Critical care medicine
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Critical care medicine · Mar 2015
Randomized Controlled Trial Multicenter StudyPrevalence, Risk Factors, and Outcomes of Delirium in Mechanically Ventilated Adults.
Delirium is common during critical illness and associated with adverse outcomes. We compared characteristics and outcomes of delirious and nondelirious patients enrolled in a multicenter trial comparing protocolized sedation with protocolized sedation plus daily sedation interruption. ⋯ In mechanically ventilated adults, delirium was common and associated with longer duration of ventilation and hospitalization. Physical restraint was most strongly associated with delirium.
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Critical care medicine · Mar 2015
Influence of Inspiration to Expiration Ratio on Cyclic Recruitment and Derecruitment of Atelectasis in a Saline Lavage Model of Acute Respiratory Distress Syndrome.
Cyclic recruitment and derecruitment of atelectasis can occur during mechanical ventilation, especially in injured lungs. Experimentally, cyclic recruitment and derecruitment can be quantified by respiration-dependent changes in PaO2 (ΔPaO2), reflecting the varying intrapulmonary shunt fraction within the respiratory cycle. This study investigated the effect of inspiration to expiration ratio upon ΔPaO2 and Horowitz index. ⋯ Inverse ratio ventilation minimizes cyclic recruitment and derecruitment of atelectasis in an experimental model of surfactant-depleted pigs. Time constants for recruitment and derecruitment, and regional ventilation distribution, reflect these findings and highlight the time dependency of cyclic recruitment and derecruitment.
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Critical care medicine · Mar 2015
Extravascular Lung Water and Pulmonary Vascular Permeability Index as Markers Predictive of Postoperative Acute Respiratory Distress Syndrome: A Prospective Cohort Investigation.
Robust markers of subclinical perioperative lung injury are lacking. Extravascular lung water indexed to predicted body weight and pulmonary vascular permeability index are two promising early markers of lung edema. We aimed to evaluate whether extravascular lung water indexed to predicted body weight and pulmonary vascular permeability index would identify patients at risk for clinically significant postoperative pulmonary edema, particularly resulting from the acute respiratory distress syndrome. ⋯ Perioperative extravascular lung water indexed to predicted body weight is an early marker that predicts risk of clinically significant postoperative pulmonary edema in at-risk surgical patients. Pulmonary vascular permeability index effectively discriminated postoperative acute respiratory distress syndrome from cardiogenic pulmonary edema. These measures will aid in the early detection of subclinical lung injury in at-risk surgical populations.
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Critical care medicine · Mar 2015
Randomized Controlled TrialPatients' Perspectives of Enrollment in Research Without Consent: The Patients' Experiences in Emergency Research-Progesterone for the Treatment of Traumatic Brain Injury Study.
Research in acute illness often requires an exception from informed consent. Few studies have assessed the views of patients enrolled in exception from informed consent trials. This study was designed to assess the views of patients and their surrogates of exception from informed consent enrollment within the context of a randomized, placebo-controlled trial of an investigational agent for traumatic brain injury. ⋯ Acceptance of exception from informed consent in this placebo-controlled trial of an investigational agent was high and exceeded acceptance among community consultation participants. Exception from informed consent enrollment appears generally consistent with patients' preferences.
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Critical care medicine · Mar 2015
The Epidemiology of Vasospasm in Children With Moderate-to-Severe Traumatic Brain Injury.
To gain a description of the prevalence and time course of vasospasm in children suffering moderate-to-severe traumatic brain injury. ⋯ Vasospasm occurs in a sizeable number of children with moderate and severe traumatic brain injury. Children in whom vasospasm developed were more likely to have been involved in a motor vehicle accident, had higher Injury Severity Scores, had fever at admission, and had lower Glasgow Coma scores than in those whom vasospasm did not develop. Based on these findings, we recommend aggressive screening for posttraumatic vasospasm in these patients. Future studies should establish the relationship between vasospasm and long-term functional outcomes and should also evaluate potential preventative or therapeutic options for vasospasm in these children.