Intensive care medicine
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Intensive care medicine · Dec 2002
Randomized Controlled Trial Comparative Study Clinical TrialNoninvasive vs. conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial.
We conducted a randomized prospective study comparing noninvasive positive pressure ventilation (NPPV) with conventional mechanical ventilation via endotracheal intubation (ETI) in a group of patients with chronic obstructive pulmonary disease who failed standard medical treatment in the emergency ward after initial improvement and met predetermined criteria for ventilatory support. ⋯ The use of NPPV in patients with chronic obstructive pulmonary disease and acute respiratory failure requiring ventilatory support after failure of medical treatment avoided ETI in 48% of the patients, had the same ICU mortality as conventional treatment and, at 1-year follow-up was associated with fewer patients readmitted to the hospital or requiring for long-term oxygen supplementation. An editorial regarding this article can be found in the same issue (http://dx.doi.org/10.1007/s00134-002-1503-3).
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Intensive care medicine · Dec 2002
Randomized Controlled Trial Clinical TrialPrevention of severe Candida infections in nonneutropenic, high-risk, critically ill patients: a randomized, double-blind, placebo-controlled trial in patients treated by selective digestive decontamination.
Infections caused by Candida spp. are a major cause of morbidity and mortality in critically ill patients and usually develop from endogenous colonization. We assessed the effectiveness of adding fluconazole to a selective digestive decontamination regimen to prevent candidal infections. ⋯ Prophylactic use of fluconazole in a selected group of mechanically ventilated patients at high risk for infection reduces the incidence of Candida infections, in particular candidemia.
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Intensive care medicine · Dec 2002
Influence of different release times on spontaneous breathing pattern during airway pressure release ventilation.
Airway pressure release ventilation (APRV) is a ventilatory mode with a time cycled change between an upper (P(high)) and lower (P(low)) airway pressure level. APRV is unique because it allows unrestricted spontaneous breathing throughout the ventilatory cycle. We studied the influence of different release times (time of P(low)) on breathing pattern and gas exchange in patients during partial mechanical ventilation. ⋯ Airway pressure release ventilation is an open system which allows patients to maintain the "time control" over the respiratory cycle independent of the chosen duration for P(high) and P(low).
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Intensive care medicine · Dec 2002
Effect of prone position on hepato-splanchnic hemodynamics in acute lung injury.
To evaluate the effects of prone position on hepato-splanchnic hemodynamics, metabolism and gut mucosal energy balance. ⋯ We conclude that if IAP and systemic hemodynamics remain unaffected, the prone position in ALI patients compromises neither hepato-splanchnic perfusion nor gastric mucosal energy balance.
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Intensive care medicine · Dec 2002
Inflammatory response of neutrophil granulocytes and monocytes after cardiopulmonary bypass in pediatric cardiac surgery.
To determine whether the activation state of polymorphonuclear neutrophils (PMNs) and monocytes contributes to the inflammatory response after cardiopulmonary bypass (CPB) in pediatric cardiac surgery. ⋯ After the end of CPB, there was an ongoing inflammatory process. In particular, there was an activation of monocytes after the end of CPB.