Critical care : the official journal of the Critical Care Forum
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The helmet may be an effective interface for the delivery of noninvasive positive pressure ventilation. The high internal gas volume of the helmet can act as a 'mixing chamber', in which the humidity of the patient's expired alveolar gases increases the humidity of the dry medical gases, thus avoiding the need for active humidification. We evaluated the temperature and humidity of respiratory gases inside the helmet, with and without a heated humidifier, during continuous positive airway pressure (CPAP) delivered with a helmet. ⋯ The fresh gas flowing through the helmet with continuous flow CPAP systems limited the possibility to increase the humidity. We suggest that a heated humidifier should be employed with continuous flow CPAP systems.
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Imported falciparum malaria is characterized by a broad spectrum of potentially life-threatening complications that may arise even after initiation of appropriate antimalarial drug therapy. Hence, at Heidelberg University Hospital, all patients with newly diagnosed falciparum malaria are initially treated in the intermediate care unit (IMC) or intensive care unit (ICU). The present study was undertaken to evaluate critically the benefit of this strategy, which includes daily consultation with senior specialists in tropical medicine. ⋯ This retrospective evaluation demonstrated favourable therapeutic results in hospitalized patients with imported falciparum malaria. Both initial treatment in the medical IMC/ICU and close collaboration between intensivists and specialists in tropical medicine may improve disease outcome among affected patients. Prospective studies are needed to confirm these preliminary findings.
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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
Barbiturates for the treatment of intracranial hypertension after traumatic brain injury.
In their article on the use of barbiturates for the treatment of intracranial hypertension after traumatic brain injury, Perez-Barcena and colleagues conclude that thiopental was more effective than pentobarbital in decreasing intracranial pressure. Here we discuss the limitations of this study and review areas of controversy surrounding barbiturate use in neurocritical care.
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The report by Chase and coworkers in the previous issue of Critical Care describes the implementation into clinical practice of the Specialized Relative Insulin Nutrition Table (SPRINT) for tight glycaemic control in critically ill patients. SPRINT is a simple, wheel-based system that modulates both insulin rate and nutritional inputs. It achieved a better glycaemic control in a severely ill critical cohort than their previous method for glycaemic control in a matched historical cohort. Reductions in mortality were also observed.