Journal of critical care
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Journal of critical care · Jun 2014
Randomized Controlled TrialCycling-off modes during pressure support ventilation: Effects on breathing pattern, patient effort, and comfort.
Expiratory asynchrony during pressure support ventilation (PSV) has been recognized as a cause of patient discomfort, increased workload, and impaired weaning process. We evaluated breathing pattern, patient comfort, and patient effort during PSV comparing 2 flow termination criteria: fixed at 5% of peak inspiratory flow vs automatic, real-time, breath-by-breath adjustment within the range of 5% to 55%. ⋯ When compared with a fixed termination criterion, the use of a variable, real-time-adjusted termination criterion improved some indices of patient-ventilator synchrony, producing better breathing pattern, less discomfort, and slightly lower patient effort during PSV.
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Journal of critical care · Jun 2014
Randomized Controlled Trial Multicenter StudyDoes the achievement of an intermediate glycemic target reduce organ failure and mortality? A post hoc analysis of the Glucontrol trial.
This research evaluates the impact of the achievement of an intermediate target glycemic band on the severity of organ failure and mortality. ⋯ There was no difference in organ failure in the Glucontrol study based on intention to treat to different glycemic targets. Actual outcomes and significant crossover indicate that this result may not be due to the difference in target or treatment. Odds ratios-associated achieving an intermediate 4.0 to 7.0 mmol/L range improved outcome.
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Journal of critical care · Jun 2014
Randomized Controlled Trial Multicenter StudyRelative adrenal insufficiency in critically ill patient after rapid sequence intubation: KETASED ancillary study.
Relative adrenal insufficiency (RAI) has been reported as a predictor of mortality in septic patient; however, its effects on mortality and outcomes for critically ill patients remain debatable. The objective of this study was to assess the effect of RAI on prognostic outcomes in patients after out-of-hospital rapid sequence intubation (RSI) and factors associated with the onset of RAI. ⋯ In critically ill patients who require RSI, RAI is common and is not associated with worsened outcomes in our cohort.
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Journal of critical care · Jun 2014
Randomized Controlled TrialThe effect of the arterial catheter insertion technique on the success of radial artery cannulation: A prospective and randomized study.
The main objective of the current investigation was to compare a single wall puncture to vessel transfixing on the success of radial artery cannulation by resident physicians. ⋯ Our findings suggest that there does not appear to be an advantage of the transfixing technique over the single wall puncture method for cannulating the radial artery by resident physicians. Cannulation was achieved in shorter time using the single wall puncture technique even after accounting for differences between residents and prior levels of experience.
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Journal of critical care · Jun 2014
Randomized Controlled TrialAssociation between sympathoadrenal activation, fibrinolysis, and endothelial damage in septic patients: A prospective study.
The purpose of this study is to investigate potential associations between sympathoadrenal activation and/or vasopressor/inotropic therapy and endothelial activation, damage, and coagulopathy in septic patients. ⋯ In septic patients, endogenous noradrenaline was independently associated with biomarkers of endothelial activation, damage, fibrinolysis and mortality, comparable with findings in trauma and myocardial infarction patients. The catecholamine surge in critical illness may contribute to balance endothelial damage and procoagulation with hypocoagulability and hyperfibrinolysis in the circulating blood.