Critical care : the official journal of the Critical Care Forum
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Recruitment maneuvers and positive end-expiratory pressure (PEEP)/tidal ventilation titration in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) are the cornerstone of mechanical ventilatory support. The net result of these possible adjustments in ventilatory parameters is the interaction of the pressure applied in the respiratory system (airway pressure/end expiratory pressure) counterbalanced by chest wall configuration/abdominal pressure along the mechanical ventilatory support duration. Refinements in the ventilatory adjustments in ALI/ARDS are necessary for minimizing the biotrauma in this still life-threatening clinical problem.
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Randomized Controlled Trial Comparative Study
Efficiency of 7.2% hypertonic saline hydroxyethyl starch 200/0.5 versus mannitol 15% in the treatment of increased intracranial pressure in neurosurgical patients - a randomized clinical trial [ISRCTN62699180].
This prospective randomized clinical study investigated the efficacy and safety of 7.2% hypertonic saline hydroxyethyl starch 200/0.5 (7.2% NaCl/HES 200/0.5) in comparison with 15% mannitol in the treatment of increased intracranial pressure (ICP). ⋯ 7.2% NaCl/HES 200/0.5 is more effective than mannitol 15% in the treatment of increased ICP. A dose of 1.4 ml/kg of 7.2% NaCl/HES 200/0.5 can be recommended as effective and safe. The advantage of 7.2% NaCl/HES 200/0.5 might be explained by local osmotic effects, because there were no clinically relevant differences in hemodynamic clinical chemistry parameters.
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Randomized Controlled Trial
Recombinant human erythropoietin therapy in critically ill patients: a dose-response study [ISRCTN48523317].
The aim of this study was to assess the efficacy of two dosing schedules of recombinant human erythropoietin (rHuEPO) in increasing haematocrit (Hct) and haemoglobin (Hb) and reducing exposure to allogeneic red blood cell (RBC) transfusion in critically ill patients. ⋯ Administration of rHuEPO to critically ill patients significantly reduced the need for RBC transfusion. The magnitude of the reduction did not differ between the two dosing schedules, although there was a dose response for Hct and Hb to rHuEPO in these patients.
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Recent advances in acid-base physiology and in the epidemiology of acid-base disorders have refined our understanding of the basic control mechanisms that determine blood pH in health and disease. These refinements have also brought parity between the newer, quantitative and older, descriptive approaches to acid-base physiology. This review explores how the new and older approaches to acid-base physiology can be reconciled and combined to result in a powerful bedside tool. A case based tutorial is also provided.
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We summarize all original research in the field of respirology and critical care published in 2003 and 2004 in Critical Care. Articles were grouped into the following categories to facilitate a rapid overview: pathophysiology, therapeutic approaches, and outcome in acute lung injury and acute respiratory distress syndrome; hypoxic pulmonary arterial hypertension; mechanical ventilation; liberation from mechanical ventilation and tracheostomy; ventilator-associated pneumonia; multidrug-resistant infections; pleural effusion; sedation and analgesia; asthma; and techniques and monitoring.