Intensive care medicine
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Intensive care medicine · Apr 2009
Adult ICU ventilators to provide neonatal ventilation: a lung simulator study.
Traditionally, specific ventilators have been manufactured to only provide neonatal mechanical ventilation. However, many of the current generation of ICU ventilators also include a neonatal mode. ⋯ All ICU ventilators tested were able to at least equal the performance of the Babylog 8000 Plus on all variables evaluated.
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Intensive care medicine · Apr 2009
Mechanical determinants of early acute ventilatory failure in COPD patients: a physiologic study.
The purpose of this study is to investigate the respiratory mechanics, breathing pattern, and pressure-generating capacity of respiratory muscles during the early phases of an acute exacerbation of COPD. ⋯ During the early phases of an acute exacerbation, patients with COPD and acute respiratory failure had an imbalance between the decreased capacity of the respiratory muscles to generate pressure and the increased respiratory load. This imbalance was similar to that recorded in patients with COPD and chronic ventilatory failure. In both groups, the imbalance was associated with rapid shallow breathing. Among the mechanical constraints to ventilation, only PEEPi,dyn was different between acute and chronic patients with ventilatory failure.
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Intensive care medicine · Apr 2009
Randomized Controlled Trial Multicenter StudyIron lung versus mask ventilation in acute exacerbation of COPD: a randomised crossover study.
To compare iron lung (ILV) versus mask ventilation (NPPV) in the treatment of COPD patients with acute on chronic respiratory failure (ACRF). ⋯ The sequential use of NPPV and ILV avoided EI in a large percentage of COPD patients with ACRF; ILV was more effective than NPPV on the basis of minor criteria for EI but after the crossover the need of EI on the basis of major criteria and mortality was similar in both groups of patients.
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Intensive care medicine · Apr 2009
ReviewControversies in paediatric continuous renal replacement therapy.
Continuous renal replacement therapy (CRRT) is an invaluable means of supporting critically ill children with many illnesses, including acute renal failure, drug intoxication, inborn errors of metabolism, and multiorgan failure. However, the ideal method of applying the technique is unknown. ⋯ Current evidence suggests that early initiation of CRRT before the onset of substantial fluid overload, considering continuous haemofiltration in disease states such as respiratory failure following stem cell transplantation, and the use of continuous haemodialysis and citrate anticoagulation to prolong circuit life may be associated with improved outcomes.
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Intensive care medicine · Apr 2009
A preliminary study of atorvastatin plasma concentrations in critically ill patients with sepsis.
A lack of published pharmacokinetic data on statins in sepsis has prompted concerns about their safety and toxicity. This study determined single dose pharmacokinetics of Atorvastatin administered orally to acutely ill patients. ⋯ Very high plasma concentrations were achieved in intensive care patients with sepsis. This can only be partly explained by altered metabolism of atorvastatin. Further investigations are essential to better describe the pharmacokinetics of statins in various groups of critically ill patients. Caution should be exercised prior to adopting high dose regimens in patients with severe sepsis.