Journal of critical care
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Journal of critical care · Jun 2006
Hypernatremia in the neurologic intensive care unit: how high is too high?
Hypernatremia is associated with increased mortality in hospitalized patients and in medical/surgical intensive care units. This relationship has not been studied in neurologic/neurosurgical intensive care units (NNICUs), where hypernatremia is often a component of treatment of cerebral edema. We performed a retrospective analysis of prospectively collected data in patients admitted to the NNICU over a 6.5-year period. ⋯ Other factors independently associated with mortality were age, mechanical ventilation, initial Acute Physiology and Chronic Health Evaluation II probability of death or low admission Glasgow Coma Scale score, and a diagnosis of cerebrovascular disease. In conclusion, hypernatremia is common in the NNICU, more so in patients treated with mannitol. In this population, severe (but not mild or moderate) hypernatremia is independently associated with increased mortality.
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Journal of critical care · Jun 2006
Milrinone improves oxygenation in neonates with severe persistent pulmonary hypertension of the newborn.
Many neonates with severe persistent pulmonary hypertension of the newborn (PPHN) are nonresponders to inhaled nitric oxide (iNO). Milrinone is a promising adjunctive therapy because of its pulmonary vasodilator properties and cardiotropic effects. ⋯ Intravenous milrinone produces early improvements in oxygenation without compromising systemic blood pressure.
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Journal of critical care · Jun 2006
Transthoracic ultrasound approach of thoracic aorta in critically ill patients with lung consolidation.
Normally, the aortic arch and the descending aorta are not visible using transthoracic ultrasonography. We hypothesize that lung consolidation of upper and lower lobes, by opening an acoustic window, may allow the ultrasound examination of the thoracic aorta. ⋯ In critically ill patients, the presence of consolidated upper and left lower lobes may allow the ultrasound examination of the different parts of the thoracic aorta.
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Journal of critical care · Jun 2006
Comparative StudyPleurodesis using autologous blood: a new concept in the management of persistent air leak in acute respiratory distress syndrome.
Pneumothorax is present as a frequent complication in acute respiratory distress syndrome (ARDS). Persistent air leak (PAL) prolongs pneumothorax in 2% of cases of ARDS, increasing the rate of mortality by 26%. Pleurodesis using autologous blood (PAB) is an effective method in cases of oncological pulmonary surgery. The goal of this study was to compare PAB with the conventional drain and water seal in the management of PAL in patients with ARDS and pneumothorax. ⋯ The use of PAB makes possible a decrease in ventilator WT and a shorter stay in the ICU, with a resulting increase in functional recuperation and decrease in patient mortality.
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Journal of critical care · Jun 2006
Dealing with aggressive behavior within the health care team: a leadership challenge.
During an interdisciplinary Canadian leadership forum [ (click on the Conferences icon)], participants were challenged to develop an approach to a difficult leadership/management situation. In a scenario involving aggressive behavior among health care providers, participants identified that, before responding, an appropriate leader should collect additional information to identify the core problem(s) causing such behavior. ⋯ Additional education around communication and team interaction was felt to be a priority. In summary, clinical leaders probably have a great deal to gain from augmenting their leadership/management skills.