Critical care medicine
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Critical care medicine · Jan 2010
Multicenter Study Comparative StudyMemories and health-related quality of life after intensive care: a follow-up study.
The overall aim of this study was to describe changes in health-related quality of life, anxiety, depression, and return to work from 0.5-1.5 yrs to 4.5-5.5 yrs after injury in patients with and without delusional memories during their intensive care unit stay. A secondary aim was to explore factors that were related to health-related quality of life and to compare trauma patients' health-related quality of life 4.5 to 5.5 yrs after injury with a reference group. ⋯ From a long-term perspective, health-related quality of life has improved but not reached the reference sample scores in Short Form-36. Seventy-five percent had returned to work. Patients with delusional memories still experienced poorer health-related quality of life and more patients had anxiety and depression compared with patients without those memories.
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Critical care medicine · Jan 2010
Randomized Controlled TrialPositive end-expiratory pressure-induced functional recruitment in patients with acute respiratory distress syndrome.
In acute respiratory distress syndrome, alveolar recruitment improves gas exchange only if perfusion of the recruited alveolar units is adequate. To evaluate functional recruitment induced by positive end-expiratory pressure, we assessed pulmonary conductance for gas exchange based on lung diffusion for carbon monoxide and its components, including pulmonary capillary blood volume. ⋯ The functional response to positive end-expiratory pressure in patients with acute lung injury/acute respiratory distress syndrome seems better when the lungs are smaller and with a higher capillary blood-volume-to-lung-volume ratio. Lung diffusion for carbon monoxide measurement supplies additional information about functional lung recruitment, which is not synonymous with mechanical recruitment.
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Critical care medicine · Jan 2010
Randomized Controlled Trial Comparative StudyEffect of vancomycin plus rifampicin in the treatment of nosocomial methicillin-resistant Staphylococcus aureus pneumonia.
To investigate whether adding rifampicin to vancomycin could cure more patients with nosocomial methicillin-resistant Staphylococcus aureus pneumonia compared with vancomycin-only. ⋯ Vancomycin plus rifampicin seems to be more effective than vancomycin alone in the treatment of nosocomial methicillin-resistant Staphylococcus aureus pneumonia.
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Critical care medicine · Jan 2010
Multicenter Study Comparative StudyDifferences in outcome between obese and nonobese patients following severe blunt trauma are not consistent with an early inflammatory genomic response.
Obesity has been demonstrated to alter a number of acute and chronic medical conditions. The effect of obesity on severely injured patients, however, remains incompletely defined. We sought to unravel potential physiologic and genomic alterations induced by obesity in severely injured blunt trauma patients. ⋯ Increasing body mass index is associated with increased morbidity following severe blunt trauma. The initial blood leukocyte inflammatory response to blunt trauma does not appear to differ significantly between patients despite increasing body mass index. Resolution of the inflammatory response may differ between patients on the basis of body mass index; however, additional work is needed to clarify the potential causality of this finding.
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Critical care medicine · Jan 2010
ReviewAcute kidney injury in the intensive care unit: an update and primer for the intensivist.
Acute kidney injury is common in critically ill patients and is associated with significant morbidity and mortality. Patients across the spectrum of critical illness have acute kidney injury. This requires clinicians from across disciplines to be familiar with recent advances in definitions, diagnosis, prevention, and management of acute kidney injury in the intensive care unit. The purpose of this concise review, therefore, is to address, for the non-nephrologist, clinically relevant topical questions regarding acute kidney injury in the intensive care unit. ⋯ Acute kidney injury in the intensive care unit is a clinically relevant problem requiring awareness and expertise among physicians from a wide variety of fields. Although many questions remain controversial and without definitive answers, a periodic update of this rapidly evolving field provides a framework for understanding and managing acute kidney injury in the intensive care unit.