Journal of critical care
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Journal of critical care · Apr 2012
ReviewEffectiveness of extracorporeal membrane oxygenation when conventional ventilation fails: valuable option or vague remedy?
The mortality and morbidity of patients with severe acute respiratory distress syndrome (ARDS) remains high despite the advances in intensive care practice. The low-tidal-volume ventilation strategy (ARDS net protocol) has been shown to be effective in improving survival. Unfortunately, however, some patients have such severe ARDS that they cannot be managed with the ARDS net strategy. ⋯ The recent increased incidence of severe respiratory failure due to H1N1 influenza pandemic has led to an increased use of ECMO. Although several reports showed ECMO use to be encouraging, some scepticism remains. In this article, we reviewed the usefulness of ECMO in patients with severe ARDS in the light of current evidence.
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Journal of critical care · Apr 2012
The evaluation of the effect of body positioning on intra-abdominal pressure measurement and the effect of intra-abdominal pressure at different body positioning on organ function and prognosis in critically ill patients.
Current literatures confirmed the widespread and frequent development of both intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) among the critically ill with a significant associated risk of organ failure and increased mortality. The 2004 International ACS Consensus Conference committee proposed that intra-abdominal pressure (IAP) be measured in complete supine position; however, the supine position of intensive care unit (ICU) patients (<30° of bed increase) presented a significant risk for ventilator-associated pneumonia. Therefore, the potential contribution of head of bed (HOB) position in elevating IAP should be considered. The purpose of this study was to evaluate the effect of body positioning on IAP measurement and the effect of IAP at different body positions on organ function and prognosis in critically ill patients. ⋯ There is a significant and independent relationship between IAP and HOB positioning in critically ill patients, with the HOB of 30° and 45° showing significant difference. Abdominal perfusion pressure and FG are significantly decreased when the patient's HOB is elevated. The potential contribution of body position in elevating IAP should be considered in critically ill patients with the risk of IAH and ACS.
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Journal of critical care · Apr 2012
Relationship between the timing of administration of IgM and IgA enriched immunoglobulins in patients with severe sepsis and septic shock and the outcome: a retrospective analysis.
Because the use of IgM and IgA enriched polyclonal intravenous immunoglobulins (eIg) is a standard of care in critically ill patients admitted to our intensive care unit (ICU) with the diagnosis of severe sepsis or septic shock, we investigated if the delay from the onset of severe sepsis and septic shock and their administration could influence the outcome. ⋯ The efficacy of eIg, being maximal in early phases of severe sepsis and/or septic shock, is probably time dependent.
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Journal of critical care · Apr 2012
Physiologic determinants of prolonged mechanical ventilation in patients after major surgery.
The aim of the study was to evaluate the physiologic determinants of ventilator dependency in patients who underwent major surgery. ⋯ Difficult-to-wean patients after major surgery have overall a limited diaphragm endurance time, in particular, FW breathe very close to the fatigue threshold, and they adopt a rapid shallow breathing respiratory pattern to avoid crossing this threshold.
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Journal of critical care · Apr 2012
Procalcitonin level as an aid for the diagnosis of bacterial infections following pediatric cardiac surgery.
The aim of the present study was to determine if blood procalcitonin can serve as an aid to differentiate between bacterial and nonbacterial cause of fever in children after cardiac surgery. ⋯ During the critical early and late periods after cardiac surgery in children, procalcitonin level may help to differentiate patients with bacterial infection from patients in whom the fever is secondary to nonbacterial infectious causes.