Journal of critical care
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Journal of critical care · Mar 2006
Randomized Controlled Trial Multicenter StudyClinical trial design--effect of prone positioning on clinical outcomes in infants and children with acute respiratory distress syndrome.
This paper describes the methodology of a clinical trial of prone positioning in pediatric patients with acute lung injury (ALI). Nonrandomized studies suggest that prone positioning improves oxygenation in patients with ALI/acute respiratory distress syndrome without the risk of serious iatrogenic injury. It is not known if these improvements in oxygenation result in improvements in clinical outcomes. A clinical trial was needed to answer this question. ⋯ This paper describes the process, multidisciplinary input, and procedures used to support the design of the clinical trial, as well as the challenges faced by the clinical scientists during the conduct of the clinical trial.
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Journal of critical care · Mar 2006
ReviewThe evolution of intensive care unit performance assessment.
Intensive care units (ICUs) share the problems experienced by the health care system at large. Various approaches to define and manage the quality of care patients receive in the ICU have been proposed. ⋯ Successful performance assessment requires the quantification of relevant indexes of performance. Although these indexes are increasingly being developed, it will be some time before widely recognized, validated systems are available.
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Journal of critical care · Mar 2006
Incidence, risk factors, and outcome of ventilator-associated pneumonia.
The purpose of this study is to determine the incidence, risk factors, and outcome of ventilator-associated pneumonia (VAP). ⋯ In a large cohort of mechanically ventilated patients, VAP is more likely in patients with underlying lung disease (acute or chronic). Ventilator-associated pneumonia was associated with a significant increase in ICU length of stay but no increase in mortality.
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Journal of critical care · Mar 2006
Investigation of altered heart rate variability, nonlinear properties of heart rate signals, and organ dysfunction longitudinally over time in intensive care unit patients.
To investigate longitudinally over time heart rate dynamics and relation with mortality and organ dysfunction alterations in patients admitted to a multidisciplinary intensive care unit. ⋯ Loss of variability and increase in periodicity in heart rate of critically ill patients are linked with parallel deterioration of organ dysfunction and high mortality.
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Journal of critical care · Mar 2006
Relative adrenal insufficiency in patients with septic shock; a close look to practice patterns.
To assess patterns of practice in our institution specifically regarding corticosteroid deficiency diagnosis in patients with septic shock. ⋯ Relative adrenal insufficiency was diagnosed in half of the patients investigated. Patients with presumed RAI were more likely to be on phenylephrine or vasopressin infusions and treated with activated protein C and had a longer intensive care unit stay but no difference in intensive care unit survival.