Mayo Clinic proceedings
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Tracheostomy is a common critical care procedure in patients with acute respiratory failure who require prolonged mechanical ventilatory support. Tracheostomy usually is considered if weaning from mechanical ventilation has been unsuccessful for 14 to 21 days. A recent clinical trial suggested that early tracheostomy may benefit patients who are not improving and who are expected to require prolonged respiratory support. ⋯ In expert hands, the 2 techniques are equivalent in complications and safety; however, the bedside percutaneous approach may be more cost-effective. Tracheostomy should be considered early (within the first week of mechanical ventilation) in patients with a high likelihood of prolonged mechanical ventilation. Depending on local medical expertise and costs, either the percutaneous or the surgical technique may be used.
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Mayo Clinic proceedings · Dec 2005
Influence of individual characteristics on outcome of glycemic control in intensive care unit patients with or without diabetes mellitus.
To clarify the relationship of patient and critical illness characteristics (including any history of diabetes mellitus) to glycemic control with insulin and hospital mortality. ⋯ Critical illness characteristics determined glycemic control and clinical outcome in ICU patients. Acute insulin resistance was associated with worse outcomes in nondiabetic patients. Although critical illness characteristics influenced glycemic control, future evaluation of the effect of insulin administration and optimal glycemic control in ICU patients is necessary.
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Mayo Clinic proceedings · Nov 2005
Celiac disease in type 1 diabetes mellitus in a North American community: prevalence, serologic screening, and clinical features.
To estimate the prevalence of cellac disease (CD) in pediatric and adult type 1 diabetes melitus in a defined population and to describe clinical features and HLA class II genotypes predictive of CD in screened patients with type 1 diabetes. ⋯ Celiac disease Is not rare In North American patients with type 1 diabetes, and most CD-positive diabetic patients are asymptomatic Irrespective of age at screening.