Journal of critical care
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Journal of critical care · Apr 2012
ReviewEffectiveness of extracorporeal membrane oxygenation when conventional ventilation fails: valuable option or vague remedy?
The mortality and morbidity of patients with severe acute respiratory distress syndrome (ARDS) remains high despite the advances in intensive care practice. The low-tidal-volume ventilation strategy (ARDS net protocol) has been shown to be effective in improving survival. Unfortunately, however, some patients have such severe ARDS that they cannot be managed with the ARDS net strategy. ⋯ The recent increased incidence of severe respiratory failure due to H1N1 influenza pandemic has led to an increased use of ECMO. Although several reports showed ECMO use to be encouraging, some scepticism remains. In this article, we reviewed the usefulness of ECMO in patients with severe ARDS in the light of current evidence.
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Journal of critical care · Apr 2012
ReviewEmotional consequences of intensive care unit delirium and delusional memories after intensive care unit admission: a systematic review.
The aim of this study was to review literature exploring the emotional consequences of delirium and delusional memories in intensive care unit patients. ⋯ Based on current literature, no relationship could be shown for delirium and emotional outcome. Regarding delusional memories and adverse emotional outcome, results were in contradiction.
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Journal of critical care · Apr 2012
ReviewEffects of intracellular acidosis on endothelial function: an overview.
The endothelium represents the largest functional organ in the human body playing an active role in vasoregulation, coagulation, inflammation, and microvascular permeability. Endothelium contributes to maintain vascular integrity, intravascular volume, and tissue oxygenation promoting inflammatory network response for local defense and repair. Acid-basis homeostasis is an important physiologic parameter that controls cell function, and changes in pH can influence vascular tone by regulating endothelium and vascular smooth muscle cells. This review presents a current perspective of the effects of intracellular acidosis on the function and the basic regulatory mechanisms of endothelial cells.
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Most existing literature on noninvasive ventilation (NIV) in combination with helium-oxygen (HELIOX) mixtures focuses on its use in adults, basically for treatment of acute exacerbations of chronic obstructive pulmonary disease. This article reviews and summarizes the theoretical basis, existing clinical evidence, and practical aspects of the use of NIV with HELIOX in children. There is only a small body of literature on HELIOX in pediatric NIV but with positive results. ⋯ The inert nature of helium adds no biological risk to NIV performance. Noninvasive ventilation with HELIOX is a promising therapeutic option for children with various respiratory pathologies who do not respond to conventional treatment. Further controlled studies should be warranted.
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Journal of critical care · Oct 2011
ReviewA systematic review of short courses for nonspecialist education in intensive care.
The availability of reliable and accessible educational material for the training of nonspecialist intensive care physicians is potentially advantageous. We assessed the availability, cost, and content of generic short courses designed to teach basic critical care skills to junior physicians or nonspecialist intensive care physicians taking up duties in intensive care units. ⋯ Both identified courses use a mixture self-learning, didactic lectures, and experiential learning using manikins and "minisimulations." Organizing bodies provide administrative support and can readily be located and contacted online. Basic Assessment and Support in Intensive Care charges no license fee, whereas Fundamental Critical Care Support offers fees at a reduced rate for developing countries. Both courses are recognized and conducted internationally.