Intensive care medicine
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Intensive care medicine · Sep 2002
Comparative Study Clinical TrialEffects of positive end-expiratory pressure on dead space and its partitions in acute lung injury.
A large tidal volume (VT) and lung collapse and re-expansion may cause ventilator-induced lung injury (VILI) in acute lung injury (ALI). A low VT and a positive end-expiratory pressure (PEEP) can prevent VILI, but the more VT is reduced, the more dead space (VD) compromises gas exchange. We investigated how physiological, airway and alveolar VD varied with PEEP and analysed possible links to respiratory mechanics. ⋯ Alveolar VD is large and does not vary systematically with PEEP in patients with various degrees of ALI. Individual measurements show a diverse response to PEEP. Respiratory mechanics were of no help in optimising PEEP with regard to gas exchange.
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Intensive care medicine · Sep 2002
Comparative StudyDiagnostic accuracy of G-CSF, IL-8, and IL-1ra in critically ill children with suspected infection.
To elucidate the diagnostic accuracy of granulocyte colony-stimulating factor (G-CSF), interleukin-8 (IL-8), and interleukin-1 receptor antagonist (IL-1ra) in identifying patients with sepsis among critically ill pediatric patients with suspected infection. ⋯ In this heterogeneous population of critically ill children with suspected infection, a model combining plasma levels of IL-8 and G-CSF identified patients with sepsis. Negative results do not rule out S. epidermidis bacteremia or locally confined infectious processes. The model requires validation in an independent data-set.
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Intensive care medicine · Sep 2002
Comparative StudyPredictive value of procalcitonin and interleukin 6 in critically ill patients with suspected sepsis.
To evaluate the performance of procalcitonin (PCT), interleukin-6 (IL-6), C-reactive protein, leukocyte count, D-dimer, and antithrombin III at onset of septic episode and 24 h later in prediction of hospital mortality in critically ill patients with suspected sepsis. ⋯ Admission and day 2 IL-6, and day 2 PCT, and day 2 D-dimer values differed significantly between hospital survivors and nonsurvivors among critically ill patients with suspected sepsis. However, in prediction of hospital mortality, only the discriminative power of day 2 PCT and IL-6 values, and APACHE II was reasonable as judged by AUC analysis (>0.75).
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Intensive care medicine · Sep 2002
Clinical Trial Controlled Clinical TrialNoninvasive ventilation for treating acute respiratory failure in AIDS patients with Pneumocystis carinii pneumonia.
To compare noninvasive positive pressure ventilation (NPPV) vs. invasive mechanical ventilation in AIDS patients with Pneumocystis carinii pneumonia (PCP)-related acute respiratory failure (ARF). ⋯ The findings of this study seem to provide further support for applying NPPV in AIDS patients with severe PCP-related ARF as a first-line therapeutic choice, but randomized controlled trials are required to confirm our results.
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Intensive care medicine · Sep 2002
Comparative StudyOutcome and prognostic features of intensive care unit treatment in patients with hematological malignancies.
To assess the outcome of intensive care unit (ICU) treatment in patients with hematological malignancies. ⋯ The outcome of patients not requiring ventilatory support in this study was encouraging, while invasive ventilation was again confirmed as predicting a dismal prognosis in this population. Efforts should be directed to avoiding this procedure by reducing the pulmonary toxicity of antineoplastic treatment and to making ventilatory support more tolerable.