Journal of critical care
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Journal of critical care · Sep 2010
ReviewWhole-body ultrasound in the intensive care unit: a new role for an aged technique.
Management of critically ill patients requires rapid and safe diagnostic techniques. Ultrasonography has become an indispensable tool that supplements physical examination in the intensive care unit. ⋯ Furthermore, it detects possible infectious sites and renders therapeutic invasive procedures more convenient and less complicated. Whole-body ultrasound in the hands of adequately trained intensivists has the ability to reinvigorate the physical examination, without subjecting the patient to excessive irradiation and the risks of transport.
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Journal of critical care · Mar 2010
ReviewBiosignal analysis techniques for weaning outcome assessment.
Discontinuation of mechanical ventilation in critically ill patients is a challenging task and involves a careful weighting of the benefits of early extubation and the risks of premature spontaneous breathing trial. Recently, apart from studying different physiological variables by means of descriptive statistical tests, breathing pattern variability analysis has been performed for the assessment of weaning readiness. A limited number of clinical studies implementing different weaning protocols in heterogeneous groups of patients and using a variable set of signal processing techniques have appeared in the critical care literature, with varying results. The purpose of this review article is 3-fold: (1) to describe the different signal processing techniques being implemented for the assessment of weaning readiness, (2) to provide insight into the pathophysiological mechanisms that may govern breath-to-breath variability/complexity in health and disease, and (3) to present results from the critical care literature derived from the application of biosignal analysis tools for the identification of possible weaning indices.
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Journal of critical care · Mar 2010
ReviewBest interests at end of life: a review of decisions made by the Consent and Capacity Board of Ontario.
When patients are unable to communicate their own wishes, surrogates are commonly used to aid in decision making. Although each jurisdiction has its own rules or legislation governing how surrogates are to make health care decisions, many rely on the notion of "best interests" when no prior expressed wishes are known. ⋯ Several lessons are drawn for the benefit of health care teams engaged in end-of-life conflicts with substitute decision makers over the best interests of patients.
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Journal of critical care · Dec 2009
ReviewState of the art: sedation concepts with volatile anesthetics in critically Ill patients.
The use of volatile anesthetics in the intensive care unit (ICU) has only been possible at great cost with the use of commercially available anesthesia systems. A new anesthetic-conserving device (AnaConDa) now facilitates, from a technical viewpoint, the routine use of volatile anesthetics in intensive care patients as part of prolonged sedation, using ICU ventilators. The volatile anesthetic is hereby applied continually via a syringe pump into a miniature vaporizer, which is integrated into the ventilator circuit in place of the usual respiratory filter. ⋯ Aside from the possibility of using a central anesthetic gas scavenging system, the use of special passive residual gas filters, which can be connected to the expiratory outlet of the respirator machine, appears above all to be practical. The use of volatile anesthetics on the ICU could adopt a permanent position in various intensive care analgosedation concepts in future. It may be possible thereby to optimize the treatment process both in medical and economical terms.
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Journal of critical care · Sep 2009
ReviewSurvival benefit of the full selective digestive decontamination regimen.
We assessed the impact of the full protocol of selective decontamination of the digestive tract (SDD) using parenteral and enteral antimicrobials on mortality. ⋯ The findings strongly indicated that the full protocol of SDD reduces mortality in critically ill patients, in particular when successful decontamination is obtained. Eighteen patients should be treated with SDD to prevent one death.