estimated prevalence of prolonged and home
   ventilation increased from 2.8/100,000 inhabitants in 1983 to
   7.1/100,000 inhabitants in 2006, and the majority of them are in
   long-term acute-care facilities, large urban teaching hospitals, and at
   home.
TC 12
ZB 0
Z8 0
ZS 0
Z9 12
SN 0020-1324
UT WOS:000286129700007
PM 21122178
ER

PT J
AU Vasilevskis, Eduard E.
   Ely, E. Wesley
   Speroff, Theodore
   Pun, Brenda T.
   Boehm, Leanne
   Dittus, Robert S.
TI Reducing Iatrogenic Risks ICU-Acquired Delirium and Weakness-Crossing
   the Quality Chasm
SO CHEST
VL 138
IS 5
BP 1224
EP 1233
DI 10.1378/chest.10-0466
PD NOV 2010
PY 2010
AB ICUs are experiencing an epidemic of patients with acute brain
   dysfunction (delirium) and weakness, both associated with increased
   mortality and long-term disability. These conditions are commonly
   acquired in the ICU and are often initiated or exacerbated by sedation
   and ventilation decisions and management. Despite >10 years of evidence
   revealing the hazards of delirium, the quality chasm between current and
   ideal processes of care continues to exist. Monitoring of delirium and
   sedation levels remains inconsistent. In addition, sedation,
   ventilation, and physical therapy practices proven successful at
   reducing the frequency and severity of adverse outcomes are not
   routinely practiced. In this article, we advocate for the adoption and
   implementation of a standard bundle of ICU measures with great potential
   to reduce the burden of ICU-acquired delirium and weakness. Individual
   components of this bundle are evidence based and can help standardize
   communication, improve interdisciplinary care, reduce mortality, and
   improve cognitive and functional outcomes. We refer to this as the
   "ABCDE bundle," for awakening and breathing coordination, delirium
   monitoring, and exercise/early mobility. This evidence-based bundle of
   practices will build a bridge across the current quality chasm from the
   "front end" to the "back end" of critical care and toward improved
   cognitive and functional outcomes for ICU survivors. CHEST 2010;
   138(5):1224-1233
TC 66
ZB 6
Z8 0
ZS 2
Z9 69
SN 0012-3692
UT WOS:000284341700031
PM 21051398
ER

PT J
AU Sheean, P. M.
   Peterson, S. J.
   Gurka, D. P.
   Braunschweig, C. A.
TI Nutrition assessment: the reproducibility of subjective global
   assessment in patients requiring mechanical ventilation
SO EUROPEAN JOURNAL OF CLINICAL NUTRITION
VL 64
IS 11
BP 1358
EP 1364
DI 10.1038/ejcn.2010.154
PD NOV 2010
PY 2010
AB Background/Objectives: The detection of malnutrition in the intensive
   care unit (ICU) is critical to appropriately address its contribution on
   outcomes. The primary objective of this investigation was to determine
   if nutritional status could be reliably classified using subjective
   global assessment (SGA) in mechanically ventilated (MV) patients.
   Subjects/Methods: Fifty-seven patients requiring MV 448 h in a
   university-affiliated medical ICU were evaluated in this cross-sectional
   study over a 3-month period. Nutritional status was categorized
   independently by two registered dietitians using SGA. Frequencies, means
   (+ s.d.), chi(2) and t-tests were used to describe the population
   characteristics; agreement between raters was evaluated using the kappa
   statistic.
   Results: On admission, the average patient was 50.4 (+/- 14.2) years of
   age, overweight (body mass index: 29.0 +/- 9.2kg/m(2)), had an acute
   physiology and chronic health evaluation II score of 24 (+/- 10) and
   respiratory failure. Fifty percent (n = 29) of patients were categorized
   as malnourished. Agreement between raters was 95% before consensus,
   reflecting near perfect agreement (kappa = 0.90) and excellent
   reliability. Patients categorized as malnourished were more often
   admitted to the hospital floor before the ICU (n = 32; 56%), reported
   decreased dietary intake (69 vs 46%, P = 0.02) and exhibited signs of
   muscle wasting (45 vs 7%, P<0.001, respectively) and fat loss (52 vs 7%,
   P<0.001, respectively) on physical exam when compared with normally
   nourished individuals.
   Conclusions: SGA can serve as a reliable nutrition assessment technique
   for detecting malnutrition in patients requiring MV. Its routine use
   should be incorporated into future studies and clinical practice.
   European Journal of Clinical Nutrition (2010) 64, 1358- 1364; doi:
   10.1038/ejcn.2010.154; published online 11 August 2010
TC 17
ZB 7
Z8 0
ZS 0
Z9 17
SN 0954-3007
UT WOS:000283749800016
PM 20700137
ER

PT J
AU Berry, Richard B.
   Chediak, Alejandro
   Brown, Lee K.
   Finder, Jonathan
   Gozal, David
   Iber, Conrad
   Kushida, Clete A.
   Morgenthaler, Timothy
   Rowley, James A.
   Davidson-Ward, Sally L.
TI Best Clinical Practices for the Sleep Center Adjustment of Noninvasive
   Positive Pressure Ventilation (NPPV) in Stable Chronic Alveolar
   Hypoventilation Syndromes
SO JOURNAL OF CLINICAL SLEEP MEDICINE
VL 6
IS 5
BP 491
EP 509
PD OCT 15 2010
PY 2010
AB Noninvasive positive pressure ventilation (NPPV) devices are used during
   sleep to treat patients with diurnal chronic alveolar hypoventilation
   (CAH). Bilevel positive airway pressure (BPAP) using a mask interface is
   the most commonly used method to provide ventilatory support in these
   patients. BPAP devices deliver separately adjustable inspiratory
   positive airway pressure (IPAP) and expiratory positive airway pressure
   (EPAP). The IPAP and EPAP levels are adjusted to maintain upper airway
   patency, and the pressure support (PS = IPAP-EPAP) augments ventilation.
   NPPV devices can be used in the spontaneous mode (the patient cycles the
   device from EPAP to IPAP), the spontaneous timed (ST) mode (a backup
   rate is available to deliver IPAP for the set inspiratory time if the
   patient does not trigger an IPAP/EPAP cycle within a set time window),
   and the timed (T) mode (inspiratory time and respiratory rate are
   fixed). During NPPV titration with polysomnography (PSG), the pressure
   settings, backup rate, and inspiratory time (if applicable) are adjusted
   to maintain upper airway patency and support ventilation. However, there
   are no widely available guidelines for the titration of NPPV in the
   sleep center. A NPPV Titration Task Force of the American Academy of
   Sleep Medicine reviewed the available literature and developed
   recommendations based on consensus and published evidence when
   available. The major recommendations derived by this consensus process
   are as follows:
   General Recommendations:
   1. The indications, goals of treatment, and side effects of NPPV
   treatment should be discussed in detail with the patient prior to the
   NPPV titration study.
   2. Careful mask fitting and a period of acclimatization to low pressure
   prior to the titration should be included as part of the NPPV protocol.
   3. NPPV titration with PSG is the recommended method to determine an
   effective level of nocturnal ventilatory support in patients with CAH.
   In circumstances in which NPPV treatment is initiated and adjusted
   empirically in the outpatient setting based on clinical judgment, a PSG
   should be utilized if possible to confirm that the final NPPV settings
   are effective or to make adjustments as necessary.
   4. NPPV treatment goals should be individualized but typically include
   prevention of worsening of hypoventilation during sleep, improvement in
   sleep quality, relief of nocturnal dyspnea, and providing respiratory
   muscle rest.
   5. When OSA coexists with CAH, pressure settings for treatment of OSA
   may be determined during attended NPPV titration PSG following AASM
   Clinical Guidelines for the Manual Titration of Positive Airway Pressure
   in Patients with Obstructive Sleep Apnea.
   6. Attended NPPV titration with PSG is the recommended method to
   identify optimal treatment pressure settings for patients with the
   obesity hypoventilation syndrome (OHS), CAH due to restrictive chest
   wall disease (RTCD), and acquired or central CAH syndromes in whom NPPV
   treatment is indicated.
   7. Attended NPPV titration with PSG allows definitive identification of
   an adequate level of ventilatory support for patients with neuromuscular
   disease (NMD) in whom NPPV treatment is planned.
   Recommendations for NPPV Titration Equipment:
   1. The NPPV device used for titration should have the capability of
   operating in the spontaneous, spontaneous timed, and timed mode.
   2. The airflow, tidal volume, leak, and delivered pressure signals from
   the NPPV device should be monitored and recorded if possible. The
   airflow signal should be used to detect apnea and hypopnea, while the
   tidal volume signal and respiratory rate are used to assess ventilation.
   3. Transcutaneous or end-tidal PCO(2) may be used to adjust NPPV
   settings if adequately calibrated and ideally validated with arterial
   blood gas testing.
   4. An adequate assortment of masks (nasal, oral, and oronasal) in both
   adult and pediatric sizes (if children are being titrated), a source of
   supplemental oxygen, and heated humidification should be available.
   Recommendations for Limits of IPAP, EPAP, and PS Settings:
   1. The recommended minimum starting IPAP and EPAP should be 8 cm H(2)O
   and 4 cm H(2)O, respectively.
   2. The recommended maximum IPAP should be 30 cm H(2)O for patients >= 12
   years and 20 cm H(2)O for patients < 12 years.
   3. The recommended minimum and maximum levels of PS are 4 cm H(2)O and
   20 cm H(2)O, respectively.
   4. The minimum and maximum incremental changes in PS should be 1 and 2
   cm H(2)O, respectively.
   Recommendations for Adjustment of IPAP, EPAP, and PS:
   1. IPAP and/or EPAP should be increased as described in AASM Clinical
   Guidelines for the Manual Titration of Positive Airway Pressure in
   Patients with Obstructive Sleep Apnea until the following obstructive
   respiratory events are eliminated (no specific order): apneas,
   hypopneas, respiratory effort-related arousals, and snoring.
   2. The pressure support (PS) should be increased every 5 minutes if the
   tidal volume is low (< 6 to 8 mL/kg)
   3. The PS should be increased if the arterial PCO(2) remains 10 mm Hg or
   more above the PCO(2) goal at the current settings for 10 minutes or
   more. An acceptable goal for PCO(2) is a value less than or equal to the
   awake PCO(2).
   4. The PS may be increased if respiratory muscle rest has not been
   achieved by NPPV treatment at the current settings for 10 minutes of
   more.
   5. The PS may be increased if the SpO(2) remains below 90% for 5 minutes
   or more and tidal volume is low (< 6 to 8 mL/kg).
   Recommendations for Use and Adjustment of the Backup Rate/Respiratory
   Rate:
   1. A backup rate (i.e., ST mode) should be used in all patients with
   central hypoventilation, those with a significant number of central
   apneas or an inappropriately low respiratory rate, and those who
   unreliably trigger IPAP/EPAP cycles due to muscle weakness.
   2. The ST mode may be used if adequate ventilation or adequate
   respiratory muscle rest is not achieved with the maximum (or maximum
   tolerated) PS in the spontaneous mode.
   3. The starting backup rate should be equal to or slightly less than the
   spontaneous sleeping respiratory rate (minimum of 10 bpm).
   4. The backup rate should be increased in 1 to 2 bpm increments every 10
   minutes if the desired goal of the backup rate has not been attained.
   5. The IPAP time (inspiratory time) should be set based on the
   respiratory rate to provide an inspiratory time (IPAP time) between 30%
   and 40% of the cycle time (60/respiratory rate in breaths per minute).
   6. If the spontaneous timed mode is not successful at meeting titration
   goals then the timed mode can be tried.
   Recommendations Concerning Supplemental Oxygen:
   1. Supplemental oxygen may be added in patients with an awake SpO(2)
   <88% or when the PS and respiratory rate have been optimized but the
   SpO(2) remains < 90% for 5 minutes or more.
   2. The minimum starting supplemental oxygen rate should be 1 L/minute
   and increased in increments of 1 L/minute about every 5 minutes until an
   adequate SpO(2) is attained (> 90%).
   Recommendations to Improve Patient Comfort and Patient-NPPV Device
   Synchrony:
   1. If the patient awakens and complains that the IPAP and/or EPAP is too
   high, pressure should be lowered to a level comfortable enough to allow
   return to sleep.
   2. NPPV device parameters (when available) such as pressure relief, rise
   time, maximum and minimum IPAP durations should be adjusted for patient
   comfort and to optimize synchrony between the patient and the NPPV
   device.
   3. During the NPPV titration mask refit, adjustment, or change in mask
   type should be performed whenever any significant unintentional leak is
   observed or the patient complains of mask discomfort. If mouth leak is
   present and is causing significant symptoms (e.g., arousals) use of an
   oronasal mask or chin strap may be tried. Heated humidification should
   be added if the patient complains of dryness or significant nasal
   congestion.
   Recommendations for Follow-Up:
   1. Close follow-up after initiation of NPPV by appropriately trained
   health care providers is indicated to establish effective utilization
   patterns, remediate side effects, and assess measures of ventilation and
   oxygenation to determine if adjustment to NPPV is indicated.
TC 31
ZB 9
Z8 2
ZS 0
Z9 33
SN 1550-9389
UT WOS:000282868800015
PM 20957853
ER

PT J
AU Hall, Jesse B.
TI Creating the animated intensive care unit
SO CRITICAL CARE MEDICINE
VL 38
BP S668
EP S675
DI 10.1097/CCM.0b013e3181f203aa
SU S
PD OCT 2010
PY 2010
AB Critical care medicine has matured greatly as a field in the past
   decade. Much has been learned concerning the institution of life support
   therapies to sustain patients with diverse and multiple organ failures,
   thus providing patients with a window of opportunity to recover from
   potentially life-ending insults. The management of critically ill
   patients has increasingly involved creation of a highly controlled
   environment by care providers, with patients immobilized, tethered to
   devices, and receiving multiple drugs to facilitate the entire process.
   Although it has been assumed that such control of the patient has been
   necessary to implement essential therapies and to tailor life support
   systems such as mechanical ventilation, this assumption may be unfounded
   or at least overplayed, as knowledge of the adverse effects of this
   approach have been identified and quantified. Extant information, based
   on observational studies and a few interventional trials, would suggest
   a radically different approach to care is warranted, even given the
   difficulties in reversing the current culture of critical care
   management. Specifically, methods to avoid entirely, or minimize,
   neuromuscular blockade and sedation are supported by recent literature.
   These methods include the use of noninvasive ventilation in
   appropriately selected patients, the development of mechanical
   ventilators more synchronous with patient efforts and needs, and the use
   of sedation strategies to avoid drug accumulations with protracted
   effects. These methods, in turn, afford opportunities to avoid extreme
   immobilization and institute physiotherapy earlier than previously had
   been thought possible. In addition to the neuropsychiatric and
   neuromuscular benefits that could derive from minimizing opiate
   administration in critically ill patients, gut hypomotility could be
   avoided. This, in turn, could facilitate earlier and more complete
   enteral nutrition. Even when opioids have to be administered in generous
   amounts for control of pain that may accompany critical illness, it is
   now possible to block the peripheral actions of these medications with
   the mu-receptor antagonist methylnaltrexone. Other new drugs being
   introduced into the critical care unit such as dexmedetomidine may also
   provide a greater ability to achieve analgesia and anxiolysis without
   some of the adverse concomitant effects seen with more traditional drug
   regimens. The ultimate goal of this multipronged program to facilitate
   the maintenance of patients who are more interactive with their care
   providers, and the life support provided in the intensive care unit
   would be to speed the pace of recovery and to diminish the need for the
   protracted rehabilitation that often follows survival from critical
   illness. (Crit Care Med 2010; 38[Suppl.]:S668-S675)
CT Conference on Thinking Outside the Box
CY MAR, 2010
CL Brussels, BELGIUM
TC 7
ZB 1
Z8 0
ZS 0
Z9 7
SN 0090-3493
UT WOS:000289148900025
PM 21164413
ER

PT J
AU Vasilevskis, Eduard E.
   Pandharipande, Pratik P.
   Girard, Timothy D.
   Ely, E. Wesley
TI A screening, prevention, and restoration model for saving the injured
   brain in intensive care unit survivors
SO CRITICAL CARE MEDICINE
VL 38
BP S683
EP S691
DI 10.1097/CCM.0b013e3181f245d3
SU S
PD OCT 2010
PY 2010
AB We face a profound and emerging public health problem in the form of
   acute and chronic brain dysfunction. This affects both young and elderly
   intensive care unit survivors and is altering the landscape of society.
   Two-thirds of intensive care unit patients develop delirium, and this is
   associated with longer stays, increased costs, and excess mortality. In
   addition, over half of intensive care unit survivors suffer a
   dementia-like illness that impacts their physical and cognitive
   functional abilities and which appears to be related to the duration of
   their intensive care unit delirium. A new paradigm of how intensivists
   handle the brain is required. We propose a three-step approach to
   address this emerging epidemic, which includes Screening, Prevention,
   and Restoration of brain function (SPR). Screening combines risk factor
   identification and delirium assessment using validated instruments.
   Prevention of acute and chronic brain dysfunction requires
   implementation of a core model of care that combines evidence-based
   practices: awakening and breathing, coordination with target-based
   sedation, delirium monitoring, and exercise/early mobility (ABCDE).
   Restoration introduces strategies of ongoing screening and treatment for
   intensive care unit survivors at high risk of ongoing brain dysfunction.
   This practical system applying many evidence-based concepts incorporates
   personalized medicine, systems-based practice, and continuing research
   and development toward improving acute and chronic cognitive outcomes.
   (Crit Care Med 2010; 38[Suppl.]: S683-S691)
CT Conference on Thinking Outside the Box
CY MAR, 2010
CL Brussels, BELGIUM
TC 34
ZB 5
Z8 0
ZS 0
Z9 34
SN 0090-3493
UT WOS:000289148900027
PM 21164415
ER

PT J
AU Ambrosino, Nicolino
   Gabbrielli, Luciano
TI The difficult-to-wean patient.
SO Expert review of respiratory medicine
VL 4
IS 5
BP 685
EP 92
DI 10.1586/ers.10.58
PD 2010-Oct
PY 2010
AB Up to 20% of patients requiring mechanical ventilation will suffer from
   difficult weaning (the need of more than 7 days of weaning after the
   first spontaneous breathing trial), which may depend on several
   reversible causes: respiratory and/or cardiac load, neuromuscular and
   neuropsychological factors, and metabolic and endocrine disorders.
   Clinical consequences (and/or often causes) of prolonged mechanical
   ventilation comprise features such as myopathy, neuropathy, and body
   composition alterations and depression, which increase the costs,
   morbidity and mortality of this. These difficult-to-wean patients may be
   managed in two type of units: respiratory intermediate-care units and
   specialized regional weaning centers. Two weaning protocols are normally
   used: progressive reduction of ventilator support (which we usually
   use), or progressively longer periods of spontaneous breathing trials.
   Physiotherapy is an important component of weaning protocols. Weaning
   success depends strongly on patients&#x2019; complexity and
   comorbidities, hospital organization and personnel expertise,
   availability of early physiotherapy, use of weaning protocols,
   patients&#x2019; autonomy and families&#x2019; preparation for home
   discharge with mechanical ventilation.
TC 12
ZB 4
Z8 2
ZS 0
Z9 14
UT MEDLINE:20923345
PM 20923345
ER

PT J
AU Pickler, Rita H.
   McGrath, Jacqueline M.
   Reyna, Barbara A.
   McCain, Nancy
   Lewis, Mary
   Cone, Sharon
   Wetzel, Paul
   Best, Al
TI A Model of Neurodevelopmental Risk and Protection for Preterm Infants
SO JOURNAL OF PERINATAL & NEONATAL NURSING
VL 24
IS 4
BP 356
EP 365
DI 10.1097/JPN.0b013e3181fb1e70
PD OCT-DEC 2010
PY 2010
AB The purpose of this article is to introduce a model of
   neurodevelopmental risk and protection that may explain some of the
   relationships among biobehavioral risks, environmental risks, and
   caregiving behaviors that potentially contribute to neurobehavioral and
   cognitive outcomes. Infants born before 30 weeks of gestation have the
   poorest developmental prognosis of all infants. These infants have
   lengthy hospitalization periods in the neonatal intensive care unit
   (NICU,) an environment that is not always supportive of brain
   development and long-term developmental needs. The model supports the
   premise that interventions focused on neuroprotection during the
   neonatal period have the potential to positively affect long-term
   developmental outcomes for vulnerable very preterm infants. Finding ways
   to better understand the complex relationships among NICU-based
   interventions and long-term outcomes are important to guiding caregiving
   practices in the NICU.
TC 12
ZB 5
Z8 0
ZS 0
Z9 12
SN 0893-2190
UT WOS:000283742100012
PM 21045616
ER

