MedWorm: Intensive Care

The kinetics of T regulatory cells in shock: beyond sepsis

Critical Care — Fri, 19 Mar 2010 00:00:00 +0100

During the past decade, there have been an increasing number of studies investigating the precise role of T regulatory cells in human disease. First recognized for their ability to prevent autoimmunity, T regulatory cells control effector CD4+ and CD8+ T lymphocytes and innate immune cells by several different suppressive mechanisms, like cell to cell contact, secretion of inhibitory cytokines and cytolysis. This suppressive function of T regulatory cells could contribute in a similar way to the profound immune dysfunction seen in critical illness whether the latter is due to sepsis or severe injury. (Source: Critical Care)

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Non-invasive ventilation in acute respiratory failure related to 2009 pandemic Influenza A/H1N1 virus infection

Critical Care — Fri, 19 Mar 2010 00:00:00 +0100

Noninvasive ventilation (NIV) is considered first-line intervention for different causes of acute respiratory failure (ARF). (Source: Critical Care)

Enoxaparin - effective dosage for intensive care patients: double-blinded, randomised clinical trial

Critical Care — Thu, 18 Mar 2010 00:00:00 +0100

Conclusions: Our study confirmed that a standard dose of 40 mg enoxaparin yielded sub- therapeutic levels of aFXa in critically ill patients. Higher doses resulted in better peak aFXa levels, with a ceiling effect observed at 60 mg. The present study seems to suggest inadequate dosage as one of the possible mechanisms for the higher failure rate of enoxaparin in ICU patients.Trial Registration: ISRCTN03037804 (Source: Critical Care)

Mechanical ventilation with high tidal volume induces inflammation in patients without lung disease

Critical Care — Thu, 18 Mar 2010 00:00:00 +0100

Conclusions: The use of lower tidal volumes may limit pulmonary inflammation in mechanically ventilated patients even without lung injury.Clinical Trial registration: NCT00935896 (Source: Critical Care)

Resuscitation with low volume hydroxyethylstarch 130kDa/0.4 is not associated with acute kidney injury

Critical Care — Thu, 18 Mar 2010 00:00:00 +0100

Conclusions: Volume expansion with low volume HES 130kDa/0.4 was not associated with AKI. (Source: Critical Care)

Cardiopulmonary Bypass

Critical Care — Thu, 18 Mar 2010 00:00:00 +0100

No description available (Source: Critical Care)

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Authors' reply

Indian Journal of Critical Care Medicine — Wed, 17 Mar 2010 16:11:54 +0100

Singh Harsimran, Tewari Anurag, Kaur Balvinder, Garg SuchitaIndian Journal of Critical Care Medicine 2009 13(4):225-225 (Source: Indian Journal of Critical Care Medicine)

Venous air embolism

Indian Journal of Critical Care Medicine — Wed, 17 Mar 2010 16:11:54 +0100

Aggarwal SourabhIndian Journal of Critical Care Medicine 2009 13(4):225-225 (Source: Indian Journal of Critical Care Medicine)

Patient communication (SMS) in ICU

Indian Journal of Critical Care Medicine — Wed, 17 Mar 2010 16:11:54 +0100

Haranath P. S. R. KIndian Journal of Critical Care Medicine 2009 13(4):224-225 (Source: Indian Journal of Critical Care Medicine)

Anaphylactoid to polyurethane foam (yellow foam) among architects

Indian Journal of Critical Care Medicine — Wed, 17 Mar 2010 16:11:54 +0100

Wiwanitkit VirojIndian Journal of Critical Care Medicine 2009 13(4):224-224 (Source: Indian Journal of Critical Care Medicine)

Acute renal failure caused by pheniramine maleate induced rhabdomyolysis: An unusual case

Indian Journal of Critical Care Medicine — Wed, 17 Mar 2010 16:11:54 +0100

We report a case of a suicide attempt in a young male, where ingestion of antihistamine pheniramine maleate was complicated by nontraumatic rhabdomyolysis and oliguric acute renal failure. Rhabdomyolysis and acute renal failure is a rarely reported but potentially serious complication among patients who present to the emergency after intentional overdoses making recognition and prompt intervention essential. We also describe the potential mechanism of muscle injury in antihistamine overdose. (Source: Indian Journal of Critical Care Medicine)

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Extreme metabolic alkalosis in intensive care

Indian Journal of Critical Care Medicine — Wed, 17 Mar 2010 16:11:54 +0100

Tripathy SwagataIndian Journal of Critical Care Medicine 2009 13(4):217-220Metabolic alkalosis is a commonly seen imbalance in the intensive care unit (ICU). Extreme metabolic alkalemia, however, is less common. A pH greater than 7.65 may carry a high risk of mortality (up to 80%). We discuss the entity of life threatening metabolic alkalemia by means of two illustrative cases - both with a pH greater than 7.65 on presentation. The cause, modalities of managing and complications of this condition is discussed from the point of view of both the traditional method of Henderson and Hasselbalch and the mathematical model based on physiochemical model described by Stewart. Special mention to the pitfalls in managing patients of metabolic alkalosis with concomitant renal compromise is mad...

Ultrasonography: A novel approach to central venous cannulation

Indian Journal of Critical Care Medicine — Wed, 17 Mar 2010 16:11:54 +0100

Conclusion: USG-guided CVC is thus easier, quicker, and safer than landmark approach. (Source: Indian Journal of Critical Care Medicine)

Role of noninvasive ventilation in weaning from mechanical ventilation in patients of chronic obstructive pulmonary disease: An Indian experience

Indian Journal of Critical Care Medicine — Wed, 17 Mar 2010 16:11:54 +0100

Prasad Shiva B.N, Chaudhry Dhruva, Khanna RajanIndian Journal of Critical Care Medicine 2009 13(4):207-212Background: Endotracheal intubation and mechanical ventilation (MV) are often needed in patients of chronic obstructive pulmonary disease (COPD) with acute hypercapnic respiratory failure. The rate of weaning failure is high and prolonged MV increases intubation associated complications. Objective: To evaluate the role of Noninvasive ventilation (NIV) in weaning patients of chronic obstructive pulmonary disease (COPD) from MV, after T piece trial failure. Design: A prospective, randomized, controlled study was conducted in a tertiary care centre. 30 patients of acute exacerbation of COPD with acute on chronic hypercapnic respiratory failure, who were mechanically ventilated, were inclu...

Quality indicators for ICU: ISCCM guidelines for ICUs in India

Indian Journal of Critical Care Medicine — Wed, 17 Mar 2010 16:11:54 +0100

Ray B, Samaddar D P, Todi S K, Ramakrishnan N, John George, Ramasubban SureshIndian Journal of Critical Care Medicine 2009 13(4):173-206 (Source: Indian Journal of Critical Care Medicine)

Non-invasive ventilation for critically ill patients with Pandemic H1N1 2009 Influenza A Virus infection.

Critical Care — Wed, 17 Mar 2010 00:00:00 +0100

N/A (Source: Critical Care)

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Attributable mortality of ventilator-associated pneumonia: respective impact of main characteristics at ICU admission and VAP onset using conditional logistic regression and multi-state models

Intensive Care Medicine — Tue, 16 Mar 2010 09:02:59 +0100

Conclusion A multistate model that appropriately handled VAP as a time-dependent event produced lower VAP-AM values than conditional logistic regression. VAP-AM varied widely with case-mix. Disease severity at VAP onset markedly influenced VAP-AM; this may contribute to the variability of previous estimates. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1824-6Authors Molière Nguile-Makao, University Grenoble 1, Albert Bonniot Institute INSERM U823 Grenoble FranceJean-Ralph Zahar, University Grenoble 1, Albert Bonniot Institute INSERM U823 Grenoble FranceAdrien Français, University Grenoble 1, Albert Bonniot Institute INSERM U823 Grenoble FranceAlexis Tabah, University Grenoble 1, Albert Bonniot Institute INSERM U823 Grenoble FranceMaité Garr...

