Heart & Lung - The Journal of Critical Care

Information for Authors

2010-03-04

Reviewer Application

2010-03-04

Reader Communication

2010-03-04

Moving beyond the salt shaker

Sue Wingate — 2010-03-04

One of the most common interventions we do as cardiovascular nurses is advise patients to reduce their sodium intake. These efforts use enormous amounts of time and resources, frequently need to be repeated, and inconsistently result in behavior change and better health outcomes.

Using a webcast support service: Experiences of in-person attendees of an implantable cardioverter defibrillator support group

Eva R. Serber, Nancy J. Finch, Lawrence B. Afrin, W. James Greenland — 2009-08-26

Objective: Most patients with implantable cardioverter defibrillators (ICDs) adjust well to living with the device; however, some experience difficulties. Support groups assist in coping with the psychologic effects of living with an ICD. The study's aim was to examine acceptability of the in-person attendees of an ICD support group that was cast on the Internet.Sample: A patient satisfaction survey describing the participants' experience was used as a measure of acceptability in this non-experimental, survey, pilot study.Methods: The survey assessed reactions of the in-person participants with ICDs (N=46) to the introduction of webcasting and remote participation by other individuals with ICDs. Descriptive statistics were conducted.Results: Participating in a webcasted support group was viewed as highly favorable, and responses indicated high satisfaction.Conclusion: Participants were satisfied with the webcast technology, enabling broader access to patients. Research is needed to assess the acceptability and satisfaction among remote participants and the group's effectiveness on clinical outcomes.

Living with heart disease after angioplasty: A qualitative study of patients who have been successful or unsuccessful in multiple behavior change

2009-08-26

Objective: To document values, attitudes, and beliefs that influence behavior change among a diverse group of patients post-angioplasty.Methods: Purposive and maximum-variation sampling were used to assemble a demographically diverse patient cohort (N=61) who had been successful or unsuccessful at post-angioplasty multibehavior change. Semistructured interviews and grounded theory methods were used to collect and analyze qualitative data.Results: Themes showed the following: a) Patients reported surviving a life-threatening event and feared disease recurrence and death; b) the perception of a turning point and self-determination facilitated behavior change; c) social support and spiritual beliefs promoted coping with the uncertainty of living with heart disease; and d) unsuccessful behavior change was related to physical limitations, a sense that “nothing helps,” and the belief that angioplasty “cures” heart disease.Conclusion: Lifestyle interventions should be culturally relevant and adapted to physical abilities. Fostering self-determination and social support may promote successful behavior change.

Coronary artery disease in patients with peripheral artery disease

2009-10-16

Objectives: Peripheral artery disease (PAD) is an atherosclerotic disease associated with cardiovascular risk factors, and with high cardiovascular morbidity and mortality. This study sought to assess the prevalence of angiographic coronary artery disease (CAD), and to determine the predictive value of traditional cardiovascular risk factors on the presence of CAD in patients with PAD of the lower extremities.Methods: In total, 231 patients who presented at hospital complaining of intermittent claudication were included. All patients underwent simultaneous peripheral and cardiac angiography. Age, gender, hypertension, diabetes, smoking, and lipid values were recorded.Results: The coronary angiograms of 64 (28%) patients were within normal limits, and 167 (72%) patients manifested CAD. Logistic regression analysis revealed that hypertension and diabetes were independent predictors for the presence of CAD or PAD.Conclusion: Aggressive treatment of cardiovascular risk factors, especially hypertension and diabetes, in PAD is critically important in reducing mortality and morbidity.