PT J
AU Papazian, Laurent
   Forel, Jean-Marie
   Gacouin, Arnaud
   Penot-Ragon, Christine
   Perrin, Gilles
   Loundou, Anderson
   Jaber, Samir
   Arnal, Jean-Michel
   Perez, Didier
   Seghboyan, Jean-Marie
   Constantin, Jean-Michel
   Courant, Pierre
   Lefrant, Jean-Yves
   Guerin, Claude
   Prat, Gwenael
   Morange, Sophie
   Roch, Antoine
CA ACURASYS Study Investigators
TI Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome.
SO NEW ENGLAND JOURNAL OF MEDICINE
VL 363
IS 12
BP 1107
EP 1116
DI 10.1056/NEJMoa1005372
PD SEP 16 2010
PY 2010
AB Background: In patients undergoing mechanical ventilation for the acute
   respiratory distress syndrome (ARDS), neuromuscular blocking agents may
   improve oxygenation and decrease ventilator-induced lung injury but may
   also cause muscle weakness. We evaluated clinical outcomes after 2 days
   of therapy with neuromuscular blocking agents in patients with early,
   severe ARDS.
   Methods: In this multicenter, double-blind trial, 340 patients
   presenting to the intensive care unit (ICU) with an onset of severe ARDS
   within the previous 48 hours were randomly assigned to receive, for 48
   hours, either cisatracurium besylate (178 patients) or placebo (162
   patients). Severe ARDS was defined as a ratio of the partial pressure of
   arterial oxygen (PaO(sub 2)) to the fraction of inspired oxygen (FIO(sub
   2)) of less than 150, with a positive end-expiratory pressure of 5 cm or
   more of water and a tidal volume of 6 to 8 ml per kilogram of predicted
   body weight. The primary outcome was the proportion of patients who died
   either before hospital discharge or within 90 days after study
   enrollment (i.e., the 90-day in-hospital mortality rate), adjusted for
   predefined covariates and baseline differences between groups with the
   use of a Cox model.
   Results: The hazard ratio for death at 90 days in the cisatracurium
   group, as compared with the placebo group, was 0.68 (95% confidence
   interval [CI], 0.48 to 0.98; P=0.04), after adjustment for both the
   baseline PaO(sub 2):FIO(sub 2) and plateau pressure and the Simplified
   Acute Physiology II score. The crude 90-day mortality was 31.6% (95% CI,
   25.2 to 38.8) in the cisatracurium group and 40.7% (95% CI, 33.5 to
   48.4) in the placebo group (P=0.08). Mortality at 28 days was 23.7% (95%
   CI, 18.1 to 30.5) with cisatracurium and 33.3% (95% CI, 26.5 to 40.9)
   with placebo (P=0.05). The rate of ICU-acquired paresis did not differ
   significantly between the two groups.
   Conclusions: In patients with severe ARDS, early administration of a
   neuromuscular blocking agent improved the adjusted 90-day survival and
   increased the time off the ventilator without increasing muscle
   weakness. (Funded by Assistance Publique-Hopitaux de Marseille and the
   Programme Hospitalier de Recherche Clinique Regional 2004-26 of the
   French Ministry of Health; ClinicalTrials.gov number, NCT00299650.)
   N Engl J Med 2010;363:1107-16.
TC 353
ZB 89
Z8 22
ZS 0
Z9 378
SN 0028-4793
UT WOS:000281795800005
PM 20843245
ER

PT J
AU Cabrera Serrano, Macarena
   Rabinstein, Alejandro A
TI Causes and outcomes of acute neuromuscular respiratory failure.
SO Archives of neurology
VL 67
IS 9
BP 1089
EP 94
DI 10.1001/archneurol.2010.207
PD 2010-Sep
PY 2010
AB OBJECTIVE: To identify the spectrum of causes, analyze the usefulness of
   diagnostic tests, and recognize prognostic factors in patients with
   acute neuromuscular respiratory failure.
   METHODS: We evaluated 85 patients admitted to the intensive care unit
   (ICU) at Mayo Clinic, Rochester, between 2003 and 2009 with acute
   neuromuscular respiratory failure, defined as a need for mechanical
   ventilation owing to primary impairment of the peripheral nervous
   system. Outcome was assessed at hospital discharge and at last
   follow-up. Poor outcome was defined as a modified Rankin score greater
   than 3.
   RESULTS: The median age was 66 years; median follow-up, 5 months. The
   most frequent diagnoses were myasthenia gravis, Guillain-Barre syndrome,
   myopathies, and amyotrophic lateral sclerosis (27, 12, 12, and 12
   patients, respectively). Forty-seven patients (55%) had no known
   neuromuscular diagnosis before admission, and 36 of them (77%) had poor
   short-term outcomes. In 10 patients (12%), the diagnosis remained
   unknown on discharge; only 1 (10%) had regained independent function.
   Older age was associated with increased mortality during
   hospitalization. Longer mechanical ventilation times and ICU stays were
   associated with poor outcome at discharge but not at the last follow-up.
   Patients without a known neuromuscular diagnosis before admission had
   longer duration of mechanical ventilation, longer ICU stays, and worse
   outcomes at discharge. Electromyography was the most useful diagnostic
   test in patients without previously known neuromuscular diagnoses. The
   presence of spontaneous activity on needle insertion predicted poor
   short-term outcome regardless of final diagnosis. Coexistent
   cardiopulmonary diseases also predicted poor long-term outcome.
   CONCLUSIONS: Among patients with neuromuscular respiratory failure,
   those without known diagnosis before admission have poorer outcomes.
   Patients whose diagnoses remain unclear at discharge have the highest
   rates of disability.
TC 1
ZB 1
Z8 0
ZS 0
Z9 1
UT MEDLINE:20837853
PM 20837853
ER

PT J
AU Gurjar, Mohan
   Azim, Afzal
   Baronia, Arvind K
   Poddar, Banani
TI Facial nerve involvement in critical illness polyneuropathy.
SO Indian journal of anaesthesia
VL 54
IS 5
BP 472
EP 4
DI 10.4103/0019-5049.71038
PD 2010-Sep
PY 2010
AB Although ICU-acquired neuromuscular weakness is a well-known problem,
   critical illness neuropathy is an under-diagnosed entity in critically
   ill patients. Facial musculature is typically not involved in critical
   illness neuropathy. This report highlights an unusual presentation of
   critical illness polyneuropathy in a patient with involvement of facial
   musculature.
TC 2
ZB 1
Z8 2
ZS 0
Z9 3
UT MEDLINE:21189890
PM 21189890
ER

PT J
AU Combe, L.
   Appleton, R.
   Gilhooly, C.
   Kinsella, J.
TI INTENSIVE CARE UNIT ACQUIRED WEAKNESS
SO INTENSIVE CARE MEDICINE
VL 36
MA 1325
BP S418
EP S418
SU 2
PD SEP 2010
PY 2010
CT 23rd Annual Meeting of the European-Society-of-Intensive-Care-Medicine
CY OCT 09-13, 2010
CL Barcelona, SPAIN
SP European Soc Intens Care Med
RI Kinsella, John/B-8252-2011; Gilhooly, Charlotte/C-4253-2012
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0342-4642
UT WOS:000281679501370
ER

PT J
AU Johns, Robin H.
   Dawson, Deborah
   Ball, Jonathan
TI Considerations and proposals for the management of patients after
   prolonged intensive care unit admission
SO POSTGRADUATE MEDICAL JOURNAL
VL 86
IS 1019
BP 541
EP 551
DI 10.1136/pgmj.2010.100206
PD SEP 2010
PY 2010
AB The majority of patients admitted to the intensive care unit (ICU) have
   a short stay of only a few days However a small but significant number
   require prolonged intensive care This is typically due to persisting,
   and sometimes complex, medical/surgical problems Discharge of such ICU
   patients requires a comprehensive, multidisciplinary, verbal and written
   handover to the receiving ward team As with any acutely ill adult in
   hospital, post-ICU patients should be carefully monitored with 'track
   and trigger' systems such as the Early Warning Score Those with
   unexpected physiological deterioration should be promptly reviewed by
   senior clinicians and/or medical emergency/critical care outreach teams
   and considered for ICU re-admission where appropriate Patients who have
   received prolonged organ support in the ICU are often affected by a
   number of specific medical problems such as ventilatory insufficiency,
   cardiac dysfunction, kidney injury, nutritional deficiency, ICU acquired
   weakness, and brain injury They also frequently experience physical
   disability and psychosocial problems including delirium, anxiety,
   depression, post-traumatic stress disorder, cognitive dysfunction, and
   disturbed sleep Structured rehabilitation programmes for post-ICU
   patients, tailored to individual needs, should be commenced on the ICU
   and continued through to and beyond hospital discharge Care bundles,
   which are widely used on the ICU, are groups of interventions employed
   to optimise treatments or minimise complication rates They may be
   additionally useful in the post-ICU ward setting by prompting clinicians
   to focus on, and address, commonly occurring medical and psychosocial
   problems in these patients
TC 5
ZB 0
Z8 0
ZS 0
Z9 5
SN 0032-5473
UT WOS:000282632800006
PM 20702433
ER

PT J
AU Tobin, Martin J.
   Laghi, Franco
   Jubran, Amal
TI Narrative Review: Ventilator-Induced Respiratory Muscle Weakness
SO ANNALS OF INTERNAL MEDICINE
VL 153
IS 4
BP 240
EP U56
PD AUG 17 2010
PY 2010
AB Clinicians have long been aware that substantial lung injury results
   when mechanical ventilation imposes too much stress on the pulmonary
   parenchyma. Evidence is accruing that substantial injury may also result
   when the ventilator imposes too little stress on the respiratory
   muscles. Through adjustment of ventilator settings and administration of
   pharmacotherapy, the respiratory muscles may be rendered almost (or
   completely) inactive. Research in animals has shown that diaphragmatic
   inactivity produces severe injury and atrophy of muscle fibers. Human
   data have recently revealed that 18 to 69 hours of complete
   diaphragmatic inactivity associated with mechanical ventilation
   decreased the cross-sectional areas of diaphragmatic fibers by half or
   more. The atrophic injury seems to result from increased oxidative
   stress leading to activation of protein-degradation pathways. Scientific
   understanding of ventilator-induced respiratory muscle injury has not
   reached the stage where meaningful controlled trials can be done, and
   thus, it is not possible to give concrete recommendations for patient
   management. In the meantime, clinicians are advised to select ventilator
   settings that avoid both excessive patient effort and excessive
   respiratory muscle rest. The contour of the airway pressure waveform on
   a ventilator screen provides the most practical indication of patient
   effort, and clinicians are advised to pay close attention to the
   waveform as they titrate ventilator settings. Research on
   ventilator-induced respiratory muscle injury is in its infancy and
   portends to be an exciting area to follow.
TC 24
ZB 2
Z8 2
ZS 0
Z9 26
SN 0003-4819
UT WOS:000280973000004
PM 20713792
ER

PT J
AU Unroe, Mark
   Kahn, Jeremy M.
   Carson, Shannon S.
   Govert, Joseph A.
   Martinu, Tereza
   Sathy, Shailaja J.
   Clay, Alison S.
   Chia, Jessica
   Gray, Alice
   Tulsky, James A.
   Cox, Christopher E.
TI One-Year Trajectories of Care and Resource Utilization for Recipients of
   Prolonged Mechanical Ventilation A Cohort Study
SO ANNALS OF INTERNAL MEDICINE
VL 153
IS 3
BP 167
EP U62
PD AUG 3 2010
PY 2010
AB Background: Growing numbers of critically ill patients receive prolonged
   mechanical ventilation. Little is known about the patterns of care as
   patients transition from acute care hospitals to postacute care
   facilities or about the associated resource utilization.
   Objective: To describe 1-year trajectories of care and resource
   utilization for patients receiving prolonged mechanical ventilation.
   Design: 1-year prospective cohort study.
   Setting: 5 intensive care units at Duke University Medical Center,
   Durham, North Carolina.
   Participants: 126 patients receiving prolonged mechanical ventilation
   (defined as ventilation for >= 4 days with tracheostomy placement or
   ventilation for >= 21 days without tracheostomy), as well as their 126
   surrogates and 54 intensive care unit physicians, enrolled consecutively
   over 1 year.
   Measurements: Patients and surrogates were interviewed in the hospital,
   as well as 3 and 12 months after discharge, to determine patient
   survival, functional status, and facility type and duration of
   postdischarge care. Physicians were interviewed in the hospital to
   elicit prognoses. Institutional billing records were used to assign
   costs for acute care, outpatient care, and interfacility transportation.
   Medicare claims data were used to assign costs for postacute care.
   Results: 103 (82%) hospital survivors had 457 separate transitions in
   postdischarge care location (median, 4 transitions [interquartile range,
   3 to 5 transitions]), including 68 patients (67%) who were readmitted at
   least once. Patients spent an average of 74% (95% CI, 68% to 80%) of all
   days alive in a hospital or postacute care facility or receiving home
   health care. At 1 year, 11 patients (9%) had a good outcome (alive with
   no functional dependency), 33 (26%) had a fair outcome (alive with
   moderate dependency), and 82 (65%) had a poor outcome (either alive with
   complete functional dependency [4 patients; 21%] or dead [56 patients;
   44%]). Patients with poor outcomes were older, had more comorbid
   conditions, and were more frequently discharged to a postacute care
   facility than patients with either fair or good outcomes (P < 0.05 for
   all). The mean cost per patient was $306 135 (SD, $285 467), and total
   cohort cost was $38.1 million, for an estimated $3.5 million per
   independently functioning survivor at 1 year.
   Limitation: The results of this single-center study may not be
   applicable to other centers.
   Conclusion: Patients receiving prolonged mechanical ventilation have
   multiple transitions of care, resulting in substantial health care costs
   and persistent, profound disability. The optimism of surrogate decision
   makers should be balanced by discussions of these outcomes when
   considering a course of prolonged life support.
RI Benneyworth, Brian/A-4667-2009
OI Benneyworth, Brian/0000-0002-4692-5303
TC 106
ZB 17
Z8 0
ZS 0
Z9 107
SN 0003-4819
UT WOS:000280557600005
PM 20679561
ER

PT J
AU Perkes, Iain
   Baguley, Ian J.
   Nott, Melissa T.
   Menon, David K.
TI A Review of Paroxysmal Sympathetic Hyperactivity after Acquired Brain
   Injury
SO ANNALS OF NEUROLOGY
VL 68
IS 2
BP 126
EP 135
DI 10.1002/ana.22066
PD AUG 2010
PY 2010
AB Severe excessive autonomic overactivity occurs in a subgroup of people
   surviving acquired brain injury, the majority of whom show paroxysmal
   sympathetic and motor overactivity. Delayed recognition of paroxysmal
   sympathetic hyperactivity (PSH) after brain injury may increase
   morbidity and long-term disability. Despite its significant clinical
   impact, the scientific literature on this syndrome is confusing; there
   is no consensus on nomenclature, etiological information for diagnoses
   preceding the condition is poorly understood, and the evidence base
   underpinning our knowledge of the pathophysiology and management
   strategies is largely anecdotal. This systematic literature review
   identified 2 separate categories of paroxysmal autonomic overactivity, 1
   characterized by relatively pure sympathetic overactivity and another
   group of disorders with mixed parasympathetic/sympathetic features. The
   PSH group comprised 349 reported cases, with 79.4% resulting from
   traumatic brain injury (TBI), 9.7% from hypoxia, and 5.4% from
   cerebrovascular accident. Although TBI is the dominant causative
   etiology, there was some suggestion that the true incidence of the
   condition is highest following cerebral hypoxia. In total, 31 different
   terms were identified for the condition. Although the most common term
   in the literature was dysautonomia, the consistency of sympathetic
   clinical features suggests that a more specific term should be used. The
   findings of this review suggest that PSH be adopted as a more clinically
   relevant and appropriate term. The review highlights major problems
   regarding conceptual definitions, diagnostic criteria, and nomenclature.
   Consensus on these issues is recommended as an essential basis for
   further research in the area. ANN NEUROL 2010;68:126-135
RI Baguley, Ian/K-6878-2013
OI Baguley, Ian/0000-0001-5650-3705
TC 42
ZB 21
Z8 3
ZS 0
Z9 45
SN 0364-5134
UT WOS:000280721500006
PM 20695005
ER

PT J
AU Sharshar, Tarek
   Bastuji-Garin, Sylvie
   De Jonghe, Bernard
   Stevens, Robert D.
   Polito, Andrea
   Maxime, Virginie
   Rodriguez, Pablo
   Cerf, Charles
   Outin, Herve
   Touraine, Philippe
   Laborde, Kathleen
CA Grp Reflexion Etud Neuromyopathies
TI Hormonal status and ICU-acquired paresis in critically ill patients
SO INTENSIVE CARE MEDICINE
VL 36
IS 8
BP 1318
EP 1326
DI 10.1007/s00134-010-1840-6
PD AUG 2010
PY 2010
AB The pathogenesis of intensive care unit-acquired paresis (ICUAP), a
   frequent and severe complication of critical illness, is poorly
   understood. Since ICUAP has been associated with female gender in some
   studies, we hypothesized that hormonal dysfunction might contribute to
   ICUAP.
   To determine the relationship between hormonal status, ICUAP and
   mortality in patients with protracted critical illness.
   Prospective observational study.
   Four medical and surgical ICUs.
   ICU patients mechanically ventilated for > 7 days.
   None.
   Plasma levels of insulin growth factor-1 (IgF1), prolactin, thyroid
   stimulating hormone (TSH), follicular stimulating hormone (FSH),
   luteinizing hormone (LH), estradiol, progesterone, testosterone,
   dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphate (DHEAS)
   and cortisol were measured on the first day patients were awake (day 1).
   Mean blood glucose from admission to day 1 was calculated. ICUAP was
   defined as Medical Research Council sum score < 48/60 on day 7.
   We studied 102 patients (65 men and 37 women, 29 post-menopausal), of
   whom 24 (24%) died during hospitalization. Among the 86 patients tested
   at day 7, 39 (49%) had ICUAP, which was more frequent in women (63%
   versus men 36%, p = 0.02). Mean blood glucose was higher in patients
   with ICUAP. Estradiol/testosterone ratio was greater in men with ICUAP.
   ICUAP 7 days after awakening was associated with increased blood glucose
   and with biological evidence of hypogonadism in men, while an
   association with hormonal dysfunction was not detected in women.
TC 10
ZB 4
Z8 0
ZS 0
Z9 10
SN 0342-4642
UT WOS:000279683400005
PM 20333354
ER

PT J
AU Szeder, Viktor
   Ortega-Gutierrez, Santiago
   Ziai, Wendy
   Torbey, Michel T.
TI The TRACH Score: Clinical and Radiological Predictors of Tracheostomy in
   Supratentorial Spontaneous Intracerebral Hemorrhage
SO NEUROCRITICAL CARE
VL 13
IS 1
BP 40
EP 46
DI 10.1007/s12028-010-9346-1
PD AUG 2010
PY 2010
AB Spontaneous intracerebral hemorrhage (sICH) continues to have high
   morbidity and mortality. Patients with sICH and poor mental status are
   at high risk of airway compromise and frequently require intubation. The
   traditional ventilatory weaning parameters are not reliable in patients
   with brain pathology. The objective of this study is to identify
   clinical and radiological predictors for tracheostomy in mechanically
   ventilated patients with sICH and to develop a scale that will
   accurately predict the need for tracheostomy in these patients.
   Only patients with supratentorial sICH intubated on the field or on
   admission who survived the first 3 days were included. Univariate and
   multivariate logistic regression analysis of clinical and radiological
   variables was performed, and independent predictors were identified. A
   risk stratification scale (TRACH Score) was developed using these
   independent predictors.
   Several independent factors were associated with early tracheostomy. The
   signficant clinical predictor was Glasgow Coma Scale (GCS) score (P <
   0.003). Radiological predictors were presence of hydrocephalus (OR:
   12.5; P < 0.002), septum pellucidum shift (OR: 9; P < 0.025), and
   location of sICH in the thalamus (OR: 9; P < 0.025). The TRACH score was
   defined by two variables radiological scale (RScale) and Glasgow Outcome
   Score (GOS). TRACH score = 3 + (1 x RScale) - (0.5x GCS). The RScale (L
   + H + S) was obtained by adding individual points assigned according
   presence of: sICH location in the thalamus (L) 2 points, hydrocephalus
   (H) 1.5 points, septum pellucidum shift (S) 3 points. The scale was very
   predictive of tracheostomy needs (OR: 2.57, P < 0.0001) with an ROC =
   0.92, sensitivity of 94%, positive predictive value of 83%, and negative
   predictive value of 95%.
   The TRACH Score is a practical clinical grading scale that will allow
   physicians to identify patients who will be needing tracheostomy.
   Application of this scale could have significant impact on length of
   stay and cost of hospitalization.
TC 7
ZB 2
Z8 0
ZS 0
Z9 8
SN 1541-6933
UT WOS:000279505900007
PM 20393814
ER

