Critical care : the official journal of the Critical Care Forum
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Sedatives and analgesics are routinely used in the intensive care unit to relieve pain and anxiety. These agents have numerous side effects and may contribute to poor outcomes such as increased length of mechanical ventilation, longer ICU stays and acute and long-term cognitive dysfunction. Modifying sedation paradigms utilizing either narcotic-based regimens with remifentanil or fentanyl, or by using alpha2 agonists such as dexmedetomidine may help in improving these outcomes in critically ill patients.
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Mechanical ventilation during acute respiratory failure in children is associated with development of ventilator-induced lung injury. Experimental models of mechanical ventilation that limit phasic changes in lung volumes and prevent alveolar overdistension appear to be less damaging to the lung. High-frequency oscillatory ventilation, using very small tidal volumes and relatively high end-expiratory lung volumes, provides a safe and effective means of delivering mechanical ventilatory support with the prospect of reducing the development of ventilator-induced lung injury. Despite theoretical advantages and convincing laboratory data, however, the use of high-frequency oscillatory ventilation in the paediatric population has not yet been associated with significant improvements in clinically significant outcome measures.
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Our objective was to determine the effect of ventilator-associated tracheobronchitis (VAT) on outcome in patients without chronic respiratory failure. ⋯ VAT is associated with longer durations of mechanical ventilation and ICU stay in patients not suffering from chronic respiratory failure.
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The number of publications and the impact factor of journals are accepted estimates of the quantity and quality of research productivity. The objective of the present study was to assess the worldwide scientific contribution in the field of critical care medicine. ⋯ Significant scientific progress in critical care research took place during the period of study (1995-2003). Leaders of research productivity (in terms of absolute numbers) were Western Europe and the USA. Publications originating from Western European countries increased significantly in quantity and quality over the study period. Articles originating from Canada, Japan, and the USA had the highest mean impact factor. Canada was the leader in productivity when adjustments for gross domestic product and population were made.
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Numerous lines of evidence support the premise that withholding and withdrawing life support measures in the intensive care unit are not the same. These include questionnaires, practical observations and an examination of national medical guidelines. It is important to distinguish between the two end of life options as their outcomes and management are significantly different. Appreciation of these differences allows the provision of accurate information, and facilitates decision making that is compassionate, caring and adherent to the needs of the patient and their family.