Qualitative examination of compliance in heart failure patients in The Netherlands

2009-10-19

Background: Noncompliance with pharmacological and nonpharmacological recommendations is a problem in many heart failure (HF) patients, leading to worse symptoms and readmission. Although knowledge is available regarding factors related to compliance with HF regimens, little is known about patients' perspectives. We investigated patients' reasons and motivations for compliance with HF regimens from their perspective, and we studied how patients manage these recommendations in daily life. The health belief model was used as a framework for this study.Methods: A qualitative descriptive study was used, and 15 HF patients were interviewed about reasons for compliance, barriers to compliance, interventions that helped them comply with medications, sodium restriction, fluid restriction, and daily weighing.Results: The most commonly reported reasons for compliance included fear of hospitalization and HF symptoms. Barriers to compliance were mainly related to the negative aspects of a regimen, e.g., taste of the food and thirst. Most patients tried to make their lifestyle changes part of the daily routine. Several problems and misunderstandings with the regimen were evident. Patients themselves offered many tips that helped them comply with the regimen.Conclusions: To improve compliance in HF patients, patient-tailored interventions must be targeted at specific problems and patients' beliefs regarding the regimen, and aim at implementing the regimen into daily life. Healthcare providers need to emphasize the benefits of compliance, motivate patients to comply, and focus on individual barriers to compliance, knowledge deficits, and misunderstandings regarding the regimen. More specific advice about medications and diet is needed. Group interventions, including tips patients themselves provide, might also be useful in helping patients implement the HF regimen in their daily lives.

Clinical presentation and treatment of atrial fibrillation in Wolff-Parkinson-White syndrome

Joanne L. Thanavaro, Samer Thanavaro — 2009-08-26

A case of Wolff-Parkinson-White syndrome with atrial fibrillation (AF) is reported in a patient who presented with syncope, tachycardia, and hypotension. The electrocardiogram (ECG) showed a fast irregular rhythm with wide polymorphic QRS tachycardia without the QRS twisting around the isoelectric baseline, diagnostic of AF and Wolff-Parkinson-White syndrome. The patient did not respond to intravenous amiodarone. Elective cardioversion restored sinus rhythm, and the ECG showed a wide QRS complex, short PR interval, and delta wave, indicating the presence of an accessory pathway and pre-excitation. AF was easily induced during the electrophysiologic study, requiring electrical cardioversion for severe hypotension. Successful radiofrequency ablation of the accessory pathway completely prevented further inducible AF. The patient no longer had any evidence of pre-excitation on ECG and remained symptom-free with no medications for 11 months.

An evaluation of family-centered care services and organization of visiting policies in Belgian intensive care units: A multicenter survey

2009-07-23

Background: Admission in an intensive care unit (ICU) is a major cause of psychologic stress for the patient and the entire family, and liberalization of visitation has been shown to have a beneficial impact. However, despite the data available, practice has not changed much to incorporate these findings.Objective: This study aimed to evaluate the visiting policies of Belgian ICUs.Methods: A descriptive multicenter questionnaire survey was prospectively conducted.Results: Fifty-seven ICUs completed the questionnaire (75.0%). All (100%) reported restricted visiting-hour policies, and limited numbers of visitors. Mean total daily visiting time was 69±33minutes. The type of visitors was restricted to only immediate relatives in 11 ICUs (19.3%). Children were not allowed in 5 ICUs (8.8%), and 46 ICUs (80.7%) fixed an age limit for visiting. Thirty ICUs (52.6%) were providing families with information in a special room in addition to the waiting room, whereas 6 (10.5%) reported having no waiting room available, and 9 ICUs (15.8%) provided an information leaflet. A structured first family meeting at time of admission was organized in 42 ICUs (73.7%). A final family meeting at ICU discharge was planned in only 16 centers (28.1%).Conclusion: Participating ICUs homogeneously reported restricted visiting policies regarding visiting hours and type and number of visitors. According to the evidence available, providing a plea for more liberal visitation, these results may be a first step toward reorganization of visiting policies in Belgian ICUs.

