Category: News


Basic Transesophageal and Critical Care Ultrasound

André Denault, Annette Vegas, Yoan Lamarche, Jean-Claude Tardif, Pierre Couture
September 8, 2017 by CRC Press
Reference – 412 Pages – 476 Color Illustrations
ISBN 9781482237122 – CAT# K23154

Basic Transesophageal and Critical Care Ultrasound provides an overview of transesophageal ultrasound of the heart, lung, and upper abdomen as well as basic ultrasound of the brain, lung, heart, abdomen, and vascular system. Ultrasound-guided procedures commonly used in critically ill patients are also covered.

With more than 400 clinical images, this well-illustrated text and its accompanying videos demonstrate new developments and challenges for those interested in mastering basic transesophageal echocardiography (TEE) and bedside surface ultrasound.

Each chapter is presented in an easy-to-read format that includes color diagrams and ultrasound images which optimize interactive learning for both novice and experienced clinicians. The book is divided into two parts. The first is dedicated to basic TEE while the second provides focused coverage of bedside ultrasound.

The book also includes chapters on extra-cardiac TEE and ultrasound of the brain—unconventional areas that will become more important in the future as clinicians evaluate not only the etiology of hemodynamic instability but also the impact on multiple organs and systems such as the kidney, liver, splanchnic perfusion, and brain.

This text is an invaluable resource to those preparing for the National Board of Echocardiography’s Examination of Special Competence in Basic Perioperative Transesophageal Echocardiography (PTEeXAM) and its equivalents outside the USA and Canada.

In addition, it prepares physicians for the American College of Chest Physician’s critical care ultrasound certification. The contents follow the syllabus of the TEE basic echo exam to ensure complete coverage of a trainee’s requirements. It also includes sample questions and two helpful mock exams. Written by a multidisciplinary team of experts in TEE, the book is a must-have for those in training and in practice.

Us promo code FLR40 at check out to have 20% discount

Us this link to order

 

By DANIELA J. LAMAS
APRIL 1, 2017

 

He is breathing better and the doctors say his lungs will recover, but he can’t remember his appointments or where he put his keys.

It has been months since the surgery and the scars are fading, yet she still wakes almost nightly to the sound of phantom alarms.

Those are the sorts of stories I heard one morning at a support group for patients who had survived a critical illness and their family members. It seems simple — a few doctors, a social worker, a psychiatrist, former patients and their husbands and wives, a conference room, pastries, coffee. In a way it was. But this was the first time that many of these men and women had been asked to talk about their struggles after critical illness with those who’d shared similar experiences.

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By NICHOLAS BAKALAR

Taking statins the day of a coronary artery bypass operation may significantly improve survival, a study in the Annals of Thoracic Surgery found.

Researchers looked at 3,021 heart surgery patients, most of whom were taking cholesterol-lowering statins. The 1,788 who continued statins up to the day of surgery had a risk of death within 30 days of 1.7 percent, compared with 2.9 percent for 452 who stopped one to three days before surgery, and 3.8 percent for 781 who did not take statins or stopped more than 72 hours before their operations.

See article

THIS PODCAST COVERS:

How can we best describe ventricular function and the effect of ECMO?

What factors influence the net effect of VA ECMO on patient haemodynamics?

What are the primary haemodynamic effects of VA ECMO?

How does cannulation site influence the haemodynamics of VA ECMO?

What do you do about a non-ejecting heart on VA ECMO?

What about the RV? How does the unique functional anatomy and physiology contribute to RV failure?

What are the haemodynamic effects of VA ECMO on the RV?

What are the haemodynamic effects of VV ECMO?

Abstract
OBJECTIVE:
To provide an update to “Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012″.
DESIGN:
A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development.
METHODS:
The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.
RESULTS:
The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions.
CONCLUSIONS:
Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.
KEYWORDS:
Evidence-based medicine; Grading of Recommendations Assessment, Development, and Evaluation criteria; Guidelines; Infection; Sepsis; Sepsis bundles; Sepsis syndrome; Septic shock; Surviving Sepsis Campaign

The CJC supplement with our content is out.  Link to Jan 2017

Lantry – Complications of ECMO from maryland.ccproject.com on Vimeo.