PT J
AU Demirkol, D.
   Caliskan, M.
   Gokcay, G.
   Yanni, D.
   Citak, A.
   Oflazer, P. S.
   Karabocuoglu, M.
TI A Severe Form of Non-Classic Pompe's Disease with Normal Creatinine
   Kinase Level
SO NEUROPEDIATRICS
VL 41
IS 4
BP 193
EP 195
DI 10.1055/s-0030-1267961
PD AUG 2010
PY 2010
AB A 24-month-old boy was referred to our pediatric intensive care unit
   because of difficulty in weaning from artificial ventilation. He had 2
   bronchopneumonia attacks in 2 months; the diagnosis of Pompe's disease
   was confirmed by low glucosidase activity in lymphocytes and cultured
   fibroblasts without abnormality in the serum creatine kinase level. Our
   patient's creatine kinase levels were permanently normal. To the best of
   our knowledge, our Pompe's case is the first in the literature who has
   normal creatinine kinase levels despite earlier onset and rapidly
   progressive disease.
RI Gokcay, Gulden/B-2342-2013
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0174-304X
UT WOS:000284356800008
PM 21086226
ER

PT J
AU van der Jagt, Mathieu
TI Intensive care unit-acquired weakness
SO CRITICAL CARE MEDICINE
VL 38
IS 7
BP 1617
EP 1619
DI 10.1097/CCM.0b013e3181dd0a77
PD JUL 2010
PY 2010
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0090-3493
UT WOS:000278920000030
PM 20562562
ER

PT J
AU Griffiths, Richard D.
   Hall, Jesse B.
TI Intensive care unit-acquired weakness Reply
SO CRITICAL CARE MEDICINE
VL 38
IS 7
BP 1619
EP 1619
DI 10.1097/CCM.0b013e3181ddc578
PD JUL 2010
PY 2010
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0090-3493
UT WOS:000278920000031
ER

PT J
AU Peek, G. J.
   Elbourne, D.
   Mugford, M.
   Tiruvoipati, R.
   Wilson, A.
   Allen, E.
   Clemens, F.
   Firmin, R.
   Hardy, P.
   Hibbert, C.
   Jones, N.
   Killer, H.
   Thalanany, M.
   Truesdale, A.
TI Randomised controlled trial and parallel economic evaluation of
   conventional ventilatory support versus extracorporeal membrane
   oxygenation for severe adult respiratory failure (CESAR)
SO HEALTH TECHNOLOGY ASSESSMENT
VL 14
IS 35
BP 1
EP +
DI 10.3310/hta14350
PD JUL 2010
PY 2010
AB Objectives: To determine the comparative effectiveness and
   cost-effectiveness of conventional ventilatory support versus
   extracorporeal membrane oxygenation (ECMO) for severe adult respiratory
   failure.
   Design: A multicentre, randomised controlled trial with two arms.
   Setting: The ECM centre at Glenfield Hospital, Leicester, and approved
   conventional treatment centres and referring hospitals throughout the
   UK.
   Participants: Patients aged 18-65 years with severe, but potentially
   reversible, respiratory failure, defined as a Murray lung injury score
   >= 3.0, or uncompensated hypercapnoea with a pH <7.20 despite optimal
   conventional treatment. Interventions: Participants were randomised to
   conventional management (CM) or to consideration of ECMO. Main outcome
   measures: The primary outcome measure was death or severe disability at
   6 months. Secondary outcomes included a range of hospital indices:
   duration of ventilation, use of high frequency/oscillation/jet
   ventilation, use of nitric oxide, prone positioning, use of steroids,
   length of intensive care unit stay, and length of hospital stay and (for
   ECMO patients only) mode (venovenous/veno-arterial), duration of ECMO,
   blood flow and sweep flow.
   Results: A total of 180 patients (90 in each arm) were randomised from
   68 centres. Three patients in 10.75 for the ECM group compared with 7.31
   for the conventional group. Costs to patients and their relatives,
   including out of pocket and time costs, were higher for patients
   allocated to ECMO.
   Conclusions: Compared with CM, transferring adult patients with severe
   but potentially reversible respiratory failure to a single centre
   specialising in the treatment of severe respiratory failure for
   consideration of ECM significantly increased survival without severe
   disability. Use of ECM in this way is likely to be costeffective when
   compared with other technologies currently competing for health
   resources.
TC 40
ZB 13
Z8 0
ZS 0
Z9 40
SN 1366-5278
UT WOS:000280915500002
PM 20642916
ER

PT J
AU Hassan, K A
   Hasan, M K
   Chowdhury, M G
   Akhter, H
TI Aspects of infection in intensive care unit--prevention and control.
SO Mymensingh medical journal : MMJ
VL 19
IS 3
BP 474
EP 6
PD 2010-Jul
PY 2010
AB Nosocomial infections are the main source of infection in a hospitalized
   patient. Source of contaminant may be multiple. In a cardiac ICU the
   vulnerable open heart surgery patients are with multiple invasive lines
   and monitors. Pediatrics and neonates are more vulnerable because of
   their poor immunity and nutritional debility. Frequent indwelling line
   access makes a patient more prone to systemic infection with variable
   organisms. Our aim is to minimize the chances of hospital acquired
   infection as far as possible by the use of systemic approach to the
   patients as guided by the international standard hospital protocol.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1022-4742
UT MEDLINE:20639848
PM 20639848
ER

PT J
AU Walgaard, Christa
   Lingsma, Hester F.
   Ruts, Liselotte
   Drenthen, Judith
   van Koningsveld, Rinske
   Garssen, Marcel J. P.
   van Doom, Pieter A.
   Steyerberg, Ewout W.
   Jacobs, Bart C.
TI Prediction of Respiratory Insufficiency in Guillain-Barre Syndrome
SO ANNALS OF NEUROLOGY
VL 67
IS 6
BP 781
EP 787
DI 10.1002/ana.21976
PD JUN 2010
PY 2010
AB Objective: Respiratory insufficiency is a frequent and serious
   complication of the Guillain-Barre syndrome (GBS). We aimed to develop a
   simple but accurate model to predict the chance of respiratory
   insufficiency in the acute stage of the disease based on clinical
   characteristics available at hospital admission.
   Methods: Mechanical ventilation (MV) in the first week of admission was
   used as an indicator of acute stage respiratory insufficiency.
   Prospectively collected data from a derivation cohort of 397 GBS
   patients were used to identify predictors of MV. A multivariate logistic
   regression model was validated in a separate cohort of 191 GBS patients.
   Model performance criteria comprised discrimination (area under receiver
   operating curve [AUC]) and calibration (graphically). A scoring system
   for clinical practice was constructed from the regression coefficients
   of the model in the combined cohorts.
   Results: In the derivation cohort, 22% needed MV in the first week of
   admission. Days between onset of weakness and admission, Medical
   Research Council sum score, and presence of facial and/or bulbar
   weakness were the main predictors of MV. The prognostic model had a good
   discriminative ability (AUC, 0.84). In the validation cohort, 14% needed
   MV in the first week of admission, and both calibration and
   discriminative ability of the model were good (AUC, 0.82). The scoring
   system ranged from 0 to 7, with corresponding chances of respiratory
   insufficiency from 1 to 91%.
   Interpretation: This model accurately predicts development of
   respiratory insufficiency within 1 week in patients with GBS, using
   clinical characteristics available at admission. After further
   validation, the model may assist in clinical decision making, for
   example, on patient transfer to an intensive care unit. ANN NEUROL
   2010;67:781-787
TC 21
ZB 9
Z8 0
ZS 0
Z9 22
SN 0364-5134
UT WOS:000278208400012
PM 20517939
ER

PT J
AU Raoof, Suhail
   Goulet, Keith
   Esan, Adebayo
   Hess, Dean R.
   Sessler, Curtis N.
TI Severe Hypoxemic Respiratory Failure Part 2-Nonventilatory Strategies
SO CHEST
VL 137
IS 6
BP 1437
EP 1448
DI 10.1378/chest.09-2416
PD JUN 2010
PY 2010
AB ARDS is characterized by hypoxemic respiratory failure, which can be
   refractory and life-threatening. Modifications to traditional mechanical
   ventilation and nontraditional modes of ventilation are discussed in
   Part 1 of this two-part series. In this second article, we examine
   nonventilatory strategies that can influence oxygenation, with
   particular emphasis on their role in rescue from severe hypoxemia. A
   literature search was conducted and a narrative review written to
   summarize the use of adjunctive, nonventilatory interventions intended
   to improve oxygenation in ARDS. Several adjunctive interventions have
   been demonstrated to rapidly ameliorate severe hypoxemia in many
   patients with severe ARDS and therefore may be suitable as rescue
   therapy for hypoxemia that is refractory to prior optimization of
   mechanical ventilation. These include neuromuscular blockade, inhaled
   vasoactive agents, prone positioning, and extracorporeal life support.
   Although these interventions have been linked to physiologic
   improvement, including relief from severe hypoxemia, and some are
   associated with outcome benefits, such as shorter duration of mechanical
   ventilation, demonstration of survival benefit has been rare in clinical
   trials. Furthermore, some of these nonventilatory interventions carry
   additional risks and/or high cost; thus, when used as rescue therapy for
   hypoxemia, it is important that they be demonstrated to yield clinically
   significant improvement in gas exchange, which should be periodically
   reassessed. Additionally, various management strategies can produce a
   more gradual improvement in oxygenation in ARDS, such as conservative
   fluid management, intravenous corticosteroids, and nutritional
   modification. Although improvement in oxygenation has been reported with
   such strategies, demonstration of additional beneficial outcomes, such
   as reduced duration of mechanical ventilation or ICU length of stay, or
   improved survival in randomized controlled trials, as well as
   consideration of potential adverse effects should guide decisions on
   their use. Various nonventilatory interventions can positively impact
   oxygenation as well as outcomes of ARDS. These interventions may be
   considered for use, particularly for cases of refractory severe
   hypoxemia, with proper appreciation of potential costs and adverse
   effects. CHEST 2010; 137(6):1437-1448
TC 49
ZB 11
Z8 5
ZS 2
Z9 55
SN 0012-3692
UT WOS:000278561400031
PM 20525656
ER

PT J
AU Prentice, Claire E.
   Paratz, Jennifer D.
   Bersten, Andrew D.
TI Differences in the degree of respiratory and peripheral muscle
   impairment are evident on clinical, electrophysiological and biopsy
   testing in critically ill adults: a qualitative systematic review
SO CRITICAL CARE AND RESUSCITATION
VL 12
IS 2
BP 111
EP 120
PD JUN 2010
PY 2010
AB Background: Critically ill patients are exposed to a combination of
   insults that affect both respiratory and peripheral skeletal muscle
   function. However, different muscle groups may not be affected to the
   same extent by a prolonged critical illness.
   Objective: To review original observational studies that measured an
   aspect of respiratory and peripheral muscle function in adults in the
   intensive care setting.
   Design: Systematic review strategy and qualitative data synthesis.
   Data sources and review methods: Four major citation databases were
   searched. Search terms included intensive care, critical care,
   diaphragm, quadriceps, and skeletal, respiratory and limb muscle. Titles
   and abstracts were reviewed to identify studies that measured both
   respiratory and peripheral muscle function. Reference lists of suitable
   publications were screened. Studies sampling critically ill patients
   with a neurological condition were excluded.
   Results: 1119 items were identified, and 19 full-text/abstract
   publications were reviewed. Ten studies investigated patients with a
   critical illness-related neuromuscular disorder. Nine studies targeted
   septic patients with multiple organ failure or patients requiring
   prolonged mechanical ventilation. Clinical, electrophysiological and
   muscle biopsy specimen data were collected at different time-points and
   milestones relating to alertness, weaning criteria, respiratory support
   reduction and extubation.
   Conclusions: Currently available bedside methods of measuring
   respiratory and peripheral muscle function in critically ill patients
   are somewhat inadequate. Yet there is evidence suggesting that
   respiratory muscles may be relatively spared from the damage that can
   occur as a result of immobility, prolonged mechanical ventilation and
   systemic inflammation in critical illness.
RI Baldwin, Claire/F-4478-2013
OI Baldwin, Claire/0000-0002-5022-8498
TC 7
ZB 1
Z8 0
ZS 0
Z9 7
SN 1441-2772
UT WOS:000295818700008
PM 20513220
ER

PT J
AU Unroe, Mark
   MacIntyre, Neil
TI Evolving approaches to assessing and monitoring patient-ventilator
   interactions
SO CURRENT OPINION IN CRITICAL CARE
VL 16
IS 3
BP 261
EP 268
DI 10.1097/MCC.0b013e328338661e
PD JUN 2010
PY 2010
AB Purpose of review
   Patient-ventilator dyssynchrony (PVD) is prevalent in critically ill
   patients and causes increased work of breathing, which can lead to
   ventilatory muscle overload and fatigue as well as impairment in sleep
   efficiency, both important factors in determining ventilator duration.
   Recent findings
   New ways to analyze and communicate information, such as embedded
   computerized algorithms that are able to calculate a dyssynchrony index
   and enhanced ventilator graphical displays, may assist the clinician
   with recognition of PVD. Esophageal pressure monitoring allows the
   clinician to address trigger, flow and cycle dyssynchrony as well as
   quantify the incremental work of breathing imposed by PVD. An analysis
   using relationships in the equation of motion allows for onset and
   cycling off of breaths that match closer with the patient effort
   compared with current algorithms. Monitoring diaphragmatic electrical
   activity permits the accurate assessment of relationships between neural
   drive and ventilator flow delivery, and can assess the workload of the
   diaphragm.
   Summary
   Although computerized algorithms and user-friendly graphic displays show
   promise in minimizing the time to recognition of dyssynchrony,
   monitoring diaphragmatic electrical activity comes closest to
   representing the ideal in ventilator monitoring. Further work, however,
   is needed to demonstrate outcomes benefit to patients and to make this a
   reliable and user-friendly system for clinicians.
TC 9
ZB 2
Z8 0
ZS 0
Z9 9
SN 1070-5295
UT WOS:000278106100014
PM 20305557
ER

PT J
AU Zanni, Jennifer M.
   Korupolu, Radha
   Fan, Eddy
   Pradhan, Pranoti
   Janjua, Kashif
   Palmer, Jeffrey B.
   Brower, Roy G.
   Needham, Dale M.
TI Rehabilitation therapy and outcomes in acute respiratory failure: An
   observational pilot project
SO JOURNAL OF CRITICAL CARE
VL 25
IS 2
BP 254
EP 262
DI 10.1016/j.jcrc.2009.10.010
PD JUN 2010
PY 2010
AB Purpose: The aim of this study was to describe the frequency,
   physiologic effects, safety, and patient outcomes associated with
   traditional rehabilitation therapy in patients who require mechanical
   ventilation.
   Materials and Methods: Prospective observational report of consecutive
   patients ventilated 4 or more days and eligible for rehabilitation in a
   single medical intensive care unit (ICU) during a 13-week period was
   conducted.
   Results: Of the 32 patients who met the inclusion criteria, only 21
   (66%) received physician orders for evaluation by rehabilitation
   services (physical and/or occupational therapy). Fifty rehabilitation
   treatments were provided to 19 patients on a median of 12% of medical
   ICU days per patient, with deep sedation and unavailability of
   rehabilitation staff representing major barriers to treatment.
   Physiologic changes during rehabilitation therapy were minimal. Joint
   contractures were frequent in the lower extremities and did not improve
   during hospitalization. In 53% and 79% of initial ICU assessments,
   muscle weakness was present in upper and lower extremities,
   respectively, with a decreased prevalence of 19% and 43% at hospital
   discharge, respectively. New impairments in physical function were
   common at hospital discharge.
   Conclusions: This pilot project illustrated important barriers to
   providing rehabilitation to mechanically ventilated patients in an ICU
   and impairments in strength, range of motion, and functional outcomes at
   hospital discharge. (C) 2010 Elsevier Inc. All rights reserved.
RI Benneyworth, Brian/A-4667-2009
OI Benneyworth, Brian/0000-0002-4692-5303
TC 55
ZB 7
Z8 2
ZS 0
Z9 57
SN 0883-9441
UT WOS:000278638200014
PM 19942399
ER

PT J
AU Jani-Acsadi, Agnes
   Lisak, Robert P.
TI Myasthenia Gravis
SO CURRENT TREATMENT OPTIONS IN NEUROLOGY
VL 12
IS 3
BP 231
EP 243
DI 10.1007/s11940-010-0070-0
PD MAY 2010
PY 2010
AB Treatment of patients with acquired (autoimmune) myasthenia gravis
   should rely on evidence-based therapeutic choices, taking into account
   the individual's needs according to disease severity (mild to severe),
   extent (ocular or generalized), comorbidities (including other
   autoimmune diseases, infections, thymoma, and pregnancy), age,
   iatrogenic factors (the risks and benefits of therapy), patient autonomy
   and quality of life, financial burden to the patient, and associated
   health care costs. Therapy is aimed at managing symptoms by improving
   neuromuscular junction transmission (cholinesterase inhibitors) and/or
   modifying the underlying immunopathogenetic cause of acquired myasthenia
   gravis via immunosuppression or immunomodulation. Myasthenic patients
   with operable thymoma should be referred for surgery and closely
   followed up for tumor recurrence. A concerted international effort is
   addressing treatment recommendations for thymectomy in myasthenic
   patients with no radiologic evidence of thymoma who are positive for
   circulating acetylcholine receptor antibodies. There is a lack of
   evidence-based treatment guidelines for both acute and long-term
   management of ocular myasthenia. Acute management of myasthenic crisis
   requires intensive monitoring of the patient and institution of an
   efficient and safe treatment such as plasma exchange. Patient education
   is essential to a comprehensive long-term treatment plan.
TC 8
ZB 1
Z8 1
ZS 0
Z9 9
SN 1092-8480
UT WOS:000277166200006
PM 20842584
ER

PT J
AU Whidden, Melissa A.
   Smuder, Ashley J.
   Wu, Min
   Hudson, Matthew B.
   Nelson, W. Bradley
   Powers, Scott K.
TI Oxidative stress is required for mechanical ventilation-induced protease
   activation in the diaphragm
SO JOURNAL OF APPLIED PHYSIOLOGY
VL 108
IS 5
BP 1376
EP 1382
DI 10.1152/japplphysiol.00098.2010
PD MAY 2010
PY 2010
AB Whidden MA, Smuder AJ, Wu M, Hudson MB, Nelson WB, Powers SK. Oxidative
   stress is required for mechanical ventilation-induced protease
   activation in the diaphragm. J Appl Physiol 108: 1376-1382, 2010. First
   published March 4, 2010; doi: 10.1152/japplphysiol.00098.2010.-Prolonged
   mechanical ventilation (MV) results in diaphragmatic weakness due to
   fiber atrophy and contractile dysfunction. Recent work reveals that
   activation of the proteases calpain and caspase-3 is required for
   MV-induced diaphragmatic atrophy and contractile dysfunction. However,
   the mechanism(s) responsible for activation of these proteases remains
   unknown. To address this issue, we tested the hypothesis that oxidative
   stress is essential for the activation of calpain and caspase-3 in the
   diaphragm during MV. Cause-and-effect was established by prevention of
   MV-induced diaphragmatic oxidative stress using the antioxidant Trolox.
   Treatment of animals with Trolox prevented MV-induced protein oxidation
   and lipid peroxidation in the diaphragm. Importantly, the
   Trolox-mediated protection from MV-induced oxidative stress prevented
   the activation of calpain and caspase-3 in the diaphragm during MV.
   Furthermore, the avoidance of MV-induced oxidative stress not only
   averted the activation of these proteases but also rescued the diaphragm
   from MV-induced diaphragmatic myofiber atrophy and contractile
   dysfunction. Collectively, these findings support the prediction that
   oxidative stress is required for MV-induced activation of calpain and
   caspase-3 in the diaphragm and are consistent with the concept that
   antioxidant therapy can retard MV-induced diaphragmatic weakness.
RI Hudson, Matthew/E-4246-2010
TC 48
ZB 32
Z8 2
ZS 1
Z9 51
SN 8750-7587
UT WOS:000277301000044
PM 20203072
ER

