Acute Liver Failure Due to Budd-Chiari Syndrome in the Setting of Cardiac Synovial Sarcoma.

Primary malignant tumors of the heart, specifically cardiac sarcomas, are rare and mainly diagnosed at autopsy. Acute Budd-Chiari syndrome is a recognized cause of acute liver failure and has been associated with several rare cardiac tumors: atrial myxoma, caval rhabdomyosarcoma, and primary cardiac adenocarcinoma. We present the first case of a fatal, highly differentiated cardiac synovial sarcoma that presented as acute liver failure from Budd-Chiari syndrome.

Clinical outcomes associated with high, intermediate, and low rates of failed extubation in an intensive care unit.

Purpose: Extubation failure is associated with adverse outcomes in mechanically ventilated patients, and it is believed that high rates of failed planned extubation (FPE) should be avoided. However, many believe that very low rates may also correlate with adverse outcomes if resulting from overly conservative weaning practices. We examined the relationship between the percentage of FPE (%FPE) and associated outcomes, with the aim of elucidating a favorable middle range.

Diagnostic utility of B-type natriuretic peptide in critically ill patients with pulmonary edema: a prospective cohort study.

Introduction: Distinguishing pulmonary edema due to acute lung injury (ALI) or the acute respiratory distress syndrome (ARDS) from hydrostatic or cardiogenic edema is challenging in critically ill patients. B-type natriuretic peptide (BNP) can effectively identify congestive heart failure in the emergency room setting but, despite increasing use, its diagnostic utility has not been validated in the intensive care unit (ICU).

Methods: We performed a prospective, blinded cohort study in the medical and surgical ICUs at the University of Chicago Hospitals.

Daily sedative interruption in mechanically ventilated patients at risk for coronary artery disease.

Objectives: To determine the prevalence of myocardial ischemia in mechanically ventilated patients with coronary risk factors and compare periods of sedative interruption vs. sedative infusion.

Design: Prospective, blinded observational study.

Usefulness of the external jugular vein examination in detecting abnormal central venous pressure in critically ill patients.

Background: Central venous pressure (CVP) provides important information for the management of critically ill patients. The external jugular vein (EJV) is easier to visualize than the internal jugular vein and may give a reliable estimate of CVP.

Methods: To determine the usefulness of the EJV examination in detecting abnormal CVP values, we performed a prospective blinded evaluation comparing it with CVP measured using an indwelling catheter in critically ill patients with central venous catheters.

The relationship between sedative infusion requirements and permissive hypercapnia in critically ill, mechanically ventilated patients.

Objective: Permissive hypercapnia (PH) may result from mechanical ventilation (MV) strategies that intentionally reduce minute ventilation. Sedative doses required to tolerate PH have not been well characterized. With increased attention to lung-protective ventilation, characterization of sedative requirements with PH and determination of sedative dose changes with PH are needed.