Journal of intensive care medicine
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J Intensive Care Med · Jan 2008
ReviewNonventilatory interventions in the acute respiratory distress syndrome.
Acute respiratory distress syndrome was first described in 1967. Acute respiratory distress syndrome and acute lung injury are diseases the busy intensivist treats almost daily. The etiologies of acute respiratory distress syndrome are many. ⋯ Most of these therapies either have not been studied in large trials or have failed to show a benefit in terms of long-term patient mortality. Many of these therapies have shown promise in terms of improved oxygenation and may therefore be beneficial as rescue therapy for severely hypoxic patients. Recommendations regarding the use of each of these strategies are made, and an algorithm for implementing these strategies is suggested.
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J Intensive Care Med · Jan 2008
Efficacy of magnesium-amiodarone step-up scheme in critically ill patients with new-onset atrial fibrillation: a prospective observational study.
Amiodarone is considered a first-choice antiarrhythmic drug in critically ill patients with new-onset atrial fibrillation (AF). However, evidence supporting the use of this potentially toxic drug in critically ill patients is scarce. Magnesium sulphate (MgSO4) has shown to be effective for both rate and rhythm control, to act synergistically with antiarrhythmic drugs, and to prevent proarrhythmia. ⋯ The 24-hour conversion rate was 90%. Relapse atrial fibrillation was seen in 7 patients. The magnesium-amiodarone step-up scheme reduces the need for amiodarone, effectively converts new-onset atrial fibrillation into a sinus rhythm within 24 hours, and seems to be safe in critically ill patients.
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J Intensive Care Med · Jan 2008
Minute ventilation recovery time measured using a new, simplified methodology predicts extubation outcome.
Extubation failure is associated with poor intensive care unit and hospital outcomes. Minute ventilation recovery time, an integrative measure of a patient's respiratory reserve, has been shown in a pilot study to predict extubation outcome; however, the methodology is subjective and impractical for routine use. The authors hypothesize that minute ventilation recovery time, measured using an objective and simpler method, would predict extubation outcome. ⋯ Adjustment for significant covariates did not alter the relationship between minute ventilation recovery time >or=5 minutes and extubation failure (odds ratio = 4.9, 95% confidence interval 1.45-16.2, P < .02). C statistic was 0.79 +/- 0.17. It was concluded that minute ventilation recovery time, measured using a feasible methodology, can predict extubation outcome in medical and surgical intensive care unit patients.
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J Intensive Care Med · Nov 2007
Case ReportsExtracorporeal life support in severe propranolol and verapamil intoxication.
Combined poisoning with calcium-channel blockers and beta-blockers is usually associated with severe heart failure. This report shows the effectiveness of emergency extracorporeal life support in treating life-threatening simultaneous propranolol and verapamil intoxication. A 15-year-old girl presented in cardiogenic shock after alcohol consumption and a propranolol and verapamil overdose; plasma concentrations: propranolol, 0.53 m/mL; verapamil, 1.06 mg/mL. ⋯ Emergency extracorporeal life support can successfully maintain vital organ blood flow and allows time for drug metabolism, redistribution, and removal. Therapeutic plasma exchange may reduce the time of emergency extracorporeal life support. Emergency extracorporeal life support should be considered early in cases of near-fatal intoxications with cardiodepressive drugs.
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Overt status epilepticus and persistent obtundation after a witnessed clinical seizure are neurologic emergencies. Early recognition and intervention in the electroclinical syndrome of status epilepticus reduces morbidity, although treatment of the underlying etiology is also critical. ⋯ This review is written from the perspective of the intensive care unit clinician, and the approach and opinions expressed stem from clinical experience and review of the current literature. Particular attention is given to an overall approach to the management of convulsive status epilepticus in adults and older children as well as exploring novel approaches and diagnostic tools that may prove useful in difficult-to-control status epilepticus.