Journal of intensive care medicine
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J Intensive Care Med · Nov 2014
ReviewThe effect of the pressure-volume curve for positive end-expiratory pressure titration on clinical outcomes in acute respiratory distress syndrome: a systematic review.
Methods to optimize positive end-expiratory pressure (PEEP) in acute respiratory distress syndrome (ARDS) remain controversial despite decades of research. The pressure-volume curve (PVC), a graphical ventilator relationship, has been proposed for prescription of PEEP in ARDS. Whether the use of PVC's improves survival remains unclear. ⋯ This analysis supports an association that ventilator management guided by the PVC for PEEP management may augment survival in ARDS. Nonetheless, only 3 randomized trials have addressed the question, and the total number of patients remains low. Further outcomes studies appear required for the validation of this methodology.
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J Intensive Care Med · Nov 2014
Multicenter StudyThe prevalence and impact of mortality of the acute respiratory distress syndrome on admissions of patients with ischemic stroke in the United States.
To determine the epidemiology of the acute respiratory distress syndrome (ARDS) and impact on in-hospital mortality in admissions of patients with acute ischemic stroke (AIS) in the United States. ⋯ Our analysis demonstrates that ARDS is rare after AIS. Despite an overall significant reduction in mortality after AIS, ARDS carries a higher risk of death in this patient population.
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J Intensive Care Med · Nov 2014
ReviewRetrospective computed tomography mapping of intrapleural air may demonstrate optimal window for ultrasound diagnosis of pneumothorax.
When a pneumothorax exists, free air should rise to the most nondependent region within the chest. Current ultrasound (US) examination methodologies may exclude visualization of these areas that may limit the sensitivity of the examination. This retrospective study uses computed tomography (CT) scans to precisely evaluate where free air within the thorax occurs and correlates this location with a presumably optimal US interrogation window. ⋯ The CT scans demonstrate that intrapleural air most often collects along the mediastinum between ribs 3 and 6 on either side of the chest. Although no USs were performed in this retrospective study, one may infer that a parasternal approach along rib interspaces 3 to 6 is an easy and sensitive window to diagnose pneumothorax with US.
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J Intensive Care Med · Nov 2014
ReviewModern trends in infection control practices in intensive care units.
Hospital-acquired infections (HAIs) are common in intensive care unit (ICU) patients and are associated with increased morbidity and mortality. There has been an increasing effort to prevent HAIs, and infection control practices are paramount in avoiding these complications. In the last several years, numerous developments have been seen in the infection prevention strategies in various health care settings. This article reviews the modern trends in infection control practices to prevent HAIs in ICUs with a focus on methods for monitoring hand hygiene, updates in isolation precautions, new methods for environmental cleaning, antimicrobial bathing, prevention of ventilator-associated pneumonia, central line-associated bloodstream infections, catheter-associated urinary tract infections, and Clostridium difficile infection.
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Although anorectal disorders such as abscess, fissure, and hemorrhoids are typically outpatient problems, they also occur in the critically ill patient population, where their presentation and management are more difficult. This article will provide a brief review of anorectal anatomy, explain the proper anorectal examination, and discuss the current understanding and treatment concepts with regard to the most common anorectal disorders that the intensive care unit clinician is likely to face.