Intensive care medicine
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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
End-of-life practices in 282 intensive care units: data from the SAPS 3 database.
To report incidence and characteristics of decisions to forgo life-sustaining therapies (DFLSTs) in the 282 ICUs who contributed to the SAPS3 database. ⋯ This large study identifies structural variables that are associated with substantial variations in the incidence and the characteristics of decisions to forgo life-sustaining therapies.
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Intensive care medicine · Apr 2009
Randomized Controlled TrialA simple aspiration test to determine the accuracy of oesophageal placement of fine-bore feeding tubes.
To evaluate whether a simple aspiration test can be used to accurately confirm the correct placement of fine-bore feeding tubes in the oesophagus and prevent their inadvertent placement in the bronchial tree. ⋯ A simple aspiration test could be a useful adjunct to prevent inadvertent bronchial placement of fine-bore feeding tubes. Careful attention must be paid to the technique to ensure that no false positives occur.
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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
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.