In 1901 Jokichi Takamine (1854-1922) isolated the pure form of adrenaline, also known as epinephrine.

In 1893, George Oliver (1841– 1915), using his own instruments, studied the impact of glycerol extracts on arteries.

Routine use of adrenaline for cardiac arrest was first proposed in the 1960’s. Its inclusion within cardiac arrest management was based upon an understanding of the physiological role of adrenaline, and experimental data from animal research which showed that ROSC was more likely when the drug was used. It was not included on the basis of evidence of benefit in humans, but has remained, since today, a significant component of advanced life support despite minimal human data indicating beneficial effect .

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The FDA has identified this as a Class I recall, the most serious type of recall.  Use of these devices may cause serious injuries or death.

Recalled Product:

  • HeartWare Ventricular Assist Device (HVAD)
  • Serial Numbers: All HVADs with serial numbers lower than HW25838
  • Product Codes: 1103, 1104
  • Manufacturing Dates: March 17, 2006 to June 27, 2016
  • Devices Recalled in the U.S.:105 units distributed nationwide

Device Use

The HVAD helps deliver blood from the heart to the rest of the body. It is used in patients who are at risk of death from end-stage left ventricular heart failure and who are waiting for a heart transplant. The system includes a pump implanted in the space around the heart (pericardium) and a controller that controls the speed and function of the pump.

The HVAD is designed for use both in and out of hospital settings, including during patient transport.

Reason for Recall

HeartWare Inc. is recalling the HVAD pumps due to a design problem with the driveline connector. The driveline is a tube that connects the HVAD’s pump to the external controller and power source. Contamination of the driveline may result in fluid or other material entering the pump and causing electrical issues or pump stops that may lead to serious adverse health consequences, including death.

Who May be Affected

  • Patients receiving cardiac support using the HVAD system
  • Health care providers and caregivers monitoring patients with a HVAD system

What to Do

On August 17, 2016, HeartWare Inc. sent an “Urgent Medical Device Recall Letter” to affected customers. The letter instructed consumers to:

  • Identify affected HVADs in hospital inventory
  • Complete and return the “Acknowledgement Form” attached to the letter
  • Return affected products to HeartWare Inc.
  • After returning the affected products, complete and return the “Completion Form” to a HeartWare representative no later than 2 months from the date on the letter
  • Remind their patients about the safe use of the HVAD System, particularly with regard to moisture and proper connection to power and data sources.

Contact Information

Health care providers who have questions should contact their HeartWare representative or contact HeartWare Inc. at cs@heartware.com or 1-877-367-4823 with any questions related to this recall.

Date Recall Initiated:

July 29, 2016

Additional Resources:

How do I report a problem?

Health care professionals and consumers may report adverse reactions or quality problems they experienced using these devices to MedWatch: The FDA Safety Information and Adverse Event Reporting Program either online, by regular mail or by FAX to 1-800-FDA-0178.

Abstract
BACKGROUND:
This clinical practice guideline addresses six questions related to liberation from mechanical ventilation in critically ill adults. It is the result of a collaborative effort between the American Thoracic Society (ATS) and American College of Chest Physicians (CHEST).
METHODS:
A multi-disciplinary panel posed six clinical questions in a Population, Intervention, Comparator and Outcomes (PICO) format. A comprehensive literature search and evidence synthesis was performed for each question, which included appraising the certainty in the evidence (i.e., the quality of evidence) using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. The Evidence-to-Decision Framework was applied to each question, requiring the panel to evaluate and weigh the: importance of the problem, confidence in the evidence, certainty about how much the public value the main outcomes, magnitude and balance of desirable and undesirable outcomes, resources and costs associated with the intervention, impact on health disparities, and acceptability and feasibility of the intervention.
RESULTS:
Evidence-based recommendations were formulated and graded, initially by subcommittees and then modified following full panel discussions. The recommendations were confirmed by confidential electronic voting; approval required that at least 80% of the panel members agree with the recommendation.
CONCLUSION:
The panel provides recommendations regarding liberation from mechanical ventilation. The details regarding the evidence and rationale for each recommendation are presented in the American Journal of Respiratory and Critical Care Medicine and CHEST.