Critical care : the official journal of the Critical Care Forum
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Comparative Study
Nitrogen washout/washin, helium dilution and computed tomography in the assessment of end expiratory lung volume.
End expiratory lung volume (EELV) measurement in the clinical setting is routinely performed using the helium dilution technique. A ventilator that implements a simplified version of the nitrogen washout/washin technique is now available. We compared the EELV measured by spiral computed tomography (CT) taken as gold standard with the lung volume measured with the modified nitrogen washout/washin and with the helium dilution technique. ⋯ The EELV measurement with the helium dilution technique (at low volumes) and modified nitrogen washout/washin technique (at all lung volumes) correlates well with CT scanning and may be easily used in clinical practice.
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The purpose of this study was to determine the incidence, time course, and outcome of acute kidney injury after major burns and to evaluate the impact of possible predisposing factors (age, gender, and depth and extent of injury) and the relation to other dysfunctioning organs and sepsis. ⋯ Acute kidney injury is common, develops soon after the burn, and parallels other dysfunctioning organs. Although acute kidney injury recovered in all survivors, in higher acute kidney injury groups, together with cardiovascular dysfunction, it correlated with mortality.
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Without specific strategies to address tracheostomy care on the wards, patients discharged from the intensive care unit (ICU) with a tracheostomy may receive suboptimal care. We formed an intensivist-led multidisciplinary team to oversee ward management of such patients. To evaluate the service, we compared outcomes for the first 3 years of the service with those in the year preceding the service. ⋯ An intensivist-led tracheostomy team is associated with shorter decannulation time and length of stay which may result in financial savings for institutions.
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Sustained re-opening of collapsed lung tissue (recruitment) requires the application of airway pressures that exceed those of the tidal cycle. The post-maneuver PEEP as well as the duration of high pressure application are also key factors in its success, with their accompanying potential for hemodynamic compromise. Although a wide variety of recruiting maneuvers have been described, the technique that strikes the best balance between efficacy and risk may well vary among patients with differing right heart loading status and lung properties.
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Editorial Comment Comparative Study
Circuit lifespan during continuous renal replacement therapy: children and adults are not equal.
In the field of continuous renal replacement therapy (CRRT), session length, downtime and dose require detailed research, which will provide information important in relation to prescription, anticoagulation and circuit material choice (membrane type and size, vascular access site and size). In particular, it appears that many of the data currently existing in the literature and accepted regarding CRRT prescription and delivery in critically ill adult patients are not strictly applicable to the paediatric setting. Furthermore, many of the available paediatric studies are small, retrospective or underpowered. In paediatric CRRT, epidemiological investigations and prospective trials to investigate practical aspects of extracorporeal therapies are welcome and urgently needed.