Intensive care medicine
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Intensive care medicine · Sep 2016
Multicenter Study Observational StudyContinuous renal replacement therapy versus intermittent hemodialysis in intensive care patients: impact on mortality and renal recovery.
The best renal replacement therapy (RRT) modality remains controversial. We compared mortality and short- and long-term renal recovery between patients treated with continuous RRT and intermittent hemodialysis. ⋯ Continuous RRT did not appear to improve 30-day and 6-month patient outcomes. It seems beneficial for patients with fluid overload, but might be deleterious in the absence of hemodynamic failure.
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Intensive care medicine · Sep 2016
Multicenter Study Observational StudyQuantifying unintended exposure to high tidal volumes from breath stacking dyssynchrony in ARDS: the BREATHE criteria.
Breath stacking dyssynchrony generates higher tidal volumes than intended, potentially increasing lung injury risk in acute respiratory distress syndrome (ARDS). Lack of validated criteria to quantify breath stacking dyssynchrony contributes to its under-recognition. This study evaluates performance of novel, objective criteria for quantifying breath stacking dyssynchrony (BREATHE criteria) compared to existing definitions and tests if neuromuscular blockade eliminates high-volume breath stacking dyssynchrony in ARDS. ⋯ The BREATHE criteria provide an objective definition of breath stacking dyssynchrony emphasizing occult exposure to high tidal volumes. BREATHE identified high-volume breaths missed by other methods for quantifying this dyssynchrony. Neuromuscular blockade prevented breath stacking dyssynchrony, assuring provision of the intended lung-protective strategy.
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Intensive care medicine · Sep 2016
Multicenter StudyDeterminants of time to death in hospital in critically ill patients around the world.
To investigate which factors influence time to death in hospital in critically ill patients worldwide, including the possible impact of gross national income (GNI). ⋯ Duration of hospital stay prior to death in critically ill patients is longer in older patients, surgical patients, and patients with infection. GNI is a major determinant of time to death in hospital in these patients. These observations may have important organizational and ethical implications.
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Intensive care medicine · Sep 2016
Editorial ReviewVolume responsive, but does the patient need volume?