PT J
AU Marchese, Santino
   Corrado, Antonio
   Scala, Raffaele
   Corrao, Salvatore
   Ambrosino, Nicolino
CA Italian Assoc Hosp Pulmonologists
TI Tracheostomy in patients with long-term mechanical ventilation: A survey
SO RESPIRATORY MEDICINE
VL 104
IS 5
BP 749
EP 753
DI 10.1016/j.rmed.2010.01.003
PD MAY 2010
PY 2010
AB Background: Tracheostomy is increasingly performed in intensive care
   units (ICU), with many patients transferred to respiratory ICU (RICU).
   Indications/timing for closing tracheostomy are discussed.
   Aim and Method: We report results of a one-year survey evaluating: 1)
   clinical characteristics, types of tracheostomy, complications in
   patients admitted to Italian RICU in 2006; 2) clinical criteria and
   systems for performing decannulation, and outcome of patients undergoing
   tracheostomy (number decannulated; number
   non-decannulated/non-ventilated; number non-decannulated/ventilated;
   dead/lost patients).
   Results: 22/32 RICUs replied. There were 846 admissions of 719 patients
   (Mean age 64,3 (+/- 14.2) years, 489 (68%) males). Causes of admission
   were: acute respiratory failure with underlying chronic co-morbidities
   176 (24.4%); exacerbation of Chronic Obstructive Pulmonary Disease 222
   (34.4%); neuromuscular diseases 200 (27.8%); surgical patients 77
   (10.7%); thoracic dysmorphism 28 (3.8%); obstructive sleep apnea
   syndrome 16 (2.2%). Percutaneous tracheostomies were 65.9%. Major
   complications after tracheostomy were 2%. 427 tracheostomies were
   evaluated for decannulation: 96(22.5%) were closed; 175 patients (41%)
   were discharged with home mechanical ventilation; 114 patients (26.5%)
   maintained the tracheostomy despite weaning from mechanical ventilation
   and 42 patients (10%) died or lost.
   The clinical criteria chosen for decannulation were: stability of
   respiratory conditions, effective cough, underlying diseases and ability
   to swallow. The systems for evaluating feasibility of decannulation
   were: closure of tracheostomy tube; laryngo-tracheoscopy; use of
   tracheal button and down-sizing.
   Conclusions: There were few major complications of tracheostomy. A
   substantial proportion of patients maintain the tracheostomy despite not
   requiring mechanical ventilation. There was no agreement on indications
   and systems for closing tracheostomy. Published by Elsevier Ltd.
TC 14
ZB 3
Z8 0
ZS 1
Z9 15
SN 0954-6111
UT WOS:000278282200018
PM 20122822
ER

PT J
AU Ianov, Igor
   Wilkerson, Danny L
TI Hypophosphatemia and acute postoperative respiratory distress.
SO The Journal of the Arkansas Medical Society
VL 106
IS 11
BP 265
EP 6
PD 2010-May
PY 2010
AB In conclusion, the possibility of prolonged mechanical ventilation in
   patients with hypophosphatemia can be anticipated. Neuromuscular
   function should be monitored carefully when NMBAs are given as muscular
   dysfunction can arise even with apparent complete reversal. The cause of
   the respiratory failure (in this case, hypophosphatemia) must be sought
   and corrected while the patient's respiratory function is supported.
   Slow phosphorus replacement (10-45 mmol over 6-8 hours) must take place
   to avoid the complications of rapid infusion which are hypocalcemia and
   formation of calcium phosphate calcifications. Patients with electrolyte
   disorders are known to be a challenge for an anesthesiologist because of
   vital system involvements. Urgent surgery in a patient with
   hypophosphatemia should alert the anesthesiologist to the possibility of
   multiorgan failure and perhaps the need for postoperative mechanical
   ventilation.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0004-1858
UT MEDLINE:20465049
PM 20465049
ER

PT J
AU Finley Caulfield, A
   Gabler, L
   Lansberg, M G
   Eyngorn, I
   Mlynash, M
   Buckwalter, M S
   Venkatasubramanian, C
   Wijman, C A C
TI Outcome prediction in mechanically ventilated neurologic patients by
   junior neurointensivists.
SO Neurology
VL 74
IS 14
BP 1096
EP 101
DI 10.1212/WNL.0b013e3181d8197f
PD 2010-Apr-6
PY 2010
AB OBJECTIVE: Physician prediction of outcome in critically ill neurologic
   patients impacts treatment decisions and goals of care. In this
   observational study, we prospectively compared predictions by
   neurointensivists to patient outcomes at 6 months.
   METHODS: Consecutive neurologic patients requiring mechanical
   ventilation for 72 hours or more were enrolled. The attending
   neurointensivist was asked to predict 6-month 1) functional outcome
   (modified Rankin scale [mRS]), 2) quality of life (QOL), and 3) whether
   supportive care should be withdrawn. Six-month functional outcome was
   determined by telephone interviews and dichotomized to good (mRS 0-3)
   and poor outcome (mRS 4-6).
   RESULTS: Of 187 eligible patients, 144 were enrolled. Neurointensivists
   correctly predicted 6-month functional outcome in 80% (95% confidence
   interval [CI], 72%-86%) of patients. Accuracy for a predicted good
   outcome was 63% (95% CI, 50%-74%) and for poor outcome 94% (95% CI,
   85%-98%). Excluding patients who had life support withdrawn, accuracy
   for good outcome was 73% (95% CI, 60%-84%) and for poor outcome 87% (95%
   CI, 74%-94%). Accuracy for exact agreement between neurointensivists'
   mRS predictions and actual 6-month mRS was only 43% (95% CI, 35%-52%).
   Predicted accuracy for QOL was 58% (95% CI, 39%-74%) for good/excellent
   and 67% (95% CI, 46%-83%) for poor/fair. Of 27 patients for whom
   withdrawal of care was recommended, 1 patient survived in a vegetative
   state.
   CONCLUSIONS: Prediction of long-term functional outcomes in critically
   ill neurologic patients is challenging. Our neurointensivists were more
   accurate in predicting poor outcome than good outcome in patients
   requiring mechanical ventilation >or=72 hours.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
UT MEDLINE:20368630
PM 20368630
ER

PT J
AU Subramony, Hariharan
   Lai, Florence Y. L.
   Ang, Li Wei
   Cutter, Jeffery L.
   Lim, Poh Lian
   James, Lyn
TI An Epidemiological Study of 1348 Cases of Pandemic H1N1 Influenza
   Admitted to Singapore Hospitals from July to September 2009
SO ANNALS ACADEMY OF MEDICINE SINGAPORE
VL 39
IS 4
BP 283
EP 290
PD APR 2010
PY 2010
AB Introduction: We reviewed the epidemiological features of 1348
   hospitalised cases of influenza A (H1N1-2009) [pandemic H1N1] infection
   in Singapore reported between 15 July and 28 September 2009. Materials
   and Methods: Data on the demographic and epidemiological characteristics
   of hospitalised patients with confirmed pandemic H1N1 infection were
   collected from all restructured and private hospitals in Singapore using
   a standard template and were analysed retrospectively. Results: Of the
   1348 cases, 92 were classified as severely ill (i.e. were admitted to an
   intensive care unit and/or who died). Of these severely ill cases, 50
   (54.3%) required mechanical ventilation. While overall hospitalisation
   rates were highest in the 0 to 11 months age group, the incidence of
   severely ill cases was highest in patients aged 65 years and older.
   Fifty per cent of all hospitalised cases and 28% of all severely ill
   cases did not have any underlying medical conditions. The following
   factors were found to be independently associated with a higher
   likelihood of severe illness: older age and the presence of the
   following comorbidities: neuromuscular disorders, epilepsy and obesity.
   Conclusion: Between 15 July and 28 September 2009, pandemic H1N1
   infection caused significant illness requiring hospitalisation, as well
   as intensive care and mechanical ventilation in some cases. There were
   18 deaths from pandemic H1N1 during this period, which corresponded to a
   case-fatality rate of 7 deaths for every 100,000 cases of pandemic H1N1.
   Ann Acad Med Singapore 2010;39:283-90
TC 20
ZB 14
Z8 0
ZS 0
Z9 20
SN 0304-4602
UT WOS:000277538100004
PM 20473452
ER

PT J
AU Needham, Dale M.
   Korupolu, Radha
   Zanni, Jennifer M.
   Pradhan, Pranoti
   Colantuoni, Elizabeth
   Palmer, Jeffrey B.
   Brower, Roy G.
   Fan, Eddy
TI Early Physical Medicine and Rehabilitation for Patients With Acute
   Respiratory Failure: A Quality Improvement Project
SO ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
VL 91
IS 4
BP 536
EP 542
DI 10.1016/j.apmr.2010.01.002
PD APR 2010
PY 2010
AB Needham DM, Korupolu R, Zanni JM, Pradhan P. Colantuoni E, Palmer JB,
   Brower RG, Fan E. Early physical medicine and rehabilitation for
   patients with acute respiratory failure: a quality improvement project.
   Arch Phys Med Rehabil 2010;91:536-42:
   Objectives: To (I) reduce deep sedation and delirium to permit
   mobilization, (2) increase the frequency of rehabilitation consultations
   and treatments to improve patients' functional mobility, and (3)
   evaluate effects on length of stay.
   Design: Seven-month prospective before/after quality improvement
   project.
   Setting: Sixteen-bed medical intensive care unit (MICU) in academic
   hospital.
   Participants: 57 patients mechanically ventilated 4 days or longer.
   Intervention: A multidisciplinary team focused on reducing heavy
   sedation and increasing MICU staffing to include full-time physical and
   occupational therapists with new consultation guidelines.
   Main Outcome Measures: Sedation and delirium status, rehabilitation
   treatments, functional mobility.
   Results: Compared with before the quality improvement project,
   benzodiazepine use decreased markedly (proportion of MICU days that
   patients received benzodiazepines [50% vs 25%, P=.002]), with lower
   median daily sedative doses (47 vs 15mg midazolam equivalents [P=.09]
   and 71 vs 24 mg morphine equivalents [P=.01]). Patients had improved
   sedation and delirium status (MICU days alert [30% vs 67%, P<.001] and
   not delirious [21% vs 53%, P=.003]). There were a greater median number
   of rehabilitation treatments per patient (1 vs 7, P<.001) with a higher
   level of functional mobility (treatments involving sitting or greater
   mobility, 56% vs 78%, P=.03). Hospital administrative data demonstrated
   that across all MICU patients, there was a decrease in intensive care
   unit and hospital length of stay by 2.1(95% confidence interval:
   0.4-3.8) and 3.1 (0.3-5.9) days, respectively, and a 20% increase in
   MICU admissions compared with the same period in the prior year.
   Conclusions: Using a quality improvement process, intensive care unit
   delirium, physical rehabilitation, and functional mobility were markedly
   improved and associated with decreased length of stay.
CT 70th Annual Meeting of the
   American-Academy-of-Physical-Medicine-and-Rehabilitation
CY OCT 22-25, 2009
CL Austin, TX
SP Amer Acad Phys Med & Rehabil
TC 134
ZB 24
Z8 5
ZS 1
Z9 140
SN 0003-9993
UT WOS:000277002000006
PM 20382284
ER

PT J
AU Mandel, Micha
TI The competing risks illness-death model under cross-sectional sampling
SO BIOSTATISTICS
VL 11
IS 2
BP 290
EP 303
DI 10.1093/biostatistics/kxp048
PD APR 2010
PY 2010
AB The competing risks illness-death model describes the dynamics of
   healthy subjects who may move to an "illness" state before entering into
   one of several competing terminal states. A motivating example concerns
   patients in a hospital who may acquire infections during their stay,
   where the competing terminal states are discharged alive and death in
   the hospital. We consider a cross-sectional sampling of independent
   competing risks illness-death processes in which data are subject to
   length bias and censoring and develop estimators for functionals of the
   underlying distribution such as the joint probability of the terminal
   state and illness (infection) and cumulative incidence functions. We
   apply the methodology to infection data obtained in a cross-sectional
   study of patients hospitalized in intensive care units.
TC 3
ZB 1
Z8 0
ZS 0
Z9 3
SN 1465-4644
UT WOS:000275243900009
PM 19933879
ER

PT J
AU Appleton, Richard
   Kinsella, John
TI Nonexcitable muscle membrane predicts intensive care unit-acquired
   paresis in mechanically ventilated, sedated patients
SO CRITICAL CARE MEDICINE
VL 38
IS 4
BP 1233
EP 1234
DI 10.1097/CCM.0b013e3181cfb264
PD APR 2010
PY 2010
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 0090-3493
UT WOS:000276499700052
PM 20335724
ER

PT J
AU Weber-Carstens, Steffen
   Koch, Susanne
TI Nonexcitable muscle membrane predicts intensive care unit-acquired
   paresis in mechanically ventilated, sedated patients Reply
SO CRITICAL CARE MEDICINE
VL 38
IS 4
BP 1234
EP 1234
DI 10.1097/CCM.0b013e3181d3aef9
PD APR 2010
PY 2010
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0090-3493
UT WOS:000276499700053
ER

PT J
AU Rothberg, Michael B.
   Haessler, Sarah D.
TI Complications of seasonal and pandemic influenza
SO CRITICAL CARE MEDICINE
VL 38
BP E91
EP E97
DI 10.1097/CCM.0b013e3181c92eeb
SU S
PD APR 2010
PY 2010
AB Influenza is a seasonal viral infection associated with significant
   morbidity and mortality. In 2009, a novel H1N1 influenza A virus emerged
   and has been classified as a pandemic. In contrast to seasonal
   influenza, severe disease from pandemic H1N1 seems concentrated in older
   children and young adults, with almost no cases reported in patients
   older than 60 yrs. Although patients with underlying cardiopulmonary
   disease remain at risk, most complications have occurred among
   previously healthy individuals, with obesity and respiratory disease as
   the strongest risk factors. Pulmonary complications are common. Primary
   influenza pneumonia occurs most commonly in adults and may progress
   rapidly to acute lung injury requiring mechanical ventilation. Secondary
   bacterial infection is more common in children. Staphylococcus aureus,
   including methicillin-resistant strains, is an important cause of
   secondary bacterial pneumonia with a high mortality rate. Treatment of
   pneumonia should include empirical coverage for this pathogen.
   Neuromuscular and cardiac complications are unusual but may occur. (Crit
   Care Med 2010; 38[Suppl.]: e91-e97)
TC 73
ZB 51
Z8 9
ZS 1
Z9 84
SN 0090-3493
UT WOS:000289147300011
PM 19935413
ER

PT J
AU Latronico, Nicola
   Rasulo, Frank A.
TI Presentation and management of ICU myopathy and neuropathy
SO CURRENT OPINION IN CRITICAL CARE
VL 16
IS 2
BP 123
EP 127
DI 10.1097/MCC.0b013e328336a229
PD APR 2010
PY 2010
AB Purpose of review
   Critical illness myopathy and neuropathy are common complications in the
   ICU, causing limb and respiratory muscle weakness. We review the most
   recent data concerning their presentation, diagnosis and treatment.
   Recent findings
   Limb muscle strength can be reliably assessed by using the Medical
   Research Council scale or handgrip dynamometry. A Medical Research
   Council sum score below 48 or mean Medical Research Council score below
   4 (antigravity strength) across all testable muscle groups, and a force
   value of less than 11 kg-force for men and less than 7 kg-force for
   women at dominant-hand dynamometry identify ICU-acquired weakness in
   previously healthy individuals admitted to an ICU for nonneuromuscular
   disorder. Clinical signs, together with measurements of the maximal
   inspiratory and expiratory pressures and vital capacity, are important
   to timely diagnose respiratory muscle weakness. Electrophysiological
   testing is usefully implemented in unconscious patients or in awake
   patients who do not improve despite appropriate treatments. Early
   physiotherapy in the ICU can increase the proportion of patients
   reaching an independent functional status following their ICU stay.
   Critical illness myopathy and neuropathy may occur outside the ICU;
   however, exact estimates are lacking.
   Summary
   Systematic application of diagnostic criteria and early physiotherapy
   may help clinicians to timely diagnose critical illness myopathy and
   neuropathy and to reduce the associated morbidity.
RI Latronico, Nicola/F-1557-2010
OI Latronico, Nicola/0000-0002-2521-5871
TC 7
ZB 3
Z8 1
ZS 1
Z9 8
SN 1070-5295
UT WOS:000276662500007
PM 20075723
ER

PT J
AU Dreyer, Pia Sander
   Steffensen, Birgit F.
   Pedersen, Birthe D.
TI Life with home mechanical ventilation for young men with Duchenne
   muscular dystrophy
SO JOURNAL OF ADVANCED NURSING
VL 66
IS 4
BP 753
EP 762
DI 10.1111/j.1365-2648.2009.05233.x
PD APR 2010
PY 2010
AB P>Title.
   Life with home mechanical ventilation for young men with Duchenne
   muscular dystrophy
   Aim.
   This paper is a report of a study from a patient perspective of the life
   experiences with home mechanical ventilation among young men with
   Duchenne muscular dystrophy.
   Background.
   People with chronic respiratory failure due to neuromuscular diseases
   have been offered life-long ventilator support at home for more than a
   decade. People having this treatment are positive about it and agree on
   having made the right choice about receiving it.
   Method.
   Nineteen people with Duchenne muscular dystrophy and invasive home
   mechanical ventilation were interviewed in 2007. The interviews were
   tape-recorded, transcribed verbatim and analysed according to a method
   inspired by Ricoeur's theory of interpretation, which consists of: a
   naive reading, a structural analysis, and a critical analysis and
   discussion.
   Findings.
   The participants described how the ventilators had saved their lives and
   were the best thing that had happened to them, but they had had
   difficulty making the decision of when to start invasive ventilation.
   Invasive ventilation was preferred to non-invasive ventilation by those
   who had experienced both. The participants wanted individualized care
   tailored to their needs in the home setting. Problems were described as
   being due to both human and technical factors, and sometimes resulted in
   inadequate ventilation.
   Conclusion.
   Society needs to discuss if it is a basic human right to be able to
   breathe, and whether people with Duchenne muscular dystrophy therefore
   have the right to invasive home mechanical ventilation. Healthcare
   professionals need to guide ventilator-users in decision-making about
   when to receive invasive home mechanical ventilation.
TC 6
ZB 0
Z8 0
ZS 0
Z9 6
SN 0309-2402
UT WOS:000275465900005
PM 20423363
ER

PT J
AU Ermilov, Leonid G.
   Pulido, Juan N.
   Atchison, Fawn W.
   Zhan, Wen-Zhi
   Ereth, Mark H.
   Sieck, Gary C.
   Mantilla, Carlos B.
TI Impairment of diaphragm muscle force and neuromuscular transmission
   after normothermic cardiopulmonary bypass: effect of low-dose inhaled CO
SO AMERICAN JOURNAL OF PHYSIOLOGY-REGULATORY INTEGRATIVE AND COMPARATIVE
   PHYSIOLOGY
VL 298
IS 3
BP R784
EP R789
DI 10.1152/ajpregu.00737.2009
PD MAR 2010
PY 2010
AB Ermilov LG, Pulido JN, Atchison FW, Zhan WZ, Ereth MH, Sieck GC,
   Mantilla CB. Impairment of diaphragm muscle force and neuromuscular
   transmission after normothermic cardiopulmonary bypass: effect of
   low-dose inhaled CO. Am J Physiol Regul Integr Comp Physiol 298:
   R784-R789, 2010. First published January 20, 2010;
   doi:10.1152/ajpregu.00737.2009.-Cardiopulmonary bypass (CPB) is
   associated with significant postoperative morbidity, but its effects on
   the neuromuscular system are unclear. Recent studies indicate that even
   relatively short periods of mechanical ventilation result in significant
   neuromuscular effects. Carbon monoxide (CO) has gained recent attention
   as therapy to reduce the deleterious effects of CPB. We hypothesized
   that 1) CPB results in impaired neuromuscular transmission and reduced
   diaphragm force generation; and 2) CO treatment during CPB will mitigate
   these effects. In adult male Sprague-Dawley rats, diaphragm
   muscle-specific force and neuromuscular transmission properties were
   measured 90 min after weaning from normothermic CPB (1 h). During CPB,
   either low-dose inhaled CO (250 ppm) or air was administered. The short
   period of mechanical ventilation used in the present study (similar to 3
   h) did not adversely affect diaphragm muscle contractile properties or
   neuromuscular transmission. CPB elicited a significant decrease in
   isometric diaphragm muscle-specific force compared with time-matched,
   mechanically ventilated rats (similar to 25% decline in both twitch and
   tetanic force). Diaphragm muscle fatigability to 40-Hz repetitive
   stimulation did not change significantly. Neuromuscular transmission
   failure during repetitive activation was 60 +/- 2% in CPB animals
   compared with 76 +/- 4% in mechanically ventilated rats (P < 0.05). CO
   treatment during CPB abrogated the neuromuscular effects of CPB, such
   that diaphragm isometric twitch force and neuromuscular transmission
   were no longer significantly different from mechanically ventilated
   rats. Thus, CPB has important detrimental effects on diaphragm muscle
   contractility and neuromuscular transmission that are largely mitigated
   by CO treatment. Further studies are needed to ascertain the underlying
   mechanisms of CPB-induced neuromuscular dysfunction and to establish the
   potential role of CO therapy.
RI Mantilla, Carlos/A-3562-2013
TC 8
ZB 7
Z8 0
ZS 0
Z9 8
SN 0363-6119
UT WOS:000274980000031
PM 20089713
ER

