Journal of critical care
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Journal of critical care · Dec 2009
Comparative StudyDopamine therapy in septic shock: detrimental effect on survival?
The aim of this study is to examine the potential impact of dopamine therapy on 28-day mortality in adult septic shock. ⋯ In our cohort study, dopamine use was linked to mortality as compared to other vasopressor therapies, particularly in patients with essential hypertension. Future randomized studies attempting to compare dopamine with other therapies in septic shock should pay attention to patients with essential hypertension.
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Journal of critical care · Dec 2009
Meta Analysis Comparative StudyImpact of patient position on the incidence of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials.
The aim of this study is to summarize the effect of position (prone and semirecumbent 45 degrees ) of mechanically ventilated patients on the incidence of ventilator-associated pneumonia (VAP) and other outcomes. ⋯ This meta-analysis provides additional evidence that the usual practice of back-rest elevation of 15 degrees to 30 degrees is not sufficient to prevent VAP in mechanically ventilated patients. Patients positioned semirecumbently 45 degrees have significantly lower incidence of clinically diagnosed VAP compared to patients positioned supinely. On the other hand, the incidence of clinically diagnosed VAP among patients positioned pronely does not differ significantly from the incidence of clinically diagnosed VAP among patients positioned supinely.
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Journal of critical care · Dec 2009
ReviewState of the art: sedation concepts with volatile anesthetics in critically Ill patients.
The use of volatile anesthetics in the intensive care unit (ICU) has only been possible at great cost with the use of commercially available anesthesia systems. A new anesthetic-conserving device (AnaConDa) now facilitates, from a technical viewpoint, the routine use of volatile anesthetics in intensive care patients as part of prolonged sedation, using ICU ventilators. The volatile anesthetic is hereby applied continually via a syringe pump into a miniature vaporizer, which is integrated into the ventilator circuit in place of the usual respiratory filter. ⋯ Aside from the possibility of using a central anesthetic gas scavenging system, the use of special passive residual gas filters, which can be connected to the expiratory outlet of the respirator machine, appears above all to be practical. The use of volatile anesthetics on the ICU could adopt a permanent position in various intensive care analgosedation concepts in future. It may be possible thereby to optimize the treatment process both in medical and economical terms.
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Journal of critical care · Dec 2009
Randomized Controlled Trial Comparative StudyComparison between dexmedetomidine and midazolam for sedation of eclampsia patients in the intensive care unit.
This study compares the effectiveness of midazolam and dexmedetomidine for the sedation of eclampsia patients admitted to our intensive care unit (ICU). ⋯ Dexmedetomidine sedation in eclampsia patients is effective in reducing the demand for antihypertensive medicine and duration of ICU stay.
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Journal of critical care · Dec 2009
Effect of a clinical decision support system on adherence to a lower tidal volume mechanical ventilation strategy.
The purpose of the study was to measure the effect of a computerized decision support system (CDSS) on adherence to tidal volume (V(T)) recommendations. ⋯ The use of a CDSS, integrated in a patient data management system, improves implementation of a lower V(T) mechanical ventilation strategy for patients ventilated for longer than 24 hours.