Recovery and outcomes after the acute respiratory distress syndrome (ARDS) in patients and their family caregivers

Intensive Care Medicine, Год журнала: 2016, Номер 42(5), С. 725 - 738

Опубликована: Март 30, 2016

Язык: Английский

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Mechanical Ventilation: State of the Art

Mayo Clinic Proceedings, Год журнала: 2017, Номер 92(9), С. 1382 - 1400

Опубликована: Сен. 1, 2017

Язык: Английский

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Rehabilitation After Critical Illness in People With COVID-19 Infection

American Journal of Physical Medicine & Rehabilitation, Год журнала: 2020, Номер 99(6), С. 470 - 474

Опубликована: Апрель 13, 2020

Abstract The current COVID-19 pandemic will place enormous pressure on healthcare systems around the world. Large numbers of people are predicted to become critically ill with acute respiratory distress syndrome and require management in intensive care units. High levels physical, cognitive, psychosocial impairments can be anticipated. Rehabilitation providers serve as an important link continuum care, helping move patients from sites eventual discharge community. Likely impairment patterns, considerations for practitioner resilience, organization services meet demand discussed. Innovative approaches such virtual rehabilitation, likely common this environment.

Язык: Английский

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Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version.

DOAJ (DOAJ: Directory of Open Access Journals), Год журнала: 2015, Номер 13, С. Doc19 - Doc19

Опубликована: Янв. 1, 2015

In 2010, under the guidance of DGAI (German Society Anaesthesiology and Intensive Care Medicine) DIVI Interdisciplinary Association for Emergency Medicine), twelve German medical societies published "Evidence- Consensus-based Guidelines on Management Analgesia, Sedation Delirium in Care". Since then, several new studies publications have considerably increased body evidence, including recommendations from American College Critical Medicine (ACCM) conjunction with (SCCM) Health-System Pharmacists (ASHP) 2013. For this update, a major restructuring extension guidelines were needed order to cover aspects treatment, such as sleep anxiety management. The literature was systematically searched evaluated using criteria Oxford Center Evidence Based Medicine. evidence used formulate these reviewed approved by representatives 17 national societies. Three grades recommendation follows: Grade "A" (strong recommendation), "B" (recommendation) "0" (open recommendation). result is comprehensive, interdisciplinary, consensus-based set level 3 guidelines. This publication designed all ICU professionals, takes into account critically ill patient populations. It represents guide symptom-oriented prevention, diagnosis, treatment delirium, anxiety, stress, protocol-based analgesia, sedation, sleep-management intensive care medicine. Die vorherige Version der S3-Leitlinie „Analgesie, Sedierung und Delirmanagement Intensivmedizin“ wurde 2010 unter Federführung Deutschen Gesellschaft für Anästhesiologie Intensivmedizin (DGAI) Interdisziplinären Vereinigung Intensiv- Notfallmedizin (DIVI) publiziert. Neue Evidenz aus Studien ebenso wie neue Leitlinien, u.a. die 2013 erschienene Leitlinie U.S.-amerikanischen (SCCM), des (ASHP), gaben nicht nur Anlass zu einem Update deutschen Empfehlungen von 2010. Für Fortschreibung wurden eine Neuformulierung klinisch relevanten Schlüsselfragen signifikante Erweiterung um Facetten Behandlung, zum Beispiel das Schlafmanagement, notwendig. Dazu systematisch gesuchte Literatur nach Kriterien Centre bewertet. Der enorme Evidenzkörper bildete Grundlage Empfehlungen, Mandatsträgern Fachgesellschaften konsentiert wurden. den „A“ (starke Empfehlung), „B“ (Empfehlung) „0“ (offene Empfehlung) gewählt. Als Ergebnis dieses Prozesses liegt nun weltweit umfassendste, interdisziplinär erarbeitete evidenz- konsensbasierte Stufe vor. richtet sich an alle auf Intensivstation tätigen Berufsgruppen, berücksichtigen intensivmedizinisch-behandelten Patientengruppen. Sie stellt einen Leitfaden zur symptomorientierten Prävention, Diagnostik Therapie Delir, Angst, Stress protokollbasierten Analgesie, dem Schlafmanagement Erwachsene Kinder dar.

Язык: Английский

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Long-term cognitive impairment after acute respiratory distress syndrome: a review of clinical impact and pathophysiological mechanisms

Critical Care, Год журнала: 2019, Номер 23(1)

Опубликована: Ноя. 12, 2019

Abstract Acute respiratory distress syndrome (ARDS) survivors experience a high prevalence of cognitive impairment with concomitantly impaired functional status and quality life, often persisting months after hospital discharge. In this review, we explore the pathophysiological mechanisms underlying following ARDS, interrelations between risk factors, interventions that may mitigate impairment. Risk factors for decline ARDS include pre-existing impairment, neurological injury, delirium, mechanical ventilation, prolonged exposure to sedating medications, sepsis, systemic inflammation, environmental in intensive care unit, which can co-occur synergistically various combinations. Detection characterization imparts challenges clinical management longitudinal outcome study enrollment. Patients brain injury who constitute distinct population particular combination mechanisms: considerations raised by neurogenic pulmonary edema, differences sympathetic activation cholinergic transmission, effects positive end-expiratory pressure on cerebral microcirculation intracranial pressure, sensitivity vasopressor use volume status. The blood-brain barrier represents physiological interface at multiple interact, as acute weakening from ventilation inflammation compound existing chronic dysfunction Alzheimer’s-type pathophysiology, rendering vulnerable both amyloid-beta accumulation cytokine-mediated hippocampal damage. Although some contributory elements, such presenting or be irreversible, minimizing tidal volume, duration maintaining hemodynamic stability, optimizing fluid balance, implementing bundles enhance patient help dramatically reduce delirium prevent acquisition long-term

