Journal of critical care
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Journal of critical care · Dec 2018
Positive end-expiratory pressure titrated according to respiratory system mechanics or to ARDSNetwork table did not guarantee positive end-expiratory transpulmonary pressure in acute respiratory distress syndrome.
Pulmonary recruitment and positive end-expiratory pressure (PEEP) titrated according to minimal static elastance of the respiratory system (PEEPEstat,RS) compared to PEEP set according to the ARDSNetwork table (PEEPARDSNetwork) as a strategy to prevent ventilator-associated lung injury (VALI) in patients with acute respiratory distress syndrome (ARDS) increases mortality. Alternatively, avoiding negative end-expiratory transpulmonary pressure has been discussed as superior PEEP titration strategy. Therefore, we tested whether PEEPEstat,RS or PEEPARDSNetwork prevent negative end-expiratory transpulmonary pressure in ARDS patients. ⋯ In patients with moderate-to-severe ARDS, PEEP titrated according to the minimal static elastance of the respiratory system or according to the ARDSNetwork table did not prevent negative end-expiratory transpulmonary pressure.
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To determine predictors of inability to return to work due to health six-months after intensive care admission; and compare functional recovery between patients who had not returned to work and employed patients. ⋯ Major trauma, lower GCS and increased hospital length of stay predicted inability to return to work due to health at six-months post-ICU admission. Compared to employed patients, those who had not returned to work reported poorer functional recovery.
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Journal of critical care · Dec 2018
Development and feasibility of a smartphone-based test for the objective detection and monitoring of attention impairments in delirium in the ICU.
Delirium in the ICU is under-diagnosed. We evaluated feasibility and performance of a novel smartphone-based test for objectively detecting inattention in delirium. ⋯ DelApp-ICU shows promise for assessing inattention and delirium in ICU patients, including longitudinally monitoring deficits and providing a metric of delirium severity.
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Journal of critical care · Dec 2018
Acute skeletal muscle wasting and relation to physical function in patients requiring extracorporeal membrane oxygenation (ECMO).
Muscle weakness is common in patients requiring extracorporeal membrane oxygenation (ECMO), but early identification is challenging. This study aimed to 1) quantify the change in quadriceps size and quality (echogenicity) from baseline to day 10 using ultrasound in patients requiring ECMO, 2) determine the relationship between ultrasound measures, muscle strength and highest mobility level. ⋯ In patients requiring ECMO there was marked wasting of the quadriceps over the first 10 days. Ultrasound measures were related to muscle strength and highest mobility level.
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Journal of critical care · Dec 2018
Using survival analysis to predict septic shock onset in ICU patients.
To determine the efficacy of survival analysis for predicting septic shock onset in ICU patients. ⋯ This methodology has the potential to be implemented in the ICU for real time prediction and can be used as a building block to expand the approach to other hospital wards or care environments.