Journal of critical care
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Journal of critical care · Apr 2012
High-frequency oscillatory ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease.
High-frequency oscillatory ventilation (HFOV) is usually considered not indicated for treatment of patients with chronic obstructive pulmonary disease (COPD) because of the theoretical risk of air trapping and hyperinflation. The aim of our study was to establish whether HFOV can be safely applied in patients with acute exacerbation of COPD and hypercapnic respiratory failure. ⋯ Our study indicates that short-term HFOV, using lower mean airway pressures than recommended for acute respiratory distress syndrome, appears safe in patients with COPD while securing adequate pulmonary gas exchange.
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Journal of critical care · Apr 2012
Comparative StudyComparison of CAM-ICU and ICDSC for the detection of delirium in critically ill patients focusing on relevant clinical outcomes.
Delirium is a frequent and serious problem in the intensive care unit (ICU) that is associated with increased mortality, prolonged mechanical ventilation, and prolonged hospital length of stay (LOS). The main objective of the present study was to compare and assess the agreement between the diagnosis of delirium obtained by the Confusion Assessment Method for the ICU (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC) in patients admitted to the ICU and their association with outcomes. ⋯ The findings of our study suggest that the CAM-ICU is better predictor of outcome when compared with ICDSC.
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Most existing literature on noninvasive ventilation (NIV) in combination with helium-oxygen (HELIOX) mixtures focuses on its use in adults, basically for treatment of acute exacerbations of chronic obstructive pulmonary disease. This article reviews and summarizes the theoretical basis, existing clinical evidence, and practical aspects of the use of NIV with HELIOX in children. There is only a small body of literature on HELIOX in pediatric NIV but with positive results. ⋯ The inert nature of helium adds no biological risk to NIV performance. Noninvasive ventilation with HELIOX is a promising therapeutic option for children with various respiratory pathologies who do not respond to conventional treatment. Further controlled studies should be warranted.
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Journal of critical care · Apr 2012
Feasibility of continuous multiorgan variability analysis in the intensive care unit.
The aim of the study was to evaluate the feasibility of continuous heart and respiratory rate variability (HRV and RRV, respectively) monitoring in critically ill patients derived from electrocardiogram (ECG) and end-tidal capnography (etCO(2)) waveforms. ⋯ The quality of continuously recorded ECG and etCO(2) waveforms in critically ill patients is adequate for subsequent continuous variability monitoring in this pilot study. The clinical utility of continuous variability analysis merits further investigation.
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Journal of critical care · Apr 2012
Multicenter StudyBlood glucose amplitude variability as predictor for mortality in surgical and medical intensive care unit patients: a multicenter cohort study.
The aim of this study was to test the hypothesis that blood glucose amplitude variability (BGAV) is associated with mortality in critically ill patients. ⋯ Not all BGAV measures were associated with mortality. Blood glucose amplitude variability as quantified by SD was consistently independently associated with hospital mortality.