PT J
AU Griffiths, Richard D.
   Hall, Jesse B.
TI Intensive care unit-acquired weakness
SO CRITICAL CARE MEDICINE
VL 38
IS 3
BP 779
EP 788
DI 10.1097/CCM.0b013e3181cc4b53
PD MAR 2010
PY 2010
AB Objective: Severe weakness is being recognized as a complication that
   impacts significantly on the pace and degree of recovery and return to
   former functional status of patients who survive the organ failures that
   mandate life-support therapies such as mechanical ventilation. Despite
   the apparent importance of this problem, much remains to be understood
   about its incidence, causes, prevention, and treatment.
   Design: Review from literature and an expert round-table.
   Setting: The Brussels Round Table Conference in 2009 convened more than
   20 experts in the fields of intensive care, neurology, and muscle
   physiology to review current understandings of intensive care
   unit-acquired weakness and to improve clinical outcome.
   Main Results: Formal electrophysiological evaluation of patients with
   intensive care unit-acquired weakness can identify peripheral
   neuropathies, myopathies, and combinations of these disorders, although
   the correlation of these findings to weakness measurable at the bedside
   is not always precise. For routine clinical purposes, bedside assessment
   of neuromuscular function can be performed but is often confounded by
   complicating factors such as sedative and analgesic administration. Risk
   factors for development of intensive care unit-acquired weakness include
   bed rest itself, sepsis, and corticosteroid exposure. A strong
   association exists between weakness and long-term ventilator dependence;
   weakness is a major determinant of patient outcomes after surviving
   acute respiratory failure and may be present for months, or
   indefinitely, in the convalescence phase of critical illness.
   Conclusion: Although much has been learned about the physiology and cell
   and molecular biology of skeletal and diaphragm dysfunction under
   conditions of aging, exercise, disuse, and sepsis, the application of
   these understandings to the bedside requires more study in both bench
   models and patients. Although a trend toward greater immobilization and
   sedation of patients has characterized the past several decades of
   intensive care unit care, recent studies have demonstrated that early
   physical and occupational therapy, including during the period of
   intubation and ventilator support, can be safely performed and will
   likely improve patient outcomes with regard to functional status. (Crit
   Care Med 2010; 38: 779-787)
TC 78
ZB 15
Z8 3
ZS 1
Z9 82
SN 0090-3493
UT WOS:000275266200006
PM 20048676
ER

PT J
AU Peterson, Sarah J.
   Tsai, Annalisa A.
   Scala, Celina M.
   Sowa, Diane C.
   Sheean, Patricia M.
   Braunschweig, Carol L.
TI Adequacy of Oral Intake in Critically Ill Patients 1 Week after
   Extubation
SO JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
VL 110
IS 3
BP 427
EP 433
DI 10.1016/j.jada.2009.11.020
PD MAR 2010
PY 2010
AB Hospital malnutrition is associated with increased morbidity and
   mortality, particularly among patients admitted to intensive care units
   (ICUs). The purpose, of this observational study (August to November
   2007) was to examine the adequacy of oral intake and to identify
   predictors of oral intake after ICU patients were removed from invasive
   mechanical ventilation. Patients aged years who required mechanical
   ventilation for at least 24 hours, advanced to an oral diet
   postextubation, and did not require supplemental enteral or parenteral
   nutrition were included. The first 7 days of oral intake after
   extubation were assessed via modified multiple-pass 24-hour recall and
   the numbers of days on therapeutic diets and reasons for decreased
   intake were collected. Oral intake <75% of daily requirements was
   considered inadequate. Descriptive statistics, chi(2) Student t tests,
   and logistic regression analyses were conducted. Of the 64 patients who
   met eligibility criteria, 50 were included. Of these 50 patients, 54%
   were women and intubated for 5.2 days, with a mean age of 59.1 years,
   body mass index of 28.7, and Acute Physiology and Chronic Health
   Evaluation II score of 21.9. Subjective Global Assessment determined 44%
   were malnourished upon admission to the ICU. The average daily energy
   and protein intake failed to exceed 50% of daily requirements on all 7
   days for the entire population. The majority of patients who consumed
   <75% of daily requirements were prescribed a therapeutic diet and/or
   identified "no appetite" and nausea/vomiting as the barriers to eating.
   Although more research is needed, these data call into question the use
   of restrictive oral diets and suggest that alternative medical nutrition
   therapies are needed to optimize nutrient intake in this unique patient
   population. J Am Diet Assoc. 2010;110:427-433.
TC 28
ZB 9
Z8 0
ZS 0
Z9 28
SN 0002-8223
UT WOS:000276994100014
PM 20184993
ER

PT J
AU Li, Wei
   D'Ayala, Marcus
   Hirshberg, Asher
   Briggs, William
   Wise, Leslie
   Tortolani, Anthony
TI Comparison of conservative and operative treatment for blunt carotid
   injuries: Analysis of the National Trauma Data Bank
SO JOURNAL OF VASCULAR SURGERY
VL 51
IS 3
BP 593
EP 599
DI 10.1016/j.jvs.2009.10.108
PD MAR 2010
PY 2010
AB Objectives: Blunt carotid injury (BCI) is uncommon but potentially
   devastating. The best treatment modality for this injury remains
   undetermined. We conducted this study to better understand the hospital
   course and treatment outcomes for patients with BCI who received
   different interventions.
   Methods: BCI and related vascular procedures were identified by ICD-9-CM
   codes front the National Trauma Data Bank(1) using data gathered from
   2002 to 2006. Conservative and operative treatment groups were compared
   by variables of patient demographics, initial assessment in the
   emergency department (ED), hospital Course, and treatment outcomes. Open
   surgical and endovascular interventions were further compared.
   Results: A total of 842 BCI were identified front 1,633,126 discharged
   blunt trauma patients (0.05%). Of these, 762 (90.5%) were treated
   conservatively and 80 (9.53%) received operative intervention. No
   differences in demographics were observed between these treatment
   groups. Oil initial assessment, no differences between conservative and
   operative treatment groups were noted with regard to vital signs,
   Glasgow coma scale, presence of drugs or alcohol in blood, or Trauma
   Related Injury Severity Score survival probability. Significant
   differences were seen in terms of the presence of a base deficit (-3.1
   +/- 6.8 vs -7.6 +/- 8.3; P = .01), likelihood of a positive head
   computed tomography (CT) scan (58.6% vs 26.1%; P = .003), and total
   Injury Severity Score (29.8 +/- 13.3 vs 26.1 +/- 14.1; P = .02).
   Hospital course and treatment outcomes were comparable, with no
   differences in hospital length of stay (13.4 +/- 15.3 days vs 13.7 +/-
   13.6 clays; P = .86), total Functional I Independence Measure (8.8 +/-
   3.3 vs 9.3 +/- 3.1; P = .38), progression of original neurologic insult
   (7.5% vs 4.6%; 11 = .61) or mortality (28.1% vs 19%; P = .08). When
   comparing open surgical to endovascular interventions (46 open, 34
   endovascular, including 3 combined), the only significant differences
   were in the total Injury Severity Score (22.4 +/- 12.2 vs 31.4 +/- 15.4;
   P = .01) and length of intensive care unit (ICU) and hospital stay (5.0
   +/- 6.0 days vs 10.7 +/- 10.4 days; P = .01, and 10.3 +/- 9.2 days vs
   19.3 +/- 17.7 days; P = .01). Multivariate regression analysis confirmed
   that neither Functional Independence Measure (FIM) nor mortality was
   associated with conservative: or operative treatment.
   Conclusion: BCI is rare and carries a poor prognosis. Operative
   intervention is not associated with functional improvement or a survival
   advantage. This study was unable to support that less invasive
   endovascular treatment improves treatment outcome when compared to open
   surgery. (J Vasc Surg 2010;51:593-9.)
CT 63rd Annual Meeting of the Society-for-Vascular-Surgery/Vascular Annual
   Meeting
CY JUN 11-14, 2009
CL Denver, CO
SP Soc Vasc Surg
TC 9
ZB 7
Z8 0
ZS 0
Z9 9
SN 0741-5214
UT WOS:000275738600009
PM 20206804
ER

PT J
AU Panitch, Howard B.
TI Diurnal hypercapnia in patients with neuromuscular disease
SO PAEDIATRIC RESPIRATORY REVIEWS
VL 11
IS 1
BP 3
EP 8
DI 10.1016/j.prrv.2009.10.005
PD MAR 2010
PY 2010
AB Subjects with progressive neuromuscular diseases undergo a typical
   sequence of respiratory compromise, leading from normal unassisted gas
   exchange to nocturnal hypoventilation with normal daytime gas exchange,
   and eventually to respiratory failure requiring continuous ventilatory
   support. Several different abnormalities in respiratory pump function
   have been described to explain the development of respiratory failure in
   subjects with neuromuscular weakness. Early in the progression of
   respiratory failure, the use of nocturnal assisted ventilation can
   reverse both night- and day-time hypercapnia. Eventually, however,
   diurnal hypercapnia will persist despite correction of nocturnal
   hypoventilation. The likely beneficial effects of mechanical ventilatory
   support include resting fatigue-prone respiratory muscles and resetting
   of the central chemoreceptors to PaCO(2). Recent experience shows that
   select patients who require daytime ventilation can be supported with
   non-invasive ventilation continuously to correct gas exchange
   abnormalities while avoiding detrimental aspects of tracheostomy
   placement. (C) 2009 Elsevier Ltd. All rights reserved.
TC 3
ZB 3
Z8 0
ZS 0
Z9 3
SN 1526-0542
UT WOS:000276550300003
PM 20113985
ER

PT J
AU Saldir, Mehmet
   Sarici, S. Umit
   Bakar, Emel Erdogan
   Ozcan, Okan
TI Neurodevelopmental Status of Preterm Newborns at Infancy, Born at a
   Tertiary Care Center in Turkey
SO AMERICAN JOURNAL OF PERINATOLOGY
VL 27
IS 2
BP 121
EP 128
DI 10.1055/s-0029-1224863
PD FEB 2010
PY 2010
AB Our objective was to determine the incidence of early neonatal problems
   and the neurodevelopmental status and probable risk factors associated
   with neurodevelopmental abnormality in preterm infants of <= 32 weeks of
   gestation. Preterm newborns of <= 32 weeks of gestation followed at the
   neonatal intensive care unit of the Department of Pediatrics of Gulhane
   Military Medical Academy, Ankara, Turkey, were evaluated with a complete
   neurological examination and the Bayley Scales of Infant Development at
   a mean age of 25.85 +/- 11.79 months (range, 10 to 42 months).
   Multivariate logistic regression analyses were performed to determine
   the probable risk factors associated with neurodevelopmental
   abnormalities. Regarding the results of the neurological examination in
   a total of 169 preterms included in the study, 28 (16.6%) and 14 (8.3%)
   patients were determined to have mild neurological dysfunction or
   cerebral palsy, respectively. The rate of psychomotor abnormality
   according to a low Bayley Psychomotor Development Index (PDI) score was
   24.8%, and the rate of mental/cognitive abnormality on the basis of a
   low Bayley Mental Development Index (MDI) score was 25.4%. In the
   subgroup of infants with <= 29 weeks of gestational age (n = 55); 22
   (40%) patients had an abnormal neurological examination, and 24 (43.6%)
   and 23 (41.8%) patients had low Bayley PDI and MDI scores, respectively.
   In the study group, logistic regression analysis revealed the
   significant predictors of an abnormal neurological examination to be the
   duration of mechanical ventilation (odds ratio [OR], 1.133; 95%
   confidence interval [CI], 1.062 to 1.208) and necrotizing enterocolitis
   (OR, 6.697; 95% CI, 1.776 to 25.252). One of the major conclusions of
   the present study is the risk of neurodevelopmental sequelae in one of
   every four preterm infants with <32 weeks of gestation and the need for
   follow-up in this group. Measures in neonatal care and treatment, such
   as the use of less traumatic modes of mechanical ventilation with as
   short duration as possible as well as increasing perinatal/antenatal
   care, should be taken to overcome these risk factors.
TC 6
ZB 4
Z8 0
ZS 0
Z9 6
SN 0735-1631
UT WOS:000273825500004
PM 19504426
ER

PT J
AU Petrof, Basil J.
   Jaber, Samir
   Matecki, Stefan
TI Ventilator-induced diaphragmatic dysfunction
SO CURRENT OPINION IN CRITICAL CARE
VL 16
IS 1
BP 19
EP 25
DI 10.1097/MCC.0b013e328334b166
PD FEB 2010
PY 2010
AB Purpose of review
   Diaphragmatic function is a major determinant of the ability to
   successfully wean patients from mechanical ventilation. There is
   increasing recognition of a condition termed ventilator-induced
   diaphragmatic dysfunction. The purpose of the present review is to
   present evidence that mechanical ventilation can itself be a cause of
   diaphragmatic dysfunction, to outline our current understanding of the
   cellular mechanisms responsible for this phenomenon, and to discuss the
   implications of recent research for future therapeutic strategies.
   Recent findings
   Many critically ill patients demonstrate diaphragmatic weakness. A large
   body of evidence from animal models, and more limited data from humans,
   indicates that mechanical ventilation can cause muscle fiber injury and
   atrophy within the diaphragm. Current data support a complex underlying
   pathophysiology involving oxidative stress and the activation of several
   intracellular proteolytic pathways involved in degradation of the
   contractile apparatus. This includes the calpain, caspase, and
   ubiquitin-proteasome systems. In addition, there is a simultaneous
   downregulation of protein synthesis pathways. Studies in animal models
   suggest that future therapies may be able to specifically target these
   processes, whereas for the time being current preventive measures in
   humans are primarily based upon allowing persistent diaphragmatic
   activation during mechanical ventilation.
   Summary
   Diaphragmatic dysfunction is common in mechanically ventilated patients
   and is a likely cause of weaning failure. Recently, there has been a
   great expansion in our knowledge of how mechanical ventilation can
   adversely affect diaphragmatic structure and function. Future studies
   need to better define the evolution and mechanistic basis for
   ventilator-induced diaphragmatic dysfunction in humans, in order to
   allow the development of mechanical ventilation strategies and
   pharmacologic agents that will decrease the incidence of
   ventilator-induced diaphragmatic dysfunction.
TC 33
ZB 11
Z8 3
ZS 1
Z9 37
SN 1070-5295
UT WOS:000273700200004
PM 19935062
ER

PT J
AU Dionne, Annie
   Nicolle, Michael W.
   Hahn, Angelika F.
TI CLINICAL AND ELECTROPHYSIOLOGICAL PARAMETERS DISTINGUISHING ACUTE-ONSET
   CHRONIC INFLAMMATORY DEMYELINATING POLYNEUROPATHY FROM ACUTE
   INFLAMMATORY DEMYELINATING POLYNEUROPATHY
SO MUSCLE & NERVE
VL 41
IS 2
BP 202
EP 207
DI 10.1002/mus.21480
PD FEB 2010
PY 2010
AB Up to 16% of chronic inflammatory demyelinating polyneuropathy (CIDP)
   patients may present acutely. We performed a retrospective chart review
   on 30 acute inflammatory demyelinating polyneuropathy (AIDIP) and 15
   acute-onset CIDIP (A-CIDP) patients looking for any clinical or
   electrophysiological parameters that might differentiate AIDP from
   acutely presenting CIDP. A-CIDP patients were significantly more likely
   to have prominent sensory signs. They were significantly less likely to
   have autonomic nervous system involvement, facial weakness, a preceding
   infectious illness, or need for mechanical ventilation. With regard to
   electrophysiological features, neither sural-sparing pattern, sensory
   ratio >1, nor the presence of A-waves was different between the two
   groups. This study suggests that patients presenting acutely with a
   demyelinating polyneuropathy and the aforementioned clinical features
   should be closely monitored as they may be more likely to have CIDIP at
   follow-up. Muscle Nerve 41: 202-207, 2010
TC 23
ZB 14
Z8 1
ZS 0
Z9 24
SN 0148-639X
UT WOS:000274130700008
PM 19882646
ER

PT J
AU Diedler, Jennifer
   Sykora, Marek
   Juettler, Eric
   Veltkamp, Roland
   Steiner, Thorsten
   Rupp, Andre
TI EEG Power Spectrum to Predict Prognosis after Hemicraniectomy for
   Space-Occupying Middle Cerebral Artery Infarction
SO CEREBROVASCULAR DISEASES
VL 29
IS 2
BP 162
EP 169
DI 10.1159/000262313
PD 2010
PY 2010
AB Background: Early prediction of outcome after decompressive surgery for
   space-occupying middle cerebral artery (MCA) infarction is needed to
   guide further therapy. Here we applied spectral EEG analysis to
   determine the prognosis early after hemicraniectomy, while the patient
   is still treated in the intensive care unit. Methods: Continuous EEG
   monitoring following hemicraniectomy was performed in 10 patients with
   space-occupying MCA infarction. All patients were analgosedated and
   mechanically ventilated. The first 6 h of monitoring after surgery were
   evaluated by spectral analysis. Outcome measures included Glasgow
   Outcome Scale (GOS), Level of Consciousness Scale (LOC) and National
   Institute of Health Stroke Scale (NIHSS) at discharge. Outcome after 3
   months was assessed by modified Rankin Scale. Results: Six patients
   displayed a peak at 5-10 Hz in the EEG power spectrum. All these
   patients had a GOS score of 3 and an LOC score >= 7 at discharge. In
   contrast, the 4 patients without faster EEG activity had a GOS of 2 and
   LOC <= 6. GOS (r = 1, p < 0.001), LOC (r = 0.89, p = 0.001) and NIHSS (r
   = -0.8; p < 0.01) at discharge significantly correlated with the
   presence of 5- to 10-Hz activity, but not with age, time to
   hemicraniectomy, duration of hospital stay or baseline NIHSS scores.
   Outcome after 3 months significantly correlated with age (r = 0.67; p <
   0.05) and the presence of faster EEG activity (r = -0.76; p < 0.01).
   Conclusions: Spectral analysis in the subacute phase following
   hemicraniectomy may represent a parameter to predict early regain of
   consciousness and thus the capability and potential for further
   rehabilitation and favorable outcome. Copyright (C) 2009 S. Karger AG,
   Basel
RI Steiner, Thorsten/A-7391-2014
TC 6
ZB 1
Z8 0
ZS 0
Z9 6
SN 1015-9770
UT WOS:000273775900009
PM 19955741
ER

PT J
AU PEN Yan-hong
   ZHAN Qing-yuan
   WANG Chen
Z2 任雁宏
   詹庆元
   王辰
TI The second grade national prize for science and technology progress
   study on pathogenesis and treatment of respiratory failure
Z1 2009年国家科学技术进步二等奖之呼吸衰竭的发病机制与治疗研究
Z3 中国实用内科杂志
SO Chinese Journal of Practical Internal Medicine
VL 30
IS 4
BP 291
EP 293
AR 1005-2194(2010)30:4<291:2NGJKX>2.0.TX;2-D
PD 2010
PY 2010
AB To improve the status of management in respiratory failure in China,the
   project of Study on Pathogenesis and Treatment of Respiratory Failure
   was designed and conducted by three medical centers(Beijing Institute of
   Respiratory Medicine-Beijing Chaoyang Hospital,Affiliated to Capital
   Medical University,Zhongshang Hospital-Fudan University,Guangzhou
   Institute of Respiratory Medicine-First Guangzhou Medical College) for
   more than ten years.This project was focused on pathogenesis and
   treatment strategies of respiratory failure and achieved the following
   important innovations:(1) Pulmonary Infection Control Window(PIC Window)
   was firstly proposed and used to determine the time switching point of
   sequential invasive-noninvasive ventilation;(2) The largest sampie size
   of early use of noninvasive positive pressure ventilation (NPPV) for
   acute exacerbated COPD (AECOPD) on general ward provided the
   evidence-based data for expanding the indication of NPPV from treating
   respiratory failure to alleviating respiratory muscle fatigue;(3)Three
   new types of masks with intellectual property for NPPV were
   developed;(4) Designing of intrinsic expiratory end positive pressure
   (PEEPi) lung model with property of expiratory flow limitation confirmed
   that PEEPi was the most important factor that increased inspiratory
   difficulty;(5) The systematic measurement was established for diaphragm
   strength and endurance;(6) Aquaporin 1(AQP1) was firstly proved the key
   channel of fluid transportation in the lung;(7) A multicenter
   prospective cohort study provided objective data that depression had
   causal effect on COPD exacerbation and hospitalization;(8) Two
   guidelines for NPPV and mechanical ventilation of AECOPD were initiated
   by this group.This project has been widely used in clinical practice and
   promoted the research and treatment of respiratory failure in China.
Z4 针对中国在呼吸衰竭救治方面长期落后的状况,项目系统地对呼吸衰竭发病中的关键环节,治疗呼吸衰竭的关键技术、方法与治疗策略进行研究,作出了重要的科技
   创新.提出"肺部感染控制窗"的概念,并创立有创-无创序贯通气疗法;提出针对呼吸肌疲劳和呼吸功能不全的无创正压通气(NPPV)治疗新观念;研发并生
   产出具有自主知识产权的3种新型无创通气面罩;创制具有气道动态萎陷特性的肺模型,证实内源性呼气末正压(PEEPi)导致慢性阻塞性肺疾病(COPD)
   患者呼吸困难的作用途径;最早在国内建立系统的膈肌肌力和耐力测定方法;证实水通道蛋白1(AQPl,aquaporin
   1)是肺内液体转运的关键调控点;以前瞻性研究发现抑郁可显著增加COPD急性加重风险;主持制订中国第一部<无创正压通气临床应用中的几点建议>和<A
   ECOPD的机械通气指南>.以多种形式积极推广研究成果,从整体上提高了中国在该领域的治疗与研究水平.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 1005-2194
UT CSCD:3859244
ER

