Journal of critical care
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Journal of critical care · Dec 2007
Adrenal exhaustion in septic patients with vasopressor dependency.
The use of low-dose corticosteroids for patients with septic shock who remain vasopressor dependent after adequate fluid resuscitation is recommended, but there is lack of agreement on how to diagnose relative adrenal insufficiency (RAI) and when to start steroid supplementation among these patients. This case series reports changes in cortisol concentrations during the course of vasopressor-dependent septic shock. ⋯ Adrenal function in the critically ill is a dynamic process, and an appropriate initial adrenal response does not preclude later development of RAI.
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Journal of critical care · Dec 2007
Hypercapnic acidosis modulates inflammation, lung mechanics, and edema in the isolated perfused lung.
Low tidal volume (V(T)) ventilation strategies may be associated with permissive hypercapnia, which has been shown by ex vivo and in vivo studies to have protective effects. We hypothesized that hypercapnic acidosis may be synergistic with low V(T) ventilation; therefore, we studied the effects of hypercapnia and V(T) on unstimulated and lipopolysaccharide-stimulated isolated perfused lungs. ⋯ We conclude that hypercapnia exerts a protective effect by modulating inflammation, lung mechanics, and edema. The moderately high V(T) used in this study stimulated inflammation but paradoxically improved edema and lung mechanics with an associated increase in surfactant release.
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Journal of critical care · Sep 2007
Comparative Study Controlled Clinical TrialPatient-ventilator synchrony during pressure-targeted versus flow-targeted small tidal volume assisted ventilation.
Low tidal volume (V(T)) delivered by flow-targeted breaths reduces ventilator-induced lung injury but may increase patient breathing effort because of limited flow. We hypothesized that a variable-flow, pressure-targeted breath would improve breathing effort versus a fixed flow-targeted breath. ⋯ In patients receiving small V(T) VACV with increased breathing effort, variable-flow, pressure-targeted ventilation may provide more comfort by decreasing respiratory drive during the triggering phase.
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Journal of critical care · Sep 2007
Multicenter Study Comparative StudyIntensive care unit safety incidents for medical versus surgical patients: a prospective multicenter study.
The aim of this study is to determine if patient safety incidents and the system-related factors contributing to them systematically differ for medical versus surgical patients in intensive care units. ⋯ Medical and surgical patients in the intensive care unit experience very similar types of safety incidents with similar associated patient harm and system factors. Common initiatives to improve patient safety for medical and surgical patients should be undertaken with a specific focus on improving training and teamwork among the intensive care team.
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Journal of critical care · Sep 2007
Multicenter Study Comparative StudyThe COASST study: cost-effectiveness of albumin in severe sepsis and septic shock.
The cost-effectiveness of albumin-based fluid support in patients with severe sepsis is not known. ⋯ The application of the SAFE Study results to CUB-Réa data shows that albumin infusion is cost-effective in severe sepsis.