Critical care medicine
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Critical care medicine · Nov 2008
Effect of the chest wall on pressure-volume curve analysis of acute respiratory distress syndrome lungs.
Previously published methods to assess the chest wall effect on total respiratory system pressure-volume (P-V) curves in acute respiratory distress syndrome have been performed on the lung and chest wall in isolation. We sought to quantify the effect of the chest wall by considering the chest wall and lung in series. ⋯ This method of "correcting" the total respiratory system P-V curve for the chest wall allows for calculation of an airway pressure that would place the lung at a desired volume on its P-V curve. For most patients, the chest wall had little influence on the total respiratory system P-V curve. However, there were patients in whom the chest wall did potentially have clinical significance.
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Critical care medicine · Nov 2008
Comparative StudyAccuracy of bedside glucose measurement from three glucometers in critically ill patients.
Implementation of strict glucose control in most intensive care units has resulted in increased use of point-of-care glucose devices in the intensive care unit. The aim of this study was to determine the reliability of point-of-care testing glucose meters among critically ill patients under intensive insulin treatment. ⋯ Under standardized conditions, glucose results from three point-of-care testing devices were inaccurate in both intensive care unit and non-intensive care unit patients. Among intensive care unit patients, inaccurate glucose readings were most frequently falsely elevated, resulting in misinterpretation of high glucose values with subsequent inappropriate insulin administration or masking of true hypoglycemia.
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Critical care medicine · Nov 2008
The amplitude spectrum area correctly predicts improved resuscitation and facilitated defibrillation with head cooling.
When systemic hypothermia was maintained before inducing cardiac arrest, the likelihood of successful defibrillation and meaningful survival was increased. When hypothermia is induced during cardiopulmonary resuscitation, mortality is also improved. With the introduction of the amplitude spectrum area as a predictor of the success of electrical defibrillation, we investigated the effect of preferential head cooling initiated coincident with cardiopulmonary resuscitation on amplitude spectrum area as a predictor. We hypothesized that rapid head cooling initiated coincident with cardiopulmonary resuscitation improves amplitude spectrum area, and therefore is predictive of successful defibrillation. ⋯ Amplitude spectrum area served as a useful predictor for improved resuscitation and facilitated defibrillation in the setting of rapid head cooling initiated coincident with cardiopulmonary resuscitation.
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Critical care medicine · Nov 2008
Neuroprotection with delayed calpain inhibition after transient forebrain ischemia.
Delayed neurodegeneration after transient global brain ischemia offers a therapeutic window for inhibiting molecular injury mechanisms. One such mechanism is calpain-mediated proteolysis, which peaks 24 to 48 hrs after transient forebrain ischemia in rats. This study tests the hypothesis that delayed calpain inhibitor therapy can reduce brain calpain activity and neurodegeneration after transient forebrain ischemia. ⋯ These results suggest a causal role for calpains in delayed postischemic neurodegeneration, and demonstrate a broad therapeutic window for calpain inhibition in this model.
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Critical care medicine · Nov 2008
Ability of pulse power, esophageal Doppler, and arterial pulse pressure to estimate rapid changes in stroke volume in humans.
Measures of arterial pulse pressure variation and left ventricular stroke volume variation induced by positive-pressure breathing vary in proportion to preload responsiveness. However, the accuracy of commercially available devices to report dynamic left ventricular stroke volume variation has never been validated. ⋯ Arterial pulse pressure, as well as, left ventricular stroke volume estimated from esophageal Doppler monitor and pulse power reflects short-term steady-state left ventricular stroke volume values and tract dynamic changes in left ventricular stroke volume moderately well in humans.