Journal of critical care
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Journal of critical care · Apr 2017
Randomized Controlled TrialActivation of respiratory muscles during weaning from mechanical ventilation.
Respiratory muscle dysfunction is a key component of weaning failure. Balancing respiratory muscle loading and unloading by applying different ventilation modes along with spontaneous breathing episodes are established weaning strategies. However, the effects of body positioning on the respiratory muscles during weaning remains unclear. ⋯ This is the first study to show that body positioning influences respiratory drive to the diaphragm in tracheotomized patients with prolonged weaning from mechanical ventilation during unassisted breathing. Sitting position reduces respiratory drive compared with semirecumbent and supine positioning and might therefore be favored during spontaneous breathing trials.
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Journal of critical care · Apr 2017
Effectiveness of 7.5% hypertonic saline in children with severe traumatic brain injury.
Hyperosmolar therapies aim at controlling increased intracranial pressure (ICP) in patients with traumatic brain injury (TBI). The aim of this study was to evaluate the effect of 7.5% hypertonic saline (HTS) on ICP and cerebral perfusion pressure (CPP) in children with severe TBI. ⋯ In our study, 7.5% HTS infusion as a second-tier osmotic therapy was associated with significant reduction of ICP and increase of CPP in children with severe TBI.
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Journal of critical care · Apr 2017
Mortality, length of stay, bloodstream and respiratory viral infections in a pediatric intensive care unit.
We investigated whether diagnostic categories and presence of infections were associated with increased mortality or length of stay (LOS) in patients admitted to a pediatric intensive care unit (PICU). ⋯ Patients with diagnoses of leukemia, lymphoma, cardiomyopathy/myocarditits, encephalitis, and comorbidity of bloodstream infections and pneumococcal disease were significantly at risk of PICU mortality. Length of stay of survivors was associated with bloodstream gram-positive infection. The highest odds for death were among patients with leukemia/lymphoma and bloodstream coinfection. As early diagnosis of these childhood malignancies is desirable but not always possible, adequate and early antimicrobial coverage for gram-positive and gram-negative bacteria might be the only feasible option to reduce PICU mortality in these patients. In Hong Kong, a subtropical Asian city, none of the common respiratory viruses were associated with increased mortality or LOS in PICU.
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Journal of critical care · Apr 2017
Risk factors for acute kidney injury in critically ill patients with complicated intra-abdominal infection.
The aim was to determine the factors related to acute kidney injury (AKI) in surgical septic patients with complicated intra-abdominal infection (CIAI) and mortality associated to AKI. ⋯ Acute kidney injury in patients with CIAI is clearly associated with SOFA and creatinine at admission. Severe AKI with RRT need is highly associated with both previous arterial hypertension and the number of previous medications potentially affecting renal function.