Journal of intensive care medicine
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J Intensive Care Med · May 2005
Comparative StudyOutcome of morbid obesity in the intensive care unit.
This was a retrospective chart review of consecutive obese patients admitted to the medical intensive care unit. Patients were divided into 2 groups: mild to moderately obese (group 1, body mass index =30-40 kg/m(2)) and morbidly obese (group 2, body mass index >40 kg/m(2)). Acute Physiology and Chronic Health Evaluation II scores were not significantly different between the 2 groups. ⋯ Their median length of mechanical ventilation was longer (2 days, range 2-12 vs 9 days, range 1-37,P = .009). In a logistic regression analysis, morbid obesity remained a significant predictor of death or disposition to nursing home even after controlling for age (P = .019, odds ratio = 7.60, 95% confidence interval = 1.39-41.6). Morbidly obese patients (body mass index >40 kg/m(2)) admitted to intensive care units have higher rates of mortality, nursing home admission, and intensive care unit complications and have longer stays in the intensive care unit and time on mechanical ventilation.
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J Intensive Care Med · Mar 2005
Review Case ReportsDexmedetomidine in the treatment of withdrawal syndromes in cardiothoracic surgery patients.
Dexmedetomidine (Precedex, Abbott Laboratories, Abbott Park, IL) is an alpha 2 adrenergic agonist that possesses a high ratio of specificity for the alpha 2 versus the alpha 1 receptor. It is currently approved for the provision of sedation during mechanical ventilation in adults. ⋯ The authors present their experience with the use of dexmedetomidine to control withdrawal behavior in 3 patients following cardiothoracic surgery. Previous reports regarding the use of dexmedetomidine to treat withdrawal and its potential application in this clinical arena are reviewed.
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J Intensive Care Med · Mar 2005
Review Comparative StudyUse of cellular and plasma apheresis in the critically ill patient: Part II: Clinical indications and applications.
Apheresis is the process of separating the blood and removing or manipulating a cellular or plasma component for therapeutic benefit. Such procedures may be indicated in the critical care setting as primary or adjunctive therapy for certain hematologic, neurologic, renal, and autoimmune/rheumatologic disorders. In part I of this series, the technical aspects of apheresis were described and the physiologic rationale and clinical considerations were discussed. ⋯ The choice of plasma or cellular apheresis in these cases is guided by well-accepted, evidence-based clinical treatment guidelines. For some disorders, such as liver failure, severe sepsis, and multiple-organ dysfunction syndrome, apheresis treatment approaches remain experimental. Ongoing studies are investigating the potential utility of conventional plasma exchange, ex vivo plasma manipulation, and newer technologies for these and other disorders in severely ill patients.
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J Intensive Care Med · Jan 2005
Clinical TrialAcute effects of upright position on gas exchange in patients with acute respiratory distress syndrome.
Patients with acute respiratory distress syndrome (ARDS) have dorsal atelectasis of the lungs. This is probably caused by several mechanisms: compression on dependent lung zones, purulent secretions in alveoli, and upward shift of the diaphragm. An upright position (UP) of the patient (the whole body in a straight line at 40 to 45 degrees) can theoretically ameliorate these mechanisms. ⋯ There was a significant increase of the PaO2/FiO2 ratio during UP (P < .001). Except for the need for volume resuscitation in 5 patients (27.8%), there was no significant change in the hemodynamic profile of the patients. Upright positioning of patients with ARDS, a relatively simple maneuver, resulted in an improvement of gas exchange and was tolerated hemodynamically relatively well during a 12-hour observation period.
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J Intensive Care Med · Jan 2005
Comparative StudyCVP and PAoP measurements are discordant during fluid therapy after traumatic brain injury.
The objective of the study was to compare measurements of central venous pressure (CVP) and pulmonary artery occlusion pressures (PAoP) as estimates of intravascular volume during the first 96 hours of fluid therapy after traumatic brain injury (TBI). One thousand five hundred ten simultaneous CVP and PAoP measurements from 31 patients entered into the National Acute Brain Injury Study: Hypothermia (NABISH:H) protocol were retrospectively compared. The effect of fluid administration and body temperature upon the paired measurements was statistically assessed. ⋯ However, during initial therapy, estimates of intravascular volume provided by the CVP and PAoP are discordant. Although documented in other clinical conditions, the disparity noted here after TBI has not been previously reported. Assessment of intravascular volume to avoid hypovolemia should utilize other measurement techniques.