Intensive care medicine
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Intensive care medicine · Sep 2014
Observational StudyImpact of fluid balance on outcome of adult patients treated with extracorporeal membrane oxygenation.
To assess the relationship between early daily fluid balance (FB) and 90-day outcome in adult patients treated with extracorporeal membrane oxygenation (ECMO). ⋯ Positive FB at ECMO day 3 is an independent predictor of 90-day mortality. Further interventional studies aimed at testing the value of strategy of tight control of FB during the early ECMO period are now warranted.
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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.