Critical care medicine
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Critical care medicine · Jul 2015
Review Meta AnalysisUltrasound-Guided Subclavian Vein Catheterization: A Systematic Review and Metaanalysis.
Use of ultrasound guidance for subclavian vein cannulation reduces the incidence of arterial puncture, pneumothorax, and hematoma.
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Critical care medicine · Jul 2015
Review Meta AnalysisAssociation Between Arterial Hyperoxia and Outcome in Subsets of Critical Illness: A Systematic Review, Metaanalysis, and Meta-Regression of Cohort Studies.
Oxygen is vital during critical illness, but hyperoxia may harm patients. Our aim was to systematically evaluate the methodology and findings of cohort studies investigating the effects of hyperoxia in critically ill adults. ⋯ In various subsets of critically ill patients, arterial hyperoxia was associated with poor hospital outcome. Considering the substantial heterogeneity of included studies and the lack of a clinical definition, more evidence is needed to provide optimal oxygen targets to critical care physicians.
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Critical care medicine · Jul 2015
Multicenter Study Observational StudyEffects and Clinical Characteristics of Intracranial Pressure Monitoring-Targeted Management for Subsets of Traumatic Brain Injury: An Observational Multicenter Study.
To evaluate the efficacy of traumatic brain injury management guided by intracranial pressure monitoring and to explore the specific subgroups for which intracranial pressure monitoring might be significantly associated with improved outcomes based on a classification of the various traumatic brain injury pathophysiologies using the clinical features and CT scans. ⋯ There were multiple differences between the intracranial pressure monitoring and no intracranial pressure monitoring groups regarding patient characteristics, injury severity, characteristics of CT scan, and hospital type. Intracranial pressure monitoring in conjunction with intracranial pressure-targeted therapies is significantly associated with lower mortality in some special traumatic brain injury subgroups. The prospective randomized controlled trials specifically investigating these subgroups will be required to further characterize the effects of intracranial pressure monitoring on behavioral outcomes in patients with traumatic brain injury.
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Critical care medicine · Jul 2015
Comparative StudyRadial Artery Applanation Tonometry for Continuous Noninvasive Cardiac Output Measurement: A Comparison With Intermittent Pulmonary Artery Thermodilution in Patients After Cardiothoracic Surgery.
Radial artery applanation tonometry allows completely noninvasive continuous cardiac output estimation. The aim of the present study was to compare cardiac output measurements obtained with applanation tonometry (AT-CO) using the T-Line system (Tensys Medical, San Diego, CA) with cardiac output measured by intermittent pulmonary artery thermodilution using a pulmonary artery catheter (PAC-CO) with regard to accuracy, precision of agreement, and trending ability. ⋯ Continuous cardiac output measurement using the noninvasive applanation tonometry technology is basically feasible in ICU patients after cardiothoracic surgery. The applanation tonometry technology provides cardiac output values with reasonable accuracy and precision of agreement compared with intermittent pulmonary artery thermodilution measurements in a clinical study setting and is able to reliably track cardiac output changes induced by cardiac output-modifying maneuvers.
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Critical care medicine · Jul 2015
Multicenter Study Comparative StudyComparative Effectiveness of Noninvasive and Invasive Ventilation in Critically Ill Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease.
To compare the characteristics and hospital outcomes of patients with an acute exacerbation of chronic obstructive pulmonary disease treated in the ICU with initial noninvasive ventilation or invasive mechanical ventilation. ⋯ Among critically ill adults with chronic obstructive pulmonary disease exacerbation, the receipt of noninvasive ventilation was associated with a lower risk of in-hospital mortality compared with that of invasive mechanical ventilation; noninvasive ventilation failure was associated with the worst outcomes. These results support the use of noninvasive ventilation as a first-line therapy in appropriately selected critically ill patients with chronic obstructive pulmonary disease while also highlighting the risks associated with noninvasive ventilation failure and the need to be cautious in the face of severe disease.