Intensive care medicine
-
Intensive care medicine · Jul 2011
Letter Case ReportsOne hypovolaemic shock…two kinin pathway abnormalities.
-
Intensive care medicine · Jul 2011
Randomized Controlled Trial Comparative StudyEarly and late outcome after single step dilatational tracheostomy versus the guide wire dilating forceps technique: a prospective randomized clinical trial.
Percutaneous tracheostomy is frequently performed in long-term ventilated patients in the intensive care unit (ICU). Unfortunately, despite many years of experience, the optimal technique is still unknown, especially considering the occurrence of late complications. The purpose of this study was to determine which of the two most frequently used percutaneous tracheostomy techniques performs best with the emphasis on late complications. ⋯ Compared with the GWDF, the SSDT shows a trend toward less major perioperative complications with a comparable long-term outcome.
-
Intensive care medicine · Jul 2011
Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy.
In pediatric intensive care unit (PICU) patients, fluid overload (FO) at initiation of continuous renal replacement therapy (CRRT) has been reported to be an independent risk factor for mortality. Previous studies have calculated FO based on daily fluid balance during ICU admission, which is labor intensive and error prone. We hypothesized that a weight-based definition of FO at CRRT initiation would correlate with the fluid balance method and prove predictive of outcome. ⋯ Our findings suggest that weight-based definitions of FO are useful in defining FO at CRRT initiation and are associated with increased mortality in a broad PICU patient population. This study provides evidence for a more practical weight-based definition of FO that can be used at the bedside.
-
Intensive care medicine · Jul 2011
Comparative StudyInfluence of lung collapse distribution on the physiologic response to recruitment maneuvers during noninvasive continuous positive airway pressure.
Noninvasive continuous positive airway pressure (n-CPAP) has been proposed for the treatment of hypoxemic acute respiratory failure (h-ARF). Recruitment maneuvers were shown to improve oxygenation, i.e., the ratio of arterial oxygen tension to inspiratory oxygen fraction (PaO2/FiO2), during either invasive mechanical ventilation, and n-CPAP, with a response depending on the distribution of lung collapse. We hypothesized that, during n-CPAP, early h-ARF patients with bilateral (B(L)) distribution of lung involvement would benefit from recruitment maneuvers more than those with unilateral (U(L)) involvement. ⋯ Compared to n-CPAP, n-CPAP(SIGH) further improved arterial oxygenation in B(L) patients, whereas it produced no additional benefit in those with U(L).