Critical care medicine
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Critical care medicine · Aug 2011
Comparative StudyBrainstem responses can predict death and delirium in sedated patients in intensive care unit.
In critically ill patients, the assessment of neurologic function can be difficult because of the use of sedative agents. It is not known whether neurologic signs observed under sedation can predict short-term outcomes. The objective of this study was to assess whether abnormal brainstem responses within the first 24 hrs of sedation are associated with mortality and altered mental status postsedation. ⋯ Assessment of brainstem responses is feasible in sedated critically ill patients and loss of selected responses is predictive of mortality and altered mental status.
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Critical care medicine · Aug 2011
ReviewManagement of the postoperative pediatric cardiac surgical patient.
To review the salient aspects and latest advances in the management of the postoperative pediatric cardiac patient. ⋯ The practice of pediatric cardiac intensive care has evolved considerably over the last several years. These efforts are the result of a collaborative effort from all subspecialties involved in the care of pediatric patients with congenital heart disease. Discoveries and innovations that are representative of this effort include the extension of cerebral oximetry from the operating room into the critical care setting; mechanical circulatory devices designed for pediatric patients; and surgery in very low birth weight neonates. Advances such as these impact postoperative management and make the field of pediatric cardiac intensive care an exciting, demanding, and evolving discipline, necessitating the ongoing commitment of various disciplines to pursue a greater understanding of disease processes and how to best go about treating them.
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Critical care medicine · Aug 2011
Comparative StudyDynamic and volumetric variables of fluid responsiveness fail during immediate postresuscitation period.
Fluid therapy after resuscitation from cardiac arrest is challenging since both hypovolemia and fluid overload may cause circulatory failure. Therefore, prediction of fluid responsiveness is a major issue in optimizing hemodynamic therapy. The aim of the present study was to evaluate the performance of stroke volume variation, pulse pressure variation, variation of Doppler-derived velocity time integral, and global end-diastolic volume index to predict fluid responsiveness in the postcardiac arrest period. ⋯ Prediction of fluid responsiveness failed 1 hr after successful cardiopulmonary resuscitation from cardiac arrest. Four hours after return of spontaneous circulation, however, the variables pulse pressure variation, variation of the velocity time integral, and global end-diastolic volume index, but not stroke volume variation, enabled prediction of fluid responsiveness and may, therefore, be considered for subsequent hemodynamic optimization after successful cardiopulmonary resuscitation.
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Critical care medicine · Aug 2011
Editorial Comment Comparative StudyWhat is the real role of statins in community-acquired pneumonia and sepsis?