2011 November 03

Takotsubo cardiomyopathy has a unique cardiac biomarker profile: NT-proBNP/myoglobin and NT-proBNP/troponin T ratios for the differential diagnosis of acute coronary syndromes and stress induced cardiomyopathy.

Nov 032011

Takotsubo cardiomyopathy has a unique cardiac biomarker profile: NT-proBNP/myoglobin and NT-proBNP/troponin T ratios for the differential diagnosis of acute coronary syndromes and stress induced cardiomyopathy.

Int J Cardiol. 2011 Oct 30;

Authors: Fröhlich GM, Schoch B, Schmid F, Keller P, Sudano I, Lüscher TF, Noll G, Ruschitzka F, Enseleit F

Abstract
BACKGROUND: Takotsubo cardiomyopathy (TC) usually is not recognized until heart catheterization reveals typical wall motion abnormalities in the absence of significant coronary artery disease. It was our aim to identify TC by its unique cardiac biomarker profile at an early stage and, preferably, with non-invasive procedures only. METHODS: Ratios of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and myoglobin, NT-proBNP and troponin T (TnT), NT-proBNP and creatinekinase-MB (CK-MB) were compared in patients with TC (n=39), patients with ST-elevation myocardial infarction (STEMI, n=48) and patients with non-ST-elevation myocardial infarction (NSTEMI, n=34). Biomarkers were recorded serially at admission and at the three consecutive days. Optimal cut-off values to distinguish TC from STEMI and NSTEMI were calculated with receiver operator characteristic (ROC) curves. RESULTS: At admission a NT-proBNP (ng/l)/myoglobin (?g/l) ratio of 3.8, distinguished TC from STEMI (sensitivity: 89%, specificity: 90%), while a NT-proBNP (ng/l)/myoglobin (?g/l) ratio of 14 separated well between TC and NSTEMI (sensitivity: 65%, specificity: 90%). Best differentiation of TC and ACS was possible with the ratio of peak levels of NT-proBNP (ng/l)/TnT (?g/l). A cut-off value of NT-proBNP (ng/l)/TnT (?g/l) ratio of 2889, distinguished TC from STEMI (sensitivity: 91%, specificity: 95%), while a NT-proBNP (ng/l)/TnT (?g/l) ratio of 5000 separated well between TC and NSTEMI (sensitivity: 83%, specificity: 95%). CONCLUSIONS: TC goes along with a singular cardiac biomarker profile, which might be useful to identify patients with TC among patients presenting with acute coronary syndromes (ACS).

PMID: 22044675 [PubMed - as supplied by publisher]

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Pulmonary complications of pneumococcal community-acquired pneumonia: incidence, predictors, and outcomes.

Clin Microbiol Infect Start a Discussion »

Nov 032011

Pulmonary complications of pneumococcal community-acquired pneumonia: incidence, predictors, and outcomes.

Clin Microbiol Infect. 2011 Oct 10;

Authors: Cillóniz C, Ewig S, Polverino E, Muñoz-Almagro C, Marco F, Gabarrús A, Menéndez R, Mensa J, Torres A

Abstract
Clin Microbiol Infect ABSTRACT: The aim of this study was to evaluate the clinical characteristics, predictors and outcomes of pneumococcal pneumonia developing pulmonary complications and the distribution of pneumococcal serotypes. It was a prospective study including all adult patients admitted to the Hospital Clinic of Barcelona, Spain (2001-2009) with the diagnosis of pneumococcal pneumonia. Microbiological investigation was systematically performed, including antimicrobial susceptibility and serotype distribution (only invasive strains isolated during 2006-2009). Complicated pneumonia was defined as the presence of one or more pulmonary complications: pleural effusion, empyema, or multilobar infiltrates. We included 626 patients, and 235 (38%) had the following pulmonary complications: pleural effusion, 122 (52%); empyema, 18 (8%); and multilobar infiltration, 151 (64%). Forty-six (20%) patients had more than one complication. Patients with pulmonary complications showed a higher rate of intensive-care unit admission (34% vs. 13%, p?<0.001), a higher rate of shock (16% vs. 7%, p?<0.001), a longer length of stay (9 days vs. 6 days, p?<0.001), and a lower rate of penicillin resistance (14% vs. 25%, p?0.013), but similar mortality (9% vs. 8%). No significant differences were observed in the serotype distribution between complicated and uncomplicated pneumonia. Chronic obstructive pulmonary disease (COPD) (OR 0.38, 95% CI 0.23-0.63; p?<0.001) was a protective factor against pulmonary complications, whereas chronic liver disease (OR 3.60, 95% CI 1.71-7.60; p?0.001), admission C-reactive protein level ?18?mg/dL (OR 2.77, 95% CI 1.91-4.00; p?<0.001) and admission creatinine level >1.5?mg/dL (OR 2.01, 95% CI 1.31-3.08; p?0.001) were risk factors for pulmonary complications. Complicated pneumonia was characterized by a more severe clinical presentation, but was not associated with increased mortality. Resistance to antibiotics was lower in complicated cases. No significant differences were observed in the serotype distribution between complicated and uncomplicated pneumonia. In the multivariate analysis, COPD was a protective factor against pulmonary complications.