Regional lung aeration and ventilation during pressure support and biphasic positive airway pressure ventilation in experimental lung injury

Critical Care — Tue, 16 Mar 2010 00:00:00 +0100

Conclusions: In this model of ALI, the reduction of tidal re-aeration and hyperaeration during BIPAP+SBmean compared to PSV is not due to decreased nonaerated areas at end-expiration or different distribution of ventilation, but to lower tidal volumes during BIPAP+SBspont. The ratio between spontaneous to controlled breaths seems to play a pivotal role in reducing tidal re-aeration and hyperaeration during BIPAP+SBmean. (Source: Critical Care)

Eicosapentaenoic acid preserves diaphragm force generation following endotoxin administration

Critical Care — Tue, 16 Mar 2010 00:00:00 +0100

This study examined the effect of eicosapentaenoic acid (EPA), an immunomodulator that can be safely administered to patients, on diaphragm force generation following endotoxin administration. Methods: Rats were administered the following (n=5/group): (a) saline, (b) endotoxin, 12 mg/kg IP, (c) endotoxin + EPA (1.0 g/kg/d), and (d) EPA alone. Diaphragms were removed and measurements made of the diaphragm force-frequency curve, calpain activation, caspase activation, and protein carbonyl levels. Results: Endotoxin elicited large reductions in diaphragm specific force generation (p (Source: Critical Care)

Alveolar fluid clearance in healthy pigs and influence of positive end-expiratory pressure

Critical Care — Tue, 16 Mar 2010 00:00:00 +0100

The objectives were to characterize alveolar fluid clearance (AFC) in pigs with normal lungs and to analyze the effect of immediate application of positive end-expiratory pressure (PEEP). Methods: Animals (n=25) were mechanically ventilated and divided into four groups: small edema (SE) group, producing pulmonary edema (PE) by intratracheal instillation of 4 ml/kg of saline solution; small edema with PEEP (SE+PEEP) group, same as previous but applying PEEP of 10 cmH2O; large edema (LE) group, producing PE by instillation of 10 ml/kg of saline solution; large edema with PEEP (LE+PEEP) group, same as LE group but applying PEEP of 10 cmH2O. AFC was estimated from differences in extravascular lung water values obtained by transpulmonary thermodilution method. Results: At 1 h, AFC was 19.4% in ...

Accuracy of C-reactive protein, procalcitonin, and mid-regional pro-atrial natriuretic peptide to guide site of care of community-acquired pneumonia

Intensive Care Medicine — Mon, 15 Mar 2010 18:01:46 +0100

Conclusions In a selected population of CAP with low risk of complication, a single ANP measurement was more accurate than CRP and PCT to predict appropriate admission. These results should be confirmed by additional studies. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1818-4Authors Yann-Erick Claessens, Hôpital Cochin, APHP Department of Emergency Medicine 27 rue du Faubourg Saint-Jacques 75679 Paris Cedex 14 FranceThierry Mathevon, Hôpital Gabriel Montpied Department of Emergency Medicine 58 rue Montalembert 63003 Clermont-Ferrand Cedex 1 FranceGérald Kierzek, Hôpital Hôtel-Dieu, APHP Department of Emergency Medicine 1, place du Parvis Notre-Dame 75181 Paris Cedex 4 FranceSophie Grabar, Hôpital Cochin, APHP Department of Biostatistics ...

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Comparison of high-frequency oscillation and tracheal gas insufflation versus standard high-frequency oscillation at two levels of tracheal pressure

Intensive Care Medicine — Mon, 15 Mar 2010 18:01:46 +0100

Conclusions At the same P tr level, HFO-TGI results in superior gas exchange compared with HFO. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1822-8Authors Spyros D. Mentzelopoulos, University of Athens Medical School First Department of Intensive Care Medicine Athens GreeceSotiris Malachias, University of Athens Medical School First Department of Intensive Care Medicine Athens GreeceStelios Kokkoris, University of Athens Medical School First Department of Intensive Care Medicine Athens GreeceCharis Roussos, University of Athens Medical School First Department of Intensive Care Medicine Athens GreeceSpyros G. Zakynthinos, University of Athens Medical School First Department of Intensive Care Medicine Athens Greece Journal Intensive Care M...

Gastric residual volume during enteral nutrition in ICU patients: the REGANE study

Intensive Care Medicine — Mon, 15 Mar 2010 18:01:45 +0100

Conclusions Diet volume ratio of mechanically ventilated patients treated with enteral nutrition is not affected by increasing the limit in GRV. A limit of 500 ml is not associated with adverse effects in gastrointestinal complications or in outcome variables. A value of 500 ml can be equally recommended as a normal limit for GRV. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1856-yAuthors J. C. Montejo, Hospital Universitario 12 de Octubre Medicina Intensiva, Unidad Polivalente, ICU Glorieta de Málaga s/n 28041 Madrid SpainE. Miñambres, Hospital Universitario Marqués de Valdecilla ICU Avda. Valdecilla nº 25 39008 Santander SpainL. Bordejé, Hospital Universitari Germans Trias i Pujol ICU Carretera de Canyet s/n 08916 Badalona Spa...

Impact of body mass on incidence and prognosis of acute kidney injury requiring renal replacement therapy

Intensive Care Medicine — Mon, 15 Mar 2010 18:01:45 +0100

Conclusions Obesity is an independent risk factor for developing AKI. Our results provide further evidence that body mass impacts on survival of patients with AKI requiring renal replacement therapy. Obese patients seem to have a survival benefit compared to underweight or normal weight patients. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1844-2Authors Wilfred Druml, Medical University of Vienna Division of Nephrology, Department of Internal Medicine III Vienna AustriaBarbara Metnitz, Medical University of Vienna Department of Medical Statistics Vienna AustriaEva Schaden, Medical University of Vienna Department of Anesthesiology and General Intensive Care Vienna AustriaPeter Bauer, Medical University of Vienna Department of Medical Statistic...

The effect of endotracheal suction on regional tidal ventilation and end-expiratory lung volume

Intensive Care Medicine — Mon, 15 Mar 2010 18:01:44 +0100

Conclusions ETT suction causes transient loss of EELV and V T throughout the lung. Catheter size exerts a greater influence than suction method, with CS only protecting against derecruitment when a small catheter is used, especially in the non-dependent lung. Content Type Journal ArticleCategory ExperimentalDOI 10.1007/s00134-010-1849-xAuthors D. G. Tingay, Royal Children’s Hospital Department of Neonatology Flemington Rd. Melbourne VIC 3052 AustraliaB. Copnell, Royal Children’s Hospital Department of Neonatology Flemington Rd. Melbourne VIC 3052 AustraliaC. A. Grant, Mater Children’s Hospital Paediatric Critical Care Research Group, Paediatric Intensive Care Unit Brisbane AustraliaP. A. Dargaville, Royal Hobart Hospital and University of Tasmania Department o...

Individual patient data meta-analysis in intensive care medicine and contextual effects

Intensive Care Medicine — Mon, 15 Mar 2010 18:01:42 +0100

Content Type Journal ArticleCategory CorrespondenceDOI 10.1007/s00134-010-1812-xAuthors James C. Hurley, University of Melbourne School of Rural Health Melbourne VIC Australia Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

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Tracheal pressure and endotracheal tube obstruction can be detected by continuous cuff pressure monitoring: in vitro pilot study

Intensive Care Medicine — Mon, 15 Mar 2010 18:01:42 +0100

Conclusions This study proposes a new method to predict the degree of ETT obstruction based on differences between P c and P v. The method was proved accurate on simulator, and further studies are needed on intubated patients. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1835-3Authors Shai Efrati, Tel-Aviv University Research and Development Unit, Assaf Harofeh Medical Center, Zerifin, affiliated with the Sackler School of Medicine Zerifin IsraelIsrael Deutsch, Tel-Aviv University Research and Development Unit, Assaf Harofeh Medical Center, Zerifin, affiliated with the Sackler School of Medicine Zerifin IsraelGabriel M. Gurman, Ben-Gurion University of the Negev Faculty of Health Sciences Beer-Sheva IsraelMatitiau Noff, Tel-Aviv University Res...

