Critical care medicine
-
Critical care medicine · Mar 2006
Randomized Controlled Trial Comparative StudyExtubation outcome following a spontaneous breathing trial with automatic tube compensation versus continuous positive airway pressure.
We hypothesized that the additional use of automatic tube compensation (ATC) during a spontaneous breathing trial with continuous positive airway pressure (CPAP), by minimizing respiratory work, would result in more patients undergoing successful extubation. ⋯ This is the largest single-center study to date assessing the use of commercially available ATC and suggests that this might be a useful mode for performing a spontaneous breathing trial preceding extubation in a general intensive care population.
-
Critical care medicine · Mar 2006
Multicenter StudyBody mass index is independently associated with hospital mortality in mechanically ventilated adults with acute lung injury.
To determine the association between body mass index (BMI) and hospital mortality for critically ill adults. ⋯ BMI was associated with risk-adjusted hospital mortality among mechanically ventilated adults with ALI. Lower BMIs were associated with higher odds of death, whereas overweight and obese BMIs were associated with lower odds.
-
Critical care medicine · Mar 2006
ReviewEconomics of critical care: Medicare part A versus part B payments.
To review the effect of Medicare part A payments (to hospitals) and part B payments (to providers) on critical care in the United States. ⋯ Medicare payments to hospitals, particularly for critically ill patients, seem to fall short of the costs of caring for these patients. Reimbursements to providers seem more encouraging, although the opportunity exists to improve in this area as well.
-
Critical care medicine · Mar 2006
Randomized Controlled TrialA low-volume, low-pressure tracheal tube cuff reduces pulmonary aspiration.
Leakage of fluid from the subglottic space to the lungs occurs along the longitudinal folds within the wall of an inflated high-volume, low-pressure (HVLP) cuff. The low-volume, low-pressure (LVLP) cuff does not have these folds yet allows for convenient and reliable control of tracheal wall pressure. Pulmonary aspiration during anesthesia has been linked with postoperative pneumonia and during critical illness causes ventilator-associated pneumonia. ⋯ The LVLP cuffed tracheal and tracheostomy tubes reduced pulmonary aspiration in the benchtop models and in anesthetized and critically ill patients. The single failure of the LVLP cuff in the anesthesia group was probably associated with accidental endobronchial intubation following tube movement.
-
Critical care medicine · Mar 2006
ReviewPulmonary coagulopathy as a new target in therapeutic studies of acute lung injury or pneumonia--a review.
To review the involvement of coagulation and fibrinolysis in the pathogenesis of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), pulmonary infection, and ventilator-induced lung injury (VILI). ⋯ Alveolar fibrin deposition is an important feature of ALI/ARDS and pulmonary infection. The mechanisms that contribute to disturbed alveolar fibrin turnover are localized tissue factor-mediated thrombin generation and depression of bronchoalveolar urokinase plasminogen activator-mediated fibrinolysis, caused by the increase of plasminogen activator inhibitors. These effects on pulmonary coagulation and fibrinolysis are regulated by various proinflammatory cytokines and are similar to those found in the intravascular spaces during severe systemic inflammation. Some studies also suggest that pulmonary coagulopathy is a feature of VILI. Recent studies have demonstrated the beneficial effect of anticoagulant therapy in sepsis. Theoretical considerations suggest that this anticoagulant therapy will benefit patients with primary lung pathology including VILI, but clinical studies are needed to examine this hypothesis before such therapy is to be advocated as a standard of care in critically ill patients.