Язык: Английский

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COVID-19 cognitive deficits after respiratory assistance in the subacute phase: A COVID-rehabilitation unit experience

PLoS ONE, Год журнала: 2021, Номер 16(2), С. e0246590 - e0246590

Опубликована: Фев. 8, 2021

Introduction COVID-19 complications can include neurological, psychiatric, psychological, and psychosocial impairments. Little is known on the consequences of SARS-COV-2 cognitive functions patients in sub-acute phase disease. We aimed to investigate impact admitted Rehabilitation Unit San Raffaele Hospital (Milan, Italy). Material methods 87 from March 27 th June 20 2020 were included. Patients underwent Mini Mental State Evaluation (MMSE), Montreal Cognitive Assessment (MoCA), Hamilton Rating Scale for Depression, Functional Independence Measure (FIM). Data divided 4 groups according respiratory assistance acute phase: Group1 (orotracheal intubation), Group2 (non-invasive ventilation using Biphasic Positive Airway Pressure), Group3 (Venturi Masks), Group4 (no oxygen therapy). Follow-ups performed at one month after home-discharge. Results Out (62 Male, mean age 67.23 ± 12.89 years), 80% had neuropsychological deficits (MoCA MMSE) 40% showed mild-to-moderate depression. higher scores than visuospatial/executive (p = 0.016), naming 0.024), short- long-term memory 0.010, p 0.005), abstraction orientation 0.034). was younger Groups2 3. impairments correlated with patients’ age. Only 18 presented anosmia. Their data did not differ other patients. FIM (<100) between groups. partly recovered one-month follow-up 43% signs post-traumatic stress disorder. Conclusion severe functional important emotional which might have been influenced by choice ventilatory therapy, but mostly appeared be related aging, independently scores. These findings should integrated correct neuropsychiatric subacute disease, show need psychological support treatment post-COVID-19

Язык: Английский

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Brain ultrasonography: methodology, basic and advanced principles and clinical applications. A narrative review

Intensive Care Medicine, Год журнала: 2019, Номер 45(7), С. 913 - 927

Опубликована: Апрель 25, 2019

Язык: Английский

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Comprehensive care of ICU survivors: Development and implementation of an ICU recovery center

Journal of Critical Care, Год журнала: 2018, Номер 46, С. 141 - 148

Опубликована: Июнь 18, 2018

Язык: Английский

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Post-traumatic stress disorder: A differential diagnostic consideration for COVID-19 survivors

The Clinical Neuropsychologist, Год журнала: 2020, Номер 34(7-8), С. 1498 - 1514

Опубликована: Авг. 26, 2020

Objective: SARS-CoV-2 infection and its oft-associated illness COVID-19 may lead to neuropsychological deficits, either through direct mechanisms (i.e., neurovirulance) or indirect mechanisms, most notably complications caused by the virus (e.g., stroke) medical procedures intubation). The history of past human coronavirus outbreaks resulting in similar health emergencies suggests there will be a substantial prevalence post-traumatic stress disorder (PTSD) among survivors. To prepare neuropsychologists for difficult task differentiating PTSD-related from neuropathology-related deficits oncoming wave survivors, we integrate research across spectrum related areas.Methods: Several areas literature were reviewed: psychiatric, neurologic, neuropathological outcomes SARS MERS patients; neurological survivors; PTSD associated with common due those acquired brain injuries other patient groups.Conclusions: Heightened risk occurred While data concerning is lacking, known occur groups who undergo hospital courses, including ICU patients are intubated mechanically ventilated, that experience delirium. Research develop context mild traumatic injury further account some all patient's subjective cognitive complaints test performance. Recommendations provided assessing COVID-19.

Язык: Английский

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Pattern of cognitive deficits in severe COVID-19

Journal of Neurology Neurosurgery & Psychiatry, Год журнала: 2020, Номер 92(5), С. 567 - 568

Опубликована: Ноя. 20, 2020

The severe form of COVID-19 tends to be associated with neurological deficits.1 2 Among patients acute respiratory distress syndrome (ARDS), who benefited from mechanical ventilation and were examined after discontinuation sedation neuromuscular blockade, 69% presented agitation, 65% confusion, 67% corticospinal tract signs 33% dysexecutive syndrome.2 We describe here the pattern cognitive deficits in a series 13 consecutive inpatients hospitalised Lausanne University Hospital, whom we during post-critical stage (table 1). Inclusion criteria diagnosed by PCR ARDS that required intubation intensive care unit (ICU). Exclusion prior psychiatric or diseases, including neurocognitive impairment dementia. At time testing, no longer sedated ICU delirium symptoms, which present seven patients, resolved six them (P5–P7, P10, P11, P13) subsided great extent (P12). View this table: Table 1 Patient (P1–P13) characteristics performance tests The neuropsychological evaluation comprised two standardised test batteries. Montreal Cognitive Assessment (MoCA; https://www.mocatest.org), covers main functions, revealed normal performances four 1; P1–P4), mild (P5–P8) moderate five (P9–P13). MoCA subtests selective lower executive functions for scores more extensive executive, memory, attentional visuospatial …

Язык: Английский

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