Intensive care medicine
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Intensive care medicine · Apr 2016
Randomized Controlled Trial Multicenter Study Comparative StudyHigher versus lower blood pressure targets for vasopressor therapy in shock: a multicentre pilot randomized controlled trial.
In shock, hypotension may contribute to inadequate oxygen delivery, organ failure and death. We conducted the Optimal Vasopressor Titration (OVATION) pilot trial to inform the design of a larger trial examining the effect of lower versus higher mean arterial pressure (MAP) targets for vasopressor therapy in shock. ⋯ This pilot study supports the feasibility of a large trial comparing lower versus higher MAP targets for shock. Further research may help delineate the reasons for vasopressor dosing in excess of prescribed targets and how individual patient characteristics modify the response to vasopressor therapy.
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Intensive care medicine · Apr 2016
ReviewPositive and negative effects of mechanical ventilation on sleep in the ICU: a review with clinical recommendations.
Sleep is an essential physiologic process that helps to restore normal body homeostasis. Sleep disturbances have been shown to be associated with poor clinical outcomes, such as a greater risk of cardiovascular disease and increasing mortality. Critically ill patients, particularly those receiving mechanical ventilation, may be more susceptible to sleep disruption. ⋯ We provide recommendations for clinicians regarding optimal ventilatory settings and discuss fields for future research.
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Intensive care medicine · Apr 2016
Multicenter StudyRapid response team and hospital mortality in hospitalized patients.
Although rapid response systems are known to reduce in-hospital cardiac arrest rate, their effect on mortality remains debated. The present study aimed to evaluate the effect of implementing an intensivist-led rapid response team (RRT) on mortality in hospitalized patients. ⋯ In the present retrospective study, implementation of an intensivist-led RRT along with educational modules, publicity and bedside simulation-based training was associated with a significant decrease in unexpected and overall mortality of inpatients.
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Intensive care medicine · Apr 2016
Plasma levels of danger-associated molecular patterns are associated with immune suppression in trauma patients.
Danger-associated molecular patterns (DAMPs) released of trauma could contribute to an immune suppressed state that renders patients vulnerable towards nosocomial infections. We investigated DAMP release in trauma patients, starting in the prehospital phase, and assessed its relationship with immune suppression and nosocomial infections. ⋯ Plasma levels of DAMPs are associated with immune suppression, which is apparent within minutes/hours following trauma. Furthermore, aggravated immune suppression during the initial phase following trauma is associated with increased susceptibility towards infections.