PMID: 22044658 [PubMed - as supplied by publisher]

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Communication Difficulties and Psychoemotional Distress in Patients Receiving Mechanical Ventilation.

Am J Crit Care Start a Discussion »

Nov 032011

Communication Difficulties and Psychoemotional Distress in Patients Receiving Mechanical Ventilation.

Am J Crit Care. 2011 Nov;20(6):470-479

Authors: Khalaila R, Zbidat W, Anwar K, Bayya A, Linton DM, Sviri S

Abstract
Background Difficulties in communication in intensive care patients receiving mechanical ventilation are a source of stressful experiences and psychoemotional distress. Objectives To examine the association between communication characteristics and psychoemotional distress among patients treated with mechanical ventilation in a medical intensive care unit and to identify factors that may be predictive of psychological outcomes. Methods A total of 65 critically ill patients, extubated within the preceding 72 hours, were included in this cross-sectional study. Data were collected by using a structured interview. Separate regression analysis of data on 3 psychoemotional outcomes (psychological distress, fear, and anger) were used for baseline variables, communication characteristics, and stressful experiences. Results Difficulty in communication was a positive predictor of patients' psychological distress, and length of anesthesia was a negative predictor. Fear and anger were also positively related to difficulty in communication. In addition, the number of communication methods was negatively associated with feelings of fear and anger. Finally, the stressful experiences associated with the endotracheal tube were positively related to feelings of anger. Conclusions Patients treated with mechanical ventilation experience a moderate to extreme level of psychoemotional distress because they cannot speak and communicate their needs. Nurses should be aware of the patients' need to communicate. Decreasing stressful experiences associated with the endotracheal tube and implementing more appropriate communication methods may reduce patients' distress.

PMID: 22045144 [PubMed - as supplied by publisher]

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Patients’ Instability, Emergency Response, and Outcomes in the Radiology Department.

Am J Crit Care Start a Discussion »

Nov 032011

Patients' Instability, Emergency Response, and Outcomes in the Radiology Department.

Am J Crit Care. 2011 Nov;20(6):461-469

Authors: Ott LK, Hravnak M, Clark S, Amesur NB

Abstract
Background Inpatients may be at risk of cardiopulmonary instability during radiologic testing. Calling the medical emergency team is one rescue intervention that brings a team of critical care providers to the unstable patient. Little is known, however, about patients' instability and activations of the medical emergency team in the radiology department (RD-MET). Objectives To describe the cause of activation of the RD-MET for hospitalized patients, temporal attributes of RD-MET involvement, characteristics of RD-MET patients, and characteristics associated with good and poor outcomes after RD-MET activation. Methods Retrospective pilot study of RD-MET calls for 64 inpatients in a tertiary care hospital during 2009. Results Reasons for RD-MET activation were 39% neurological, 38% cardiac, and 22% respiratory, and nearly half (42%) occurred during a computed tomography scan. Most RD-MET calls were made between 10 am and noon. RD-MET patients had a mean age of 61 (SD, 19) years; 52% were female, and 89% were white. Admitting diagnoses were most commonly neurological (20%), cardiovascular (16%), and abdominal (16%). The most common comorbid conditions were chronic obstructive pulmonary disease (23%) and diabetes (20%). Half of RD-MET inpatients were from a general care unit, and 56% required preexisting oxygen support. After RD-MET involvement, 61% of patients required a higher level of care; 3% died during the MET intervention, and 19% died later in hospitalization. Patients with preexisting comorbid conditions were more likely to have poor outcomes after the RD-MET intervention (P = .001). Conclusions RD-MET patients with comorbid conditions, from a general care unit, and at risk for neurological deterioration arrive in the radiology department with potentially underestimated support needs. Greater support in specific time frames and locations may be warranted to improve outcomes.

