Journal of critical care
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Journal of critical care · Dec 2012
Mechanical ventilation in the emergency department for 24 hours or longer is associated with delayed weaning.
We examined various aspects of critical care to identify factors in the emergency department (ED) that affected the overall duration of mechanical ventilation (MV). We specifically focused on whether 24 hours of ED MV affected the weaning success and the duration of MV. ⋯ Mechanical ventilation in the ED for 24 hours or longer is associated with delayed ventilator weaning.
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Journal of critical care · Dec 2012
Prediction of pulmonary edema by plasma protein levels in patients with sepsis.
The difficulties of fluid therapy in patients with septic shock are to maintain sufficient vascular volume while preventing pulmonary edema formation. Thus, it is important to find a biomarker that can reliably predict pulmonary edema formation after fluid loading. We evaluated the association of plasma protein levels with the increase in extravascular lung water index (ΔEVLWI) after fluid loading. ⋯ Plasma transferrin and albumin levels were associated with ΔEVLWI 10% or higher after fluid loading. The high sensitivity of both biomarkers indicated that patients with normal values were less likely to develop pulmonary edema after fluid loading.
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Journal of critical care · Dec 2012
Clinical TrialChronic heart failure modifies the response to positive end-expiratory pressure in patients with chronic obstructive pulmonary disease.
Potentially beneficial effects of positive end-expiratory pressure (PEEP) in patients with chronic obstructive pulmonary disease (COPD) must be balanced against further overinflation and increased alveolar dead space. Concurrent chronic heart failure (CHF) is common and can lead to changes in lung that can reduce the detrimental effects of PEEP. ⋯ In subjects with severe COPD alone, caution must be used when administering PEEP 10 cm H(2)O or greater. Subjects with COPD + CHF may benefit from higher levels of PEEP.