Critical care medicine
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Critical care medicine · Apr 1996
ReviewNoninvasive mechanical ventilation in patients with acute respiratory failure.
a) To describe the introduction of noninvasive means to provide positive-pressure ventilation in acute respiratory failure; b) to describe the physiologic response to noninvasive ventilation; c) to review the current published literature on using noninvasive ventilation in patients with acute hypercapnic and/or hypoxemic respiratory failure; d) to describe the technique of applying mask ventilation and current recommendations for using noninvasive ventilation and current recommendations for using noninvasive ventilation in patients with acute respiratory failure; and e) to discuss the advantages and disadvantages of noninvasive ventilation. ⋯ Noninvasive ventilation is a safe and effective means of ventilatory support for many patients with acute respiratory failure. Noninvasive ventilation is well tolerated, principally because it allows the patient to be in control and to continue verbal communication, and should be strongly considered in managing terminally ill patients with potentially reversible causes of respiratory failure. The duration of mechanical ventilation and its associated complications are significantly decreased in hypercapnic respiratory failure with noninvasive ventilation.
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Critical care medicine · Apr 1996
Comparative StudyMechanical ventilation and arterial blood gas measurements 24 hours postextracorporeal life support for survivors of pediatric respiratory failure.
To summarize our institutional experience concerning mechanical ventilation support and blood gas measurements in the 24-hr period following extracorporeal life support (ECLS) for pediatric acute respiratory failure. ⋯ Successful decannulation from ECLS for > 24 hrs resulted in long-term survival in 97% (36/37) of children. Ventilator parameters and arterial blood gas measurements during the 24-hr period following bypass have been described for this population. Such conventional support may indicate safe levels of oxygen and mechanical ventilation pressures for the postbypass recovering lung.
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Critical care medicine · Apr 1996
Comparative StudyAssociation of pre mortem diagnosis and autopsy findings in pediatric intensive care unit versus emergency department versus ward patients.
As part of the overall quality assurance program for the Department of Pediatrics, we determined whether there were differences in the rates of unexpected autopsy findings between pediatric intensive care unit (ICU), emergency department, and ward patients. ⋯ Autopsies were performed more frequently in emergency department patients. Class I through IV unexpected findings occurred more frequently in pediatric ICU patients compared with emergency department or ward patients. Autopsy examinations are an especially valuable diagnostic tool for pediatric ICU patients and physicians.
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Critical care medicine · Apr 1996
Comparative StudyEarly prediction of outcome in score-identified, postcardiac surgical patients at high risk for sepsis, using soluble tumor necrosis factor receptor-p55 concentrations.
To investigate the prognostic value of increased serum concentrations of soluble tumor necrosis factor (TNF) receptors in patients at high risk for sepsis. ⋯ This study suggest that increased soluble TNF receptor-p55 concentrations in the serum of postcardiac surgical patients allow earlier prognostication of subsequent hospital course than APACHE II scores alone. This study further suggests that the combination of physiologic scores and cytokine receptor measurements could improve the predictive power of early postoperative risk stratification.
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Critical care medicine · Apr 1996
Comparative StudyA descriptive study of skeletal muscle metabolism in critically ill patients: free amino acids, energy-rich phosphates, protein, nucleic acids, fat, water, and electrolytes.
To characterize biochemical changes in skeletal muscle in critically ill patients. ⋯ Although critically ill patients are a very heterogeneous group from a clinical point of view, there is a remarkable homogeneity in many of the biochemical parameters regardless of the severity of illness and the length of the ICU admission. The three most consistent differences were the skeletal muscle low glutamine concentration, the decrease in protein content, and the increase in extracellular water in the patients.