Journal of critical care
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Journal of critical care · Dec 2009
History of mechanical ventilation may affect respiratory mechanics evolution in acute respiratory distress syndrome.
The aim of this study was to investigate the effect of mechanical ventilation (MV) before acute respiratory distress syndrome (ARDS) on subsequent evolution of respiratory mechanics and blood gases in protectively ventilated patients with ARDS. ⋯ In protectively ventilated patients with ARDS, late alteration of respiratory mechanics occurs more commonly in patients who have been ventilated before ARDS onset, suggesting that the history of MV affects the subsequent progress of ARDS even when using protective ventilation.
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Journal of critical care · Dec 2009
A new dosing protocol reduces dexmedetomidine-associated hypotension in critically ill surgical patients.
Although no ideal sedative exists, dexmedetomidine is unique because it produces sedation and analgesia without decreasing the respiratory drive. Hemodynamic responses to dexmedetomidine are variable and dependent on the patient population. Our initial experience was associated with an unacceptable incidence of hypotension and bradycardia. We evaluated occurrence of hypotension and bradycardia in critically ill surgical patients receiving dexmedetomidine before and after implementation of a dosing protocol. ⋯ We found that use of a protocol that increases the time interval between dosage adjustments may reduce dexmedetomidine-associated hypotension.
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Journal of critical care · Dec 2009
Effect of PaCO2 variation on standard base excess value in critically ill patients.
The aim of this study was to investigate the impact of acute Paco(2) temporal variation on the standard base excess (SBE) value in critically ill patients. ⋯ Acute Paco(2) temporal variation is related to SBE changes in critically ill patients.
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Journal of critical care · Dec 2009
Age bias in clinical trials in sepsis: how relevant are guidelines to older people?
Severe sepsis has a high mortality, and both incidence and mortality increases with increasing age. In recent years, several specific therapies have been recommended by guidelines to reduce mortality in severe sepsis. ⋯ Specific evidence of benefit in the elderly is present regarding treatment with activated protein C and ventilatory strategies. In view of the pharmacokinetic and pharmacodynamic differences in older people, and the higher incidence of comorbidity in the elderly, there is a need for clinical trials in severe sepsis to specifically include older patients.
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Journal of critical care · Dec 2009
Actigraphic monitoring in critically ill patients: preliminary results toward an "observation-guided sedation".
The aim of this study is to evaluate continuous wrist actigraphy (measurement of limb movements) in intensive care unit patients as a neurologic status monitoring. ⋯ Patients' limb movements were significantly related to all studied neurologic status indexes. Continuous actigraphy measuring may become important as a clinical tool both to guide utilization of sedative drugs and to enhance early recognition and management of agitation.