Late evaluation of upper limb arterial flow in patients after long radial (PiCCO™) catheter placement

Rovira, Lucas; Aguilar, Gerardo; Cuñat, Alberto; Belda, F. Javier

doi:10.1186/s13613-014-0041-9

Cited by 25 publications

(42 citation statements)

References 19 publications

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“…In septic shock accompanied by ARDS, hemodynamic management based on transpulmonary thermodilution can add additional valuable information about extravascular lung water index (EVLWI) [ 36 ] and pulmonary vascular permeability [ 37 ]. EVLWI gives useful prognostic information regarding mortality in critically ill patients in general, in patients with sepsis or septic shock, and in patients with ARDS [ 36 ]. Recent data demonstrate that EVLWI is of high prognostic value during fluid resuscitation in septic patients after initial resuscitation [ 38 ].…”

Section: Hemodynamic Management Of Patients With Septic Shockmentioning

confidence: 99%

Advanced Hemodynamic Management in Patients with Septic Shock

Saugel

Huber

Nierhaus

et al. 2016

BioMed Research International

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In patients with sepsis and septic shock, the hemodynamic management in both early and later phases of these “organ dysfunction syndromes” is a key therapeutic component. It needs, however, to be differentiated between “early goal-directed therapy” (EGDT) as proposed for the first 6 hours of emergency department treatment by Rivers et al. in 2001 and “hemodynamic management” using advanced hemodynamic monitoring in the intensive care unit (ICU). Recent large trials demonstrated that nowadays protocolized EGDT does not seem to be superior to “usual care” in terms of a reduction in mortality in emergency department patients with early identified septic shock who promptly receive antibiotic therapy and fluid resuscitation. “Hemodynamic management” comprises (a) making the diagnosis of septic shock as one differential diagnosis of circulatory shock, (b) assessing the hemodynamic status including the identification of therapeutic conflicts, and (c) guiding therapeutic interventions. We propose two algorithms for hemodynamic management using transpulmonary thermodilution-derived variables aiming to optimize the cardiocirculatory and pulmonary status in adult ICU patients with septic shock. The complexity and heterogeneity of patients with septic shock implies that individualized approaches for hemodynamic management are mandatory. Defining individual hemodynamic target values for patients with septic shock in different phases of the disease must be the focus of future studies.

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Section: Hemodynamic Management Of Patients With Septic Shockmentioning

confidence: 99%

Advanced Hemodynamic Management in Patients with Septic Shock

Saugel

Huber

Nierhaus

et al. 2016

BioMed Research International

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“…Extended-spectrum β-lactamases (ESBLs) are a predominant cause of β-lactam resistance in Gram-negative bacilli (GNB) [ 1 , 2 ]. Incidences of infections caused by ESBLs producing GNB are increasing in prevalence worldwide, both in the healthcare as well as community settings, posing significant therapeutic challenges [ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and antibiotic susceptibility pattern of CTX-M type extended-spectrum β-lactamases among clinical isolates of gram-negative bacilli in Jimma, Ethiopia

