Cardiology
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Rate-controlled Atrial Fibrillation as a Reversible Cause of Cardiomyopathy
In patients with persistent but rate-controlled atrial fibrillation and left ventricular systolic dysfunction of otherwise uncertain etiology, catheter ablation to restore sinus rhythm can result in significant improvement or normalization of ejection fraction.
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Is a Dabigatran Reversal Agent Effective?
A pragmatic clinical study of idarucizumab for counteracting the effects of the oral anticoagulant dabigatran showed rapid and complete reversal of its effects in patients with major bleeding or urgent surgery, without any adverse safety concerns.
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RE-DUAL Deals Another Blow to Triple Therapy
In this trial of post-percutaneous coronary intervention patients with atrial fibrillation, dual antithrombotic therapy with dabigatran and a P2Y12 inhibitor showed lower rates of bleeding but similar ischemic and thrombotic outcomes compared to a triple therapy regimen with warfarin.
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Angiotensin II Raises Blood Pressure in Patients with Vasodilatory Shock
Infusion of recombinant angiotensin II improved blood pressure control in patients with vasodilatory shock already receiving conventional vasopressors.
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Spontaneous Breathing Trials and Occam’s Razor
Different ventilator modes used for a spontaneous breathing trial affected a patient’s work of breathing (WOB) variously and differed regarding WOB measured after extubation. The clinical relevance of these differences is uncertain.
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Intensive Care Enteral Nutrition in 2017
Enteral nutrition, defined as any method of feeding that uses the gastrointestinal (GI) tract (including oral feeding), usually refers to the delivery of nourishment to the GI tract through a tube. Nutrition is of utmost importance for patients suffering from a critical illness, and EN is a mainstay of nutrition in the ICU. Malnutrition and nutritional risk are common in patients admitted to the ICU. The presence of critical illness causes the body to enter a catabolic state, putting patients at risk of development or worsening of malnutrition. The Society of Critical Care Medicine and the American Society for Parenteral and Enteral Nutrition have published and revised joint guidelines to offer evidence-based recommendations for how best to feed critically ill patients.
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Functional Outcomes After Receiving Life-sustaining Therapy in the ICU
Among patients who have spent at least three days in an ICU and required even brief mechanical ventilation and/or vasopressor support, almost half are dead and only one-third return to their baseline at six months. Several factors present on the first day of admission are associated with not returning to baseline status.
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Frailty as a Patient Assessment Tool Prior to Aortic Valve Replacement
Assessment of frailty adds important prognostic information about risk of death and disability following both surgical aortic valve replacement and transcatheter aortic valve replacement. Among the available instruments for assessing frailty, a scale known as the Essential Frailty Toolkit demonstrated the best correlation with outcomes.
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Percutaneous Coronary Interventions in Nonagenarians
Nonagenarians can undergo percutaneous coronary interventions with low in-lab complication rates, but 30-day and one-year mortality is considerably higher than in younger patients.
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Palliative Care-based Intervention Improves Quality of Life in Chronic Heart Failure
Among patients with advanced heart failure, implementation of an interdisciplinary palliative care intervention was associated with improved quality of life.