Journal of intensive care medicine
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J Intensive Care Med · Jul 2009
ReviewHigh-frequency oscillatory ventilation (HFOV) and airway pressure release ventilation (APRV): a practical guide.
Despite advances in ventilator management, 31% to 38% of patients with adult respiratory distress syndrome (ARDS) will die, some from progressive respiratory failure. Inability to adequately oxygenate patients with severe ARDS has prompted extensive efforts to identify what are now known as alternative modes of ventilation including high-frequency oscillatory ventilation and airway pressure release ventilation. ⋯ Although a mortality benefit has not been proven, some patients may benefit from these alternative modes of ventilation as rescue measures while the underlying process resolves. The purpose of this article is to review the evidence and mechanisms underlying each modality and to describe the fundamental steps in initiating, adjusting, and terminating these modes of ventilation.
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J Intensive Care Med · Jul 2009
Insulin resistance despite tight glucose control is associated with mortality in critically ill surgical patients.
The hyperglycemic state following trauma and surgery is related partially to insulin resistance (IR). The objective is to determine if critically ill surgical patients vary in their extent of IR and is IR associated with mortality. ⋯ There was a large amount of variation in insulin resistance, as measured by an adapting multiplier, both across the population and within patients. In the setting of tight glucose control measures of glucose control (median blood glucose and percent in range) do not differentiate between patients who lived and died while measures of insulin resistance (median insulin dose and multiplier) do, suggesting that the insulin resistance is a better predictor of outcome.
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J Intensive Care Med · May 2009
Decannulation following tracheostomy for prolonged mechanical ventilation.
We examined the process of decannulation following tracheostomy in patients transferred to a long-term acute care (LTAC) hospital for weaning from prolonged mechanical ventilation (PMV). ⋯ Decannulation was achieved in 35% of patients transferred to an LTAC for weaning from prolonged mechanical ventilation.
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J Intensive Care Med · May 2009
ReviewCoronary angiography predicts improved outcome following cardiac arrest: propensity-adjusted analysis.
Determine if clinical parameters of resuscitated patients predict coronary angiography (CATH) performance and if receiving CATH after cardiac arrest is associated with outcome. ⋯ CATH is more likely to be performed in certain patients and identifies a significant number of high-grade stenoses in this population. Receiving CATH was independently associated with good outcome.