Journal of intensive care medicine
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J Intensive Care Med · Mar 2012
The acute effectiveness and safety of the constant-flow, pressure-volume curve to improve hypoxemia in acute lung injury.
To investigate the effectiveness of the constant-flow, pressure-volume curve (PVC) to prescribe positive end-expiratory pressure (PEEP) in acute lung injury (ALI) and risk of cardiopulmonary deterioration during the PVC process. ⋯ In the setting of acute lung injury, use of the constant-flow, pressure-volume curve to prescribe PEEP appears associated with improvement in oxygenation with limited risk of acute, process-related, cardiopulmonary deterioration.
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J Intensive Care Med · Mar 2012
Case ReportsRapid rewarming of hypothermic patient using arctic sun device.
There are multiple commercially made devices currently available for inducing hypothermia in patients with postcardiac arrest, but whether these devices can be used successfully for rewarming patients suffering from accidental hypothermia remains largely unexplored. We describe a case in which a patient with severe accidental hypothermia secondary to environmental exposure was successfully, safely, and rapidly warmed using a temperature regulation device traditionally used for therapeutic hypothermia (TH) in patients with postcardiac arrest. Clinicians may wish to consider the use of these devices when attempting to warm patients suffering from severe environmental hypothermia.
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Early recognition and differentiation of shock, as well as goal-directed resuscitation, are fundamental principles in the care of the critically ill or injured patient. Substantial progress has been made over the last decade in the understanding of both shock and resuscitation. ⋯ These include the optimal targets for perfusion pressure and oxygen delivery, endpoints of resuscitation, resuscitative fluid, and transfusion strategies for packed red blood cells and blood products. This article reviews the diagnosis and differentiation of shock, measurements of tissue perfusion, current evidence regarding various resuscitative techniques, and complications of resuscitation.
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J Intensive Care Med · Feb 2012
Comparative StudyPerspectives of physicians and nurses regarding end-of-life care in the intensive care unit.
The delivery of end-of-life care (EOLC) in the intensive care unit (ICU) varies widely among medical care providers. The differing opinions of nurses and physicians regarding EOLC may help identify areas of improvement. ⋯ Even with an increased focus on improving EOLC, significant differences continue to exist between the perspectives of nurses and physicians, as well as physicians among themselves and nurses among themselves. These differences may represent significant barriers toward providing comprehensive, consistent, and coordinated EOLC in the ICU.
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J Intensive Care Med · Feb 2012
Risk factors and outcome of changes in adrenal response to ACTH in the course of critical illness.
To evaluate the concept of critical illness-related corticosteroid insufficiency (CIRCI) by studying the clinical significance, in terms of risk factors and outcome, of changes in the cortisol response to repeated adrenocorticotropic hormone (ACTH) testing in the course of critical illness. ⋯ The findings favor the concept of dynamic adrenal function rather than poor reproducibility of the ACTH test, so that development of CIRCI, particularly in complicated septic shock and indicated by a fall in Δcortisol (to <100 nmol/L) upon ACTH, correlates to a poor prognosis, independently of baseline cortisol, cortisol binding in blood, and disease severity.