Diagnostic utility of elevated serum soluble triggering receptor expressed on myeloid cells (sTREM)-1 in infected neonates

Intensive Care Medicine — Mon, 15 Mar 2010 18:01:40 +0100

Conclusions Serum sTREM-1 increases in infected neonates. Diagnostic accuracy of sTREM-1 either alone or in combination with IL-6 is not better than that of IL-6. Content Type Journal ArticleCategory Pediatric Brief ReportDOI 10.1007/s00134-010-1819-3Authors Kosmas Sarafidis, University of Thessaloniki, “Hippokration” General Hospital 1st Department of Neonatology of Aristotle Kostantinoupoleos 49 54642 Thessaloniki GreeceVasiliki Soubasi-Griva, University of Thessaloniki, “Hippokration” General Hospital 1st Department of Neonatology of Aristotle Kostantinoupoleos 49 54642 Thessaloniki GreeceKaliopi Piretzi, University of Thessaloniki, “Hippokration” General Hospital 1st Department of Neonatology of Aristotle Kostantinoupoleos 49 54642 Thessaloniki Greece...

Imminent brain death: point of departure for potential heart-beating organ donor recognition

Intensive Care Medicine — Mon, 15 Mar 2010 18:01:40 +0100

Conclusion The definition of imminent brain death can be used as a point of departure for potential heart-beating organ donor recognition on the intensive care unit or retrospective medical chart analysis. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1848-yAuthors Yorick J. de Groot, Erasmus MC University Medical Center Rotterdam Department of Intensive Care P.O. Box 2040 3000 CA Rotterdam The NetherlandsNichon E. Jansen, Dutch Transplant Foundation Leiden The NetherlandsJan Bakker, Erasmus MC University Medical Center Rotterdam Department of Intensive Care P.O. Box 2040 3000 CA Rotterdam The NetherlandsMichael A. Kuiper, Medical Center Leeuwarden Department of Intensive Care Leeuwarden The NetherlandsStan Aerdts, Isala Clinics Department of In...

Do soluble mediators cause ventilator-induced lung injury and multi-organ failure?

Intensive Care Medicine — Mon, 15 Mar 2010 18:01:39 +0100

Conclusions Adaptation of Koch’s postulates to the biotrauma hypothesis of VALI could provide important insights. Translation of the acquired knowledge into clinical testing is challenged by the heterogeneity of the patient population (e.g., etiology, co-morbidity, genetics or concomitant therapy) and the specificity and efficacy of the therapeutic intervention on the cellular/molecular level. Content Type Journal ArticleCategory ReviewDOI 10.1007/s00134-010-1850-4Authors Thomas Jaecklin, University of Toronto Physiology and Experimental Medicine Program, Hospital for Sick Children Toronto CanadaGail Otulakowski, University of Toronto Physiology and Experimental Medicine Program, Hospital for Sick Children Toronto CanadaBrian P. Kavanagh, Hospital for Sick Childr...

Surfactant use based on the oxygenation response to lung recruitment during HFOV in VLBW infants

Intensive Care Medicine — Mon, 15 Mar 2010 18:01:38 +0100

Conclusions First intention HFOV combined with an early attempt at lung volume optimization might allow surfactants to be used more selectively (in relation to disease severity) in VLBW infants presenting with RDS at birth without negatively influencing the outcome. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1838-0Authors Pierre Tissières, University Hospital of Geneva Division of Pediatric and Neonatal Intensive Care, Department of Pediatrics 6, Rue Willy Donzé 1211 Geneva 14 SwitzerlandPatrick Myers, University Hospital of Geneva Division of Pediatric and Neonatal Intensive Care, Department of Pediatrics 6, Rue Willy Donzé 1211 Geneva 14 SwitzerlandMaurice Beghetti, University Hospital of Geneva Pediatric Cardiology Unit, Department of P...

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Correction to “Detection of architectural distortion in prior mammograms using Gabor filters, phase portraits, fractal dimension, and texture analysis [1]”

International Journal of Computer Assisted Radiology and Surgery — Mon, 15 Mar 2010 17:59:51 +0100

Content Type Journal ArticleCategory Short CommunicationDOI 10.1007/s11548-010-0408-9Authors Shantanu Banik, University of Calgary Department of Electrical and Computer Engineering, Schulich School of Engineering Calgary AB T2N 1N4 CanadaRangaraj M. Rangayyan, University of Calgary Department of Electrical and Computer Engineering, Schulich School of Engineering Calgary AB T2N 1N4 Canada Journal International Journal of Computer Assisted Radiology and SurgeryOnline ISSN 1861-6429Print ISSN 1861-6410 (Source: International Journal of Computer Assisted Radiology and Surgery)

Endocardial boundary extraction in left ventricular echocardiographic images using fast and adaptive B-spline snake algorithm

International Journal of Computer Assisted Radiology and Surgery — Mon, 15 Mar 2010 17:59:51 +0100

Conclusion In sum, the proposed method achieves satisfactory results with low computational complexity. This algorithm provides a robust and feasible technique for echocardiographic image segmentation. Suggestions for future improvements of the method are provided. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11548-010-0404-0Authors Mahdi Marsousi, K.N. Toosi University of Technology Tehran IranArmin Eftekhari, Colorado School of Mines Golden USAArmen Kocharian, Tehran University Tehran IranJavad Alirezaie, Ryerson University Toronto Canada Journal International Journal of Computer Assisted Radiology and SurgeryOnline ISSN 1861-6429Print ISSN 1861-6410 (Source: International Journal of Computer Assisted Radiology and Surgery)

Reply to Hurley

Intensive Care Medicine — Mon, 15 Mar 2010 17:53:02 +0100

Content Type Journal ArticleCategory CorrespondenceDOI 10.1007/s00134-010-1817-5Authors Michael C. Reade, University of Melbourne Intensive Care Medicine Melbourne AustraliaDonald M. Yealy, University of Pittsburgh Emergency Medicine Pittsburgh USAMichael J. Bailey, Monash University Australian and New Zealand Intensive Care Research Centre Melbourne Australia Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Age-dependent effects of gradual decreases in cerebral perfusion pressure on the neurochemical response in swine

Intensive Care Medicine — Mon, 15 Mar 2010 17:53:01 +0100

Conclusions The lower limit of CBF autoregulation was associated with modifications in neurochemical parameters that clearly occurred before brain oxidative metabolism was compromised. Early indicators for mild to moderate hypoperfusion are elevated levels of lactate and dopamine, but elevated levels of glutamate appear to be an indicator of brain ischemia. The shift to the left of the lower autoregulatory threshold is mainly responsible for the postponed neurochemical response to decrements in the CPP in the immature brain. Content Type Journal ArticleCategory ExperimentalDOI 10.1007/s00134-010-1846-0Authors Bernd Walter, Friedrich Schiller University Institute of Molecular Cell Biology, Universitätsklinikum Jena 07745 Jena GermanyKristina Aisenpreis, Friedrich ...

