Intensive care medicine
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Intensive care medicine · Nov 2009
Comparison of four methods of lung volume recruitment during high frequency oscillatory ventilation.
To compare four methods of volume recruitment upon initiation of high frequency oscillatory ventilation (HFOV). ⋯ Escalating recruitment produced the greatest increase in lung volume and resolution of atelectasis, and is recommended for lung volume recruitment upon initiation of HFOV.
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Intensive care medicine · Nov 2009
Dose-dependent benefit of nitroglycerin on microcirculation of patients with severe heart failure.
Microcirculatory abnormalities are frequently observed in patients with severe heart failure and correlate to worse outcomes. We tested the hypothesis that nitroglycerin dose-dependently improves perfusion in severe heart failure and that this could be monitored by measuring central-peripheral temperature gradient and with Sidestream Dark Field imaging of the sublingual mucosa. ⋯ Nitroglycerin dose-dependently increases tissue perfusion in patients with severe heart failure, as observed by a decrease in central-peripheral temperature gradient and an increase in sublingual perfused capillary density.
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Intensive care medicine · Nov 2009
Multicenter Study Comparative Study Controlled Clinical TrialImpact of acute hypercapnia and augmented positive end-expiratory pressure on right ventricle function in severe acute respiratory distress syndrome.
To evaluate the effects of acute hypercapnia induced by positive end-expiratory pressure (PEEP) variations at constant plateau pressure (P (plat)) in patients with severe acute respiratory distress syndrome (ARDS) on right ventricular (RV) function. ⋯ Acidosis and hypercapnia induced by tidal volume reduction and increase in PEEP at constant P (plat) were associated with impaired RV function and hemodynamics despite positive effects on oxygenation and alveolar recruitment ( ClinicalTrials.gov #NCT00236262).
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Intensive care medicine · Nov 2009
ReviewDeterminants of regional ventilation and blood flow in the lung.
The principles of ventilation and perfusion distribution in the lung form the foundation of pulmonary physiology and remain cornerstones in caring for critically ill patients. Due to improved imaging technologies with greater spatial resolution, our understanding of the determinants of local ventilation and blood flow have evolved over the past five decades. This review provides a brief history of how the concepts governing regional ventilation and perfusion have developed and presents the most recent studies that are shaping new perspectives on the determinants of ventilation and perfusion. How these new principles apply to acute lung injury and gas exchange in the intensive care unit(ICU) are reviewed.
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Intensive care medicine · Nov 2009
ReviewDiagnostic considerations regarding pediatric delirium: a review and a proposal for an algorithm for pediatric intensive care units.
If delirium is not diagnosed, it is unlikely that any effort will be made to reverse it. Given evidence for under-diagnosis, tools that aid recognition are required. ⋯ This is the first proposal for a PD diagnostic algorithm. Given the high prevalence of predelirious states at the PICU, daily evaluation is mandatory. Future algorithmic refinement is urgently required.