Journal of critical care
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Journal of critical care · Sep 2005
Hypoxic respiratory failure in term newborns: clinical indicators for inhaled nitric oxide and extracorporeal membrane oxygenation therapy.
The criteria for starting extracorporeal membrane oxygenation (ECMO) therapy in term newborn patients with hypoxemic respiratory failure consist of an oxygenation index (OI) of 25 or higher and alveolar-arterial oxygen (Aao(2)) gradient of more than 600 at sea level. In such conditions, inhaled nitric oxide (iNO) may improve oxygenation and reduce the need for ECMO therapy. We studied early changes in OI and Aao(2) gradients in response to iNO treatment that may indicate a need to continue iNO treatment or the necessity to start an ECMO therapy. ⋯ Persisting levels of OI of more than 20 or Aao(2) gradients of more than 600 after 4 hours of iNO therapy could be indicative of an immediate need for ECMO therapy.
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Journal of critical care · Sep 2005
Incidence of acute respiratory distress syndrome and its relation to age.
The incidence of acute respiratory distress syndrome (ARDS) was previously considered to be relatively low, at less than 10 cases per 100,000 inhabitants per year, but recent reports suggest a higher incidence, especially in elderly patients. The objective was to determine the incidence and mortality of ARDS in our setting, both overall and by age group. ⋯ The incidence of ARDS is higher than reported a decade ago and is especially elevated in the elderly. The mortality remains high.
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Journal of critical care · Sep 2005
Barriers to communication regarding end-of-life care: perspectives of care providers.
Communication regarding end-of-life care is frequently perceived as suboptimal, despite the intent of both health care providers and patients. We interviewed health care providers to determine their perspective regarding these barriers to communication. ⋯ Attending physicians, residents, and nurses perceive the recipients of their care, and the system within which they provide this care, to be the major source of barriers to communication regarding end-of-life care. This finding may impact on the effectiveness of quality-improvement initiatives in end-of-life care.
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Journal of critical care · Sep 2005
"Futile" care: do we provide it? Why? A semistructured, Canada-wide survey of intensive care unit doctors and nurses.
To qualitatively explore the process of the provision of futile care in Canadian intensive care units (ICUs). ⋯ Caregivers voice the opinion that provision of futile care occurs, for multiple reasons, not the least of which is provider-driven. Nurses and physicians of Canadian ICUs perceive the need for increased availability of more ICU-directed and ethically trained resources to help them in providing end-of-life care.
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Journal of critical care · Jun 2005
Case ReportsTreatment of severe coagulopathy after gunshot injury to the head using recombinant activated factor VII.
Patients with severe penetrating head injury often have a coagulopathy that is difficult to correct. In this report, we describe 3 such patients who were treated with activated factor VII (FVIIa) to stop ongoing hemorrhage that was refractory to conventional treatment. ⋯ In patients with a severe head injury and coagulopathy, use of FVIIa may help in correction of coagulopathy and decrease transfusion requirements. In patients where ongoing bleeding precludes the declaration of brain death, the use of this agent might help in achieving hemodynamic stability and preserve the possibility of organ donation. The ethical implications of using FVIIa in this situation are discussed.