Zeynudin

Pritsch

Schubert³

et al. 2018

BMC Infect Dis

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BackgroundThe prevalence of extended-spectrum β-lactamases (ESBLs) have been reported in clinical isolates obtained from various hospitals in Ethiopia. However, there is no data on the prevalence and antibiotic susceptibility patterns of CTX-M type ESBL produced by Gram-negative bacilli. The aim of this study was to determine the frequency and distribution of the blaCTX-M genes and the susceptibility patterns in ESBL producing clinical isolates of Gram-negative bacilli in Jimma University Specialized Hospital (JUSH), southwest Ethiopia.MethodsA total of 224 non-duplicate and pure isolates obtained from clinically apparent infections, were included in the study. Identification of the isolates was performed by MALDI-TOF mass spectrometry. Susceptibility testing and ESBL detection was performed using VITEK® 2, according to EUCAST v4.0 guidelines. Genotypic analysis was performed using Check-MDR CT103 Microarrays.ResultsOf the total 112 (50.0%) isolates screen positive for ESBLs, 63.4% (71/112) tested positive for ESBL encoding genes by Check-MDR array, which corresponds to 91.8% (67/73) of the total Enterobacteriaceae and 10.3% (4/39) of nonfermenting Gram-negative bacilli. Among the total ESBL gene positive isolates, 95.8% (68/71) carried blaCTX-M genes with CTX-M group 1 type15 being predominant (66/68; 97.1% of CTX-M genes). The blaCTX-M carrying Enterobacteriaceae (n = 64) isolates showed no resistance against imipenem and meropenem and a moderate resistance rate against tigecycline (14.1%), fosfomycin (10.9%) and amikacin (1.6%) suggesting the effectiveness of these antibiotics against most isolates. On the other hand, all the blaCTX-M positive Enterobacteriaceae showed a multidrug resistant (MDR) phenotype with remarkable co-resistances (non-susceptibility rates) to aminoglycosides (92.2%), fluoroquinolones (78.1%) and trimethoprim/sulfamethoxazol (92.2%).ConclusionsThis study demonstrates a remarkably high prevalence of blaCTX-M genes among ESBL-producing isolates. The high level of resistance to β-lactam and non-β-lactam antibiotics as well as the trend to a MDR profile associated with the blaCTX-M genes are alarming and emphasize the need for routine diagnostic antimicrobial susceptibility testing for appropriate choice of antimicrobial therapy.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3436-7) contains supplementary material, which is available to authorized users.

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“…However, these states are often defined in terms of mean values of the vital signs, and the notion of normality is defined with respect to the healthy individuals and at the population level. There remains significant controversy regarding the normal range of vital signs in the critically ill patients under various pathological conditions [51], [52]. Given the importance of healthy variability and autoregulatory mechanisms, it has been suggested that goal-directed therapies should aim at restoring the healthy vital signs variability and coupling [53], [54].…”

Section: Discussionmentioning

confidence: 99%

A Model-Based Machine Learning Approach to Probing Autonomic Regulation From Nonstationary Vital-Sign Time Series

Lehman

Mark

Nemati

2018

IEEE J. Biomed. Health Inform.

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Physiological variables, such as heart rate (HR), blood pressure (BP) and respiration (RESP), are tightly regulated and coupled under healthy conditions, and a break-down in the coupling has been associated with aging and disease. We present an approach that incorporates physiological modeling within a switching linear dynamical systems (SLDS) framework to assess the various functional components of the autonomic regulation through transfer function analysis of nonstationary multivariate time series of vital signs. We validate our proposed SLDS-based transfer function analysis technique in automatically capturing 1) changes in baroreflex gain due to postural changes in a tilt-table study including ten subjects, and 2) the effect of aging on the autonomic control using HR/RESP recordings from 40 healthy adults. Next, using HR/BP time series of more than 450 adult ICU patients, we show that our technique can be used to reveal coupling changes associated with severe sepsis (AUC = 0.74, sensitivity = 0.74, specificity = 0.60). Our findings indicate that reduced HR/BP coupling is significantly associated with severe sepsis even after adjusting for clinical interventions (P <= 0.001). These results demonstrate the utility of our approach in phenotyping complex vital-sign dynamics, and in providing mechanistic hypotheses in terms of break-down of autoregulatory systems under healthy and disease conditions.

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Late evaluation of upper limb arterial flow in patients after long radial (PiCCO™) catheter placement

Cited by 25 publications

References 19 publications

Advanced Hemodynamic Management in Patients with Septic Shock

Advanced Hemodynamic Management in Patients with Septic Shock

Prevalence and antibiotic susceptibility pattern of CTX-M type extended-spectrum β-lactamases among clinical isolates of gram-negative bacilli in Jimma, Ethiopia

A Model-Based Machine Learning Approach to Probing Autonomic Regulation From Nonstationary Vital-Sign Time Series

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