Background Little information exists about the role of anemia in patients with acute coronary syndromes(ACS)admitted to Intensive Cardiac Care Units(ICCU).The aim of this study was to assess the prevalence of anemia a...Background Little information exists about the role of anemia in patients with acute coronary syndromes(ACS)admitted to Intensive Cardiac Care Units(ICCU).The aim of this study was to assess the prevalence of anemia and its impact on management and outcomes in this clinical setting.Methods All consecutive patients admitted to eight different ICCUs with diagnosis of non-ST segment elevation ACS(NSTEACS)were prospectively included.Anemia was defined as hemoglobin<130 g/L in men and<120 g/L in women.The association between anemia and mortality or readmission at six months was assessed by the Cox regression method.Results A total of 629 patients were included.Mean age was 66.6 years.A total of 197 patients(31.3%)had anemia.Coronary angiography was performed in most patients(96.2%).Patients with anemia were significantly older,with a higher prevalence of comorbidities,poorer left ventricle ejection fraction and higher GRACE score values.Patients with anemia underwent less often coronary angiography,but underwent more often intraaortic counterpulsation,non-invasive mechanical ventilation and renal replacement therapies.Both ICCU and hospital stay were significantly longer in patients with anemia.Both the incidence of mortality(HR=3.36,95%CI:1.43–7.85,P=0.001)and the incidence of mortality/readmission were significantly higher in patients with anemia(HR=2.80,95%CI:2.03–3.86,P=0.001).After adjusting for confounders,the association between anemia and mortality/readmission remained significant(P=0.031).Conclusions Almost one of three NSTEACS patients admitted to ICCU had anemia.Most patients underwent coronary angiography.Anemia was independently associated to poorer outcomes at 6 months.展开更多
Recent developments of the wireless sensor network will revolutionize the way of remote monitoring in dif-ferent domains such as smart home and smart care, particularly remote cardiac care. Thus, it is challenging to ...Recent developments of the wireless sensor network will revolutionize the way of remote monitoring in dif-ferent domains such as smart home and smart care, particularly remote cardiac care. Thus, it is challenging to propose an energy efficient technique for automatic ECG diagnosis (AED) to be embedded into the wireless sensor. Due to the high resource requirements, classical AED methods are unsuitable for pervasive cardiac care (PCC) applications. This paper proposes an embedded real-time AED algorithm dedicated to PCC sys-tems. This AED algorithm consists of a QRS detector and a rhythm classifier. The QRS detector adopts the linear time-domain statistical and syntactic analysis method and the geometric feature extraction modeling technique. The rhythm classifier employs the self-learning expert system and the confidence interval method. Currently, this AED algorithm has been implemented and evaluated on the PCC system for 30 patients in the Gabriel Monpied hospital (CHRU of Clermont-Ferrand, France) and the MIT-BIH cardiac arrhythmias da-tabase. The overall results show that this energy efficient algorithm provides the same performance as the classical ones.展开更多
Aims: The purpose of this study was to assess the knowledge and practices among nurses regarding patient care, following cardiac catheterization, at a tertiary care hospital in Karachi, Pakistan. Background: Cardiovas...Aims: The purpose of this study was to assess the knowledge and practices among nurses regarding patient care, following cardiac catheterization, at a tertiary care hospital in Karachi, Pakistan. Background: Cardiovascular diseases (CVDs) are the major cause of morbidity and mortality, globally. Nurses are the largest body of health care professionals who attempt to reduce the burden of cardiovascular diseases. Design: This study employed a descriptive analytical cross-sectional study design to answer the research questions. Methodology: The data were collected from 70 participants using two instruments. Knowledge was assessed through a 50-multiple-choice questions-based questionnaire, whereas, to assess the practices, an observational checklist was utilized which comprised of 20 components. Findings: The majority of the nurses, 54.3%, had adequate, 40% nurses had inadequate, and only 5.7% nurses had excellent knowledge scores. Moreover, 87.1% nurses were observed as carrying out unsatisfactory practices, whereas, only 12.9% nurses were found carrying out satisfactory practices. Conclusion: Since variation in the practices was observed in each of the department, therefore, there is a need for further research, to assess nurses’ attitudes through a qualitative approach and to develop and implement a standard post-cardiac catheterization care protocol.展开更多
