Critical care : the official journal of the Critical Care Forum
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Randomized Controlled Trial Comparative Study
Prediction of extubation outcome: a randomised, controlled trial with automatic tube compensation vs. pressure support ventilation.
Tolerance of a spontaneous breathing trial is an evidence-based strategy to predict successful weaning from mechanical ventilation. Some patients may not tolerate the trial because of the respiratory load imposed by the endotracheal tube, so varying levels of respiratory support are widely used during the trial. Automatic tube compensation (ATC), specifically developed to overcome the imposed work of breathing because of artificial airways, appears ideally suited for the weaning process. We further evaluated the use of ATC in this setting. ⋯ This study confirms the usefulness of ATC during the weaning process, being at least as effective as PSV in predicting successful extubation outcome and significantly improving the predictive value of the f/VT.
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Laryngeal edema is a frequent complication of intubation. It often presents shortly after extubation as post-extubation stridor and results from damage to the mucosa of the larynx. Mucosal damage is caused by pressure and ischemia resulting in an inflammatory response. ⋯ The use of non-invasive positive pressure ventilation is not indicated since this will delay reintubation. Reintubation should be considered early after onset of laryngeal edema to adequately secure an airway. Reintubation leads to increased cost, morbidity and mortality.
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Multicenter Study
Mortality in sepsis versus non-sepsis induced acute lung injury.
Sepsis-induced acute lung injury (ALI) has been reported to have a higher case fatality rate than other causes of ALI. However, differences in the severity of illness in septic vs. non-septic ALI patients might explain this finding. ⋯ Greater severity of illness contributes to the higher case fatality rate observed in sepsis-induced ALI. Sepsis was not independently associated with mortality in our study.
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We summarize original research in the field of critical care nephrology accepted or published during 2008 in Critical Care and, when considered relevant or directly linked to this research, in other journals. Three main topics have been identified for a rapid overview. (1) The classification of acute kidney injury, with particular attention to differences and similarities between the RIFLE and AKIN classifications. (2) Fluid balance in patients requiring renal replacement therapy (RRT) has been shown as an independent risk factor for mortality in critically ill patients: current evidence and uncertainties are described. (3) Management of anticoagulation during RRT has been explored by several researchers in 2008: diagnosis of heparin-induced thrombocytopenia, the use of tirofiban and optimal anticoagulation during drotrecogin A activated treatment have been evaluated.
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Multicenter Study
Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill.
Hyperlactatemia is frequent in critically ill patients and is often used as a marker of adverse outcome. However, studies to date have focused on selected intensive care unit (ICU) populations. We sought to determine the occurrence and relation of hyperlactatemia with ICU mortality in all patients admitted to four ICUs in a large regional critical care system. ⋯ Hyperlactatemia is common among the critically ill and predicts risk for death.