Journal of critical care
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Ventilator-associated pneumonia (VAP) is difficult to diagnose. Recent data suggest quantitative endotracheal aspirate (ETA) may be noninferior diagnostically to quantitative bronchoalveolar lavage (BAL). We hypothesized this would be the case. ⋯ Quantitative BAL is safe and has greater diagnostic utility than ETA for VAP facilitates de-escalation. This study provides support for quantitative BAL in VAP diagnosis.
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Journal of critical care · Sep 2009
Effects of inhalational bronchodilator treatment during noninvasive ventilation in severe chronic obstructive pulmonary disease exacerbations.
To study the effects of withdrawing noninvasive ventilation (NIV) used during acute exacerbation of chronic obstructive pulmonary disease for the delivery of aerosolized medications on physiologic parameters and dyspnea sensation. ⋯ Short-term cessation of NIV for nebulization treatment did not result in distress, discomfort, or physiologic instabilities. The only detectable changes were increase in SBP and HR, probably due to the systemic adrenergic effects of salbutamol.
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Journal of critical care · Sep 2009
Prognosis and 1-year mortality of intensive care unit patients with severe hepatic encephalopathy.
Data regarding outcome of patients with chronic liver disease with severe hepatic encephalopathy in intensive care unit are currently scarce. ⋯ Predictors of outcome were similar to other groups of patients with liver disease admitted for other reasons. Intensive care unit mortality was lower than reported for other groups of patients with similar illness. Patients with severe HE admitted to ICU with no organ dysfunction other than mechanical ventilation had a better outcome and may require ICU admission.
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Journal of critical care · Sep 2009
Outcomes of cardiopulmonary resuscitation for patients on vasopressors or inotropes: a pilot study.
Outcomes of critically ill patients who receive cardiopulmonary resuscitation (CPR) are poor, and the subgroup on vasopressors or inotropes before cardiopulmonary arrest (CPA) rarely survives. ⋯ Survival of patients requiring CPR during critical care admission was 17%. Very few patients survived who required vasopressors or inotropes immediately before CPA. This study is limited significantly by its retrospective design and small cohort, and so this question should be reexamined in a larger study.
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Journal of critical care · Sep 2009
The diagnosis of myocardial infarction in critically ill patients: an agreement study.
The aim of the study was to assess agreement among 4 intensivists in diagnosing myocardial infarction (MI) in critically ill patients based on screening electrocardiograms (ECGs) and cardiac troponin (cTn) levels. ⋯ Diagnosing MI in the ICU remains a challenge due to variable agreement in 12-lead ECG interpretation. Such variation in practice may contribute to underrecognition of MI during critical illness.