In many patients in the intensive care unit (ICU) continuous temperature monitoring is performed with rectal probes. Currently there are more options to measure temperature in critically ill patients. Since bladder ca...In many patients in the intensive care unit (ICU) continuous temperature monitoring is performed with rectal probes. Currently there are more options to measure temperature in critically ill patients. Since bladder catheters are routinely used in the majority of ICU patients, using bladder temperature (Tb) could do away with rectal probes. In this prospective study, we compared Tb, rectal temperature (Tr) and pulmonary artery catheter temperature (Tpa) in patients who underwent cardiac surgery. We also evaluated if urinary production affected Tb. Patients admitted after cardiac surgery with sensors in place for measurement of Tr, Tb and Tpa upon arrival at the ICU were included. Diuresis was recorded every hour. Data were collected until 24 h after admission or until ICU discharge. Nineteen consecutive patients (9 males;mean age 61 years) were evaluated. Over a median observation period of 17 hours 382 Tb, 333 Tr and 371 Tpa measurements were recorded. Linear correlations (R) between Tb and Tr, between Tb and Tpa and between Tr and Tpa were 0.95, 0.95 and 0.91 respectively (P < 0.001). Bland-Altman analysis demonstrated no relation between temperature and the (Tb-Tr) offset. No relation of diuresis with (Tb- Tr) or (Tb-Tpa) was observed. After cardiac surgery, bladder temperature performed as well as conventional rectal probes with no interference of diuresis on bladder temperature measurement. Thus, the use of bladder temperature probes may be preferable to rectal probes in patients after cardiac surgery.展开更多
Used for over 3600 years, hypothermia, or targeted temperature management(TTM), remains an ill defined medical therapy. Currently, the strongest evidence for TTM in adults are for out-of-hospital ventricular tachycard...Used for over 3600 years, hypothermia, or targeted temperature management(TTM), remains an ill defined medical therapy. Currently, the strongest evidence for TTM in adults are for out-of-hospital ventricular tachycardia/ventricular fibrillation cardiac arrest, intracerebral pressure control, and normothermia in the neurocritical care population. Even in these disease processes, a number of questions exist. Data on disease specific therapeutic markers, therapeutic depth and duration, and prognostication are limited. Despite ample experimental data, clinical evidence for stroke, refractory status epilepticus, hepatic encephalopathy, and intensive care unit is only at the safety and proof-of-concept stage. This review explores the deleterious nature of fever, the theoretical role of TTM in the critically ill, and summarizes the clinical evidence for TTM in adults.展开更多
One of the most exciting developments to come to the aid of the critically ill patient in recent years is not new at all, but rather has been repackaged and evolved to a level where point-of-care use by critical care ...One of the most exciting developments to come to the aid of the critically ill patient in recent years is not new at all, but rather has been repackaged and evolved to a level where point-of-care use by critical care physicians has been made possible. Critical care or point-of-care ultrasound dates back more than twenty years, but has come to prominence in the last 5 years and is spreading quickly. Multiple critical care societies have taken up ultrasound policy and training and one organization has been formed that concentrates only on point-of-care ultrasound in critical settings and interventions. The amount of literature generated on the topic is increasing rapidly and hardly a major clinical journal exists that has not published ultrasound related topics.展开更多
Background: COVID-19 pneumonia increases the risk for pregnant women and the fetuses that often require intensive therapy. In addition to obvious therapeutic targets, ICU staff has to control the psycho-emotional cond...Background: COVID-19 pneumonia increases the risk for pregnant women and the fetuses that often require intensive therapy. In addition to obvious therapeutic targets, ICU staff has to control the psycho-emotional conditions of COVID-19 patients, e.g. intensive care unit syndrome and post-intensive care syndrome. Case presentation: Patient M., Uzbek, 24 years old, gravida 1 (27 weeks) was admitted to the Maternity Department of Zangiota hospital on 19.07.2021 with the diagnosis of extremely severe COVID-19 pneumonia and respiratory failure with psychomotor agitation. On day 4 her general condition deteriorated due to the progression of pneumonia and involvement of abdominal organs associated with 27-week pregnancy. On that day the fetus had no signs of life, and the caesarean delivery was performed;the child was stillborn. For the next two weeks the patient had been in medical coma due to the progression of respiratory and multi-organ failure. The patient had two separate cardiac arrests. Cardio-pulmonary resuscitation was successful. By day 20, the dynamics of her cardiac activity has been completely restored. The brain function restored to 15 on the Glasgow Coma Scale. Conclusion: Special measures of prevention and treatment of multi-organ failure, intensive care unit syndrome and post-intensive care syndrome should be taken in an ICU for pregnant women with COVID-19 pneumonia.展开更多