Depressive disorders during weaning from prolonged mechanical ventilation

Intensive Care Medicine — Mon, 15 Mar 2010 17:53:00 +0100

Conclusion Depressive disorders were diagnosed in 42% of patients who were being weaned from prolonged ventilation. Patients with depressive disorders were more likely to experience weaning failure and death. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1842-4Authors Amal Jubran, Hines IL and Loyola University of Chicago Stritch School of Medicine Division of Pulmonary and Critical Care Medicine, Edward Hines Jr. Veterans Affairs Hospital Maywood IL USAGerald Lawm, RML Specialty Hospital Hinsdale IL USAJoanne Kelly, RML Specialty Hospital Hinsdale IL USALisa A. Duffner, RML Specialty Hospital Hinsdale IL USAGokay Gungor, Hines IL and Loyola University of Chicago Stritch School of Medicine Division of Pulmonary and Critical Care Medicine, Edward...

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Impact of digestive and oropharyngeal decontamination on the intestinal microbiota in ICU patients

Intensive Care Medicine — Mon, 15 Mar 2010 17:52:59 +0100

Conclusions The composition of the intestinal microbiota is importantly affected by SDD. The F. prausnitzii group was significantly suppressed during SDD. This group of microbiota is a predominant producer of butyrate, the main energy source for colonocytes. Reduction of this microbiota is an important trade-off while reducing gram-negative bacteria by SDD. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1826-4Authors Robin F. Benus, University of Groningen Department of Medical Microbiology, University Medical Centre Groningen Groningen The NetherlandsHermie J. Harmsen, University of Groningen Department of Medical Microbiology, University Medical Centre Groningen Groningen The NetherlandsGjalt W. Welling, University of Groningen Department of Me...

The diagnostic value of serum leptin monitoring and its correlation with tumor necrosis factor-alpha in critically ill patients: a prospective observational study

Critical Care — Mon, 15 Mar 2010 00:00:00 +0100

Conclusions: Serum leptin correlates well with serum level of IL-6 and TNF-alpha. Leptin helps to differentiate SIRS from non-SIRS patients. CRP is a classic marker of sepsis but is of late onset. (Source: Critical Care)

Ischemia as a possible effect of increased intra-abdominal pressure on central nervous system cytokines, lactate and perfusion pressures

Critical Care — Mon, 15 Mar 2010 00:00:00 +0100

IntroductionThe aims of our study were to evaluate the impact of increased intra-abdominal pressure (IAP) on central nervous system (CNS) cytokines (interleukin 6 and tumor necrosis factor), lactate and perfusion pressures, testing the hypothesis that intra-abdominal hypertension (IAH) may possibly lead to CNS ischemia. Methods: Fifteen pigs were studied. Helium pneumoperitoneum was established and IAP was increased initially at 20mmHg and subsequently at 45mmHg, which was finally followed by abdominal desufflation. Interleukin 6 (IL-6), tumor necrosis factor alpha (TNFa) and lactate were measured in the cerebrospinal fluid (CSF) and intracranial (ICP), intraspinal (ISP), cerebral perfusion (CPP) and spinal perfusion (SPP) pressures recorded. Results: Increased IAP (20mmHg) was followed by...

Intensivmedizinische Therapie der aneurysmatischen Subarachnoidalblutung

Intensivmedizin und Notfallmedizin — Sun, 14 Mar 2010 11:27:43 +0100

Zusammenfassung Die Intensivtherapie der aneurysmatischen Subarachnoidalblutung erfordert ein Verständnis der Pathophysiologie der Grundkrankheit und ihrer Komplikationen sowie eine Kenntnis moderner multimodaler Monitoringtechniken. Diese Übersicht beschreibt die wesentlichen potenziell lebensbedrohlichen Komplikationen der Subarachnoidalblutung und das intensivneurologische Management. Da in den letzten Jahren die Bedeutung der Rezidivblutung infolge der favorisierten Frühversorgung des rupturierten Aneurysmas durch neurochirurgisches Clipping oder endovaskuläres Coiling eine zunehmend untergeordnete Rolle spielt, stellen aktuell die Behandlung von Hydrozephalus, Hirnödem, Vasospasmus-assoziierten ischämischen Defiziten und von neurogenen kardialen und pulmonalen Ko...

Airway pressure release ventilation versus assist-control ventilation: a comparative propensity score and international cohort study

Intensive Care Medicine — Sun, 14 Mar 2010 11:26:41 +0100

Conclusions In this study, the APRV/BIPAP ventilation mode is being used widely across many causes of respiratory failure, but only in selected geographic areas. In our patient population we could not demonstrate any improvement in outcomes with APRV/BIPAP compared with assist-control ventilation. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1837-1Authors Marco González, Clínica Medellín y Universidad Pontificia Bolivariana Medellín ColombiaAlejandro C. Arroliga, Scott and White, and Texas A&M Health Science Center, College of Medicine Temple TX USAFernando Frutos-Vivar, Hospital Universitario de Getafe Intensive Care Unit Carretera de Toledo, Km 12.500 28905 Madrid SpainKonstantinos Raymondos, Medizinische Hochschule Hannover GermanyAndre...

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Type 2 diabetes mellitus is associated with impaired cytokine response and adhesion molecule expression in human endotoxemia

Intensive Care Medicine — Sun, 14 Mar 2010 11:26:41 +0100

Conclusions Patients with type 2 diabetes exhibit an attenuated increase in plasma levels of TNF and IL-1ra, as well as an attenuated upregulation of VCAM-1 and ICAM-1 to LPS in vivo. This finding may provide a mechanistic explanation for the adverse outcome seen during infectious diseases in diabetic patients. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1845-1Authors Anne Sofie Andreasen, University Hospital Rigshospitalet Centre of Inflammation and Metabolism, Department of Infectious Diseases Rigshospitalet-M 7641, Blegdamsvej 9 2100 Copenhagen DenmarkTheis Pedersen-Skovsgaard, University Hospital Rigshospitalet Centre of Inflammation and Metabolism, Department of Infectious Diseases Rigshospitalet-M 7641, Blegdamsvej 9 2100 Copenhagen Den...

The influence of infection sites on development and mortality of ARDS

Intensive Care Medicine — Sun, 14 Mar 2010 11:26:38 +0100

Conclusions In critically ill infected patients, pulmonary infection is associated with higher risk of ARDS development than are infections at other sites. Pulmonary versus nonpulmonary infection significantly affects ARDS development but not mortality. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1851-3Authors Chau-Chyun Sheu, Harvard School of Public Health Department of Environmental Health 665 Huntington Avenue Boston MA 02115 USAMichelle N. Gong, Montefiore Medical Center Division of Critical Care Medicine Bronx NY 10461 USARihong Zhai, Harvard School of Public Health Department of Environmental Health 665 Huntington Avenue Boston MA 02115 USAEdnan K. Bajwa, Harvard Medical School Pulmonary and Critical Care Unit, Department of Medicine, M...

Death in emergency departments: a multicenter cross-sectional survey with analysis of withholding and withdrawing life support

Intensive Care Medicine — Sun, 14 Mar 2010 11:26:38 +0100

Conclusions Death occurring in emergency departments mainly concerned elderly patients with multiple chronic diseases and was frequently preceded by a decision to withdraw and/or withhold life-support therapies. Training of future ED physicians must be aimed at improving the level of care of dying patients, with particular emphasis on collegial decision-taking and institution of palliative care. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1800-1Authors Philippe Le Conte, Nantes University Hospital Department of Emergency Medicine 44093 Nantes Cedex 01 FranceDavid Riochet, Nantes University Hospital Department of Emergency Medicine 44093 Nantes Cedex 01 FranceEric Batard, Nantes University Hospital Department of Emergency Medicine 44093 Nante...

