Critical care : the official journal of the Critical Care Forum
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Severe asthma, although difficult to define, includes all cases of difficult/therapy-resistant disease of all age groups and bears the largest part of morbidity and mortality from asthma. Acute, severe asthma, status asthmaticus, is the more or less rapid but severe asthmatic exacerbation that may not respond to the usual medical treatment. The narrowing of airways causes ventilation perfusion imbalance, lung hyperinflation, and increased work of breathing that may lead to ventilatory muscle fatigue and life-threatening respiratory failure. ⋯ Permissive hypercapnia, increase in expiratory time, and promotion of patient-ventilator synchronism are the mainstay in mechanical ventilation of status asthmaticus. Close monitoring of the patient's condition is necessary to obviate complications and to identify the appropriate time for weaning. Finally, after successful treatment and prior to discharge, a careful strategy for prevention of subsequent asthma attacks is imperative.
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Review Comparative Study
Clinical review: hemodynamic monitoring in the intensive care unit.
Since the beginning of modern anesthesia, in 1846, the anesthetist has relied on his natural senses to monitor the patient, aided more recently by simple technical devices such as the stethoscope. There has been a tremendous increase in the availability of monitoring devices in the past 30 years. Modern technology has provided a large number of sophisticated monitors and therapeutic instruments, particularly in the past decade. ⋯ The most important aspect in monitoring the critically ill patient is the detection of life-threatening derangements of vital functions. Aggressive marketing strategies have been promoted to monitor almost every aspect of the patient's status. However, these strategies are only telling us what is possible; they do not tell us whether they enhance patient safety, improve our therapy, or even improve patient outcome.
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Review Comparative Study
Clinical review: a paradigm shift: the bidirectional effect of inflammation on bacterial growth. Clinical implications for patients with acute respiratory distress syndrome.
Clinical studies have shown positive associations among sustained and intense inflammatory responses and the incidence of bacterial infections. We hypothesized that cytokines secreted by the host during acute respiratory distress syndrome may indeed favor the growth of bacteria and explain the association between exaggerated and protracted systemic inflammation and the frequent development of nosocomial infections. To test this hypothesis, we conducted in vitro studies evaluating the extracellular and intracellular growth response of three clinically relevant bacteria in response to graded concentrations of pro-inflammatory cytokines tumor necrosis factor-alpha, IL-1beta, and IL-6. ⋯ When the bacteria were exposed in vitro to a lower concentration of cytokines, extracellular and intracellular bacterial growth was not promoted and human monocytic cells were efficient in killing the ingested bacteria. Conversely, when bacteria were exposed to higher concentrations of pro-inflammatory cytokines, intracellular and extracellular bacterial growth was enhanced in a dose-dependent manner. The bidirectional effects of proinflammatory cytokines on bacterial growth may help to explain the frequent occurrence of nosocomial infections in patients with unresolving acute respiratory distress syndrome.
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Comparative Study
Use of a rapid arterial blood gas analyzer to estimate blood hemoglobin concentration among critically ill adults.
To evaluate whether measurement of the hemoglobin (Hb) concentration with a blood gas analyzer approximates that determined by a conventional coulter counter in critically ill adults. ⋯ An arterial blood gas analyzer may provide a valid alternative method to the traditional coulter counter for the rapid assessment of Hb concentration among critically ill adults. Since issues related to its safety, quality control, data entry and cost savings have yet to be addressed, however, use of such point of care testing should be viewed as a supplement to conventional laboratory testing.