PT J
AU Ali, Naeem A.
TI Have we found the prevention for intensive care unit-acquired paresis?
SO CRITICAL CARE
VL 14
IS 3
AR 160
DI 10.1186/cc9005
PD 2010
PY 2010
AB Several recent reports have highlighted the utility of transcutaneous
   electrical muscle stimulation to preserve muscle mass and strength in
   ICU patients. Specifically, Serafim Nanas and colleagues report a
   significant reduction in the odds of ICU-acquired weakness with its use.
   Whether these findings are relevant to all patients with acute
   respiratory failure remains to be seen. As critical care studies attempt
   to study the outcome of physical recovery, significant additional data
   need to be provided in order for the results to be reported in the
   appropriate context. Future studies need to be performed in a setting
   where secondary injuries like sedation and immobilization are quantified
   so any benefit can be weighed against other interventions available.
TC 4
ZB 0
Z8 0
ZS 0
Z9 4
SN 1466-609X
UT WOS:000283781800029
PM 20519035
ER

PT J
AU Brahmbhatt, Naishadh
   Murugan, Raghavan
   Milbrandt, Eric B.
TI Early mobilization improves functional outcomes in critically ill
   patients
SO CRITICAL CARE
VL 14
IS 5
AR 321
DI 10.1186/cc9262
PD 2010
PY 2010
AB Citation
   Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL
   Spears L, Miller M, Franczyk M, Deprizio D, Schmidt GA, Bowman A, Barr
   R, McCalliste KE, Hall JB, Kress JP. Early physical and occupational
   therapy in mechanically ventilated, critically ill patients: a
   randomized controlled trial. Lancet 2009; 373(9678): 1874-1882. PubMed
   PMID: 19446324. This is available on www.pubmed.gov.
   Background
   Long-term complications of critical illness include intensive care unit
   (ICU)-acquired weakness and neuropsychiatric disease. Immobilization
   secondary to sedation might potentiate these problems.
   Methods
   Objective: To assess efficacy of combining daily interruption of
   sedation with physical and occupational therapy on functional outcomes
   in patients receiving mechanical ventilation in intensive care.
   Design: Open label randomized clinical trial.
   Setting: Study was conducted at two university hospitals on patients
   receiving sedation and mechanical ventilation. Subjects were those who
   received mechanical ventilation for < 72 hrs, were functionally
   independent prior to hospitalization, and were expected to continue for
   at least 24 hrs after enrollment.
   Subjects: 104 mechanically ventilated patients in the ICU. Intervention:
   Patients were randomized to receive either early exercise and
   mobilization (physical and occupational therapy) during periods of daily
   interruption of sedation (intervention; n=49) or daily interruption of
   sedation with therapy as ordered by the primary care team (control;
   n=55). Therapists who undertook patient assessments were blinded to
   treatment assignment.
   Outcomes: The primary endpoint was the number of patients returning to
   independent functional status at hospital discharge defined as the
   ability to perform six activities of daily living and the ability to
   walk independently. Secondary endpoints included duration of delirium
   and ventilator-free days during the first 28 days of hospital stay.
   Results
   The return to independent functional status at hospital discharge
   occurred in 29 (59%) patients in the intervention group compared with 19
   (35%) patients in the control group (p=0.02; odds ratio 2.7 [95% CI
   1.2-6.1]). Patients in the intervention group had shorter duration of
   delirium (median 2.0 days, IQR 0.0-6.0 vs 4.0 days, 2.0-8.0; p=0.02),
   and more ventilator-free days (23.5 days, 7.4-25.6 vs 21.1 days,
   0.0-23.8; p=0.05) during the 28-day follow-up period than did controls.
   There was one serious adverse event in 498 therapy sessions
   (desaturation less than 80%). Discontinuation of therapy as a result of
   patient instability occurred in 19 (4%) of all sessions, most commonly
   for perceived patient-ventilator asynchrony.
   Conclusions
   A strategy for whole-body rehabilitation consisting of interruption of
   sedation and physical and occupational therapy in the earliest days of
   critical illness was safe and well tolerated, and resulted in better
   functional outcomes at hospital discharge, a shorter duration of
   delirium, and more ventilator-free days compared with standard care.
TC 2
ZB 0
Z8 1
ZS 0
Z9 3
SN 1466-609X
UT WOS:000284596500049
PM 20880413
ER

PT J
AU Callahan, Leigh Ann
   Supinski, Gerald S.
TI Diaphragm weakness and mechanical ventilation what's the critical issue?
SO CRITICAL CARE
VL 14
IS 4
AR 187
DI 10.1186/cc9189
PD 2010
PY 2010
AB While animal studies indicate that controlled mechanical ventilation
   (MV) induces diaphragm weakness and myofiber atrophy, there are no data
   in humans that confirm MV per se produces diaphragm weakness. Whether or
   not diaphragm weakness results from MV, sepsis, corticosteroids,
   hyperglycemia, or a combination of these factors, however, is not the
   most important issue raised by the recent study from Hermans and
   colleagues. This study makes an important contribution by providing
   additional evidence that many critically ill patients have profound
   diaphragm weakness. If diaphragm weakness of this magnitude is present
   in most mechanically ventilated patients, a strong argument can be made
   that respiratory muscle weakness is a major contributor to respiratory
   failure.
TC 4
ZB 2
Z8 0
ZS 0
Z9 4
SN 1466-609X
UT WOS:000284227900050
PM 20701738
ER

PT J
AU Christ-Crain, Mirjam
   Opal, Steven M.
TI Clinical review: The role of biomarkers in the diagnosis and management
   of community-acquired pneumonia
SO CRITICAL CARE
VL 14
IS 1
AR 203
DI 10.1186/cc8155
PD 2010
PY 2010
AB In patients with community-acquired pneumonia, traditional criteria of
   infection based on clinical signs and symptoms, clinical scoring
   systems, and general inflammatory indicators (for example, leukocytosis,
   fever, C-reactive protein and blood cultures) are often of limited
   clinical value and remain an unreliable guide to etiology, optimal
   therapy and prognosis. Procalcitonin is superior to other commonly used
   markers in its specificity for bacterial infection (allowing alternative
   diagnoses to be excluded), as an indicator of disease severity and risk
   of death, and mainly as a guide to the necessity for antibiotic therapy.
   It can therefore be viewed as a diagnostic, prognostic, and perhaps even
   theragnostic test. It more closely matches the criteria for usefulness
   than other candidate biomarkers such as C-reactive protein, which is
   rather a nonspecific marker of acute phase inflammation, and
   proinflammatory cytokines such as plasma IL-6 levels that are highly
   variable, cumbersome to measure, and lack specificity for systemic
   infection. Elevated levels of pro-adrenomedullin, copeptin (which is
   produced in equimolar amounts to vasopressin), natriuretic peptides and
   cortisol are significantly related to mortality in community-acquired
   pneumonia, as are other prohormones such as pro-atrial natriuretic
   peptide, coagulation markers, and other combinations of inflammatory
   cytokine profiles. However, all biomarkers have weaknesses as well as
   strengths. None should be used on its own; and none is anything more
   than an aid in the exercise of clinical judgment based upon a synthesis
   of available clinical, physiologic and laboratory features in each
   patient.
TC 51
ZB 18
Z8 3
ZS 1
Z9 55
SN 1466-609X
UT WOS:000276989800026
PM 20236471
ER

PT J
AU Hermans, Greet
   Agten, Anouk
   Testelmans, Dries
   Decramer, Marc
   Gayan-Ramirez, Ghislaine
TI Increased duration of mechanical ventilation is associated with
   decreased diaphragmatic force: a prospective observational study
SO CRITICAL CARE
VL 14
IS 4
AR R127
DI 10.1186/cc9094
PD 2010
PY 2010
AB Introduction: Respiratory muscle weakness is an important risk factor
   for delayed weaning. Animal data show that mechanical ventilation itself
   can cause atrophy and weakness of the diaphragm, called
   ventilator-induced diaphragmatic dysfunction (VIDD). Transdiaphragmatic
   pressure after magnetic stimulation (TwPdi BAMPS) allows evaluation of
   diaphragm strength. We aimed to evaluate the repeatability of TwPdi
   BAMPS in critically ill, mechanically ventilated patients and to
   describe the relation between TwPdi and the duration of mechanical
   ventilation.
   Methods: This was a prospective observational study in critically ill
   and mechanically ventilated patients, admitted to the medical intensive
   care unit of a university hospital. Nineteen measurements were made in a
   total of 10 patients at various intervals after starting mechanical
   ventilation. In seven patients, measurements were made on two or more
   occasions, with a minimum interval of 24 hours.
   Results: The TwPdi was 11.5 +/- 3.9 cm H(2)O (mean +/- SD), indicating
   severe respiratory muscle weakness. The between-occasion coefficient of
   variation of TwPdi was 9.7%, comparable with data from healthy
   volunteers. Increasing duration of mechanical ventilation was associated
   with a logarithmic decline in TwPdi (R = 0.69; P = 0.038). This
   association was also found for cumulative time on pressure control (R =
   0.71; P = 0.03) and pressure-support ventilation (P = 0.05; R = 0.66)
   separately, as well as for cumulative dose of propofol (R = 0.66; P =
   0.05) and piritramide (R = 0.79; P = 0.01).
   Conclusions: Duration of mechanical ventilation is associated with a
   logarithmic decline in diaphragmatic force, which is compatible with the
   concept of VIDD. The observed decline may also be due to other
   potentially contributing factors such as sedatives/analgesics, sepsis,
   or others.
TC 51
ZB 24
Z8 3
ZS 2
Z9 56
SN 1466-609X
UT WOS:000284227900002
PM 20594319
ER

PT J
AU Routsi, Christina
   Gerovasili, Vasiliki
   Vasileiadis, Ioannis
   Karatzanos, Eleftherios
   Pitsolis, Theodore
   Tripodaki, Elli
   Markaki, Vasiliki
   Zervakis, Dimitrios
   Nanas, Serafim
TI Electrical muscle stimulation prevents critical illness
   polyneuromyopathy: a randomized parallel intervention trial
SO CRITICAL CARE
VL 14
IS 2
AR R74
DI 10.1186/cc8987
PD 2010
PY 2010
AB Introduction: Critical illness polyneuromyopathy (CIPNM) is a common
   complication of critical illness presenting with muscle weakness and is
   associated with increased duration of mechanical ventilation and weaning
   period. No preventive tool and no specific treatment have been proposed
   so far for CIPNM. Electrical muscle stimulation (EMS) has been shown to
   be beneficial in patients with severe chronic heart failure and chronic
   obstructive pulmonary disease. Aim of our study was to assess the
   efficacy of EMS in preventing CIPNM in critically ill patients.
   Methods: One hundred and forty consecutive critically ill patients with
   an APACHE II score >= 13 were randomly assigned after stratification to
   the EMS group (n = 68) (age:61 +/- 19 years) (APACHE II: 18 +/- 4, SOFA:
   9 +/- 3) or to the control group (n = 72) (age:58 +/- 18 years) (APACHE
   II:18 +/- 5, SOFA:9 +/- 3). Patients of the EMS group received daily EMS
   sessions. CIPNM was diagnosed clinically with the medical research
   council (MRC) scale for muscle strength (maximum score 60, <48/60 cut
   off for diagnosis) by two unblinded independent investigators. Duration
   of weaning from mechanical ventilation and intensive care unit (ICU)
   stay were recorded.
   Results: Fifty two patients could be finally evaluated with MRC; 24 in
   the EMS group and 28 in the control group. CIPNM was diagnosed in 3
   patients in the EMS group as compared to 11 patients in the control
   group (OR = 0.22; CI: 0.05 to 0.92, P = 0.04). The MRC score was
   significantly higher in patients of the EMS group as compared to the
   control group [58 (33 to 60) vs. 52 (2 to 60) respectively, median
   (range), P = 0.04). The weaning period was statistically significantly
   shorter in patients of the EMS group vs. the control group [1 (0 to 10)
   days vs. 3 (0 to 44) days, respectively, median (range), P = 0.003].
   Conclusions: This study suggests that daily EMS sessions prevent the
   development of CIPNM in critically ill patients and also result in
   shorter duration of weaning. Further studies should evaluate which
   patients benefit more from EMS and explore the EMS characteristics most
   appropriate for preventing CIPNM.
TC 48
ZB 24
Z8 2
ZS 0
Z9 51
SN 1466-609X
UT WOS:000278816800049
PM 20426834
ER

PT J
AU Weber-Carstens, Steffen
   Deja, Maria
   Koch, Susanne
   Spranger, Joachim
   Bubser, Florian
   Wernecke, Klaus D.
   Spies, Claudia D.
   Spuler, Simone
   Keh, Didier
TI Risk factors in critical illness myopathy during the early course of
   critical illness: a prospective observational study
SO CRITICAL CARE
VL 14
IS 3
AR R119
DI 10.1186/cc9074
PD 2010
PY 2010
AB Introduction: Non-excitable muscle membrane indicates critical illness
   myopathy (CIM) during early critical illness. We investigated
   predisposing risk factors for non-excitable muscle membrane at onset of
   critical illness.
   Methods: We performed sequential measurements of muscle membrane
   excitability after direct muscle stimulation (dmCMAP) in 40 intensive
   care unit (ICU) patients selected upon a simplified acute physiology
   (SAPS-II) score >= 20 on 3 successive days within 1 week after ICU
   admission. We then investigated predisposing risk factors, including the
   insulin-like growth factor (IGF)-system, inflammatory, metabolic and
   hemodynamic parameters, as well as suspected medical treatment prior to
   first occurrence of abnormal dmCMAP. Nonparametric analysis of
   two-factorial longitudinal data and multivariate analysis were used for
   statistical analysis.
   Results: 22 patients showed abnormal muscle membrane excitability during
   direct muscle stimulation within 7 (5 to 9.25) days after ICU admission.
   Significant risk factors for the development of impaired muscle membrane
   excitability in univariate analysis included inflammation, disease
   severity, catecholamine and sedation requirements, as well as IGF
   binding protein-1 (IGFBP-I), but did not include either adjunctive
   hydrocortisone treatment in septic shock, nor administration of
   neuromuscular blocking agents or aminoglycosides. In multivariate Cox
   regression analysis, interleukin-6 remained the significant risk factor
   for the development of impaired muscle membrane excitability (HR 1.006,
   95%-CI (1.002 to 1.011), P = 0.002).
   Conclusions: Systemic inflammation during early critical illness was
   found to be the main risk factor for development of CIM during early
   critical illness. Inflammation-induced impairment of growth-factor
   mediated insulin sensitivity may be involved in the development of CIM.
TC 31
ZB 11
Z8 1
ZS 0
Z9 32
SN 1466-609X
UT WOS:000283781800089
PM 20565863
ER

PT J
AU Winkelman, Chris
TI The role of inflammation in ICU-acquired weakness
SO CRITICAL CARE
VL 14
IS 4
AR 186
DI 10.1186/cc9187
PD 2010
PY 2010
AB A pilot observational study by Weber-Carstens and colleagues contributes
   to a mechanistic explanation of the puzzling and complex phenomena of
   ICU-acquired weakness (ICU-AW). The authors suggest systemic,
   inflammatory-mediated pathology is the most significant risk factor for
   ICU-AW. While this finding is somewhat equivocal, it provides important
   direction for future investigations and illustrates the challenges of
   interpreting significance in small observational studies.
TC 5
ZB 2
Z8 0
ZS 0
Z9 5
SN 1466-609X
UT WOS:000284227900049
PM 20727229
ER

PT J
AU Geiseler, Jens
   Karg, Ortrud
   Borger, Sandra
   Becker, Kurt
   Zimolong, Andreas
TI Invasive home mechanical ventilation, mainly focused on neuromuscular
   disorders.
SO GMS health technology assessment
VL 6
BP Doc08
EP Doc08
DI 10.3205/hta000086
PD 2010 Jun 14
PY 2010
AB INTRODUCTION AND BACKGROUND: Invasive home mechanical ventilation is
   used for patients with chronic respiratory insufficiency. This elaborate
   and technology-dependent ventilation is carried out via an artificial
   airway (tracheal cannula) to the trachea. Exact numbers about the
   incidence of home mechanical ventilation are not available. Patients
   with neuromuscular diseases represent a large portion of it.
   RESEARCH QUESTIONS: Specific research questions are formulated and
   answered concerning the dimensions of medicine/nursing, economics,
   social, ethical and legal aspects. Beyond the technical aspect of the
   invasive home, mechanical ventilation, medical questions also deal with
   the patient's symptoms and clinical signs as well as the frequency of
   complications. Economic questions pertain to the composition of costs
   and the differences to other ways of homecare concerning costs and
   quality of care. Questions regarding social aspects consider the
   health-related quality of life of patients and caregivers. Additionally,
   the ethical aspects connected to the decision of home mechanical
   ventilation are viewed. Finally, legal aspects of financing invasive
   home mechanical ventilation are discussed.
   METHODS: Based on a systematic literature search in 2008 in a total of
   31 relevant databases current literature is viewed and selected by means
   of fixed criteria. Randomized controlled studies, systematic reviews and
   HTA reports (health technology assessment), clinical studies with
   patient numbers above ten, health-economic evaluations, primary studies
   with particular cost analyses and quality-of-life studies related to the
   research questions are included in the analysis.
   RESULTS AND DISCUSSION: Invasive mechanical ventilation may improve
   symptoms of hypoventilation, as the analysis of the literature shows. An
   increase in life expectancy is likely, but for ethical reasons it is not
   confirmed by premium-quality studies. Complications (e. g. pneumonia)
   are rare. Mobile home ventilators are available for the implementation
   of the ventilation. Their technical performance however, differs
   regrettably. Studies comparing the economic aspects of ventilation in a
   hospital to outpatient ventilation, describe home ventilation as a more
   cost-effective alternative to in-patient care in an intensive care unit,
   however, more expensive in comparison to a noninvasive (via mask)
   ventilation. Higher expenses arise due to the necessary equipment and
   the high expenditure of time for the partial 24-hour care of the
   affected patients through highly qualified personnel. However, none of
   the studies applies to the German provisionary conditions. The
   calculated costs strongly depend on national medical fees and wages of
   caregivers, which barely allows a transmission of the results. The
   results of quality-of-life studies are mostly qualitative. The patient's
   quality of life using mechanical ventilation is predominantly considered
   well. Caregivers of ventilated patients report positive as well as
   negative ratings. Regarding the ethical questions, it was researched
   which aspects of ventilation implementation will have to be considered.
   From a legal point of view the financing of home ventilation, especially
   invasive mechanical ventilation, requiring specialised technical nursing
   is regulated in the code of social law (Sozialgesetzbuch V). The
   absorption of costs is distributed to different insurance carriers, who
   often, due to cost pressures within the health care system, insurance
   carriers, who consider others and not themselves as responsible.
   Therefore in practice, the necessity to enforce a claim of cost
   absorption often arises in order to exercise the basic right of free
   choice of location.
   CONCLUSION: Positive effects of the invasive mechanical ventilation
   (overall survival and symptomatic) are highly probable based on the
   analysed literature, although with a low level of evidence. An
   establishment of a home ventilation registry and health care research to
   ascertain valid data to improve outpatient structures is necessary.
   Gathering specific German data is needed to adequately depict the
   national concepts of provision and reimbursement. A differentiation of
   the cost structure according to the type of chosen outpatient care is
   currently not possible. There is no existing literature concerning the
   difference of life quality depending on the chosen outpatient care
   (homecare, assisted living, or in a nursing home specialised in invasive
   home ventilation). Further research is required. For a so called
   participative decision - made by the patient after intense counselling -
   an early and honest patient education pro respectively contra invasive
   mechanical ventilation is needed. Besides the long term survival, the
   quality of life and individual, social and religious aspects have also
   to be considered.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:21289881
PM 21289881
ER

PT J
AU Brunello, Anna-Giulia
   Haenggi, Matthias
   Wigger, Oliver
   Porta, Francesca
   Takala, Jukka
   Jakob, Stephan M.
TI Usefulness of a clinical diagnosis of ICU-acquired paresis to predict
   outcome in patients with SIRS and acute respiratory failure
SO INTENSIVE CARE MEDICINE
VL 36
IS 1
BP 66
EP 74
DI 10.1007/s00134-009-1645-7
PD JAN 2010
PY 2010
AB Neuromuscular abnormalities are common in ICU patients. We aimed to
   assess the incidence of clinically diagnosed ICU-acquired paresis
   (ICUAP) and its impact on outcome.
   Forty-two patients with systemic inflammatory response syndrome on
   mechanical ventilation for a parts per thousand yen48 h were
   prospectively studied. Diagnosis of ICUAP was defined as symmetric limb
   muscle weakness in at least two muscle groups at ICU discharge without
   other explanation. The threshold Medical Research Council (MRC) Score
   was set at 35 (of 50) points. Activities in daily living were scored
   using the Barthel Index 28 and 180 days after ICU discharge.
   Three patients died before sedation was stopped. ICUAP was diagnosed in
   13 of the 39 patients (33%). Multivariate regression analysis yielded
   five ICUAP-predicting variables (P < 0.05): SAPS II at ICU admission,
   treatment with steroids, muscle relaxants or norepinephrine, and days
   with sepsis. Patients with ICUAP had lower admission SAPS II scores [37
   +/- A 13 vs. 49 +/- A 15 (P = 0.018)], lower Barthel Index at 28 days
   and lower survival at 180 days after ICU discharge (38 vs. 77%, P =
   0.033) than patients without ICUAP. Daily TISS-28 scores were similar
   but cumulative TISS-28 scores were higher in patients with ICUAP (664
   +/- A 275) than in patients without ICUAP (417 +/- A 236; P = 0.008).
   The only independent risk factor for death before day 180 was the
   presence of ICUAP.
   A clinical diagnosis of ICUAP was frequently established in this patient
   group. Despite lower SAPS II scores, these patients needed more
   resources and had high mortality and prolonged recovery periods after
   ICU discharge.
RI Haenggi, Matthias/A-8073-2008
OI Haenggi, Matthias/0000-0001-5845-031X
TC 15
ZB 4
Z8 0
ZS 0
Z9 16
SN 0342-4642
UT WOS:000273683300010
PM 19760204
ER

