Intensive care medicine
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Intensive care medicine · Feb 2013
Multicenter StudyFactors associated with mortality in pediatric in-hospital cardiac arrest: a prospective multicenter multinational observational study.
To analyze prognostic factors associated with in-hospital cardiac arrest (CA) in children. ⋯ In-hospital CA in children has a low survival but most of the survivors have a good neurological outcome. Some prognostic risk factors cannot be modified, making it important to focus efforts on improving hospital organization to care for children at risk of CA in the PICU and, in particular, in other hospital areas.
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Intensive care medicine · Feb 2013
Clinical TrialNoninvasive mechanical ventilation in patients having declined tracheal intubation.
Noninvasive ventilation (NIV) is a treatment option in patients with acute respiratory failure who are good candidates for intensive care but have declined tracheal intubation. The aim of our study was to report outcomes after NIV in patients with a do-not-intubate (DNI) order. ⋯ Do-not-intubate status was present among one-fifth of ICU patients who received NIV. DNI patients who were alive on day 90 experienced no decrease in HRQOL compared to baseline. The prevalences of anxiety, depression, and PTSD-related symptoms in these patients and their relatives were similar to those seen after NIV was used as part of full-code management (clinicaltrial.govNCT01449331).
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Intensive care medicine · Feb 2013
Inflammatory cytokine measurement quickly discriminates gram-negative from gram-positive bacteremia in pediatric hematology/oncology patients with septic shock.
We performed a prospective study to evaluate the ability of inflammatory cytokines in discriminating gram-negative from gram-positive bacteremia in septic shock. ⋯ Flow cytometry-based inflammatory cytokine measurement is a helpful adjuvant approach for early and quick discrimination of gram-negative from gram-positive bacteremia in pediatric hematology/oncology patients with septic shock which might be useful for evaluating the severity of shock and the selection and/or timely withdrawal or switch of antibiotics.
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Intensive care medicine · Feb 2013
Patient-ventilator interaction in ARDS patients with extremely low compliance undergoing ECMO: a novel approach based on diaphragm electrical activity.
Patients with acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO) usually present very low respiratory system compliance (Cst(rs)) values (i.e., severe restrictive respiratory syndrome patients). As a consequence, they are at high risk of experiencing poor patient-ventilator interaction during assisted breathing. We hypothesized that monitoring of diaphragm electrical activity (EAdi) may enhance asynchrony assessment and that neurally adjusted ventilatory assist (NAVA) may reduce asynchrony, especially in more severely restricted patients. ⋯ EAdi allows accurate analysis of asynchrony patterns and magnitude in ARDS patients with very low Cst(rs) undergoing ECMO. In these patients, NAVA is associated with reduced asynchrony.
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Intensive care medicine · Feb 2013
Letter Case ReportsAn unusual cause of hyperammonemia in a critically ill patient.