Journal of critical care
-
Journal of critical care · Jun 2009
The impact of do-not-resuscitate order on triage decisions to a medical intensive care unit.
To determine whether the presence of a do-not-resuscitate (DNR) order impacts on triage decisions to a medical intensive care unit (MICU) of an academic medical center. ⋯ The presence of a DNR order at the time of MICU consultation was significantly associated with the decision to refuse a patient to the MICU.
-
Journal of critical care · Jun 2009
Passive decision-making preference is associated with anxiety and depression in relatives of patients in the intensive care unit.
The objectives were to describe the decision-making preferences of relatives (family members) of patients in intensive care units (ICUs), to determine whether the relatives had symptoms of anxiety and depression while the patients were in the ICU, and to determine whether there was a relationship between the relatives' preferences and symptoms. ⋯ The relatives who preferred a passive decision-making role were the most likely to be anxious and depressed.
-
Journal of critical care · Jun 2009
Positive end-expiratory pressure alters the severity and spatial heterogeneity of ventilator-induced lung injury: an argument for cyclical airway collapse.
Ventilator-induced lung injury (VILI) is a recognized complication of mechanical ventilation. Although the specific mechanism by which mechanical ventilation causes lung injury remains an active area of study, both alveolar overdistension and cyclical airway collapse and recruitment have been suggested as contributing causes. We hypothesized that mechanical ventilation in the absence of positive end-expiratory pressure (PEEP) causes VILI to be more severe and regionally variable as compared with PEEP = 8 cm H(2)O. ⋯ These results suggest that VILI is regionally heterogeneous and spatially correlates with regions in which cyclical airway collapse and recruitment is most likely to occur.
-
Journal of critical care · Jun 2009
Vascular endothelial growth factor receptor and coreceptor expression in human acute respiratory distress syndrome.
Acute respiratory distress syndrome (ARDS) is characterized by the development of noncardiogenic pulmonary edema, which has been related to the bioactivity of vascular endothelial growth factor (VEGF). Vascular endothelial growth factor receptors and coreceptors regulate this bioactivity. We hypothesized VEGF receptors 1 and 2 (VEGFR1, VEGFR2) and coreceptor neuropilin-1 (NRP-1) would be expressed in human lung tissue with a significant change in expression in ARDS lung. ⋯ Differential temporal VEGFR1, VEGFR2, and NRP-1 up-regulation occurs in human ARDS, providing evidence of further functional regulation of VEGF bioactivity via VEGFR2 consistent with a protective role for VEGF in lung injury recovery. The mechanisms behind these observations remain to be clarified.
-
Journal of critical care · Jun 2009
Continuous end-tidal carbon dioxide monitoring in pediatric intensive care units.
End-tidal carbon dioxide (ETCO(2)) monitoring has a variety of clinical applications in critically ill pediatric patients. This study was designed to explore the current availability and utilization patterns for continuous ETCO(2) monitoring in pediatric intensive care units. ⋯ End-tidal carbon dioxide monitoring is widely available and used for intubated patients. However, it could be applied more frequently in other clinical situations in pediatric intensive care units.