PT J
AU Ernest, D.
   Leung, A.
TI Ventilatory failure in shrinking lung syndrome is associated with
   reduced chest compliance
SO INTERNAL MEDICINE JOURNAL
VL 40
IS 1
BP 66
EP 68
DI 10.1111/j.1445-5994.2009.02082.x
PD JAN 2010
PY 2010
AB Shrinking lung syndrome is an extremely rare feature of systemic lupus
   erythematosus (SLE). We report on a 49-year-old woman with SLE who
   presented with dyspnoea in type 2 respiratory failure requiring
   mechanical ventilation. Medical imaging investigations revealed markedly
   reduced lung volumes and the absence of pulmonary emboli, pulmonary
   fibrosis or any significant parenchymal infiltrate consistent with
   shrinking lung syndrome. We observed significantly reduced chest
   compliance during positive pressure ventilation and noted that this
   contrasts with a widely held view that diaphragmatic weakness is the
   major pathophysiological mechanism for ventilatory failure in these
   patients. She was treated with high-dose steroids and cyclophosphamide
   and weaned slowly off full mechanical ventilation. This report
   highlights an unusual cause of respiratory failure in a patient with SLE
   and provides support for reduced chest compliance rather than the
   diaphragmatic weakness as being the significant pathophysiological
   mechanism for ventilatory failure in these patients.
TC 6
ZB 1
Z8 0
ZS 1
Z9 7
SN 1444-0903
UT WOS:000274410900010
PM 20561366
ER

PT J
AU Boddi, M.
   Barbani, F.
   Abbate, R.
   Bonizzoli, M.
   Batacchi, S.
   Lucente, E.
   Chiostri, M.
   Gensini, G. F.
   Peris, A.
TI Reduction in deep vein thrombosis incidence in intensive care after a
   clinician education program
SO JOURNAL OF THROMBOSIS AND HAEMOSTASIS
VL 8
IS 1
BP 121
EP 128
DI 10.1111/j.1538-7836.2009.03664.x
PD JAN 2010
PY 2010
AB Background: Deep vein thrombosis (DVT) is a major complication in
   intensive care units (ICU) but dedicated guidelines on its management
   are still lacking. Objectives and Methods: This study investigated the
   effect of a 1-year educational program for the implementation of DVT
   prophylaxis on the incidence of inferior limb DVT in a mixed-bed ICU
   that admits high-risk surgical and trauma patients, investigated during
   a first retrospective phase [126 patients, SAPS II score 42 (28-54)] and
   a following prospective phase [264 patients, SAPS II score II 41
   (27-55)]. The role of baseline and time-dependent DVT risk factors in
   DVT occurrence was also investigated during the prospective phase.
   Results: The educational program on implementation of DVT prophylaxis
   was associated with a significant decrease in DVT incidence from 11.9%
   to 4.5% (P < 0.01) and in the mean length of ICU stay (P < 0.01).
   Combined with pharmacological prophylaxis, the use of elastic
   compressive stockings significantly also increased in the prospective
   phase (P < 0.01). The duration of mechanical ventilation, vasopressor
   administration and neuromuscular block were significantly different
   between DVT-positive and DVT-negative patients (P < 0.01). Multivariate
   analysis identified neuromuscular block as the strongest independent
   predictor for DVT incidence. Conclusion: One-year ICU-based educational
   programs on implementation of DVT prophylaxis were associated with a
   significant decrease in the incidence of DVT and also in the length of
   stay in ICU.
TC 11
ZB 4
Z8 0
ZS 0
Z9 11
SN 1538-7933
UT WOS:000272864200021
PM 19874469
ER

PT J
AU Oxford, Corrina M.
   Ludmir, Jonathan
TI Trauma in Pregnancy
SO CLINICAL OBSTETRICS AND GYNECOLOGY
VL 52
IS 4
BP 611
EP 629
PD DEC 2009
PY 2009
AB In the United States, trauma is the leading nonobstetric cause of
   maternal death. The principal causes of trauma in pregnancy include
   motor vehicle accidents, falls, assaults, homicides, domestic violence,
   and penetrating wounds. The managing team evaluating and coordinating
   the care of the pregnant trauma patient should be multidisciplinary so
   that it is able to understand the physiologic changes in pregnancy.
   Blunt trauma to the abdomen increases the risk of placental abruption.
   Evaluation of the pregnant trauma patient requires a primary and
   secondary survey with emphasis on airway, breathing, circulation, and
   disability. The use of imaging studies, invasive hemo-dynamics, critical
   care medications, and surgery, if necessary, should be individualized
   and guided by a coordinating team effort to improve maternal and fetal
   conditions. A clear understanding of gestational age and fetal viability
   should be documented in the record.
TC 12
ZB 8
Z8 0
ZS 0
Z9 13
SN 0009-9201
UT WOS:000271754500008
PM 20393413
ER

PT J
AU O'Connor, Enda D.
   Walsham, James
TI Should we mobilise critically ill patients? A review
SO CRITICAL CARE AND RESUSCITATION
VL 11
IS 4
BP 290
EP 300
PD DEC 2009
PY 2009
AB Background: Neuromuscular weakness, a frequent complication of prolonged
   bed rest and critical illness, is associated with morbidity and
   mortality. Mobilisation physiotherapy has widespread application in
   patients hospitalised with non-critical illness.
   Objectives: We reviewed the literature to evaluate the worldwide
   availability of mobilisation therapy in intensive care units and the
   role of mobilisation therapy in patients requiring medical or surgical
   high dependency or intensive care.
   Methods: We searched Pub Med (1980 to August 2009) using the MeSH terms
   "physiotherapy" and "intensive care". Additional keyword search terms,
   "mobilisation", "mobilization", and "fast-track", were used. In
   addition, we examined reference lists in recent studies and reviews.
   Results: Routine mobilisation physiotherapy is least likely to be
   available in ICUs in the United States. Early mobilisation is
   appropriate for patients with pulmonary thromboembolic disease,
   community-acquired pneumonia and in elderly hospitalised patients.
   Although fast-track cardiac and non-cardiac surgery with early
   ambulation is safe and reduces hospital length of stay, it does not
   alter postoperative mortality. Up to 25% of patients can be safely
   mobilised within 72 hours of ICU admission. This therapy may reduce
   hospital and ICU length of stay, shorten duration of mechanical
   ventilation, and improve muscle strength and functional independence
   scores. Pooled data show a nonsignificant mortality benefit in favour of
   early mobilisation (odds ratio, 0.77; 95% Cl, 0.49-1.21).
   Conclusions: The data in support of mobilisation therapy for
   perioperative and critically ill patients, while of a low level of
   evidence, are substantial. This justifies a paradigm shift in attitudes
   towards physiotherapy and the prevention of critical illness weakness.
   Crit Care Resusc 2009; 11: 290-300
TC 17
ZB 5
Z8 0
ZS 0
Z9 17
SN 1441-2772
UT WOS:000208090900013
PM 20001881
ER

PT J
AU Sharshar, Tarek
   Bastuji-Garin, Sylvie
   Stevens, Robert D.
   Durand, Marie-Christine
   Malissin, Isabelle
   Rodriguez, Pablo
   Cerf, Charles
   Outin, Herve
   De Jonghe, Bernard
CA GRENER
TI Presence and severity of intensive care unit-acquired paresis at time of
   awakening are associated with increased intensive care unit and hospital
   mortality
SO CRITICAL CARE MEDICINE
VL 37
IS 12
BP 3047
EP 3053
DI 10.1097/CCM.0b013e3181b027e9
PD DEC 2009
PY 2009
AB Objectives: To assess whether the presence and severity of intensive
   care unit-acquired paresis are associated with intensive care unit and
   in-hospital mortality.
   Design: Prospective, observational study.
   Setting: Two medical, one surgical, and one medico-surgical intensive
   care units in two university hospitals and one university-affiliated
   hospital.
   Patients: A total of 115 consecutive patients were enrolled after > 7
   days of mechanical ventilation.
   Interventions: None.
   Measurements and Main Results: The Medical Research Council score (from
   0-60) was used to evaluate upper and lower limb strength at time of
   awakening, identified as the ability to follow five commands. Intensive
   care unit-acquired paresis was defined as a Medical Research Council
   score <48. Patients were followed-up until hospital discharge. The
   primary end point was hospital mortality. At awakening, median Medical
   Research Council score was 41 (interquartile range, 21-52), and 75 (65%)
   patients had intensive care unit-acquired paresis. Hospital
   non-survivors had a significantly lower Medical Research Council score
   at awakening (21 [11-43]) vs. 41 [28-53]; p = .008) and a significantly
   higher rate of intensive care unit-acquired paresis (85.1% vs. 58.4%; p
   = .02) compared to survivors. After multivariate risk adjustment,
   intensive care unit-acquired paresis was independently associated with
   higher hospital and intensive care unit mortality (odds ratio for
   hospital mortality, 2.02; 95% confidence interval, 1.03-8.03; p = .048).
   Each Medical Research Council point decrease was associated with a
   significantly higher hospital mortality (odds ratio, 1.03; 95%
   confidence interval, 1.01-1.05; p = .033).
   Conclusions: Both the presence and severity of intensive care
   unit-acquired paresis at the time of awakening are associated with
   increased intensive care unit and hospital mortality; the mechanisms
   underlying this association need further study. (Crit Care Med 2009;
   37:3047-3053)
TC 44
ZB 9
Z8 0
ZS 0
Z9 44
SN 0090-3493
UT WOS:000272509800007
PM 19770751
ER

PT J
AU Payo, Jorge
   Sanchez Perez-Grueso, Francisco
   Fernandez-Baillo, Nicomedes
   Garcia, Alfredo
TI Severe restrictive lung disease and vertebral surgery in a pediatric
   population
SO EUROPEAN SPINE JOURNAL
VL 18
IS 12
BP 1905
EP 1910
DI 10.1007/s00586-009-1084-8
PD DEC 2009
PY 2009
AB The aim of this study is to describe the outcome of surgical treatment
   for pediatric patients with forced vital capacity (FVC) < 40% and severe
   vertebral deformity. Few studies have examined surgical treatment in
   these patients, who are considered to be at a high risk because of their
   pulmonary disease, and in whom preoperative tracheostomy is sometimes
   recommended. Inclusion criteria include FVC < 40%, age < 19 years and
   diagnosis of scoliosis. The retrospective study of 24 patients with
   severe restrictive lung disease, who underwent spinal surgery. Variables
   studied were age and gender, pre- and postoperative spirometry (FVC,
   FEV1, FEV1/FVC), preoperative, postoperative and late use of
   non-invasive ventilation (BiPAP) or mechanical ventilation, associated
   multidisciplinary treatment, type and location of the curve, pre- and
   postoperative curve values, type of vertebral fusion, intra- and
   postoperative complications, duration of intensive care unit (ICU) stay
   and length of postoperative hospitalization. Mean age was 13 years
   (9-19) of which 13 were males and 11 females. Mean follow-up was 32
   months (24-45). The etiology was neuromuscular in 17 patients and other
   etiologies in 7 patients. Mean preoperative FVC was 26% (13-39%). Eight
   patients had preoperative home BiPAP, 15 preoperative in-hospital BiPAP,
   and 2 preoperative mechanical ventilation. Nine patients had
   preoperative nutritional support. Preoperative curve value of the
   deformity was 88A degrees (40A degrees-129A degrees). Nineteen patients
   with posterior fusion alone and 5 with anterior and posterior fusion
   were found. Mean duration of ICU stay was 5 days (1-21). Total
   postoperative hospital stay was 17 days (7-33). Ventilatory support in
   the immediate postoperative includes 16 patients requiring BiPAP and 2
   volumetric ventilation. None of the patients required a tracheostomy.
   The intraoperative complications include one death due to acute heart
   failure; immediate postoperative, four respiratory failures (2 required
   ICU readmission) and one respiratory infection; and other minor
   complications occurred in six patients. Overall, 58% of patients had
   complications. Percentage of angle correction was 56%. After a follow-up
   of 30 months, FVC was 29% (13-50%). In conclusion, corrective scoliosis
   surgery in pediatric patients with severe restrictive lung disease is
   well tolerated, but the management of this population requires extensive
   experience with the vertebral surgery involved, and a multidisciplinary
   approach that includes pulmonologists, nutritionists and
   anesthesiologists. Currently, there is no indication for routine
   preoperative tracheostomy.
TC 6
ZB 2
Z8 0
ZS 0
Z9 6
SN 0940-6719
UT WOS:000272360000010
PM 19590906
ER

PT J
AU Rochester, Carolyn L.
TI Rehabilitation in the Intensive Care Unit
SO SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE
VL 30
IS 6
BP 656
EP 669
DI 10.1055/s-0029-1242635
PD DEC 2009
PY 2009
AB Critical illness has many devastating sequelae, including profound
   neuromuscular weakness and psychological and cognitive disturbances that
   frequently result in long-term functional impairments. Early
   rehabilitation begun in the intensive care unit (ICU) is emerging as an
   important strategy both to prevent and to treat ICU-acquired weakness,
   in an effort to facilitate and improve long-term recovery.
   Rehabilitation may begin with range of motion and bed mobility,
   exercise, then may progress when the patient is fully alert and able to
   participate actively to include sitting and posture-based exercise, bed
   to chair transfers, strength and endurance exercises, and ambulation.
   Electrical muscle stimulation and inspiratory muscle training are
   additional techniques that may be employed. Studies conducted to date
   Suggest that such ICU-based rehabilitation is feasible, safe, and
   effective for carefully selected patients. Further research is needed to
   identify the optimal patient candidates and procedures and for providing
   rehabilitation in the ICU.
TC 10
ZB 3
Z8 2
ZS 0
Z9 11
SN 1069-3424
UT WOS:000272513700005
PM 19941223
ER

PT J
AU Banduseela, Varuna C.
   Ochala, Julien
   Chen, Yi-Wen
   Goransson, Hanna
   Norman, Holly
   Radell, Peter
   Eriksson, Lars I.
   Hoffman, Eric P.
   Larsson, Lars
TI Gene expression and muscle fiber function in a porcine ICU model
SO PHYSIOLOGICAL GENOMICS
VL 39
IS 3
BP 141
EP 159
DI 10.1152/physiolgenomics.00026.2009
PD NOV 6 2009
PY 2009
AB Banduseela VC, Ochala J, Chen Y-W, Goransson H, Norman H, Radell P,
   Eriksson LI, Hoffman EP, Larsson L. Gene expression and muscle fiber
   function in a porcine ICU model. Physiol Genomics 39: 141-159, 2009.
   First published August 25, 2009; doi:
   10.1152/physiolgenomics.00026.2009.-Skeletal muscle wasting and impaired
   muscle function in response to mechanical ventilation and immobilization
   in intensive care unit (ICU) patients are clinically challenging partly
   due to 1) the poorly understood intricate cellular and molecular
   networks and 2) the unavailability of an animal model mimicking this
   condition. By employing a unique porcine model mimicking the conditions
   in the ICU with long-term mechanical ventilation and immobilization, we
   have analyzed the expression profile of skeletal muscle biopsies taken
   at three time points during a 5-day period. Among the differentially
   regulated transcripts, extracellular matrix, energy metabolism,
   sarcomeric and LIM protein mRNA levels were downregulated, while
   ubiquitin proteasome system, cathepsins, oxidative stress responsive
   genes and heat shock proteins (HSP) mRNAs were upregulated. Despite 5
   days of immobilization and mechanical ventilation single muscle fiber
   cross-sectional areas as well as the maximum force generating capacity
   at the single muscle fiber level were preserved. It is proposed that HSP
   induction in skeletal muscle is an inherent, primary, but temporary
   protective mechanism against protein degradation. To our knowledge, this
   is the first study that isolates the effect of immobilization and
   mechanical ventilation in an ICU condition from various other cofactors.
TC 16
ZB 13
Z8 0
ZS 0
Z9 16
SN 1094-8341
UT WOS:000271525900002
PM 19706692
ER

PT J
AU Kumar, Anand
   Zarychanski, Ryan
   Pinto, Ruxandra
   Cook, Deborah J.
   Marshall, John
   Lacroix, Jacques
   Stelfox, Tom
   Bagshaw, Sean
   Choong, Karen
   Lamontagne, Francois
   Turgeon, Alexis F.
   Lapinsky, Stephen
   Ahern, Stephane P.
   Smith, Orla
   Siddiqui, Faisal
   Jouvet, Philippe
   Khwaja, Kosar
   McIntyre, Lauralyn
   Menon, Kusum
   Hutchison, Jamie
   Hornstein, David
   Joffe, Ari
   Lauzier, Francois
   Singh, Jeffrey
   Karachi, Tim
   Wiebe, Kim
   Olafson, Kendiss
   Ramsey, Clare
   Sharma, Sat
   Dodek, Peter
   Meade, Maureen
   Hall, Richard
   Fowler, Robert A.
CA Canadian Critical Care Trials Grp
TI Critically Ill Patients With 2009 Influenza A(H1N1) Infection in Canada
SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
VL 302
IS 17
BP 1872
EP 1879
PD NOV 4 2009
PY 2009
AB Context Between March and July 2009, the largest number of confirmed
   cases of 2009 influenza A(H1N1) infection occurred in North America.
   Objective To describe characteristics, treatment, and outcomes of
   critically ill patients in Canada with 2009 influenza A(H1N1) infection.
   Design, Setting, and Patients A prospective observational study of 168
   critically ill patients with 2009 influenza A(H1N1) infection in 38
   adult and pediatric intensive care units (ICUs) in Canada between April
   16 and August 12, 2009.
   Main Outcome Measures The primary outcome measures were 28-day and
   90-day mortality. Secondary outcomes included frequency and duration of
   mechanical ventilation and duration of ICU stay.
   Results Critical illness occurred in 215 patients with confirmed
   (n=162), probable (n=6), or suspected (n=47) community-acquired 2009
   influenza A(H1N1) infection. Among the 168 patients with confirmed or
   probable 2009 influenza A(H1N1), the mean(SD) age was 32.3 (21.4) years;
   113 were female (67.3%) and 50 were children (29.8%). Overall mortality
   among critically ill patients at 28 days was 14.3% (95% confidence
   interval, 9.5%-20.7%). There were 43 patients who were aboriginal
   Canadians (25.6%). The median time from symptom onset to hospital
   admission was 4 days (interquartile range [IQR], 2-7 days) and from
   hospitalization to ICU admission was 1 day (IQR, 0-2 days). Shock and
   nonpulmonary acute organ dysfunction was common (Sequential Organ
   Failure Assessment mean [SD] score of 6.8 [3.6] on day 1). Neuraminidase
   inhibitors were administered to 152 patients (90.5%). All patients were
   severely hypoxemic (mean [SD] ratio of PaO2 to fraction of inspired
   oxygen [FIO2] of 147 [128] mm Hg) at ICU admission. Mechanical
   ventilation was received by 136 patients (81.0%). The median duration of
   ventilation was 12 days (IQR, 6-20 days) and ICU stay was 12 days (IQR,
   5-20 days). Lung rescue therapies included neuromuscular blockade (28%
   of patients), inhaled nitric oxide (13.7%), high-frequency oscillatory
   ventilation (11.9%), extracorporeal membrane oxygenation (4.2%), and
   prone positioning ventilation (3.0%). Overall mortality among critically
   ill patients at 90 days was 17.3%(95% confidence interval, 12.0%-24.0%;
   n=29).
   Conclusion Critical illness due to 2009 influenza A(H1N1) in Canada
   occurred rapidly after hospital admission, often in young adults, and
   was associated with severe hypoxemia, multisystem organ failure, a
   requirement for prolonged mechanical ventilation, and the frequent use
   of rescue therapies. JAMA. 2009;302(17):1872-1879
RI Max, Mad/E-5238-2010; lamontagne, francois/C-6075-2014
OI Max, Mad/0000-0001-6966-6829; 
TC 657
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ZS 9
Z9 704
SN 0098-7484
UT WOS:000271375300018
PM 19822627
ER

