Critical care : the official journal of the Critical Care Forum
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Comparative Study
Inhaled beta-2 agonist salbutamol and acute lung injury: an association with improvement in acute lung injury.
Beta2 agonists have several properties that could be beneficial in acute lung injury (ALI). We therefore chose to study the effect of inhaled beta2 agonist use (salbutamol) on duration and severity of ALI. ⋯ Our retrospective study suggests that salbutamol, an inhaled beta2 agonist, is associated with a shorter duration and lower severity of ALI. A dose greater than 2.2 mg/day of inhaled salbutamol could be a minimal effective dose to evaluate in a randomized controlled trial.
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In the early phase of their disease process, patients with acute lung injury are often ventilated with strategies that control the tidal volume or airway pressure, while modes employing spontaneous breathing are applied later to wean the patient from the ventilator. Spontaneous breathing modes may integrate intrinsic feedback mechanisms that should help prevent ventilator-induced lung injury, and should improve synchrony between the ventilator and the patient's demand. Airway pressure release ventilation with spontaneous breathing was shown to decrease cyclic collapse/recruitment of dependent, juxtadiaphragmatic lung areas compared with airway pressure release ventilation without spontaneous breathing. Combined with previous data demonstrating improved cardiorespiratory variables, airway pressure release ventilation with spontaneous breathing may turn out to be a less injurious ventilatory strategy.
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Traditional teaching suggests that corticosteroids should be avoided during acute infectious episodes for fear of compromising the immune response. However, the outcome benefit shown through steroid administration in early septic shock implies this paranoia may be misplaced. We therefore performed a systematic review of the literature to identify the current strength of evidence for the use of corticosteroids in specified infections, and to make appropriate graded recommendations.
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Treatment in the intensive care unit of patients with end-stage liver disease has been limited. Liver transplantation has been a major improvement in this and has become standard in the management of these patients. However, many patients die awaiting liver transplantation, mainly due to the scarcity of organ donors. ⋯ To date, the most widely developed system has been the Molecular Adsorbent Recirculating System (MARS), which is based on the selective removal of albumin-bound toxins from the blood. MARS enables simultaneous liver and kidney detoxification, improving the patient's clinical condition. It is a major improvement in the management of patients with hepatic failure that could permit, when appropriately indicated, recovery from an acute episode and enhance the chances of survival while waiting for an available organ donor.
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In seriously infected patients with acute renal failure and who require continuous renal replacement therapy, data on continuous infusion of ceftazidime are lacking. Here we analyzed the pharmacokinetics of ceftazidime administered by continuous infusion in critically ill patients during continuous venovenous haemodiafiltration (CVVHDF) in order to identify the optimal dosage in this setting. ⋯ We conclude that a dosing regimen of 3 g/day ceftazidime, by continuous infusion, following a 2 g loading dose, results in serum concentrations more than four times the minimum inhibitory concentration for all susceptible pathogens, and we recommend this regimen in critically ill patients undergoing CVVHDF.