Critical care medicine
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Critical care medicine · Feb 2014
Intraosseous Lipid Emulsion: An Effective Alternative to IV Delivery in Emergency Situations.
To determine whether intraosseous infusion of a lipid emulsion reverses cardiac pharmacotoxicity in anaesthetized rats. ⋯ These proof-of-principle data indicate that intraosseous infusion of lipid emulsion rapidly reverses bupivacaine-induced cardiac toxicity in rats. Further studies are warranted to optimize this novel route of lipid emulsion injection in emergency situations when intravascular access is not secured.
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Critical care medicine · Feb 2014
Effect of Intermittent Phrenic Nerve Stimulation During Cardiothoracic Surgery on Mitochondrial Respiration in the Human Diaphragm.
Recent studies have shown that brief periods of mechanical ventilation in animals and humans can lead to ventilator-induced diaphragmatic dysfunction, which includes muscle atrophy, reduced force development, and impaired mitochondrial function. Studies in animal models have shown that short periods of increased diaphragm activity during mechanical ventilation support can attenuate ventilator-induced diaphragmatic dysfunction but corresponding human data are lacking. The purpose of this study was to examine the effect of intermittent diaphragm contractions during cardiothoracic surgery, including controlled mechanical ventilation, on mitochondrial respiration in the human diaphragm. ⋯ These are the first data examining the effect of intermittent contractions on mitochondrial respiration rates in the human diaphragm following surgery/mechanical ventilation. Our results indicate that very brief periods (duty cycle ~1.7%) of activity can improve mitochondrial function in the human diaphragm following surgery/mechanical ventilation.
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Critical care medicine · Feb 2014
Multidisciplinary Team Training to Enhance Family Communication in the ICU.
Current guidelines from the U.S. Society for Critical Care Medicine state that training in "good communication skills...should become a standard component of medical education and ... available for all ICU caregivers". We sought to train multidisciplinary teams of ICU caregivers in communicating with the families of critically ill patients to improve staff confidence in communicating with families, as well as family satisfaction with their experiences in the ICU. ⋯ A simple intervention resulted in improvement in staff confidence, as well as in multiple measures of family satisfaction with communication. This intervention is easily reproduced.
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Critical care medicine · Feb 2014
Microvascular Perfusion as a Target for Fluid Resuscitation in Experimental Circulatory Shock.
To study regional perfusion during experimental endotoxemic and obstructive shock and compare the effect of initial cardiac output-targeted fluid resuscitation with optimal cardiac output-targeted resuscitation on different peripheral tissues. ⋯ This study demonstrates that the relationship between the systemic and regional perfusion is dependent on the underlying cause of circulatory shock. Further research will have to demonstrate whether different microvascular perfusion variables can be used as additional resuscitation endpoints.