文摘Background Little information exists about the role of anemia in patients with acute coronary syndromes(ACS)admitted to Intensive Cardiac Care Units(ICCU).The aim of this study was to assess the prevalence of anemia and its impact on management and outcomes in this clinical setting.Methods All consecutive patients admitted to eight different ICCUs with diagnosis of non-ST segment elevation ACS(NSTEACS)were prospectively included.Anemia was defined as hemoglobin<130 g/L in men and<120 g/L in women.The association between anemia and mortality or readmission at six months was assessed by the Cox regression method.Results A total of 629 patients were included.Mean age was 66.6 years.A total of 197 patients(31.3%)had anemia.Coronary angiography was performed in most patients(96.2%).Patients with anemia were significantly older,with a higher prevalence of comorbidities,poorer left ventricle ejection fraction and higher GRACE score values.Patients with anemia underwent less often coronary angiography,but underwent more often intraaortic counterpulsation,non-invasive mechanical ventilation and renal replacement therapies.Both ICCU and hospital stay were significantly longer in patients with anemia.Both the incidence of mortality(HR=3.36,95%CI:1.43–7.85,P=0.001)and the incidence of mortality/readmission were significantly higher in patients with anemia(HR=2.80,95%CI:2.03–3.86,P=0.001).After adjusting for confounders,the association between anemia and mortality/readmission remained significant(P=0.031).Conclusions Almost one of three NSTEACS patients admitted to ICCU had anemia.Most patients underwent coronary angiography.Anemia was independently associated to poorer outcomes at 6 months.
文摘Recent developments of the wireless sensor network will revolutionize the way of remote monitoring in dif-ferent domains such as smart home and smart care, particularly remote cardiac care. Thus, it is challenging to propose an energy efficient technique for automatic ECG diagnosis (AED) to be embedded into the wireless sensor. Due to the high resource requirements, classical AED methods are unsuitable for pervasive cardiac care (PCC) applications. This paper proposes an embedded real-time AED algorithm dedicated to PCC sys-tems. This AED algorithm consists of a QRS detector and a rhythm classifier. The QRS detector adopts the linear time-domain statistical and syntactic analysis method and the geometric feature extraction modeling technique. The rhythm classifier employs the self-learning expert system and the confidence interval method. Currently, this AED algorithm has been implemented and evaluated on the PCC system for 30 patients in the Gabriel Monpied hospital (CHRU of Clermont-Ferrand, France) and the MIT-BIH cardiac arrhythmias da-tabase. The overall results show that this energy efficient algorithm provides the same performance as the classical ones.
文摘Aims: The purpose of this study was to assess the knowledge and practices among nurses regarding patient care, following cardiac catheterization, at a tertiary care hospital in Karachi, Pakistan. Background: Cardiovascular diseases (CVDs) are the major cause of morbidity and mortality, globally. Nurses are the largest body of health care professionals who attempt to reduce the burden of cardiovascular diseases. Design: This study employed a descriptive analytical cross-sectional study design to answer the research questions. Methodology: The data were collected from 70 participants using two instruments. Knowledge was assessed through a 50-multiple-choice questions-based questionnaire, whereas, to assess the practices, an observational checklist was utilized which comprised of 20 components. Findings: The majority of the nurses, 54.3%, had adequate, 40% nurses had inadequate, and only 5.7% nurses had excellent knowledge scores. Moreover, 87.1% nurses were observed as carrying out unsatisfactory practices, whereas, only 12.9% nurses were found carrying out satisfactory practices. Conclusion: Since variation in the practices was observed in each of the department, therefore, there is a need for further research, to assess nurses’ attitudes through a qualitative approach and to develop and implement a standard post-cardiac catheterization care protocol.
