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
Multicenter Study Comparative StudyPlasma-Lyte 148 vs 0.9% saline for fluid resuscitation in diabetic ketoacidosis.
The purpose of the study was to determine the effects of Plasma-Lyte 148 (PL) vs 0.9% saline (NS) fluid resuscitation in diabetic ketoacidosis (DKA). ⋯ Patients with DKA resuscitated with PL instead of NS had faster initial resolution of metabolic acidosis and less hyperchloremia, with a transiently improved blood pressure profile and urine output.
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Journal of critical care · Apr 2012
ReviewEffects of intracellular acidosis on endothelial function: an overview.
The endothelium represents the largest functional organ in the human body playing an active role in vasoregulation, coagulation, inflammation, and microvascular permeability. Endothelium contributes to maintain vascular integrity, intravascular volume, and tissue oxygenation promoting inflammatory network response for local defense and repair. Acid-basis homeostasis is an important physiologic parameter that controls cell function, and changes in pH can influence vascular tone by regulating endothelium and vascular smooth muscle cells. This review presents a current perspective of the effects of intracellular acidosis on the function and the basic regulatory mechanisms of endothelial cells.
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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.
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Journal of critical care · Apr 2012
Weaning predictors do not predict extubation failure in simple-to-wean patients.
Predictor indexes are often included in weaning protocols and may help the intensive care unit (ICU) staff to reach expected weaning outcome in patients on mechanical ventilation. ⋯ Usual weaning indexes are poor predictors for extubation outcome in the overall ICU population.