Esomeprazole-induced rhabdomyolysis in a patient with heart failure

Intensive Care Medicine — Sun, 14 Mar 2010 11:26:37 +0100

Content Type Journal ArticleCategory CorrespondenceDOI 10.1007/s00134-010-1854-0Authors Uwe Tröger, Otto-von-Guericke-University Magdeburg Institute of Clinical Pharmacology Magdeburg GermanyInes Reiche, Otto-von-Guericke-University Magdeburg Institute of Clinical Pharmacology Magdeburg GermanyMarilene S. Jepsen, Otto-von-Guericke-University Magdeburg Clinic for Heart and Thoracic Surgery Leipziger Str. 44 Magdeburg GermanyChristof Huth, Otto-von-Guericke-University Magdeburg Clinic for Heart and Thoracic Surgery Leipziger Str. 44 Magdeburg GermanyStefanie M. Bode-Böger, Otto-von-Guericke-University Magdeburg Institute of Clinical Pharmacology Magdeburg Germany Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

The worst is yet to come. Many elderly patients with chronic terminal illnesses will eventually die in the emergency department

Intensive Care Medicine — Sun, 14 Mar 2010 11:26:36 +0100

Content Type Journal ArticleCategory EditorialDOI 10.1007/s00134-010-1803-yAuthors Erwin J. O. Kompanje, Erasmus MC University Medical Center Department of Intensive Care P.O. Box 2040 3000 CA Rotterdam The Netherlands Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

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Glucose Variability is Associated With Intensive Care Unit Mortality

Medscape Critical Care Headlines — Fri, 12 Mar 2010 20:47:18 +0100

Tighter glycemic control in ICU settings can improve patient outcomes. Critical Care Medicine (Source: Medscape Critical Care Headlines)

The role of noninvasive ventilation in acute cardiogenic pulmonary edema

Critical Care — Fri, 12 Mar 2010 00:00:00 +0100

No description available (Source: Critical Care)

New versus old blood - the debate continues

Critical Care — Fri, 12 Mar 2010 00:00:00 +0100

Since the inception of blood banking, refinements in laboratory processes have allowed for progressively longer storage times of red blood cells (RBCs). Whilst advantageous for the logistics of stock management, the clinical impact of the duration of RBC storage prior to transfusion remains uncertain, and a topic of growing interest. In this issue, Ranucci and colleagues1 report an adverse outcome in infants receiving "older" blood during cardiopulmonary bypass (CPB).The current standard RBC storage time of up to 42 days is not based upon a demonstrable therapeutic benefit, but instead on the observed return of 70% of the viable transfused RBCs at 24 hours after storage for 42 days or less. The structural, biochemical and immunological changes that RBCs undergo during storage are well desc...

Fall in circulating mononuclear cell mitochondrial DNA content in human sepsis

Intensive Care Medicine — Thu, 11 Mar 2010 18:09:06 +0100

Conclusions In severe sepsis much of the apparent whole blood mtDNA depletion is due to a change in the differential leukocyte count. However mtDNA depletion in mononuclear cells occurs in patients with sepsis and correlates with disease severity. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1823-7Authors Angela Pyle, Newcastle University Mitochondrial Research Group, Institute for Ageing and Health, The Medical School Framlington Place Newcastle NE2 4HH UKDavid J. Burn, Newcastle University Clinical Ageing Research Unit, Institute for Ageing and Health, The Medical School Newcastle NE4 5PL UKCharlotte Gordon, Newcastle University Institute of Cellular Medicine Newcastle NE2 4HH UKCatherine Swan, Newcastle University Institute of Cellular Medic...

Reducing complications related to endotracheal intubation in critically ill patients

Intensive Care Medicine — Thu, 11 Mar 2010 18:09:06 +0100

Content Type Journal ArticleCategory CorrespondenceDOI 10.1007/s00134-010-1855-zAuthors P. J. Frost, University Hospital of Wales Critical Care Directorate Heath Park Cardiff CF14 4XW UKC. D. Hingston, University Hospital of Wales Critical Care Directorate Heath Park Cardiff CF14 4XW UKM. P. Wise, University Hospital of Wales Critical Care Directorate Heath Park Cardiff CF14 4XW UK Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

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Hypercytokinemia with 2009 pandemic H1N1 (pH1N1) influenza successfully treated with polymyxin B-immobilized fiber column hemoperfusion

Intensive Care Medicine — Thu, 11 Mar 2010 18:09:05 +0100

Hypercytokinemia with 2009 pandemic H1N1 (pH1N1) influenza successfully treated with polymyxin B-immobilized fiber column hemoperfusion Content Type Journal ArticleCategory CorrespondenceDOI 10.1007/s00134-010-1830-8Authors Shinhiro Takeda, Nippon Medical School Division of Intensive Care Unit and Coronary Care Unit 1-1-5 Sendagi, Bunkyo-ku Tokyo 113-8603 JapanRyo Munakata, Nippon Medical School Division of Intensive Care Unit and Coronary Care Unit 1-1-5 Sendagi, Bunkyo-ku Tokyo 113-8603 JapanShinji Abe, Nippon Medical School Internal Medicine, Department of Pulmonary Medicine/Infection and Oncology Tokyo JapanSeiji Mii, Nippon Medical School Division of Intensive Care Unit and Coronary Care Unit 1-1-5 Sendagi, Bunkyo-ku Tokyo 113-8603 JapanManabu Suzuki, Nippon Medical School Divisio...

A modular video streaming method for surgical assistance in operating room networks

International Journal of Computer Assisted Radiology and Surgery — Thu, 11 Mar 2010 02:48:41 +0100

Conclusion An OR video communications framework was developed that uses existing OR network infrastructure as an economical alternative to dedicated integrated OR solutions. This framework provides functional and semantic interoperability among imaging modalities for continuous video data communication. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11548-010-0409-8Authors Arun Kumar Raj Voruganti, Innovation Center Computer Assisted Surgery Semmelweisstraße 14 04103 Leipzig GermanyRafael Mayoral, Innovation Center Computer Assisted Surgery Semmelweisstraße 14 04103 Leipzig GermanyAdrian Vazquez, Innovation Center Computer Assisted Surgery Semmelweisstraße 14 04103 Leipzig GermanyOliver Burgert, Innovation Center Computer Assisted Surgery Semme...

Effects of terbutaline on circulatory failure and organ dysfunction induced by peritonitis in rats

Intensive Care Medicine — Thu, 11 Mar 2010 02:37:27 +0100

Conclusions Terbutaline may be developed as an alternative treatment for severe sepsis-induced MODS. The protective effect of terbutaline seems to be through inhibition of proinflammatory mediators and attenuation of oxidant production. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1839-zAuthors Cheng-Ming Tsao, Taipei Veterans General Hospital and National Yang-Ming University Department of Anesthesiology Taipei Taiwan, ROCShiu-Jen Chen, Kang-Ning Junior College of Medical Care and Management Department of Nursing Taipei Taiwan, ROCMing-Chung Shih, National Defense Medical Center Department of Pharmacology Taipei Taiwan, ROCWei-Ming Lue, National Defense Medical Center Department of Pharmacology Taipei Taiwan, ROCMei-Yung Tsou, Taipei Veterans ...

