Intensive care medicine
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Intensive care medicine · Sep 2014
Randomized Controlled TrialA randomized clinical trial of an intervention to relieve thirst and dry mouth in intensive care unit patients.
To test an intervention bundle for thirst intensity, thirst distress, and dry mouth, which are among the most pervasive, intense, distressful, unrecognized, and undertreated symptoms in ICU patients, but for which data-based interventions are lacking. ⋯ This simple, inexpensive thirst bundle significantly decreased ICU patients' thirst and dry mouth and can be considered a practice intervention for patients experiencing thirst.
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Intensive care medicine · Sep 2014
A data-driven approach to optimized medication dosing: a focus on heparin.
To demonstrate a novel method that utilizes retrospective data to develop statistically optimal dosing strategies for medications with sensitive therapeutic windows. We illustrate our approach on intravenous unfractionated heparin, a medication which typically considers only patient weight and is frequently misdosed. ⋯ This work represents an important step in the secondary use of health data in developing models to optimize drug dosing. The next step would be evaluating whether this approach indeed achieves target aPTT more reliably than the current weight-based heparin dosing in a randomized controlled trial.
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Intensive care medicine · Sep 2014
Comparative StudyWorrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002-2010).
To analyze trends in incidence and mortality of candidemia in intensive care units (ICUs) vs. non-ICU hospitalized patients and to determine risk factors for infection by specific species and for death. ⋯ The availability of new antifungals and the publication of numerous guidelines did not prevent an increase of candidemia and death in ICU patients in the Paris area.
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Intensive care medicine · Sep 2014
Letter Randomized Controlled Trial Comparative StudyEffect of noninvasive proportional assist vs pressure support ventilation on neuroventilatory coupling in chronic obstructive pulmonary patients with hypercapnia.
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Intensive care medicine · Sep 2014
A paper on the pace of recovery from diaphragmatic fatigue and its unexpected dividends.
Because the diaphragm is essential for survival, we wondered if it might be less vulnerable to the long-lasting effects of fatigue than limb muscles. Using a recently introduced magnetic probe to activate the phrenic nerves, we followed the evolution of twitch transdiaphragmatic pressure after inducing fatigue in healthy volunteers. Twenty-four hours after its induction, diaphragmatic fatigue had not fully recovered. ⋯ Employing a further modification of the technique--twitch airway pressure--it became evident that respiratory muscle weakness is a greater problem than fatigue in ventilated patients. Twitch airway pressure is now being used to document the prevalence and consequences of ventilator-induced respiratory muscle weakness. Our study--which began with a circumscribed, simple question--has yielded dividends in unforeseen directions, illustrating the fruitfulness of research into basic physiological mechanisms.