Journal of critical care
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Journal of critical care · Oct 2012
Randomized Controlled Trial Comparative StudyComparative study of pressure- and volume-controlled ventilation on stroke volume variation as a predictor of fluid responsiveness in patients undergoing major abdominal surgery.
We hypothesized that the 2 ventilation modes might have a different influence on the stroke volume variation (SVV). This study investigated the effect of the ventilation modes on SVV as a predictor of fluid responsiveness during major abdominal surgery. ⋯ Stroke volume variation can predict fluid responsiveness during both VCV and PCV modes. However, the optimal threshold values of SVV may differ according to the ventilation modes.
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Journal of critical care · Oct 2012
Randomized Controlled TrialEffect of osmotic agents on regional cerebral blood flow in traumatic brain injury.
Cerebral blood flow (CBF) is reduced after severe traumatic brain injury (TBI) with considerable regional variation. Osmotic agents are used to reduce elevated intracranial pressure (ICP), improve cerebral perfusion pressure, and presumably improve CBF. Yet, osmotic agents have other physiologic effects that can influence CBF. We sought to determine the regional effect of osmotic agents on CBF when administered to treat intracranial hypertension. ⋯ Osmotic agents, in addition to lowering ICP, improve CBF to hypoperfused brain regions in patients with intracranial hypertension after TBI.
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Journal of critical care · Oct 2012
ReviewFever in non-neurological critically ill patients: a systematic review of observational studies.
There is no recommendation on how increased body temperature should be treated in non-neurological critically ill patients. To understand the epidemiology of fever and its association with mortality, we conducted a systematic review of the literature to search for data related to the association between fever and mortality. ⋯ The limited evidence available suggests that the recommended definition of fever (38.3°C) might be too low to predict increased mortality. Because fever is common in the intensive care unit, there is an urgent need for more studies in this field.
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Journal of critical care · Oct 2012
ReviewNoise in hospital intensive care units--a critical review of a critical topic.
The aims of the study were to examine the studies related to hospital noise in intensive care units (ICUs) to understand the sources and effects of noise and to describe best practices and common problems in the varying methods commonly applied to reduce the noise level. ⋯ Significant opportunities exist to improve methodologies to study noise levels to reduce noise in hospital ICUs. Many previous studies have used inconsistent methodologies with poorly defined parameters that make it difficult to compare results. Our work points out common pitfalls in the recording and sharing of hospital acoustic parameters and also points to the paucity of important economic considerations in extant studies. These results can be helpful for future research in this area. Many past salutary interventions--including educational noise reduction programs, behavioral modification using sound detection equipment, and low- as well as high-cost environmental alterations--do not generally appear to be adequate to minimize noise to levels for hospital rooms specified by international agencies. But a potentially important clue for future work involves the finding that as the number of patients and staff of the ICU increases, noise levels appear to also increase.
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Journal of critical care · Oct 2012
African American race, obesity, and blood product transfusion are risk factors for acute kidney injury in critically ill trauma patients.
Acute kidney injury (AKI) is a common source of morbidity after trauma. We sought to determine novel risk factors for AKI, by Acute Kidney Injury Network (AKIN) criteria, in critically ill trauma patients. ⋯ Acute kidney injury in critically ill trauma patients is associated with substantial mortality. The findings of African American race, obesity, and blood product administration as independent risk factors for AKI deserve further study to elucidate underlying mechanisms.