Reply to Agrafiotis

Intensive Care Medicine — Thu, 11 Mar 2010 02:37:26 +0100

Content Type Journal ArticleCategory CorrespondenceDOI 10.1007/s00134-010-1790-zAuthors Luciano Gattinoni, Università degli Studi Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche Milan ItalyEleonora Carlesso, Università degli Studi Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche Milan ItalyFederico Polli, Università degli Studi Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche Milan Italy Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Combined analysis of cardiac output and CVP changes remains the best way to titrate fluid administration in shocked patients

Intensive Care Medicine — Thu, 11 Mar 2010 02:37:25 +0100

Content Type Journal ArticleCategory EditorialDOI 10.1007/s00134-010-1831-7Authors Fabrice Vallée, Hôpital Lariboisière Réanimation Chirurgicale et Laboratoire de Recherche du Département d’Anesthésie- Réanimation (EA 322 Université Paris 7 Denis Diderot) Paris FranceArnaud Mari, Université Paul Sabatier Pôle Anesthésie et Réanimation, Unité de Réanimation Polyvalente de Purpan GRCB 48 Toulouse FranceAnders Perner, University of Copenhagen Department of Intensive Care, Rigshospitalet Copenhagen DenmarkBenoît Vallet, Univ Lille Nord de France Anesthésie et Réanimation, CHU 59000 Lille France Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

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Effects of fluids on microvascular perfusion in patients with severe sepsis

Intensive Care Medicine — Thu, 11 Mar 2010 02:37:24 +0100

Conclusions In this non-randomized trial, fluid administration improved microvascular perfusion in the early but not late phase of sepsis. This effect is independent of global hemodynamic effects and of the type of solution. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1843-3Authors Gustavo Ospina-Tascon, Erasme University Hospital, Université Libre de Bruxelles Department of Intensive Care Route de Lennik 808 1070 Brussels BelgiumAna Paula Neves, Erasme University Hospital, Université Libre de Bruxelles Department of Intensive Care Route de Lennik 808 1070 Brussels BelgiumGiovanna Occhipinti, Erasme University Hospital, Université Libre de Bruxelles Department of Intensive Care Route de Lennik 808 1070 Brussels BelgiumKatia Donadello, Erasm...

Mechanical ventilation aggravates transfusion-related acute lung injury induced by MHC-I class antibodies

Intensive Care Medicine — Thu, 11 Mar 2010 02:37:24 +0100

Conclusions Mechanical ventilation (MV) synergistically augmented lung injury during TRALI, which was even further enhanced by the use of injurious ventilator settings. Results suggest that MV may be a risk factor for the onset of TRALI and may aggravate the course of disease. Content Type Journal ArticleCategory ExperimentalDOI 10.1007/s00134-010-1802-zAuthors A. P. J. Vlaar, Academic Medical Center Department of Intensive Care Medicine Amsterdam The NetherlandsE. K. Wolthuis, Academic Medical Center Department of Anesthesiology Amsterdam The NetherlandsJ. J. Hofstra, Academic Medical Center Laboratory of Experimental Intensive Care and Anesthesiology (LEICA) Room M0-228, Meibergdreef 9 1105 AZ Amsterdam The NetherlandsJ. J. T. H. Roelofs, Academic Medical Center D...

Whole lung lavage: a unique model for ultrasound assessment of lung aeration changes

Intensive Care Medicine — Thu, 11 Mar 2010 02:37:23 +0100

Conclusions In a controlled human model of lung air content variation, the different states of aeration determined by WLL procedure were reliably described with lung ultrasound. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1834-4Authors Gabriele Via, University of Pavia 1st Department of Anesthesia and Intensive Care, IRCCS Policlinico San Matteo Foundation Piazzale Golgi 2 27100 Pavia ItalyDaniel Lichtenstein, Service de Réanimation Médicale, Hôpital Ambroise Paré 92100 Boulogne (Paris-Ouest) FranceFrancesco Mojoli, University of Pavia 1st Department of Anesthesia and Intensive Care, IRCCS Policlinico San Matteo Foundation Piazzale Golgi 2 27100 Pavia ItalyGiuseppe Rodi, University of Pavia 1st Department of Anesthesia and Intensive Care, ...

Milrinone, dobutamine or epinephrine use in asphyxiated newborn pigs resuscitated with 100% oxygen

Intensive Care Medicine — Thu, 11 Mar 2010 02:37:22 +0100

Conclusions In newborn piglets with hypoxia-reoxygenation, epinephrine, dobutamine and milrinone are effective inotropes to improve cardiac output, carotid and intestinal perfusion, without aggravating pulmonary hypertension. Milrinone may also improve renal perfusion. Content Type Journal ArticleCategory ExperimentalDOI 10.1007/s00134-010-1820-xAuthors Chloë Joynt, University of Alberta Department of Pediatrics Edmonton AB CanadaDavid L. Bigam, University of Alberta Department of Surgery Edmonton AB CanadaGregory Charrois, University of Alberta Department of Laboratory Medicine and Pathology Edmonton AB CanadaLaurence D. Jewell, University of Alberta Department of Laboratory Medicine and Pathology Edmonton AB CanadaGregory Korbutt, University of Alberta Department ...

Dilutional acidosis: is there a role for the strong ion difference?

Intensive Care Medicine — Thu, 11 Mar 2010 02:37:21 +0100

Content Type Journal ArticleCategory CorrespondenceDOI 10.1007/s00134-010-1789-5Authors Michalis Agrafiotis, “Thriassion” General Hospital of Elefsis Department of Intensive Care Medicine Magoula Greece Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

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Validation of four prognostic scores in patients with cancer admitted to Brazilian intensive care units: results from a prospective multicenter study

Intensive Care Medicine — Thu, 11 Mar 2010 02:37:20 +0100

Conclusions In this multicenter study, the customized equation of SAPS 3 score for CSA was found to be accurate in predicting outcomes in cancer patients requiring ICU admission. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1807-7Authors Márcio Soares, Hospital de Câncer-I, Instituto Nacional de Câncer, Centro de Tratamento Intensivo ICU 10° Andar; Pça. Cruz Vermelha, 23 Rio de Janeiro RJ CEP 20230-130 BrazilUlisses V. A. Silva, Hospital do Câncer de Barretos, Fundação Pio XII ICU Barretos BrazilJosé M. M. Teles, Hospital Português ICU Salvador BrazilEliézer Silva, Hospital Israelita Albert Einstein ICU São Paulo BrazilPedro Caruso, Hospital A. C. Camargo ICU São Paulo BrazilSuzana M. A. Lobo, Medical School and Hospital de Base Di...

Ward mortality after ICU discharge: a multicenter validation of the Sabadell score

Intensive Care Medicine — Thu, 11 Mar 2010 02:37:19 +0100

Conclusion We confirm the ability of the Sabadell score at ICU discharge to define four groups of patients with very different likelihoods of hospital survival. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1825-5Authors Rafael Fernandez, Hospital Sant Joan de Deu, Fundació Althaia CIBER Enfermedades Respiratorias, ICU Manresa SpainJose Manuel Serrano, H.U. Reina Sofia Cordoba SpainIsabel Umaran, H. de Cruces Baracaldo SpainRicard Abizanda, H.G.U. Castelló Castelló SpainAndres Carrillo, H.G.U. JM Morales Messeguer Murcia SpainMª Jesus Lopez-Pueyo, H. General Yague Burgos SpainPedro Rascado, C.H.U. de A Coruña A Coruña SpainBegoña Balerdi, H.U. La Fe Valencia SpainBorja Suberviola, H.U. Marques de Valdecilla Santander SpainGonzalo Hernande...

Long-term outcome of iatrogenic gas embolism

Intensive Care Medicine — Thu, 11 Mar 2010 02:37:18 +0100

Conclusions Gas embolism complicates 2.65 per 100,000 hospitalizations, and is associated with high mortality and morbidity. Babinski sign on ICU admission is associated with poor prognosis. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1821-9Authors Jacques Bessereau, Raymond Poincaré Hospital (AP-HP), University of Versailles SQY (UniverSud Paris) General Intensive Care Unit, Hyperbaric Centre 104 boulevard Raymond Poincaré 92380 Garches FranceNicolas Genotelle, Raymond Poincaré Hospital (AP-HP), University of Versailles SQY (UniverSud Paris) General Intensive Care Unit, Hyperbaric Centre 104 boulevard Raymond Poincaré 92380 Garches FranceCendrine Chabbaut, AP-HP, Erm321-INSERM, Saint-Louis Hospital (AP-HP) Département de Biostatistiques ...