PMID: 22045143 [PubMed - as supplied by publisher]

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A Simplified Score for Transfer of Patients Requiring Mechanical Ventilation to a Long-Term Care Hospital.

Am J Crit Care Start a Discussion »

Nov 032011

A Simplified Score for Transfer of Patients Requiring Mechanical Ventilation to a Long-Term Care Hospital.

Am J Crit Care. 2011 Nov;20(6):e122-e130

Authors: Chen HY, Vanness DJ, Golestanian E

Abstract
Background Long-term care hospitals are Medicare providers of postacute care that have a mean length of stay of 25 days or more. Early identification and timely transfer of patients requiring mechanical ventilation to such hospitals may improve the efficiency of inpatient care. Objectives To develop a predictive model and a simplified score for use on day 7 of hospitalization to assess whether a patient receiving mechanical ventilation is likely to require an additional 25 days of hospitalization (ie, would qualify for transfer to a long-term care hospital). Methods A retrospective, cross-sectional study using hospital discharge and billing data from the 2005 Nationwide Inpatient Sample for 54 686 Medicare beneficiaries admitted to US community hospitals who met the study's eligibility criteria. The outcome was overall length of stay (?32 vs <32 days). Split-sample validation was used. Multivariable survey-logistic regression analyses were performed to assess predictors and probability of the outcome. A simplified score was derived from the final predictive model. Results The discriminatory power of the predictive model was 0.75 and that of the simplified score was 0.72. The model calibrated well. All predictors were significantly (P < .01) associated with a hospitalization of 32 days or longer; having a tracheostomy was the strongest predictor (odds ratio, 4.74). The simplified scores ranged from -5 to 110 points and were categorized into 3 classes of risk. Conclusions Efforts to aid discharge decision making and optimize hospital resource planning could take advantage of our predictive model and the simplified scoring tool.

PMID: 22045148 [PubMed - as supplied by publisher]

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Nocturnal asthma.

Curr Opin Pulm Med Start a Discussion »

Nov 032011

Nocturnal asthma.

Curr Opin Pulm Med. 2011 Oct 31;

Authors: Greenberg H, Cohen RI

Abstract
PURPOSE OF REVIEW: The aim is to review pathophysiological mechanisms and treatment of nocturnal asthma. RECENT FINDINGS: Physiologic changes accompanying sleep, as well as the nocturnal phase of circadian rhythms, may have an adverse effect on asthma control. Chronotherapeutic principles, which consider circadian variation in relevant biologic rhythms, may improve asthma outcomes. Administration of long-acting bronchodilators and inhaled corticosteroids which achieve maximum efficacy at night may improve nocturnal asthma. Comorbid conditions that may contribute to nocturnal asthma should be considered. The prevalence of obstructive sleep apnea is greater in a cohort of patients with severe asthma than in moderate asthma and in BMI and age matched nonasthmatic controls, suggesting a link between these diseases. A large trial concluded that esomeprazole did not improve asthma control even with comorbid acid reflux, questioning the importance of acid reflux in asthma. The role of polymorphisms of the ?2-adrenergic receptor and their relationship with nocturnal asthma remain controversial. SUMMARY: Sleep is a time of vulnerability to respiratory compromise, especially in asthma patients experiencing nocturnal exacerbations. This asthma phenotype is associated with poorer control, reduced sleep quality, daytime somnolence and increased morbidity and mortality. Nocturnal asthma is a common but under-recognized problem.

PMID: 22045347 [PubMed - as supplied by publisher]

Link to Article at PubMed

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