Journal of critical care
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Journal of critical care · Apr 2013
ReviewHyponatremia in critical care patients: frequency, outcome, characteristics, and treatment with the vasopressin V2-receptor antagonist tolvaptan.
Hyponatremia is a common problem in critical care patients and is associated with increased duration of hospital stay and increased morbidity and mortality. The prevalence of hyponatremia in the intensive care unit (ICU) has been reported to be as high as 30% to 40%. Recent studies have found hyponatremia at ICU admission in up to 14% of patients in unselected groups; patients with hyponatremia were at elevated risk of mortality vs normonatremic patients. ⋯ Tolvaptan treatment increases serum sodium via aquaresis-ie, increased electrolyte-free water excretion-and thus presents an advantage in patients with syndrome of inappropriate secretion of antidiuretic hormone or other euvolemic states or hypervolemic hyponatremia. This article provides a review of hyponatremia and of the potential use of tolvaptan in critical care settings. Case reports provide examples of tolvaptan use in correcting severe hyponatremia and associated abnormal mental status and in resolving hyponatremia prior to surgery.
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Journal of critical care · Apr 2013
Cerebral herniation associated with central venous catheter insertion: risk assessment.
Central venous catheters (CVCs) are often necessary to treat acute brain-injured patients. Four cases of cerebral herniation immediately following central venous catheterization were the impetus for an investigation of clinical and radiologic parameters associated with this complication. ⋯ Trendelenburg and even flat position during CVC placement can increase intracranial pressure leading to cerebral herniation in patients with significant intracranial mass effect. Careful review of neuroimaging for signs of impending herniation before inserting CVCs and choosing an alternative treatment plan in these cases may avoid this potentially underreported complication.
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Journal of critical care · Apr 2013
Review Meta AnalysisProphylactic magnesium for improving neurologic outcome after aneurysmal subarachnoid hemorrhage: systematic review and meta-analysis.
Neurologic disability is common after aneurysmal subarachnoid hemorrhage (aSAH). Our objective was to systematically review the prophylactic use of magnesium to improve neurologic outcomes in these patients. ⋯ Despite decreasing the incidence of DCI in patients with aSAH, prophylactic intravenous magnesium does not improve neurologic outcome or decrease cerebral infarction, radiographic vasospasm, or mortality.
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Journal of critical care · Apr 2013
Review Meta AnalysisTracheostomy teams reduce total tracheostomy time and increase speaking valve use: a systematic review and meta-analysis.
Multidisciplinary tracheostomy teams have been implemented in acute hospitals over the past 10 years. This systematic review of the literature and meta-analysis aimed to assess the effect of tracheostomy teams on patient outcomes. ⋯ There is low-quality evidence that multidisciplinary tracheostomy care contributes to a reduction in total tracheostomy time and increase speaking valve use for patients leading to improved quality of life. There is insufficient evidence to determine that multidisciplinary tracheostomy teams reduce hospital or intensive care unit LOS.
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Journal of critical care · Apr 2013
Randomized Controlled TrialInhaled Dornase alfa (Pulmozyme) as a noninvasive treatment of atelectasis in mechanically ventilated patients.
Lobar or segmental collapse of the lung in mechanically ventilated patients is a common occurrence in the intensive care unit. Management is labor and time intensive and not highly effective. ⋯ Dornase alfa does not improve the appearance of atelectasis on chest radiographs, or the "Total Chest X-Ray Score" over the first 5 days of treatment in mechanically ventilated patients. The intervention group's higher rate of extubation during the first 24 hours as well as its improved oxygenation on day 5 were likely chance findings given the multiple potential confounders for extubation and low study power.