Medical science monitor : international medical journal of experimental and clinical research
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Comparative Study
Influence of endotracheal tube bore on tidal volume during high frequency oscillatory ventilation: a model lung study.
In adults, the influence of endotracheal tube bore on tidal volume (VT) during high-frequency oscillatory ventilation (HFOV) has been little studied. ⋯ In an adult-simulating model lung, VT during HFOV varies in proportion to ETT CSA.
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Critically ill patients frequently suffer from sepsis or localized infections. Diagnosing sepsis can be a challenge since several of its signs overlap with those found with other inflammatory states. Recognition of localized infections can at times be difficult too. ⋯ The combination of systemic PCT and local and/or systemic sTREM-1 could be useful in distinguishing patients with infection from those with non-infectious illness, though. Results from several randomized intervention studies on PCT-guided antimicrobial therapy in sepsis or lower respiratory tract infections show the superiority of PCT in clinical decision making. At present, randomized intervention studies on the potential antimicrobial stewardship of sTREM-1 are lacking.
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Randomized Controlled Trial
Postoperative analgosedation with S(+)-ketamine decreases the incidences of postanesthetic shivering and nausea and vomiting after cardiac surgery.
Along with postoperative nausea and vomiting (PONV), postanesthetic shivering (PAS) is one of the leading causes of distress postoperatively. Previous studies report on a decrease in incidence of PAS due to ketamine administration; however, the S(+) isomer of ketamine has not been evaluated before. Additionally the administration of ketamine minimizes the use of opioids, one of the most important risk factor of PONV. The aim of the present study was to evaluate the efficacy of S(+)-ketamine in the prophylaxis of both PAS and PONV in patients undergoing cardiac surgery. ⋯ S(+)-ketamine reduced both postanesthetic shivering and postoperative nausea and vomiting, when administered for postoperative analgosedation.
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Intrathecal interleukin (IL)-6 is considered to be a proinflammatory biomarker for cerebral inflammatory response. This is of clinical importance for the prediction of vasospasm after subarachnoid haemorrhage (SAH). We evaluated a bedside technique for the quantitative measurement of IL-6 in the cerebrospinal fluid (CSF). ⋯ The new chip-test provides a handy tool for the neurosurgical intensive care unit, analysing CSF IL-6 concentrations within 20 minutes. This is the first time a point-of care test for IL-6 in CSF was evaluated. The test results match the values achieved by the standard Immulite technique. Therefore a tool for clinical routine interleukin-6 investigation is provided which could find use in a broad variety of neurosurgical and neurological diseases.
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Blood glucose control aiming at normoglycemia, frequently referred to as "strict glycemic control", decreases mortality and morbidity of critically ill patients. We searched the medical literature for export opinions, surveys, and clinical reports on blood glucose control in intensive care medicine. While strict glycemic control has been recommended standard of care for critically ill patients, the risk of severe hypoglycemia with strict glycemic control is frequently mentioned by experts. ⋯ Implementation of strict glycemic control is far from complete, at least in part because of the feared risks of hypoglycemia. The preference for hyperglycemia over intermittent hypoglycemia is irrational, however, because there is causal evidence of harm for the former but only associative evidence of harm for the latter. For several reasons it is wise to have strict glycemic control being a nurse-based strategy.