Journal of critical care
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Journal of critical care · Mar 2010
Randomized Controlled Trial Comparative StudyA carbohydrate-restrictive strategy is safer and as efficient as intensive insulin therapy in critically ill patients.
The aim of this study is to compare the safety and efficacy of 2 different strategies for glycemic control in critically ill adult patients. ⋯ A carbohydrate-restrictive strategy reduced significantly the incidence of hypoglycemia in critically ill patients compared to intensive insulin therapy. Mortality and morbidity were comparable between the 2 groups.
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Journal of critical care · Mar 2010
The Glucosafe system for tight glycemic control in critical care: a pilot evaluation study.
"Glucosafe' is a new model-based decision support system for glycemic control in critical care. Safety and achievement of glycemic goals using the system are tested prospectively. ⋯ Safety was demonstrated with the developed penalty functions. The low BG variance achieved may permit minor adjustments of the penalty function values to reduce average BG if desired.
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Journal of critical care · Mar 2010
Risk factors for the deterioration of oxygenation ratio in ventilated intensive care unit patients: a retrospective cohort study.
The aim of the study is to determine which factors are associated with the deterioration of Pao(2)/fraction of inspired oxygen (Fio(2)) ratio in patients with normal oxygenation at admission and ventilated according to a lung protective ventilation strategy. ⋯ Lung injury exacerbates during mechanical ventilation. In patients treated with a mean tidal volume of 7.9 mL/kg, controlled ventilation is a major risk factor.
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Journal of critical care · Mar 2010
A single recruitment maneuver in ventilated critically ill children can translocate pulmonary cytokines into the circulation.
Recruitment maneuvers (RMs) are advocated to prevent pulmonary collapse during low tidal volume ventilation and improve oxygenation. However, convincing clinical evidence for improved outcome is lacking. Recent experimental studies demonstrate that RMs translocate pulmonary inflammatory mediators into the circulation. To determine whether a single RM in ventilated children affects pulmonary and systemic cytokine levels, we performed a prospective intervention study. ⋯ A single RM can translocate pro-inflammatory cytokines from the alveolar space into the systemic circulation in ventilated critically ill children.
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Journal of critical care · Mar 2010
Validity and reliability of the CAM-ICU Flowsheet to diagnose delirium in surgical ICU patients.
Delirium occurs frequently in critical care but often remains undiagnosed because delirium monitoring is often dismissed as being too time-consuming. This study determined the validity and reliability of the "CAM-ICU Flowsheet," a practical, time-sparing algorithm to assess the 4 delirium criteria in intubated patients. ⋯ The CAM-ICU Flowsheet has high sensitivity, high specificity, and very high interrater reliability. False-negative ratings can occur infrequently and mostly reflect the fluctuating course of delirium. The CAM-ICU Flowsheet is a valid, reliable, and quickly performed bedside delirium instrument.