Oxygenation equilibration time after alteration of inspired oxygen in critically ill patients

2009-08-17

To determine the time required for arterial oxygen partial pressure (Pao2) equilibration after a change in fractional inspired oxygen (Fio2) in intensive care unit (ICU) patients, a prospective study in a 7-bed university ICU was performed. Forty adult patients were examined using sequential arterial blood gas measurements after a .3 alteration in Fio2. The Pao2 value measured at 30minutes after a step change in Fio2 in both periods was accepted as representative of the equilibrium value for Pao2. The mean equilibration time was 8.26±5.6minutes and 4.5±2.65minutes for increases and decreases in Pao2, respectively (P=.003). The constant k values were .44 ± .31minutes and .72 ± .7minutes for increases and decreases in Pao2, respectively. There was no significant difference between the increase and the decrease of 90% oxygenation times in the 2 groups (P=.150 and P=.446, respectively). The study confirms that a period of less than 10minutes is adequate for 90% of the equilibration of Pao2 to occur after an Fio2 change in ICU patients.

Outcome of patients with cystic fibrosis admitted to the intensive care unit: Is invasive mechanical ventilation a risk factor for death in patients waiting lung transplantation?

2009-08-26

Objective: The admission of patients with cystic fibrosis (CF) to the intensive care unit (ICU) is controversial. Our aim was to study the long-term outcome of patients with CF who were admitted to the ICU and the effect of ventilation modality.Methods: The medical records of 104 admissions (1996-2006) of 48 patients with CF (age 18±9 years) were reviewed. Seventeen patients were admitted with reversible conditions (group 1). Thirty-one patients were admitted for acute on chronic respiratory failure (group 2).Results: In group 1, 16 of 17 patients survived up to 10 years from ICU admission. Conversely, in group 2, 23 of 31 patients (74%) died of respiratory failure. In group 2, 17 of 18 patients who were mechanically ventilated died within 90 days from admission, and 7 of 10 patients treated for prolonged periods with bi-level positive airway pressure are still alive up to 10 years after admission and transplantation.Conclusion: Patients requiring mechanical ventilation may have a poor prognosis. The outcome of treatment with bi-level positive airway pressure is good, even in patients who had many episodes of acute respiratory failure.

Severe myocardial ischemia after concentrated epinephrine use for the treatment of anaphylaxis: Kounis syndrome or epinephrine effect?

Cemil Izgi, Cihan Cevik, Kenneth Nugent — 2009-08-26

Epinephrine is the cornerstone of treatment for anaphylaxis, which is a life-threatening condition that requires rapid management. However, epinephrine administration can have complications. We report a patient in whom accidental concentrated epinephrine use for management of anaphylaxis caused severe myocardial ischemia.

Adult Kawasaki's disease with myocarditis, splenomegaly, and highly elevated serum ferritin levels

2009-09-04

Kawasaki's disease is a disease of unknown cause. The characteristic clinical features of Kawasaki's disease are fever≥102°F for≥5 days accompanied by a bilateral bulbar conjunctivitis/conjunctival suffusion, erythematous rash, cervical adenopathy, pharyngeal erythema, and swelling of the dorsum of the hands/feet. Kawasaki's disease primarily affects children and is rare in adults. In children, Kawasaki's disease is more likely to be associated with aseptic meningitis, coronary artery aneurysms, and thrombocytosis. In adult Kawasaki's disease, unilateral cervical adenopathy, arthritis, conjunctival suffusion/conjunctivitis, and elevated serum transaminases (serum glutamic oxaloacetic transaminase [SGOT]/serum glutamate pyruvate transaminase [SGPT]) are more likely. Kawasaki's disease in adults may be mimicked by other acute infections with fever and rash, that is, group A streptococcal scarlet fever, toxic shock syndrome (TSS), and Rocky Mountain Spotted Fever (RMSF). Because there are no specific tests for Kawasaki's disease, diagnosis is based on clinical criteria and the syndromic approach. In addition to rash and fever, scarlet fever is characterized by circumoral pallor, oropharyngeal edema, Pastia's lines, and peripheral eosinophilia, but not conjunctival suffusion, splenomegaly, swelling of the dorsum of the hands/feet, thrombocytosis, or an elevated SGOT/SGPT. In TSS, in addition to rash and fever, there is conjunctival suffusion, oropharyngeal erythema, and edema of the dorsum of the hands/feet, an elevated SGOT/SGPT, and thrombocytopenia. Patients with TSS do not have cervical adenopathy or splenomegaly. RMSF presents with fever and a maculopapular rash that becomes petechial, first appearing on the wrists/ankles after 3 to 5 days. RMSF is accompanied by a prominent headache, periorbital edema, conjunctival suffusion, splenomegaly, thrombocytopenia, an elevated SGOT/SGPT, swelling of the dorsum of the hands/feet, but not oropharyngeal erythema.We present a case of adult Kawasaki's disease with myocarditis and splenomegaly. The patient's myocarditis rapidly resolved, and he did not develop coronary artery aneurysms. In addition to splenomegaly, this case of adult Kawasaki's disease is remarkable because the patient had highly elevated serum ferritin levels of 944-1303 ng/mL; (normal<189 ng/mL). To the best of our knowledge, this is the first report of adult Kawasaki's disease with highly elevated serum ferritin levels. This is also the first report of splenomegaly in adult Kawasaki's disease. We conclude that Kawasaki's disease should be considered in the differential diagnosis in adult patients with rash/fever for≥5 days with conjunctival suffusion, cervical adenopathy, swelling of the dorsum of the hands/feet, thrombocytosis and otherwise unexplained highly elevated ferritin levels.

