Intensive care medicine
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Intensive care medicine · Nov 2002
Randomized Controlled Trial Comparative Study Clinical TrialEffect of the humidification device on the work of breathing during noninvasive ventilation.
Heat and moisture exchangers (HME) increase circuitry deadspace compared to heated humidifiers (HH). This study compared the effect of HH and HME during noninvasive ventilation (NIV) on arterial blood gases and patient's effort assessed by respiratory muscles pressure-time product and by work of breathing (WOB). ⋯ In patients receiving NIV for moderate to severe acute hypercapnic respiratory failure, the use of HME lessens the efficacy of NIV in reducing effort compared to HH.
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Intensive care medicine · Nov 2002
Comparative StudyThe Multiple Organ Dysfunction Score (MODS) versus the Sequential Organ Failure Assessment (SOFA) score in outcome prediction.
To compare outcome prediction using the Multiple Organ Dysfunction Score (MODS) and the Sequential Organ Failure Assessment (SOFA), two of the systems most commonly used to evaluate organ dysfunction in the intensive care unit (ICU). ⋯ MODS and SOFA are reliable outcome predictors. Cardiovascular dysfunction is better related to outcome with the SOFA score than with the MODS.
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Intensive care medicine · Nov 2002
Acute lung injury and acute respiratory distress syndrome at the intensive care unit of a general university hospital in Brazil. An epidemiological study using the American-European Consensus Criteria.
To determine: (1) the frequency of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS); (2) the mortality associated with these syndromes and (3) the influence of risk factors, comorbidities and organ system dysfunction in the mortality of ALI patients. ⋯ (1) The frequency of ALI was 3.8%, of which the frequency of ARDS was 2.3% and of ALI/non-ARDS 1.5%; (2) The ICU and hospital mortality of ALI patients was 44.0% and 48.0%, respectively; mortality rates of ARDS and ALI/non-ARDS did not differ significantly; (3) Renal and hematological dysfunction were associated with mortality in ALI patients.
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Intensive care medicine · Nov 2002
Clinical TrialEffects of therapeutic hypothermia on intracranial pressure and outcome in patients with severe head injury.
Therapeutic hypothermia may improve outcome in patients with severe head injury, but clinical studies have produced conflicting results. We hypothesised that the severe side effects of artificial cooling might have masked the positive effects in earlier studies, and we treated a large group of patients with severe head injury with hypothermia using a strict protocol to prevent the occurrence of cooling-induced side effects. ⋯ Artificial cooling can significantly improve survival and neurological outcome in patients with severe head injury when used in a protocol with great attention to the prevention of side effects. Because there is likely to have been bias against the hypothermia group in this study, the positive effects of hypothermia might even have been underestimated. In addition, our results confirm the value of therapeutic hypothermia in treating refractory intracranial hypertension.
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Intensive care medicine · Nov 2002
Position paper of the ESICM Working Group on Nutrition and Metabolism. Metabolic basis of nutrition in intensive care unit patients: ten critical questions.
The metabolic changes associated with critical illness involve several pathways acting at different steps of the utilization of nutritive substrates. The understanding of the role of these pathways and of their complex regulation has led to the development of new strategies for the metabolic and nutritional management of critically ill patients, including the development of new products for nutritional support. The rationale for changing the profile of nutritional support solutions by adding novel substrates is also discussed. This review focuses on the metabolic specificities of critically ill patients and also includes an analysis of the adequacy of tools to monitor the metabolic status and the adequacy of the nutritional support.