PT J
AU Marasco, Silvana
   Cooper, Jamie
   Pick, Adrian
   Kossmann, Thomas
TI Pilot study of operative fixation of fractured ribs in patients with
   flail chest
SO ANZ JOURNAL OF SURGERY
VL 79
IS 11
BP 804
EP 808
DI 10.1111/j.1445-2197.2009.05104.x
PD NOV 2009
PY 2009
AB Background:
   Flail chest is a serious injury in trauma with a significant mortality
   rate, and long-term pain and disability. Traditionally, management has
   consisted of internal pneumatic splinting, leading to prolonged periods
   of mechanical ventilation, and its attendant complications. The aim of
   this study was to assess the safety of operative fixation of broken ribs
   in flail chest using absorbable prostheses.
   Methods:
   Thirteen consecutive patients with severe flail chest injury were
   enrolled in this pilot study. Surgery was planned after viewing
   three-dimensional reconstructions of the computed tomography scans of
   the chest. The plates were applied to the external cortical surface of
   the rib after reducing the fracture. Segmentally fractured ribs were
   usually plated only once to convert the flail segment to simple
   fractured ribs and correct the paradoxical wall motion abnormality.
   Results:
   All patients had a good surgical result. On average, four ribs were
   fixed per patient. All patients were able to be weaned from mechanical
   ventilation and all patients were discharged from the hospital. There
   were no deaths. No plates had to be removed. In all patients, the flail
   chest was successfully stabilized and paradoxical chest wall movement
   was eliminated.
   Conclusion:
   This pilot study of operative fixation of broken ribs in patients with
   flail chest, using absorbable plates and screws, has shown the technique
   to be safe and effective. On the basis of these results, a prospective
   randomized trial has commenced at The Alfred Hospital, comparing this
   management strategy with conservative management.
CT 7th European Congress of Trauma and Emergency Surgery
CY SEP 06-09, 2006
CL Malmo, SWEDEN
RI Cooper, D. James/G-7961-2013
OI Cooper, D. James/0000-0002-5872-9051
TC 9
ZB 5
Z8 6
ZS 0
Z9 16
SN 1445-1433
UT WOS:000271520400010
PM 20078530
ER

PT J
AU Bittner, Edward A
   Martyn, Jeevendra A
   George, Edward
   Frontera, Walter R
   Eikermann, Matthias
TI Measurement of muscle strength in the intensive care unit.
SO Critical care medicine
VL 37
IS 10 Suppl
BP S321
EP 30
DI 10.1097/CCM.0b013e3181b6f727
PD 2009-Oct
PY 2009
AB Traditional (indirect) techniques, such as electromyography and nerve
   conduction velocity measurement, do not reliably predict intensive care
   unit-acquired muscle weakness and its clinical consequences. Therefore,
   quantitative assessment of skeletal muscle force is important for
   diagnosis of intensive care unit-acquired motor dysfunction. There are a
   number of ways for assessing objectively muscle strength, which can be
   categorized as techniques that quantify maximum voluntary contraction
   force and those that assess evoked (stimulated) muscle force. Important
   factors that limit the repetitive evaluation of maximum voluntary
   contraction force in intensive care unit patients are learning effects,
   pain during muscular contraction, and alteration of consciousness.The
   selection of the appropriate muscle is crucial for making adequate
   predictions of a patient's outcome. The upper airway dilators are much
   more susceptible to a decrease in muscle strength than the diaphragm,
   and impairment of upper airway patency is a key mechanism of extubation
   failure in intensive care unit patients. Data suggest that the adductor
   pollicis muscle is an appropriate reference muscle to predict weakness
   of muscles that are typically affected by intensive care unit-acquired
   weakness, i.e., upper airway as well as extremity muscles. Stimulated
   (evoked) force of skeletal muscles, such as the adductor pollicis, can
   be assessed repetitively, independent of brain function, even in heavily
   sedated patients during high acuity of their disease.
TC 18
ZB 7
Z8 1
ZS 1
Z9 20
UT MEDLINE:20046117
PM 20046117
ER

PT J
AU Brochard, Laurent
   Thille, Arnaud W
TI What is the proper approach to liberating the weak from mechanical
   ventilation?
SO Critical care medicine
VL 37
IS 10 Suppl
BP S410
EP 5
DI 10.1097/CCM.0b013e3181b6e28b
PD 2009-Oct
PY 2009
AB The general issue of weaning can be viewed as composed of three
   different groups of patients. First, simple or easy weaning, represents
   60% to 70% of patients whose first trial of spontaneous breathing is
   successful. The main objective of the weaning process is to detect
   weaning readiness as early as possible, which is best achieved using a
   systematic approach. The percentage of patients in this group in a given
   intensive care unit represents the pretest probability of weaning. A
   second group is made of patients who experience failure of the first
   spontaneous breathing trial and in whom up to 7 days from the first
   trial may be required to achieve weaning. This group represents 20% to
   25% of patients who undergo weaning from mechanical ventilation. Muscle
   weakness contributes to the prolongation of weaning in many of these
   patients. The last group is made of patients who are characterized by a
   prolonged or very difficult weaning process (about 5% to 15% of patients
   undergoing weaning). Muscle weakness is likely to be a major
   contributing factor. Early use of spontaneous breathing, well-controlled
   use of sedation, and early mobilization may help in reducing muscle
   weakness and hasten the weaning process. The postextubation period may
   be particularly at risk in these patients. More research is needed to
   guide clinicians regarding the best ventilatory management.
TC 11
ZB 1
Z8 1
ZS 0
Z9 13
UT MEDLINE:20046128
PM 20046128
ER

PT J
AU Callahan, Leigh Ann
   Supinski, Gerald S
TI Sepsis-induced myopathy.
SO Critical care medicine
VL 37
IS 10 Suppl
BP S354
EP 67
DI 10.1097/CCM.0b013e3181b6e439
PD 2009-Oct
PY 2009
AB Sepsis is a major cause of morbidity and mortality in critically ill
   patients, and despite advances in management, mortality remains high. In
   survivors, sepsis increases the risk for the development of persistent
   acquired weakness syndromes affecting both the respiratory muscles and
   the limb muscles. This acquired weakness results in prolonged duration
   of mechanical ventilation, difficulty weaning, functional impairment,
   exercise limitation, and poor health-related quality of life. Abundant
   evidence indicates that sepsis induces a myopathy characterized by
   reductions in muscle force-generating capacity, atrophy (loss of muscle
   mass), and altered bioenergetics. Sepsis elicits derangements at
   multiple subcellular sites involved in excitation contraction coupling,
   such as decreasing membrane excitability, injuring sarcolemmal
   membranes, altering calcium homeostasis due to effects on the
   sarcoplasmic reticulum, and disrupting contractile protein interactions.
   Muscle wasting occurs later and results from increased proteolytic
   degradation as well as decreased protein synthesis. In addition, sepsis
   produces marked abnormalities in muscle mitochondrial functional
   capacity and when severe, these alterations correlate with increased
   death. The mechanisms leading to sepsis-induced changes in skeletal
   muscle are linked to excessive localized elaboration of proinflammatory
   cytokines, marked increases in free-radical generation, and activation
   of proteolytic pathways that are upstream of the proteasome including
   caspase and calpain. Emerging data suggest that targeted inhibition of
   these pathways may alter the evolution and progression of sepsis-induced
   myopathy and potentially reduce the occurrence of sepsis-mediated
   acquired weakness syndromes.
TC 55
ZB 31
Z8 3
ZS 0
Z9 58
UT MEDLINE:20046121
PM 20046121
ER

PT J
AU de Jonghe, Bernard
   Lacherade, Jean-Claude
   Sharshar, Tarek
   Outin, Herve
TI Intensive care unit-acquired weakness: risk factors and prevention.
SO Critical care medicine
VL 37
IS 10 Suppl
BP S309
EP 15
DI 10.1097/CCM.0b013e3181b6e64c
PD 2009-Oct
PY 2009
AB Intensive care unit-acquired weakness, the main clinical sign of
   critical illness neuromyopathy, is an increasingly recognized cause of
   prolonged mechanical ventilation and delayed return to physical
   self-sufficiency. Identifying risk factors and developing preventive
   measures are therefore important goals. Several studies on risk factors
   for critical illness neuromyopathy including prospective observational
   studies with a multivariate analysis of potential risk factors were
   conducted over the last decade. A large body of data is also available
   from two large prospective randomized trials comparing the effect of
   strict vs. conventional blood-glucose control on intensive care unit
   mortality and on secondary outcomes including the occurrence of critical
   illness neuromyopathy. Five central risk factors and their related
   potential measures to prevent intensive care unit-acquired weakness can
   be identified including multiple organ failure, muscle inactivity,
   hyperglycemia, and use of corticosteroids and neuromuscular blockers.
   Although strong evidence regarding the efficacy of preventive measures
   is still lacking, the results of available studies are promising and
   cast doubt on the widespread belief that the treatment of intensive care
   unit-acquired weakness is essentially supportive. Early identifying and
   treating conditions leading to multiple organ failure, especially severe
   sepsis and septic shock, avoiding unnecessary deep sedation and
   excessive blood glucose levels, promoting early mobilization, and
   carefully weighing the risks and benefits of corticosteroids might
   contribute to reduce the incidence and severity of intensive care
   unit-acquired weakness.
TC 57
ZB 13
Z8 0
ZS 1
Z9 58
UT MEDLINE:20046115
PM 20046115
ER

PT J
AU Griffiths, Richard D
   Hall, Jesse B
TI Exploring intensive care unit-acquired weakness. Preface.
SO Critical care medicine
VL 37
IS 10 Suppl
BP S295
EP S295
DI 10.1097/CCM.0b013e3181b6f411
PD 2009-Oct
PY 2009
TC 3
ZB 2
Z8 0
ZS 0
Z9 3
UT MEDLINE:20046112
PM 20046112
ER

PT J
AU Hall, Jesse B
   Schweickert, William
   Kress, John P
TI Role of analgesics, sedatives, neuromuscular blockers, and delirium.
SO Critical care medicine
VL 37
IS 10 Suppl
BP S416
EP 21
DI 10.1097/CCM.0b013e3181b6f95b
PD 2009-Oct
PY 2009
AB A major focus on critical care medicine concerns the institution of
   life-support therapies, such as mechanical ventilation, during periods
   of organ failure to permit a window of opportunity to diagnose and treat
   underlying disorders so that patients may be returned to their prior
   functional status upon recovery. With the growing success of these
   intensive care unit-based therapies and longer-term follow-up of
   patients, severe weakness involving the peripheral nervous system and
   muscles has been identified in many recovering patients, often
   confounding the time course or magnitude of recovery. Mechanical
   ventilation is often accompanied by pharmacologic treatments including
   analgesics, sedatives, and neuromuscular blockers. These drugs and the
   encephalopathies accompanying some forms of critical illness result in a
   high prevalence of delirium in mechanically ventilated patients. These
   drug effects likely contribute to an impaired ability to assess the
   magnitude of intensive care unit-acquired weakness, to additional time
   spent immobilized and mechanically ventilated, and to additional
   weakness from the patient's relative immobility and bedridden state.
   This review surveys recent literature documenting these relationships
   and identifying approaches to minimize pharmacologic contributions to
   intensive care unit-acquired weakness.
TC 7
ZB 4
Z8 0
ZS 0
Z9 9
UT MEDLINE:20046129
PM 20046129
ER

PT J
AU Hermans, Greet
   Vanhorebeek, Ilse
   Derde, Sarah
   Van den Berghe, Greet
TI Metabolic aspects of critical illness polyneuromyopathy.
SO Critical care medicine
VL 37
IS 10 Suppl
BP S391
EP 7
DI 10.1097/CCM.0b013e3181b6f01a
PD 2009-Oct
PY 2009
AB Critically ill patients frequently develop muscle weakness due to
   critical illness-related acute neuropathy and/or myopathy. This is a
   frequent disorder, with important short-term consequences that include
   difficulties in weaning from mechanical ventilation, associated
   prolonged intensive care unit and hospital stay, and increased mortality
   rates. In addition, many patients continue to suffer from decreased
   exercise capacity and quality of life for months to years after the
   acute event. Many different mechanisms seem to be involved in the
   development of this process. In this review, we will focus on the
   metabolic aspects of critical illness-related acute neuropathy and/or
   myopathy and, more specifically, on our clinical experience with
   achieving strict glycemic control using insulin. Our group has performed
   two randomized controlled trials in surgical and medical critically ill
   patients and studied the occurrence of critical illness-related acute
   neuropathy and/or myopathy and delayed weaning, one of its most
   important complications. Potential underlying mechanisms derived from
   experimental studies and from the analysis of biopsy samples harvested
   from critically ill patients or patients suffering from other catabolic
   states are discussed.
TC 10
ZB 3
Z8 0
ZS 0
Z9 10
UT MEDLINE:20046125
PM 20046125
ER

PT J
AU Herridge, Margaret S
TI Legacy of intensive care unit-acquired weakness.
SO Critical care medicine
VL 37
IS 10 Suppl
BP S457
EP 61
DI 10.1097/CCM.0b013e3181b6f35c
PD 2009-Oct
PY 2009
AB Loss of muscle mass, nerve dysfunction, and resultant weakness and
   functional disability represent important and lasting morbidities of an
   episode of critical illness. As investigators increasingly incorporate
   long-term functional, neuropsychological, and quality-of-life outcomes
   into their studies, more data are accruing that support the existence of
   often devastating and irreversible sequelae of severe illness and
   treatment in an intensive care unit. This review highlights early
   quality-of-life literature that supports significant physical
   dysfunction after intensive care unit treatment and more recent
   longitudinal studies up to 5 yrs after intensive care unit discharge,
   which clearly implicate nerve and muscle dysfunction as contributors to
   this reported disability. Additional follow-up work is needed to
   understand the pathophysiology of this injury, the spectrum of physical
   disability, and its associated risk factors. These data are crucial to
   inform risk-stratification and future rehabilitation interventions, both
   during the intensive care unit admission and after hospital discharge as
   patients reintegrate within their community and workplace.
TC 33
ZB 10
Z8 2
ZS 0
Z9 35
UT MEDLINE:20046135
PM 20046135
ER

PT J
AU Kress, John P
TI Clinical trials of early mobilization of critically ill patients.
SO Critical care medicine
VL 37
IS 10 Suppl
BP S442
EP 7
DI 10.1097/CCM.0b013e3181b6f9c0
PD 2009-Oct
PY 2009
AB Intensive care unit-acquired weakness is a common complication of
   critical illness leading to severe functional impairment in many
   intensive care unit survivors. Critically ill patients who require
   mechanical ventilation are routinely immobilized for prolonged time
   periods. This immobilization is exacerbated by frequent administration
   of sedative agents. Recently, several investigators have described the
   feasibility and potential benefits of mobilizing mechanically ventilated
   intensive care unit patients. Such an intervention requires a
   multidisciplinary team approach to patient care, involving nursing,
   physical therapy, occupational therapy, and respiratory therapy
   practitioners. Recent studies of early mobilization of mechanically
   ventilated intensive care unit patients have noted this intervention to
   be safe and associated with improved functional outcomes in this
   extremely ill patient cohort. Such outcomes include high percentages of
   patients able to ambulate on intensive care unit and hospital discharge
   and shortened hospital length of stay. With preliminary studies
   demonstrating remarkable feasibility and successes, further prospective
   studies of early mobilization are needed to evaluate this intervention.
TC 35
ZB 2
Z8 1
ZS 2
Z9 37
UT MEDLINE:20046133
PM 20046133
ER

PT J
AU Needham, Dale M
   Truong, Alex D
   Fan, Eddy
TI Technology to enhance physical rehabilitation of critically ill
   patients.
SO Critical care medicine
VL 37
IS 10 Suppl
BP S436
EP 41
DI 10.1097/CCM.0b013e3181b6fa29
PD 2009-Oct
PY 2009
AB BACKGROUND: Neuromuscular complications after critical illness are
   common and can be severe and persistent. To ameliorate complications,
   there is growing interest in starting physical medicine and
   rehabilitation therapy immediately after physiologic stabilization. The
   introduction of physical medicine and rehabilitation-related technology
   into the intensive care unit may help facilitate delivery of this
   therapy.
   DISCUSSION: Neuromuscular electrical stimulation therapy creates passive
   contraction of muscles through low-voltage electrical impulses delivered
   through skin electrodes placed over target muscles. Although
   neuromuscular electrical stimulation has not been studied in patients
   with acute critical illness, published guidelines based on available
   evidence suggest that neuromuscular electrical stimulation may be
   considered in intensive care unit patients who are at high risk of
   developing muscle weakness. Bedside cycle ergometry can provide range of
   motion and muscle strength training for intensive care unit patients who
   are either sedated or awake, and may help preserve muscle architecture
   and improve strength and function. Finally, custom-designed
   technological aids to assist with ambulating mechanically ventilated
   patients may reduce the human resource requirements and improve the
   safety and effectiveness of early mobilization in the intensive care
   unit.
   CONCLUSION: Physical medicine and rehabilitation-related technologies
   may play an important role in preventing and treating intensive care
   unit-acquired neuromuscular complications. Future studies are needed to
   evaluate their efficacy in intensive care unit patients.
TC 34
ZB 6
Z8 0
ZS 3
Z9 37
UT MEDLINE:20046132
PM 20046132
ER

PT J
AU Powers, Scott K
   Kavazis, Andreas N
   Levine, Sanford
TI Prolonged mechanical ventilation alters diaphragmatic structure and
   function.
SO Critical care medicine
VL 37
IS 10 Suppl
BP S347
EP 53
DI 10.1097/CCM.0b013e3181b6e760
PD 2009-Oct
PY 2009
AB OBJECTIVE: To review current knowledge about the impact of prolonged
   mechanical ventilation on diaphragmatic function and biology.
   MEASUREMENTS: Systematic literature review.
   CONCLUSIONS: Prolonged mechanical ventilation can promote diaphragmatic
   atrophy and contractile dysfunction. As few as 18 hrs of mechanical
   ventilation results in diaphragmatic atrophy in both laboratory animals
   and humans. Prolonged mechanical ventilation is also associated with
   diaphragmatic contractile dysfunction. Studies using animal models
   revealed that mechanical ventilation-induced diaphragmatic atrophy is
   due to increased diaphragmatic protein breakdown and decreased protein
   synthesis. Recent investigations have identified calpain, caspase-3, and
   the ubiquitin-proteasome system as key proteases that contribute to
   mechanical ventilation-induced diaphragmatic proteolysis. The scientific
   challenge for the future is to delineate the mechanical
   ventilation-induced signaling pathways that activate these proteases and
   depress protein synthesis in the diaphragm. Future investigations that
   define the signaling mechanisms responsible for mechanical
   ventilation-induced diaphragmatic weakness will provide the knowledge
   required for the development of new medicines that can maintain
   diaphragmatic mass and function during prolonged mechanical ventilation.
TC 46
ZB 26
Z8 1
ZS 1
Z9 47
UT MEDLINE:20046120
PM 20046120
ER

PT J
AU Stevens, Robert D
   Marshall, Scott A
   Cornblath, David R
   Hoke, Ahmet
   Needham, Dale M
   de Jonghe, Bernard
   Ali, Naeem A
   Sharshar, Tarek
TI A framework for diagnosing and classifying intensive care unit-acquired
   weakness.
SO Critical care medicine
VL 37
IS 10 Suppl
BP S299
EP 308
DI 10.1097/CCM.0b013e3181b6ef67
PD 2009-Oct
PY 2009
AB Neuromuscular dysfunction is prevalent in critically ill patients, is
   associated with worse short-term outcomes, and is a determinant of
   long-term disability in intensive care unit survivors. Diagnosis is made
   with the help of clinical, electrophysiological, and morphological
   observations; however, the lack of a consistent nomenclature remains a
   barrier to research. We propose a simple framework for diagnosing and
   classifying neuromuscular disorders acquired in critical illness.
TC 83
ZB 18
Z8 3
ZS 0
Z9 85
UT MEDLINE:20046114
PM 20046114
ER

PT J
AU Vincent, Jean-Louis
   Norrenberg, Michelle
TI Intensive care unit-acquired weakness: framing the topic.
SO Critical care medicine
VL 37
IS 10 Suppl
BP S296
EP 8
DI 10.1097/CCM.0b013e3181b6f1e1
PD 2009-Oct
PY 2009
AB One of the many potential sequelae of intensive care is prolonged
   weakness, which can be associated with increased morbidity during the
   intensive care unit stay and long-term functional disability. Despite
   increased awareness of this complication in recent years, diagnosing
   intensive care unit-acquired weakness remains difficult and there are no
   specific therapies. Management, therefore, relies on limiting its short-
   and long-term effects. One method by which this may be achieved is to
   reduce sedative use and promote early mobilization and exercise.
TC 12
ZB 6
Z8 0
ZS 0
Z9 12
UT MEDLINE:20046113
PM 20046113
ER

EF