Intensive care medicine
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Intensive care medicine · Nov 2001
Multicenter StudyPredictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study.
In patients with hypoxemic acute respiratory failure (ARF), randomized studies have shown noninvasive positive pressure ventilation (NPPV) to be associated with lower rates of endotracheal intubation. In these patients, predictors of NPPV failure are not well characterized. ⋯ In hypoxemic ARF, NPPV can be successful in selected populations. When patients have a higher severity score, an older age, ARDS or pneumonia, or fail to improve after 1 h of treatment, the risk of failure is higher.
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Total body computed tomography (CT) scan is increasingly used in traumatised patients, but the need for an initial rapid imaging assessment beforehand remains unknown. To address this problem, we assessed the value of an initial imaging assessment (chest X-ray, pelvic X-ray, abdominal ultrasonography) in severely traumatised patients in a prospective study. ⋯ A simple and rapid initial imaging assessment enabled appropriate emergency decisions before further imaging assessment was performed. We recommend that every patient with severe blunt trauma receive this initial assessment.
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Intensive care medicine · Nov 2001
Should we confirm our clinical diagnostic certainty by autopsies?
To evaluate the frequency of diagnostic errors assessed by autopsies. ⋯ Autopsies are performed more often in younger patients without chronic disease and in patients with a low clinical diagnostic certainty. No level of clinical diagnostic certainty could predict the pathological findings.
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Intensive care medicine · Nov 2001
Lack of association between the -260 C-->T promoter polymorphism of the endotoxin receptor CD14 gene and the CD14 density of unstimulated human monocytes and soluble CD14 plasma levels.
CD14 is a receptor for endotoxin and binds components of Gram-positive and Gram-negative bacteria. CD14-bearing monocytes respond to stimulation with the increased synthesis and release of cytokines. The recently described -260 C-->T promoter polymorphism of the CD14 gene has been found to be related to a risk of myocardial infarction. This study evaluated the role of this polymorphism in the expression of monocyte and soluble CD14. Moreover, the effect of the CD14 -260 genotypes for the ex vivo TNF-alpha response to endotoxin was analyzed in whole blood. ⋯ The CD14 -260 polymorphism does not affect the CD14 expression of unstimulated circulating monocytes or soluble CD14 plasma levels.