Critical care in the developing world - a challenge for us all

Critical Care — Thu, 11 Mar 2010 00:00:00 +0100

The rapid economic growth in parts of the developing world is being accompanied by an expansion of critical care. Hurdles to expansion include lack of critical care training for healthcare workers. This is coupled with a need for a huge number of healthcare workers due to the high populations of countries such as China and India. Intensivists in the developed world can and should help. (Source: Critical Care)

Basic Invasive Mechanical Ventilation

Medscape Critical Care Headlines — Wed, 10 Mar 2010 23:18:47 +0100

A great refresher about the modes of ventilation possible with today's ventilators. Southern Medical Journal (Source: Medscape Critical Care Headlines)

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Hypercapnic acidosis in ventilator-induced lung injury

Intensive Care Medicine — Wed, 10 Mar 2010 12:54:34 +0100

Conclusions Hypercapnia provided consistent and biologically plausible in vivo protection against VILI, but elevated lung tissue levels of nitro-tyrosine as previously described in sepsis. Clinicians and those designing clinical trials need to be aware of the potential for detrimental effects when using hypercapnia in order to balance benefits versus harm with this approach. Content Type Journal ArticleCategory ExperimentalDOI 10.1007/s00134-010-1787-7Authors Vanya Peltekova, University of Toronto Physiology and Experimental Medicine, Hospital for Sick Children Toronto ON CanadaDoreen Engelberts, University of Toronto Physiology and Experimental Medicine, Hospital for Sick Children Toronto ON CanadaGail Otulakowski, University of Toronto Physiology and Experimental ...

Tracheotomy cuff inflation and tube displacement

Intensive Care Medicine — Wed, 10 Mar 2010 12:54:34 +0100

Content Type Journal ArticleCategory CorrespondenceDOI 10.1007/s00134-010-1810-zAuthors P. Ceriana, IRCCS Fondazione “S. Maugeri” Respiratory Intermediate Care Unit Pavia ItalyG. Bertoli, IRCCS Fondazione “S. Maugeri” Radiology Department Pavia ItalyS. Nava, IRCCS Fondazione “S. Maugeri” Respiratory Intermediate Care Unit Pavia Italy Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Daily skin cleansing with chlorhexidine did not reduce the rate of central-line associated bloodstream infection in a surgical intensive care unit

Intensive Care Medicine — Wed, 10 Mar 2010 12:54:33 +0100

Conclusions In this real-world effectiveness trial, daily cleansing of surgical ICU patients’ skin with CHG had no effect on CLABSI rates, but was associated with half the rate of blood culture contamination. Controlled trials in surgical ICUs are needed to determine whether CHG bathing can prevent infections in this setting. Content Type Journal ArticleCategory Brief ReportDOI 10.1007/s00134-010-1783-yAuthors Kyle J. Popovich, Stroger Hospital of Cook County Chicago USABala Hota, Stroger Hospital of Cook County Chicago USARobert Hayes, Rush University Medical Center Rush Medical College 1653 W Congress Pkwy Chicago IL 60612 USARobert A. Weinstein, Stroger Hospital of Cook County Chicago USAMary K. Hayden, Rush University Medical Center Rush Medical College 1653 W...

Electrocardiographic effects of dexmedetomidine in patients with congenital heart disease

Intensive Care Medicine — Wed, 10 Mar 2010 12:54:33 +0100

Conclusions Use of dexmedetomidine in patients with CHD and patients following cardiothoracic surgery is not associated with any significant ECG interval abnormalities other than a trend towards lower HR. Content Type Journal ArticleCategory Pediatric OriginalDOI 10.1007/s00134-010-1782-zAuthors Constantinos Chrysostomou, Children’s Hospital of Pittsburgh of UPMC Department of Pediatric Cardiology, Division of Cardiac Intensive Care 45th and Penn Avenue Pittsburgh PA 15201 USARukmini Komarlu, Children’s Hospital of Pittsburgh of UPMC Department of Pediatric Cardiology, Division of Cardiac Intensive Care 45th and Penn Avenue Pittsburgh PA 15201 USASteven Lichtenstein, Children’s Hospital of Pittsburgh of UPMC Department of Anesthesiology 45th and Penn Avenue Pit...

Diagnostic accuracy of serum hepcidin for iron deficiency in critically ill patients with anemia

Intensive Care Medicine — Wed, 10 Mar 2010 12:54:32 +0100

Conclusions Hepcidin levels may be suppressed by ID even in case of inflammation. Serum hepcidin of 129.5 µg/l was the most accurate threshold for ID diagnosis in critically ill patients with anemia. Content Type Journal ArticleCategory Brief ReportDOI 10.1007/s00134-010-1794-8Authors Sigismond Lasocki, AP-HP, CHU Bichat-Claude Bernard, Université Paris 7 Diderot Service de Réanimation Chirugicale, Département d’Anesthésie-Réanimation chirurgicale 46, rue Henri Huchard 75877 Paris Cedex 18 FranceGabriel Baron, AP-HP, CHU Bichat-Claude Bernard, Université Paris 7 Diderot Département d’Epidémiologie, Biostatistique et Recherche Clinique Paris FranceFathi Driss, INSERM U773, CRB3 équipe 4, Université Paris 7 Diderot site Bichat Paris FranceMark Weste...

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Management der intrazerebralen Blutung

Intensivmedizin und Notfallmedizin — Wed, 10 Mar 2010 12:49:40 +0100

Zusammenfassung Trotz einer Inzidenz von jährlich 90.000 Fällen in der Europäischen Union und hoher Mortalitäts- und Invaliditätsraten sind Pathogenese und Pathophysiologie der intrazerebralen Blutung noch immer nicht hinreichend geklärt. Zahlreiche Therapieempfehlungen basieren aufgrund der geringen Anzahl kontrollierter Studien auf theoretischen Überlegungen, Beobachtungen kleiner Patientenkollektive und persönlichen Erfahrungen des behandelnden Arztes. Der vorliegende Beitrag soll unter Berücksichtigung jüngster Studienergebnisse eine Übersicht über die derzeit vorliegenden Therapieempfehlungen bieten. Diese umfasst Blutdruck- und Hirndrucktherapie, hämostaseologische Maßnahmen und neurochirurgische Therapieoptionen sowie sekundärprophylaktische Empfe...

Neuromonitoring

Intensivmedizin und Notfallmedizin — Wed, 10 Mar 2010 12:49:38 +0100

Zusammenfassung Die Dynamik verschiedener spezifischer Parameter, wie z. B. des intrakraniellen Drucks, der zerebralen Oxygenierung und der zerebralen Perfusion, ist von entscheidender Bedeutung für die Prognose bei Patienten mit Schlaganfall. Die klinisch-neurologische Beurteilung spielt dabei eine wichtige Rolle, ist allerdings gerade bei schwer betroffenen komatösen oder analgosedierten Patienten, die eine besonders intensive Überwachung benötigen, erheblich eingeschränkt. Mit dem Fortschritt technischer Entwicklungen wächst die Vielfalt invasiver und nichtinvasiver Neuromonitoring-Methoden, mit denen intrakranieller Druck, Durchblutung, Funktion und Metabolismus des Gehirns überwacht werden können. Ziel der apparativen Überwachung ist die frühe Erkennung ...

