Intensive care medicine
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Intensive care medicine · Jan 2008
Postresuscitation N-acetylcysteine treatment reduces cerebral hydrogen peroxide in the hypoxic piglet brain.
Reactive oxygen species have been implicated in the pathogenesis of hypoxia-reoxygenation injury. However, little information is known regarding the temporal profile of cerebral hydrogen peroxide (HPO) production and its response to N-acetylcysteine (an antioxidant) administration during neonatal hypoxia-reoxygenation. Using an acute swine model of neonatal hypoxia-reoxygenation, we examined the short-term neuroprotective effects of N-acetylcysteine on cerebral HPO production and oxidative stress in the brain. ⋯ In newborn piglets with hypoxia-reoxygenation, postresuscitation administration of N-acetylcysteine reduces cerebral HPO production and oxidative stress, probably through a taurine-related mechanism.
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Intensive care medicine · Jan 2008
Effects of relaxation of inspiratory muscles on ventilator pressure during pressure support.
During pressure support ventilation (PS), an abrupt increase in ventilator pressure above the pre-set level is considered to signify expiratory muscle activity. However, relaxation of inspiratory muscles may also cause the same phenomenon, and this hypothesis has not been explored. The aim of this study is to examine the cause of this increase in ventilator pressure, during PS, in critically ill patients. ⋯ We conclude that, during PS ventilation, the relaxation of inspiratory muscles accounts for the acute increase in P (aw) above the pre-set level, in addition to the contribution made by the occurrence of expiratory muscle activity.
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Psychologically stressful situations, a physically demanding workload and a high requirement for technological skills can lead ICU caregivers to burnout. The aim of our study was to evaluate their level of burnout as well as the related factors. ⋯ Almost a third of the ICU nursing team showed a high level of burnout. The factors felt to be important may not be those related to burnout. Since the well-being of the nursing team is important for the quality of care, corrective actions against the related factors should be sought in order to alleviate the suffering.
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Intensive care medicine · Jan 2008
ReviewVentilator-induced diaphragm dysfunction: the clinical relevance of animal models.
Experimental evidence suggests that controlled mechanical ventilation (CMV) can induce dysfunction of the diaphragm, resulting in an early-onset and progressive decrease in diaphragmatic force-generating capacity, called ventilator-induced diaphragmatic dysfunction (VIDD). The mechanisms of VIDD are not fully elucidated, but include muscle atrophy (resulting from lysosomal, calpain, caspase and proteasome activation), oxidative stress, structural injury (disrupted myofibrils, increased numbers of lipid vacuoles, and abnormally small and disrupted mitochondria), myofiber remodeling and mitochondrial dysfunction. The major clinical implication of the VIDD is to limit the use of CMV to the extent possible. Partial (assisted) modes of ventilatory support should be used whenever feasible, since these modes attenuate the deleterious effects of mechanical ventilation on respiratory muscles.
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Intensive care medicine · Jan 2008
An underrecognized source of organ donors: patients with brain death after successfully resuscitated cardiac arrest.
To identify predictors of brain death after successful resuscitation of out-of-hospital cardiac arrest (OHCA), with the goal of improving the detection of brain death, and to evaluate outcomes of solid organs harvested from these patients. ⋯ Brain death may occur in about one-sixth of patients after successfully resuscitated OHCA, creating opportunities for organ donation.