Intensive care medicine
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Intensive care medicine · Jul 2002
Clinical Trial Controlled Clinical TrialChest physiotherapy for the prevention of ventilator-associated pneumonia.
Pneumonia is an important complication in patients who are intubated and mechanically ventilated, when it is commonly referred to as ventilator-associated pneumonia (VAP). Since VAP may be contributed to by impaired sputum clearance, we studied whether chest physiotherapy designed to enhance sputum clearance decreases the occurrence of VAP. ⋯ In this small trial, chest physiotherapy in ventilated patients was independently associated with a reduction in VAP. This suggested benefit of physiotherapy in prevention of VAP requires confirmation with a larger randomised controlled trial.
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Intensive care medicine · Jul 2002
ReviewClinical implications of antibiotic-induced endotoxin release in septic shock.
Antibiotic-induced release of bacterial cell wall components can have immediate adverse effects for the patient. This article reviews the data on endotoxin release after initiation of antibiotic therapy and its role in the pathogenesis of sepsis and septic shock. ⋯ Antibiotics that induce the formation of long, aberrant bacterial cells before effectively killing the microorganisms show the highest degree of endotoxin liberation. There is increasing evidence from animal models and clinical studies of sepsis that the antibiotic-mediated release of biologically active cell wall components derived from Gram-positive, Gram-negative or fungal organisms is associated with a rapid clinical deterioration.
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Intensive care medicine · Jul 2002
Comparative StudyInfluences on physicians' choices of intravenous colloids.
Controversy over the optimal intravenous fluid for volume resuscitation continues unabated. Our objectives were to characterize the demographics of physicians who prescribe intravenous colloids and determine factors that enter into their decision to choose a colloid. ⋯ The majority of physicians surveyed prescribe colloid products and the reported use of albumin and pentastarch has a bimodal distribution. Although albumin appeared to be preferred in more clinical niches, most physicians did not state reasons for choosing between products. Marketing, specialty, location of practice and clinical scenario appear to play significant roles in the utilization of colloid products.
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Intensive care medicine · Jul 2002
Kinetic and reversibility of mechanical ventilation-associated pulmonary and systemic inflammatory response in patients with acute lung injury.
To investigate the kinetic and reversibility of mechanical ventilation-associated pulmonary and systemic inflammatory response in patients with acute lung injury (ALI). ⋯ In patients with ALI, initiation of low PEEP and high V(T) mechanical ventilation is associated with cytokine release into circulation which occurred within 1 h. It is independent from BAL procedures and can be reversed by reinstitution of lung protective mechanical ventilation.