Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine
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Indian J Crit Care Med · Oct 2015
Patterns of central venous oxygen saturation, lactate and veno-arterial CO2 difference in patients with septic shock.
Tissue hypoperfusion is reflected by metabolic parameters such as lactate, central venous oxygen saturation (ScvO2) and the veno-arterial CO2 (vaCO2) difference. We studied the relation of these parameters over time and with outcome in patients with severe septic shock. ⋯ In septic shock, vaCO2 ≤6 mmHg is independently associated with mortality, particularly in those with normalized ScvO2 consistent with metabolic microcirculatory abnormalities in these patients.
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Indian J Crit Care Med · Oct 2015
A study on the role of noninvasive ventilation in mild-to-moderate acute respiratory distress syndrome.
There is sparse data on the role of noninvasive ventilation (NIV) in acute respiratory distress syndrome (ARDS) from India. Herein, we report our experience with the use of NIV in mild to moderate ARDS. ⋯ Use of NIV in mild to moderate ARDS helped in avoiding intubation in about 44% of the subjects. A baseline APACHE II score of >17 and a PaO2/FiO2 ratio <150 at 1 h predicts NIV failure.
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Indian J Crit Care Med · Oct 2015
Venoarterial extracorporeal membrane oxygenation support for neonatal and pediatric refractory septic shock.
To report our institutional experience of veno-arterial extracorporeal membrane oxygenation (VA ECMO) in children with refractory septic shock. ⋯ ECMO can be safely used to resuscitate and support children with refractory septic shock. We recommend that patients with oliguria whose lactate level has not decreased within 6 h of starting maximum drug therapy be transferred to an ECMO referral center.
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Indian J Crit Care Med · Oct 2015
Right heart failure in acute respiratory distress syndrome: An unappreciated albeit a potential target for intervention in the management of the disease.
Mortality from acute respiratory distress syndrome (ARDS) has gone down recently. In spite of this trend, the absolute numbers continue to be high even with improvements in ventilator strategies and a better understanding of fluid management with this disease. ⋯ The right heart is not designed to function under situations leading to acute elevations in afterload as seen in ARDS, and hence it decompensates. This brief review focuses on the magnitude of the problem, its detection in the intensive care unit, and recognizes the beneficial effect of prone-positioning on the pulmonary vasculature and right heart.
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Indian J Crit Care Med · Sep 2015
ReviewTargeted temperature management: Current evidence and practices in critical care.
Targeted temperature management (TTM) in today's modern era, especially in intensive care units represents a promising multifaceted therapy for a variety of conditions. Though hypothermia is being used since Hippocratic era, the renewed interest of late has been since early 21(st) century. There have been multiple advancements in this field and varieties of cooling devices are available at present. ⋯ Hypothermia is generally accepted treatment for hypoxic ischemic encephalopathy in newborns. The current available technology to induce and maintain hypothermia allows for precise temperature control. Future studies should focus on optimizing hypothermic treatment to full benefit of our patients and its application in other clinical scenarios.