Intensive care medicine
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Intensive care medicine · Oct 2010
Speech effects of a speaking valve versus external PEEP in tracheostomized ventilator-dependent neuromuscular patients.
Many patients with respiratory failure related to neuromuscular disease receive chronic invasive ventilation through a tracheostomy. Improving quality of life, of which speech is an important component, is a major goal in these patients. We compared the effects on breathing and speech of low-level positive end-expiratory pressure (PEEP, 5 cmH(2)O) and of a Passy-Muir speaking valve (PMV) during assist-control ventilation. ⋯ Low-level PEEP is as effective as PMV in ensuring good speech quality, which might be explained by sealed expiratory line with low-level PEEP and/or respiratory rate increase during speech with PEEP observed in most of the patients.
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Intensive care medicine · Oct 2010
ReviewThe RAGE axis in systemic inflammation, acute lung injury and myocardial dysfunction: an important therapeutic target?
The sepsis syndromes, frequently complicated by pulmonary and cardiac dysfunction, remain a major cause of death amongst the critically ill. Targeted therapies aimed at ameliorating the systemic inflammation that characterises the sepsis syndromes have largely yielded disappointing results in clinical trials. Whilst there are many potential reasons for lack of success of clinical trials, one possibility is that the pathways targeted, to date, are only modifiable very early in the course of the illness. More recent approaches have therefore attempted to identify pathways that could offer a wider therapeutic window, such as the receptor for advanced glycation end-products (RAGE) and its ligands. ⋯ RAGE is an inflammation-perpetuating receptor with a diverse range of ligands. Evidence supporting a role of the RAGE axis in the pathogenesis of systemic inflammation, ALI and myocardial dysfunction is compelling with numerous animal experiments showing the beneficial effects of inhibiting the RAGE axis. Despite a number of unanswered questions that need to be further addressed, the potential for inhibiting RAGE-mediated inflammation in humans undoubtedly exists.
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Intensive care medicine · Oct 2010
Review Multicenter StudyHypoalbuminemia and acute kidney injury: a meta-analysis of observational clinical studies.
To test the hypothesis that hypoalbuminemia is independently associated with increased risk of acute kidney injury (AKI). ⋯ This meta-analysis provides evidence that hypoalbuminemia is a significant independent predictor both of AKI and of death following AKI development. Serum albumin determinations may be of utility in identifying patients at increased risk for AKI or for death after AKI. Controlled studies are warranted to assess interventions aimed at correcting hypoalbuminemia.
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Intensive care medicine · Oct 2010
ReviewA critical appraisal of the quality of critical care pharmacotherapy clinical practice guidelines and their strength of recommendations.
Clinical practice guideline (CPG) quality assessment is important before applying their recommendations. Determining whether recommendation strength is consistent with supporting quality of evidence is also essential. We aimed to determine quality of critical care pharmacotherapy CPGs and to assess whether high quality evidence supports strong pharmacotherapy recommendations. ⋯ Variation in AGREE domain scores explain why one-third of critical care pharmacotherapy CPGs cannot be recommended. Only one-third of strong pharmacotherapy recommendations were supported by high quality evidence. We recommend appraisal of guideline quality and the caliber of supporting evidence prior to applying recommendations.