Persistent methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia due to a linezolid “tolerant” strain

Burke A. Cunha, Sara Nausheen, Paul Schoch — 2009-09-04

Antibiotic “tolerance” is a rare cause of antibiotic failure. Antibiotic “tolerance” is defined as an minimal bactericidal concentration (MBC) 32× the minimal inhibitory concentration (MIC) of the isolate. Although susceptibility testing based on the MIC suggests susceptibility of “tolerant” strains, bactericidal concentrations are often beyond achievable serum levels and therapeutic failure may result. We present a case of persistent methicillin-sensitive S. aureus (MSSA) bacteremia due to a linezolid “tolerant” strain unresponsive to daptomycin therapy. We believe this is the first report of persistent MSSA bacteremia due to a linezolid “tolerant” strain.

Delectable deductive diagnosis: Lean children of fat parents

George Nikolić — 2009-10-05

The patient was a 75-year-old woman with chronic ischemic/hypertensive heart disease, and a permanent pacemaker had been inserted 2 years previously for a “bifascicular block.” The 12-lead electrocardiogram (ECG) shown in was performed in the emergency room (ER) after a transient ischemic attack (TIA). The patient was asymptomatic by then.

2010-03-04

Board of Directors

2010-03-04

Information for Readers

2010-03-04

Heart & Lung - The Journal of Critical Care

Information for Authors

Reviewer Application

Reader Communication

Moving beyond the salt shaker

Using a webcast support service: Experiences of in-person attendees of an implantable cardioverter defibrillator support group

Living with heart disease after angioplasty: A qualitative study of patients who have been successful or unsuccessful in multiple behavior change

Coronary artery disease in patients with peripheral artery disease

Qualitative examination of compliance in heart failure patients in The Netherlands

Clinical presentation and treatment of atrial fibrillation in Wolff-Parkinson-White syndrome

An evaluation of family-centered care services and organization of visiting policies in Belgian intensive care units: A multicenter survey

Oxygenation equilibration time after alteration of inspired oxygen in critically ill patients

Outcome of patients with cystic fibrosis admitted to the intensive care unit: Is invasive mechanical ventilation a risk factor for death in patients waiting lung transplantation?

Severe myocardial ischemia after concentrated epinephrine use for the treatment of anaphylaxis: Kounis syndrome or epinephrine effect?

Adult Kawasaki's disease with myocarditis, splenomegaly, and highly elevated serum ferritin levels

Persistent methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia due to a linezolid “tolerant” strain

Delectable deductive diagnosis: Lean children of fat parents

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