Journal of critical care
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Journal of critical care · Jun 2011
Respiratory impact of paracentesis in cirrhotic patients with acute lung injury.
Ascites may contribute to the loss of lung volume and alter the gas exchange in cirrhotic patients with acute lung injury (ALI). ⋯ In contrast to ventilatory recruitment maneuvers, paracentesis is a simple and well-tolerated technique able to improve oxygenation and alveolar recruitment without the risk of the lung overdistension in severely hypoxemic cirrhotic patients.
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Journal of critical care · Jun 2011
Survival and quality of life after tracheostomy for acute respiratory failure in patients with amyotrophic lateral sclerosis.
Acute respiratory failure (ARF) is a common event in the advanced stage of amyotrophic lateral sclerosis (ALS) and may be rarely a presenting symptom. Frequently, such patients require intubation and mechanical ventilation (MV) and, in a large proportion, receive tracheostomy, as a consequence of weaning failure. In our study, we investigated postdischarge survival and quality of life (QoL) after tracheostomy for ARF in patients with ALS. ⋯ Patients with ALS have a high chance of long-term survival after tracheostomy for ARF. Although administered at the time of a respiratory crisis without being discussed in advance, tracheostomy shows good acceptance and results in acceptable QoL.
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Journal of critical care · Jun 2011
Protein C as an early biomarker to distinguish pneumonia from sepsis.
Patients with pneumonia often are unrecognized as also having sepsis. We evaluated protein C, as a potential biomarker, to differentiate between patients with pneumonia and sepsis. ⋯ In this study, protein C levels performed well in differentiating between patients with sepsis or pneumonia in the early period after diagnosis.
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Journal of critical care · Jun 2011
Failure to achieve euglycemia despite aggressive insulin control signals abnormal physiologic response to trauma.
We hypothesize that a failure to normalize a patient's glucose on an automated euglycemia protocol signals an adverse response after trauma and that this response can identify patients with an increased mortality. ⋯ A posttraumatic patient's response to tight glycemic control revealed important prognostic information about the patients' physiologic status. Patients who failed to reach euglycemia in the first 6 hours of admission had an increased hospital mortality. The time to normalization is significantly longer in those patients who died. Patients who did not correct rapidly required significantly higher insulin doses, suggesting insulin resistance.
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Journal of critical care · Jun 2011
A polyurethane cuffed endotracheal tube is associated with decreased rates of ventilator-associated pneumonia.
The aim of this study was to determine whether the use of a polyurethane-cuffed endotracheal tube would result in a decrease in ventilator-associated pneumonia rate. ⋯ Use of a polyurethane-cuffed endotracheal tube was associated with a significant decrease in the rate of ventilator-associated pneumonia in our study.