Intensive care medicine
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Intensive care medicine · Aug 2010
Multicenter Study Comparative StudyAdaptive support ventilation versus conventional ventilation for total ventilatory support in acute respiratory failure.
To compare the short-term effects of adaptive support ventilation (ASV), an advanced closed-loop mode, with conventional volume or pressure-control ventilation in patients passively ventilated for acute respiratory failure. ⋯ Comparison between ASV and CV resulted either in similarities or in minor differences. Except for excessive Vt in a few obstructed patients, all differences were in favor of ASV.
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Intensive care medicine · Aug 2010
Multicenter StudyOutcome of children admitted to adult intensive care units in Italy between 2003 and 2007.
Centralisation of critically ill children to paediatric intensive care units is supported by a strong rationale, but evidence is not overwhelming. ⋯ The level of care provided nowadays to children admitted to adult ICUs in Italy is similar to that provided by Italian PICUs 10 years earlier. On the other hand, there is evidence that Italian PICUs have improved the level of care in the same period. These findings, if confirmed, suggest a better quality of care for children admitted to PICUs as compared to adult ICUs and support the indication, when possible, of early referral to more specialized units in countries where paediatric intensive care is not centralised.
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Intensive care medicine · Aug 2010
ReviewThe endothelium: physiological functions and role in microcirculatory failure during severe sepsis.
The endothelium is a highly dynamic cell layer that is involved in a multitude of physiological functions, including the control of vascular tone, the movement of cells and nutrients, the maintenance of blood fluidity and the growth of new vessels. During severe sepsis, the endothelium becomes proadhesive, procoagulant, antifibrinolytic and is characterized by alterations of vasomotor regulation. Most of these functions have been discovered using in vitro and animal models, but in vivo exploration of endothelium in patients remains difficult. New tools to analyze endothelial dysfunction at bedside have to be developed.
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Intensive care medicine · Aug 2010
Randomized Controlled Trial Comparative StudySmall dead space heat and moisture exchangers do not impede gas exchange during noninvasive ventilation: a comparison with a heated humidifier.
Adverse respiratory and gasometrical effects have been described in patients with acute respiratory failure (ARF) undergoing noninvasive ventilation (NIV) with standard heat and moisture exchangers (HME). We decided to evaluate respiratory parameters and arterial blood gases (ABG) of patients during NIV with small dead space HME compared with heated humidifier (HH). ⋯ If one decides to humidify patients' airways during NIV, one may do so with small dead space HME or HH without altering respiratory parameters.
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Intensive care medicine · Aug 2010
Randomized Controlled TrialBolus remifentanil for chest drain removal in ICU: a randomized double-blind comparison of three modes of analgesia in post-cardiac surgical patients.
We compared 1 versus 0.5 microg/kg bolus remifentanil versus placebo in alleviating pain due to chest drain removal. Effects on sedation, respiratory rate (RR), oxygen saturation, heart rate (HR) and blood pressure were also evaluated. ⋯ Bolus remifentanil at the tested doses delivers excellent analgesia, but 1 microg/kg remifentanil results in respiratory depression. Remifentanil bolus at 0.5 microg/kg is safe and effective for chest drain removal after heart surgery in ICU.