Intensive care medicine
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Intensive care medicine · Feb 2014
Review Practice GuidelinePalliative care in the ICU: relief of pain, dyspnea, and thirst-A report from the IPAL-ICU Advisory Board.
Pain, dyspnea, and thirst are three of the most prevalent, intense, and distressing symptoms of intensive care unit (ICU) patients. In this report, the interdisciplinary Advisory Board of the Improving Palliative Care in the ICU (IPAL-ICU) Project brings together expertise in both critical care and palliative care along with current information to address challenges in assessment and management. ⋯ Relief of symptom distress is a key component of critical care for all ICU patients, regardless of condition or prognosis. Evidence-based approaches for assessment and treatment together with well-designed work systems can help ensure comfort and related favorable outcomes for the critically ill.
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Intensive care medicine · Feb 2014
Continuous electroencephalography in a surgical intensive care unit.
Our aim was to investigate the prevalence, risk factors, and impact on outcome of nonconvulsive seizures (NCSz), nonconvulsive status epilepticus (NCSE), and periodic epileptiform discharges (PEDs) in surgical intensive care unit (SICU) patients with continuous electroencephalography (cEEG) monitoring. ⋯ In this retrospective study of SICU patients with cEEG monitoring for altered mental status, NCSz and periodic discharges were frequent and NCSz were independently associated with poor outcome. NCSz were more common when clinical seizures occurred before cEEG.
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Intensive care medicine · Feb 2014
Randomized Controlled Trial Multicenter Study Comparative StudyTight computerized versus conventional glucose control in the ICU: a randomized controlled trial.
The blood glucose target range and optimal method to reach this range remain a matter of debate in the intensive care unit (ICU). A computer decision support system (CDSS) might improve the outcome of ICU patients through facilitation of a tighter blood glucose control. ⋯ Tight computerized glucose control with the CDSS did not significantly change 90-day mortality and was associated with more frequent severe hypoglycemia episodes in comparison with conventional glucose control.
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Intensive care medicine · Feb 2014
Randomized Controlled Trial Multicenter StudyEarly postoperative prophylactic noninvasive ventilation after major lung resection in COPD patients: a randomized controlled trial.
To investigate whether prophylactic postoperative NIV prevents respiratory complications following lung resection surgery in COPD patients. ⋯ Prophylactic postoperative NIV did not reduce the rate of ARE in COPD patients undergoing lung resection surgery and did not influence other postoperative complications rates, mortality rates, and duration of ICU and hospital stay.
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Intensive care medicine · Feb 2014
Specific MAIT cell behaviour among innate-like T lymphocytes in critically ill patients with severe infections.
In between innate and adaptive immunity, the recently identified innate-like mucosal-associated invariant T (MAIT) lymphocytes display specific reactivity to non-streptococcal bacteria. Whether they are involved in bacterial sepsis has not been investigated. We aimed to assess the number and the time course of circulating innate-like T lymphocytes (MAIT, NKT and γδ T cells) in critically ill septic and non-septic patients and to establish correlations with the further development of intensive care unit (ICU)-acquired infections. ⋯ This large human study provides valuable information about MAIT cells in severe bacterial infections. The persistent depletion of MAIT cells is associated with the further development of ICU-acquired infections.