Journal of critical care
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Journal of critical care · Oct 2019
Randomized Controlled Trial Multicenter Study Comparative StudyAnalgesia-first sedation in critically ill adults: A U.S. pilot, randomized controlled trial.
To determine the feasibility of conducting a multicenter ICU RCT of AFS compared to either protocol-directed sedation (PDS) or both PDS and daily sedation interruption (DSI) in North America. ⋯ A multicenter RCT evaluating AFS is feasible to conduct in North America.
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Journal of critical care · Oct 2019
ReviewClinical controversies in abdominal sepsis. Insights for critical care settings.
Sepsis is a deadly condition in which the outcome is associated with prompt and adequate recognition, intensive supportive care, antibiotic administration and source control. This last item makes abdominal sepsis a unique treatment challenge. Although pneumonia constitutes the leading cause of sepsis, abdominal sepsis has unique features that merit discussion. ⋯ The epidemiology of abdominal sepsis and its outcomes are difficult to assess due to the large clinical heterogeneity associated with this entity. Further complicating issues is the debate surrounding the effect of early source control (i.e. the "surgeon effect"). This review evaluates and summarizes the current approach to current challenges in patient care and which are the future research directions.
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Journal of critical care · Oct 2019
Randomized Controlled TrialAeration changes induced by high flow nasal cannula are more homogeneous than those generated by non-invasive ventilation in healthy subjects.
Non-invasive mechanical ventilation (NIV) is a standard respiratory support technique used in intensive care units. High-Flow Nasal Cannula (HFNC) has emerged as an alternative, but further evidence is needed. The lung aeration and diaphragm changes achieved with these two strategies in healthy subjects have not been compared to date. ⋯ NIV and HFNC increased EELI in healthy subjects, suggesting an increase in the functional residual capacity. The EELI increase may be higher in NIV, but HFNC produced a more homogeneous change in lung ventilation. HFNC group has a higher MAR-index that could reflect a different ventilatory system adaptation.
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Journal of critical care · Oct 2019
Randomized Controlled TrialIncreasing support by nasal high flow acutely modifies the ROX index in hypoxemic patients: A physiologic study.
The ROX (Respiratory rate-OXygenation) index is an early predictor of failure of nasal high flow (NHF), with lower values indicating higher risk of intubation. We measured the ROX index at set flow rate of 30 and 60 l/min in 57 hypoxemic patients on NHF. ⋯ The ROX index variation between flows was correlated with the change in end expiratory lung volume. Set flow rate during NHF might impact the ROX index value.
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With advances in critical care and organ donation, diagnosis of brain death is gaining importance. We aimed to assess potential brain death confounders from the literature, elucidating clinical presentation and diagnostic approaches in these cases. ⋯ Brain death confounders are infrequently reported and formal studies are lacking. Mainly younger patients with polyneuritis and intoxications are described. As outcome, especially in the latter, is often favourable, high awareness and strict adherence to guidelines is crucial. The importance of identifying pathologies compatible with extensive and irreversible brain damage before proceeding to diagnostic tests should be emphasized.