Articles: adult.
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There is a growing concern of the potential injurious role of ventilatory over-distention in patients without lung injury. No formal guidelines exist for intraoperative ventilation settings, but the use of tidal volumes (VT) under 10 mL/kg predicted body weight (PBW) has been recommended in healthy patients. We explored the incidence and risk factors for receiving large tidal volumes (VT > 10 mL/kg PBW). ⋯ Ventilation with VT > 10 mL/kg PBW is still common, although poor correlation with PBW suggests it may be unintentional. BMI ≥ 30, female gender and height < 165 cm may predispose to receive large tidal volumes during general anesthesia. Further awareness of patients' height and PBW is needed to improve intraoperative ventilation practices. The impact on clinical outcome needs confirmation.
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Background There is growing interest in the potential utility of real-time PCR in diagnosing bloodstream infection by detecting pathogen DNA in blood samples within a few hours. SeptiFast is a multipathogen probe-based real-time PCR system targeting ribosomal DNA sequences of bacteria and fungi. It detects and identifies the commonest pathogens causing bloodstream infection and has European regulatory approval. ⋯ Furthermore, differences in circulating immune-inflammatory markers in patient groups differentiated by the presence/absence of culturable pathogens and pathogen DNA will help elucidate further the patho-physiology of infection developing in the critically ill. Ethics and dissemination Ethical approval has been granted by the North West 6 Research Ethics Committee (09/H1003/109). Based on the results of this first non-commercial study, independent recommendations will be made to The Department of Health (open-access health technology assessment report) as to whether SeptiFast has sufficient clinical diagnostic accuracy to move forward to efficacy testing during the provision of routine clinical care.
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Ont Health Technol Assess Ser · Jan 2011
Constraint-induced movement therapy for rehabilitation of arm dysfunction after stroke in adults: an evidence-based analysis.
The purpose of this evidence-based analysis is to determine the effectiveness and cost of CIMT for persons with arm dysfunction after a stroke. ⋯ Stroke Impact Scale (SIS) SUMMARY OF FINDINGS: A significant difference was found in our primary outcome of arm motor function measured with the Action Research Arm Test in favour of CIMT compared with usual care delivered with the same intensity and duration. Significant differences were also found in three of the five secondary outcome measures including Arm Motor Impairment and Perceived Motor Function Amount of Use and Quality of Use. There was a nonsignificant effect found with the FIM score and the quality of life Stroke Impact Scale outcome measure. The nonsignificant effect found with the scale score and the quality of life score may be a factor of a nonresponsive outcome measure (FIM scale) and/or a type II statistical error from an inadequate sample size. The quality of evidence was moderate for arm motor function and low for all other outcome measures except quality of life, which was very low. Table 1:Summary of Results(*)OutcomeOutcome MeasureNumber of Studies (n)Mean Difference in Change scores CIMT vs. Usual Care [95% C.I.]ResultsGRADE Quality of EvidenceArm motor functionAction Research Arm Test4(43)13.6[8.7, 18.6]SignificantModerateArm motor impairmentFugl-Meyer Motor Assessment8(169)6.5[2.3, 10.7]SignificantLowActivities of daily livingFunctional Independence Measure4(128)3.6[-0.22, 7.4]NonsignificantLowSelf-reported amount of arm usePerceived Arm Motor Function (Amount of Use) Scale8(241)1.1[0.60, 1.7]SignificantLowSelf-reported quality of arm usePerceived Arm Motor Function (Quality of Use) Scale8(241)0.97[0.7, 1.3]SignificantLowQuality of lifeStroke Impact Scale2(66)3.9[-5.6, 13.5]NonsignificantVery Low*CI, Confidence Intervals; n, Sample Size.
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Ther Hypothermia Temp Manag · Jan 2011
Therapeutic Hypothermia After Cardiac Arrest is Underutilized in the United States.
Little is known about the frequency of therapeutic hypothermia use after cardiac arrest in the United States. We, therefore, analyzed the Nationwide Inpatient Sample (NIS) to determine the prevalence of hypothermia use after cardiac arrest and patient and hospital factors associated with its use. Using 2007 NIS data, we identified adult patients with cardiac arrest using the ICD-9 diagnosis code, 427.5, while the use of therapeutic hypothermia was based on the ICD-9 procedure code, 99.81. ⋯ S. hospitals. We identified important patient and hospital factors associated with therapeutic hypothermia utilization. Efforts to increase generalized utilization of this effective resuscitation strategy are warranted.
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Ther Hypothermia Temp Manag · Jan 2011
Management of febrile critically ill adults: a retrospective assessment of regional practice.
The aim of this study was to report on fever epidemiology and management strategies within a general population of critically ill patients. This was a retrospective cohort study among febrile patients (temperature ≥38.3°C) without acute brain injury admitted to one of four regional adult intensive care units (ICUs). There were 7535 ICU admissions over the 30-month study period. ⋯ Fever was most commonly infectious in origin. Treatment of patients with fever was a common and nonstandardized practice in this cohort of critically ill patients. This is likely due to lack of evidence in support of a particular temperature management strategy.