Biomedical subjects

Lisa M Mielniczuk

Publications and source records attributed to Lisa M Mielniczuk.

4 recordsLinked to original sources

PubMed2006

The use of noninvasive ventilation in emergency department patients with acute cardiogenic pulmonary edema: a systematic review.

STUDY OBJECTIVE: Acute cardiogenic pulmonary edema is a common cause of respiratory distress in emergency department (ED) patients. Noninvasive ventilation by noninvasive positive pressure ventilation or continuous positive airway pressure has been studied as a treatment strategy. We critically evaluate the evidence for the use of noninvasive ventilation on rates of hospital mortality and endotracheal intubation. METHODS: We searched the databases of MEDLINE, EMBASE, and the Cochrane Library from 1980 to 2005. Additional sources included key journals, bibliographies of selected articles, and expert contact. We included studies that incorporated a randomized design; patients older than 18 years and with acute cardiogenic pulmonary edema; diagnosis and treatment initiated in the ED; noninvasive ventilation in addition to standard medical therapy compared to standard medical therapy alone, or noninvasive positive pressure ventilation compared to continuous positive airway pressure (both in addition to standard medical therapy); and data on hospital mortality or intubation. A random-effects model was used to obtain the summary risk ratios (RRs) and 95% confidence intervals (CIs) for hospital mortality and intubation. RESULTS: A pooled analysis of 494 patients suggested that noninvasive ventilation in addition to standard medical therapy significantly reduced hospital mortality compared to standard medical therapy alone (RR 0.61; [95% CI 0.41, 0.91]). Similarly, a meta-analysis of 436 patients suggested that noninvasive ventilation was associated with a significant decrease in intubation rates (RR 0.43; [95% CI 0.21, 0.87]). CONCLUSION: Our results suggest that noninvasive ventilation with standard medical therapy is advantageous over standard medical therapy alone in ED patients with acute cardiogenic pulmonary edema. Future studies, powered appropriately for mortality and intubation rates, are necessary to confirm these findings.

Acute Disease↗

PubMed2006

Frequency of peripartum cardiomyopathy.

Reports from case series have estimated the incidence of peripartum cardiomyopathy (PC) at 1 case/1,485 live births to 1 case/15,000 live births and probable mortality rates of 7% to 60%. The objective of this study was to produce the first population-based study of the incidence, mortality, and risk factors for PC. The National Hospital Discharge Survey was used. Discharge information was available for 3.6 million patient discharges from 1990 to 2002. There were an estimated 16,296 cases of PC from 1990 to 2002. During this period, there were 51,966,560 live births in the United States. Thus, the incidence of PC was 1 case/3,189 live births. There was a trend toward an increase in PC incidence during the study period, with an estimate for the years 2000 to 2002 of 1 case/2,289 live births. The in-hospital mortality rate was 1.36% (95% confidence interval 0% to 10.2%). The total mortality rate was 2.05% (95% confidence interval 0.29% to 10.8%). Patients with PC were older (mean age 29.7 vs 26.9 years), were more likely to be black (32.2% vs 15.7%), and had a higher incidence of pregnancy associated hypertensive disorders (22.5% vs 5.87%) compared with national data. In conclusion, the incidence of PC is relatively uncommon, occurring at an average frequency of 1 case/3,189 live births from 1990 to 2002. The estimated mortality of 1.36% to 2.05% (95% confidence interval 0.29% to 10.8%) is less than previously reported from most case series.

Adolescent↗

PubMed2005

Evaluation and monitoring of patients with acute heart failure syndromes.

Advanced heart failure (HF) is associated with frequent hospitalizations, poor quality of life, and increased mortality. Despite optimal medical management, readmission rates remain high and account for approximately two thirds of all costs related to HF management. Evaluation of patients with HF is critical for the appropriate selection and monitoring of therapy as well as for the prevention of recurrent hospitalizations. This evaluation can be complex and relies on integration of the bedside evaluation and information available from invasive and other noninvasive diagnostic techniques. The clinical examination remains the cornerstone of HF evaluation. Key features of the history and physical examination can be used to assign hemodynamic profiles based on the absence or presence of congestion and adequacy of perfusion. These hemodynamic profiles provide prognostic information and may be used to guide therapy. Direct measurement of hemodynamics may be helpful in patients in whom the physical examination is limited or discordant with symptoms. Although the pulmonary artery catheter (PAC) is not recommended during routine therapy of patients hospitalized with HF, it is reasonable to consider the use of PAC monitoring to adjust therapy in patients who demonstrate recurrent or refractory symptoms despite ongoing standard therapy adjusted according to clinical assessment. This is particularly relevant in centers with experience in hemodynamic monitoring for HF. B-type natriuretic peptide (BNP) testing has been shown to facilitate diagnosis of the etiology of dyspnea in the urgent setting for patients without a prior diagnosis of HF. Furthermore, BNP levels provide important prognostic information in patients with chronic HF, but serial BNP testing has not been validated as a guide to inpatient or outpatient management. Echocardiographic assessment can provide prognostic information about ventricular function and size as well as information about hemodynamic status. Development of validated and reproducible noninvasive techniques to monitor patients with acute HF will be an important step in maximizing interventions to improve outcomes in this patient population.

Acute Disease↗

PubMedDate not supplied

Immune modulation therapy in heart failure.

Several lines of evidence suggest that inflammation plays a pathogenic role in the development and progression of congestive heart failure, influencing heart contractility and hypertrophy, promoting apoptosis, and contributing to the myocardial remodeling process. As the prevalence of heart failure continues to increase, novel therapeutic strategies are employed to decrease the burden of this disease. Although multiple studies have suggested a potential for immunomodulatory therapy in heart failure patients, the precise role of this targeted approach still remains to be determined. Further research is needed to identify the key factors in the immunopathogenesis of heart failure, identify the patients who are most likely to respond, and develop management strategies that result in consistent benefit leading to decreased morbidity and mortality in the heart failure patient population.

Cytokines↗