文摘In many patients in the intensive care unit (ICU) continuous temperature monitoring is performed with rectal probes. Currently there are more options to measure temperature in critically ill patients. Since bladder catheters are routinely used in the majority of ICU patients, using bladder temperature (Tb) could do away with rectal probes. In this prospective study, we compared Tb, rectal temperature (Tr) and pulmonary artery catheter temperature (Tpa) in patients who underwent cardiac surgery. We also evaluated if urinary production affected Tb. Patients admitted after cardiac surgery with sensors in place for measurement of Tr, Tb and Tpa upon arrival at the ICU were included. Diuresis was recorded every hour. Data were collected until 24 h after admission or until ICU discharge. Nineteen consecutive patients (9 males;mean age 61 years) were evaluated. Over a median observation period of 17 hours 382 Tb, 333 Tr and 371 Tpa measurements were recorded. Linear correlations (R) between Tb and Tr, between Tb and Tpa and between Tr and Tpa were 0.95, 0.95 and 0.91 respectively (P < 0.001). Bland-Altman analysis demonstrated no relation between temperature and the (Tb-Tr) offset. No relation of diuresis with (Tb- Tr) or (Tb-Tpa) was observed. After cardiac surgery, bladder temperature performed as well as conventional rectal probes with no interference of diuresis on bladder temperature measurement. Thus, the use of bladder temperature probes may be preferable to rectal probes in patients after cardiac surgery.
文摘Used for over 3600 years, hypothermia, or targeted temperature management(TTM), remains an ill defined medical therapy. Currently, the strongest evidence for TTM in adults are for out-of-hospital ventricular tachycardia/ventricular fibrillation cardiac arrest, intracerebral pressure control, and normothermia in the neurocritical care population. Even in these disease processes, a number of questions exist. Data on disease specific therapeutic markers, therapeutic depth and duration, and prognostication are limited. Despite ample experimental data, clinical evidence for stroke, refractory status epilepticus, hepatic encephalopathy, and intensive care unit is only at the safety and proof-of-concept stage. This review explores the deleterious nature of fever, the theoretical role of TTM in the critically ill, and summarizes the clinical evidence for TTM in adults.
文摘One of the most exciting developments to come to the aid of the critically ill patient in recent years is not new at all, but rather has been repackaged and evolved to a level where point-of-care use by critical care physicians has been made possible. Critical care or point-of-care ultrasound dates back more than twenty years, but has come to prominence in the last 5 years and is spreading quickly. Multiple critical care societies have taken up ultrasound policy and training and one organization has been formed that concentrates only on point-of-care ultrasound in critical settings and interventions. The amount of literature generated on the topic is increasing rapidly and hardly a major clinical journal exists that has not published ultrasound related topics.
文摘Background: COVID-19 pneumonia increases the risk for pregnant women and the fetuses that often require intensive therapy. In addition to obvious therapeutic targets, ICU staff has to control the psycho-emotional conditions of COVID-19 patients, e.g. intensive care unit syndrome and post-intensive care syndrome. Case presentation: Patient M., Uzbek, 24 years old, gravida 1 (27 weeks) was admitted to the Maternity Department of Zangiota hospital on 19.07.2021 with the diagnosis of extremely severe COVID-19 pneumonia and respiratory failure with psychomotor agitation. On day 4 her general condition deteriorated due to the progression of pneumonia and involvement of abdominal organs associated with 27-week pregnancy. On that day the fetus had no signs of life, and the caesarean delivery was performed;the child was stillborn. For the next two weeks the patient had been in medical coma due to the progression of respiratory and multi-organ failure. The patient had two separate cardiac arrests. Cardio-pulmonary resuscitation was successful. By day 20, the dynamics of her cardiac activity has been completely restored. The brain function restored to 15 on the Glasgow Coma Scale. Conclusion: Special measures of prevention and treatment of multi-organ failure, intensive care unit syndrome and post-intensive care syndrome should be taken in an ICU for pregnant women with COVID-19 pneumonia.
