Intensive care medicine
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Intensive care medicine · Feb 2013
Multicenter StudyPredicting mortality risk in patients undergoing venovenous ECMO for ARDS due to influenza A (H1N1) pneumonia: the ECMOnet score.
The decision to start venovenous extracorporeal membrane oxygenation (VV ECMO) is commonly based on the severity of respiratory failure, with little consideration of the extrapulmonary organ function. The aim of the study was to identify predictors of mortality and to develop a score allowing a better stratification of patients at the time of VV ECMO initiation. ⋯ Mortality risk for patients receiving VV ECMO is correlated to the extrapulmonary organ function at the time of ECMO initiation. The ECMOnet score is a tool for the evaluation of the appropriateness and timing of VV ECMO in acute lung failure.
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Intensive care medicine · Feb 2013
A new formula for determining arterial oxygen saturation during venovenous extracorporeal oxygenation.
Venovenous extracorporeal membrane oxygenation (VV-ECMO) is used to treat severe forms of acute respiratory distress syndrome (ARDS). VV-ECMO management may be confusing due to the lack of information about the interplay between the determinant parameters and their impact on oxygenation. We found a relationship between arterial oxygen saturation (SaO(2)) and its relevant parameters. The aim of this study was to assess the validity of this model. ⋯ We have presented an explicit relationship between SaO(2) and its direct determinants during VV-ECMO. Good agreement was found with the measured values of SaO(2), but the model remains to be fully validated before its use in clinical practice.
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Intensive care medicine · Feb 2013
Letter Case ReportsBedside diagnosis of bilateral diaphragmatic paralysis.
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Intensive care medicine · Feb 2013
Multicenter StudySignificant perturbation of vitamin D-parathyroid-calcium axis and adverse clinical outcomes in critically ill patients.
A prospective multicentre cohort study was conducted to determine the prevalence of hypovitaminosis D in adult critically ill patients, to characterize alterations in the parathyroid hormone (PTH)-vitamin D-calcium axis and to explore associations between hypovitaminosis D and adverse clinical outcomes. ⋯ Hypovitaminosis D and secondary hyperparathyroidism are highly prevalent in critically ill patients. Low vitamin D status persists during ICU stay and is associated with worse disease severity and fewer hospital-free days.
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Intensive care medicine · Feb 2013
ReviewUse of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature.
High flow nasal cannula (HFNC) systems utilize higher gas flow rates than standard nasal cannulae. The use of HFNC as a respiratory support modality is increasing in the infant, pediatric, and adult populations as an alternative to non-invasive positive pressure ventilation. ⋯ Current evidence suggests that HFNC is well tolerated and may be feasible in a subset of patients who require ventilatory support with non-invasive ventilation. However, HFNC has not been demonstrated to be equivalent or superior to non-invasive positive pressure ventilation, and further studies are needed to identify clinical indications for HFNC in patients with moderate to severe respiratory distress.