Critical care : the official journal of the Critical Care Forum
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To determine the utility of routine chest radiographs (CXRs) in clinical decision-making in the intensive care unit (ICU). ⋯ Routine CXRs have some value in guiding management decisions in the ICU. Daily CXRs may not, however, be necessary for all patients.
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Excess information in complex ICU environments exceeds human decision making limits, increasing the likelihood of clinical errors. Explicit decision-support tools have favorable effects on clinician and patient outcomes and can reduce the variation in clinical practice that persists even when guidelines based on reputable evidence are available. ⋯ Individualization of patient therapy is preserved by these explicit protocols since they are driven by patient data. Computerized protocols that aid ICU decision-makers should be more widely distributed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Enteral feeding in the critically ill: comparison between the supine and prone positions: a prospective crossover study in mechanically ventilated patients.
Prone position is effective in mechanically ventilated patients to improve oxygenation. It is unknown if prone position affects gastric emptying and the ability of continued enteral feeding. ⋯ Our results suggest that enteral feeding can be continued when a patient is turned from supine to prone position or vice versa. The results indicate that patients with a clinically significant gastric residual volume in one position are likely to have a clinically significant gastric residual volume in the other position.
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Ventilating patients with acute respiratory failure according to standardized recommendations can lead to varying volume-pressure (V-P) relationships and overdistension. Young children may be more susceptible than adults to overdistension, and individual evaluation of the effects of ventilator settings is therefore required. Three studies have applied indices for the detection of overdistension to dynamic V-P curves in ventilated children. Two of those studies compared these indices to those obtained using a reference technique ([quasi]-static V-P curves), and suggested that the c coefficient of a second order polynomial equation (SOPE) and the ratio of the volume-dependent elastance to total dynamic elastance (%E2) were suitable indices for estimating overdistension.
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Organophosphate (OP) insecticides inhibit both cholinesterase and pseudo-cholinesterase activities. The inhibition of acetylcholinesterase causes accumulation of acetylcholine at synapses, and overstimulation of neurotransmission occurs as a result of this accumulation. The mortality rate of OP poisoning is high. Early diagnosis and appropriate treatment is often life saving. Treatment of OP poisoning consists of intravenous atropine and oximes. The clinical course of OP poisoning may be quite severe and may need intensive care management. We report our experience with the intensive care management of serious OP insecticide poisonings. ⋯ OP insecticide poisoning is a serious condition that needs rapid diagnosis and treatment. Since respiratory failure is the major reason for mortality, careful monitoring, appropriate management and early recognition of this complication may decrease the mortality rate among these patients.