Journal of critical care
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Journal of critical care · Dec 2012
Diagnosis and treatment of post-extubation dysphagia: results from a national survey.
This study sought to determine the utilization of speech-language pathologist (SLPs) for the diagnosis and treatment of post-extubation dysphagia in survivors of mechanical ventilation. ⋯ SLPs frequently evaluate acute respiratory failure survivors. However, diagnostic evaluations rely mainly upon bedside techniques with uncertain accuracy. The use of instrumental tests varies by geographic location and university affiliation. Current diagnostic practices and feeding decisions for critically ill patients should be viewed with caution until further studies determine the accuracy of bedside detection methods.
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Journal of critical care · Dec 2012
Clinical TrialSystemic and microcirculatory effects of dobutamine in patients with septic shock.
The aim of this study was to characterize the cardiovascular responses to dobutamine and their predictors. Our hypotheses were that dobutamine mainly produces tachycardia and vasodilation and fails to improve the microcirculation of patients with septic shock. ⋯ Dobutamine produced variable hemodynamic effects. Systolic dysfunction was the only variable associated with increases in SVI. Finally, dobutamine only improved sublingual microcirculation when severe alterations were found at baseline.
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Journal of critical care · Dec 2012
Predictors of mortality of mechanically ventilated patients in internal medicine wards.
Budget restrictions have led to shortage of intensive care unit (ICU) beds in several countries. Consequently, ventilated patients are often kept on the wards. This study examined survival likelihood among patients ventilated on the wards and the predictive value of commonly used severity-of-illness scores. ⋯ Mortality in patients ventilated on the ward was high, especially in the subgroup of patients with an APS score greater than 90. The early calculation of APS may assist in focusing therapeutic efforts on patients with better survival chances.
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Journal of critical care · Dec 2012
Acute respiratory distress syndrome related to influenza A H1N1 infection: correlation of pulmonary computed tomography findings to extracorporeal membrane oxygenation treatment and clinical outcome.
The aim of the present study was to correlate computed tomography appearances with clinical severity and outcome using a total lung disease (TLD) score in patients with acute respiratory distress syndrome (ARDS) related to influenza A H1N1 infection. ⋯ A greater extent of air-space disease in ARDS related to influenza A H1N1 infection is associated with progression to ECMO treatment and, therefore, clinical severity. The extent of total air-space disease is greater in younger patients, and obesity is related to a more extensive consolidation.
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Journal of critical care · Dec 2012
Predicting the need for mechanical ventilation in acute exacerbations of chronic obstructive pulmonary disease: comparing the CURB-65 and BAP-65 scores.
Clinicians lack a validated tool for risk stratification for need for mechanical ventilation (MV) in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). We sought to compare 2 risk scores, BAP-65 and CURB-65, at predicting a need for MV in AECOPDs. ⋯ BAP-65 identifies patients with AECOPD at high risk for need of MV more accurately than does CURB-65. BAP-65 may represent a useful tool for initial MV risk stratification in AECOPD.