Journal of critical care
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Journal of critical care · Sep 2010
Review Meta AnalysisCorticosteroid therapy for acute lung injury, acute respiratory distress syndrome, and severe pneumonia: a meta-analysis of randomized controlled trials.
Randomized trials investigating the effect of corticosteroids in the treatment of acute lung injury, acute respiratory distress syndrome, and severe pneumonia have had mixed results. We sought to determine whether systemic corticosteroids reduce hospital mortality from these illnesses. ⋯ Low-dose corticosteroids administered within 14 days of disease onset may reduce all-cause mortality in patients with acute lung injury, acute respiratory distress syndrome, and severe pneumonia. However, the overall quality of the evidence precludes definitive conclusions regarding the use of corticosteroids in this population.
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Journal of critical care · Sep 2010
Review Meta AnalysisCortisol levels and adrenal response in severe community-acquired pneumonia: a systematic review of the literature.
Our aim was to review the literature on the prevalence and impact of critical-illness related corticosteroid insufficiency (CIRCI) on the outcomes of patients with severe community-acquired pneumonia (CAP). ⋯ A significant proportion of patients with severe CAP fulfilled criteria for CIRCI. However, CIRCI does not seem to affect the outcomes. Noteworthy, the presence of elevated cortisol levels is associated with increased mortality and may be useful as a prognostic marker in patients with severe CAP.
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Journal of critical care · Sep 2010
Randomized Controlled Trial Comparative StudyHigh-flow nasal oxygen vs high-flow face mask: a randomized crossover trial in extubated patients.
Oxygen delivery after extubation is critical to maintain adequate oxygenation and to avoid reintubation. The delivery of oxygen in such situations is usually by high-flow face mask (HFFM). Yet, this may be uncomfortable for some patients. A recent advance in oxygen delivery technology is high-flow nasal prongs (HFNP). There are no randomized trials comparing these 2 modes. ⋯ High-flow nasal prongs are as effective as HFFM in delivering oxygen to extubated patients who require high-flow oxygen. The tolerance of HFNP was significantly better than in HFFM.
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Journal of critical care · Sep 2010
Factors associated with persistent delirium after intensive care unit admission in an older medical patient population.
This study was designed to identify factors associated with persistent delirium in an older medical intensive care unit (ICU) population. ⋯ Age, use of opioids, and haloperidol were associated with persistent delirium. Further research is needed regarding the use of haloperidol and opioids on persistent delirium.
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Journal of critical care · Sep 2010
Multicenter StudyLong-term survival according to ventilation mode in acute respiratory failure secondary to chronic obstructive pulmonary disease: a multicenter, inception cohort study.
The aim of the study was to investigate 5-year survival stratified by mechanical ventilation modality in chronic obstructive pulmonary disease (COPD) patients treated in the ICU. ⋯ The short-term survival benefit of NIV previously found in randomized controlled trials still applies after 5 years of observation.