Journal of critical care
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Journal of critical care · Sep 2009
Effects of inhalational bronchodilator treatment during noninvasive ventilation in severe chronic obstructive pulmonary disease exacerbations.
To study the effects of withdrawing noninvasive ventilation (NIV) used during acute exacerbation of chronic obstructive pulmonary disease for the delivery of aerosolized medications on physiologic parameters and dyspnea sensation. ⋯ Short-term cessation of NIV for nebulization treatment did not result in distress, discomfort, or physiologic instabilities. The only detectable changes were increase in SBP and HR, probably due to the systemic adrenergic effects of salbutamol.
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Journal of critical care · Sep 2009
Genetic polymorphism of GSTT1 and GSTM1 and susceptibility to chronic obstructive pulmonary disease (COPD).
Chronic obstructive pulmonary disease (COPD) represents a major public health care problem worldwide due to its increasing prevalence, morbidity and mortality. Chronic obstructive pulmonary disease is known to be the fourth leading cause of death and the only cause of death, which is increasing. It is generally accepted that cigarette smoking is the most important risk factor for COPD. Nevertheless, only 10% to 20% of chronic smokers develop the severe impairment of pulmonary functions associated with COPD. This indicates the presence of genetic predisposing factors in its pathogenesis. ⋯ Carriers of null GSTM1 genotype were at high risk of developing COPD especially when they were null GSTT1 and GSTM1 haplotype.
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Journal of critical care · Sep 2009
Predictors of seizure onset after intracerebral hemorrhage and the role of long-term antiepileptic therapy.
Seizures are a common complication after hemorrhagic stroke that may slow recovery and decrease quality of life. Recent evidence suggests that early- and late-onset seizures have distinct etiologies, rendering the role of prophylactic long-term antiepileptic drugs controversial. We investigated predictors of early- and late-onset seizures after evacuation of intracerebral hemorrhage (ICH) in an attempt to guide antiepileptic drug management in this patient population. ⋯ The presence of subdural hematoma and increased INR is predictive of late-onset seizures in patients undergoing clot evacuation after ICH. The use of long-term antiepileptic therapy should be further studied in patients with these radiographic and clinical characteristics.
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Journal of critical care · Sep 2009
Outcomes of critically ill children requiring continuous renal replacement therapy.
Acute kidney injury in the pediatric intensive care unit (PICU) is associated with significant morbidity, with continued mortality greater than 50%. Previous studies have described an association between percentage of fluid overload (%FO) less than 20% and improved survival. We reviewed our continuous renal replacement therapy (CRRT) experience to evaluate for factors associated with mortality as well as secondary outcomes. ⋯ For patients with acute kidney injury who require CRRT, the presence of sepsis, MODS, and FO greater than 20% at the time of CRRT initiation are significantly associated with higher mortality. In addition, we report that duration of mechanical ventilation, PICU stay, hospitalization, and time to renal recovery were all significantly prolonged for survivors who had FO greater than 20%.
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Ventilator-associated pneumonia (VAP) is difficult to diagnose. Recent data suggest quantitative endotracheal aspirate (ETA) may be noninferior diagnostically to quantitative bronchoalveolar lavage (BAL). We hypothesized this would be the case. ⋯ Quantitative BAL is safe and has greater diagnostic utility than ETA for VAP facilitates de-escalation. This study provides support for quantitative BAL in VAP diagnosis.