Leitsymptom Bewusstseinsstörung

Intensivmedizin und Notfallmedizin — Wed, 10 Mar 2010 12:49:37 +0100

Content Type Journal ArticleCategory EditorialDOI 10.1007/s00390-009-0141-1Authors C. Dodt, Städtisches Klinikum München-Bogenhausen Präklinik Englschalkinger Straße 77 81925 München Deutschland Journal Intensivmedizin und NotfallmedizinOnline ISSN 1435-1420Print ISSN 0175-3851 (Source: Intensivmedizin und Notfallmedizin)

Therapie des Schlaganfalls

Intensivmedizin und Notfallmedizin — Wed, 10 Mar 2010 12:49:36 +0100

Content Type Journal ArticleCategory EditorialDOI 10.1007/s00390-009-0116-2Authors S. Schwab, Universitätsklinikum Erlangen Neurologische Klinik Schwabachanlage 6 91054 Erlangen Deutschland Journal Intensivmedizin und NotfallmedizinOnline ISSN 1435-1420Print ISSN 0175-3851 (Source: Intensivmedizin und Notfallmedizin)

Chapter 8. Medical procedures

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:22 +0100

Conclusions Judicious planning and adoption of protocols for safe performance of medical procedures are necessary to optimize outcomes during a pandemic. Content Type Journal ArticleDOI 10.1007/s00134-010-1766-zAuthors Janice L. Zimmerman, The Methodist Hospital Critical Care Division, Department of Medicine Houston TX USACharles L. Sprung, Hadassah Hebrew University Medical Center Department of Anesthesiology and Critical Care Medicine Jerusalem Israel Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 Journal Volume Volume 36 Journal Issue Volume 36, Supplement 1 / April, 2010 (Source: Intensive Care Medicine)

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Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:22 +0100

Content Type Journal ArticleDOI 10.1007/s00134-010-1750-7 Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 Journal Volume Volume 36 Journal Issue Volume 36, Supplement 1 / April, 2010 (Source: Intensive Care Medicine)

Chapter 4. Manpower

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:18 +0100

Conclusions Judicious planning and adoption of protocols for providing adequate manpower are necessary to optimize outcomes during a pandemic. Content Type Journal ArticleDOI 10.1007/s00134-010-1767-yAuthors Christian Sandrock, UC Davis School of Medicine Intensive Care Unit, Division of Infectious Diseases, Division of Pulmonary and Critical Care Medicine Sacramento CA 95820 USA Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 Journal Volume Volume 36 Journal Issue Volume 36, Supplement 1 / April, 2010 (Source: Intensive Care Medicine)

Chapter 5. Essential equipment, pharmaceuticals and supplies

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:17 +0100

Conclusions Judicious planning and adoption of protocols for providing adequate equipment, pharmaceuticals and supplies are necessary to optimize outcomes during a pandemic. Content Type Journal ArticleDOI 10.1007/s00134-010-1763-2Authors Charles L. Sprung, Hadassah Hebrew University Medical Center Department of Anesthesiology and Critical Care Medicine Jerusalem IsraelJozef Kesecioglu, University Medical Center Utrecht Department of Intensive Care Medicine Utrecht The Netherlands Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 Journal Volume Volume 36 Journal Issue Volume 36, Supplement 1 / April, 2010 (Source: Intensive Care Medicine)

Chapter 1. Introduction

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:17 +0100

Conclusions The draft SOPs serve as benchmarks for emergency preparedness and response of ICUs to emergencies or outbreak of pandemics. Content Type Journal ArticleDOI 10.1007/s00134-010-1760-5Authors Charles L. Sprung, Hadassah Hebrew University Medical Center Department of Anesthesiology and Critical Care Medicine Jerusalem IsraelRobert Cohen, Hebrew University Israeli Ministry of Health, Faculty of Medicine Tel Aviv, Jerusalem IsraelBruria Adini, Israeli Ministry of Health, Ben-Gurion University of the Negev Tel Aviv, Beersheba Israel Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 Journal Volume Volume 36 Journal Issue Volume 36, Supplement 1 / April, 2010 (Source: Intensive Care Medicine)

Chapter 6. Protection of patients and staff during a pandemic

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:17 +0100

Conclusions Judicious planning and adoption of protocols for protection of patients and staff are necessary to optimise outcomes during a pandemic. Content Type Journal ArticleDOI 10.1007/s00134-010-1764-1Authors Bruce L. Taylor, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital Cosham Portsmouth Hants PO63LY UKHugh E. Montgomery, University College of London, Whittington Hospital Department of Intensive Care Medicine London UKAndrew Rhodes, St George’s Healthcare NHS Trust Department of Critical Care London SW17 0QT UKCharles L. Sprung, Hadassah Hebrew University Medical Center Department of Anesthesiology and Critical Care Medicine Jerusalem Israel Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 Journal Volume Volume 36 ...

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Chapter 9. Educational process

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:16 +0100

Conclusions Judicious planning and adoption of protocols for staff education are necessary to optimize outcomes during a pandemic. Content Type Journal ArticleDOI 10.1007/s00134-010-1768-xAuthors Guy A. Richards, University of the Witwatersrand Charlotte Maxeke Johannesburg Hospital Johannesburg South AfricaCharles L. Sprung, Hadassah Hebrew University Medical Center Department of Anesthesiology and Critical Care Medicine Jerusalem Israel Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 Journal Volume Volume 36 Journal Issue Volume 36, Supplement 1 / April, 2010 (Source: Intensive Care Medicine)

Chapter 3. Coordination and collaboration with interface units

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:16 +0100

Conclusions Judicious planning and adoption of protocols for coordination and collaboration with interface units are necessary to optimize outcomes during a pandemic. Content Type Journal ArticleDOI 10.1007/s00134-010-1762-3Authors Gavin M. Joynt, The Chinese University of Hong Kong, Prince of Wales Hospital Department of Anesthesia and Intensive Care Sha Tin Hong Kong People’s Republic of ChinaShi Loo, Tan Tock Seng Hospital Department of Anaesthesiology Singapore SingaporeBruce L. Taylor, Portsmouth Hospitals NHS Trust Department of Critical Care Portsmouth UKGila Margalit, Sheba Medical Center Department of Emergency Services Tel Hashomer IsraelMichael D. Christian, Mount Sinai Hospital and University Health Network, University of Toronto Department of Medicine,...

Chapter 2. Surge capacity and infrastructure considerations for mass critical care

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:15 +0100

Conclusions Judicious planning and adoption of protocols for surge capacity and infrastructure considerations are necessary to optimize outcomes during a pandemic. Content Type Journal ArticleDOI 10.1007/s00134-010-1761-4Authors John L. Hick, Hennepin County Medical Center Department of Emergency Medicine Minneapolis MN USAMichael D. Christian, Infectious Diseases and Critical Care, Mount Sinai Hospital & University Health Network, University of Toronto Department of Medicine Toronto CanadaCharles L. Sprung, Hadassah Hebrew University Medical Center Department of Anesthesiology and Critical Care Medicine Jerusalem Israel Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 Journal Volume Volume 36 Journal Issue Volume 36, Supplement...

Chapter 7. Critical care triage

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:15 +0100

Conclusions Judicious planning and adoption of protocols for critical care triage are necessary to optimize outcomes during a pandemic. Content Type Journal ArticleDOI 10.1007/s00134-010-1765-0Authors Michael D. Christian, University of Toronto Division of Infectious Diseases and Critical Care, Department of National Defence, Canadian Forces and Department of Medicine, Mount Sinai Hospital Toronto CanadaGavin M. Joynt, The Chinese University of Hong Kong Department of Anesthesia and Intensive Care, Prince of Wales Hospital Sha Tin, Hong Kong People’s Republic of ChinaJohn L. Hick, Hennepin County Medical Center Department of Emergency Medicine Minneapolis MN USAJohn Colvin, Ninewells Hospital Department of Anaesthesiology Dundee Scotland, UKMarion Danis, Clinical Cent...

Diagnosing heparin induced thrombocytopenia in critically ill patients

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:11 +0100

Content Type Journal ArticleCategory CorrespondenceDOI 10.1007/s00134-010-1806-8Authors J. O. J. Davies, Imperial College, Hammersmith Hospital Centre for Perioperative Medicine and Critical Care Research Du Cane Road London UKP. Patel, Imperial College, Hammersmith Hospital Centre for Perioperative Medicine and Critical Care Research Du Cane Road London UKZ. Zoumot, Imperial College, Hammersmith Hospital Centre for Perioperative Medicine and Critical Care Research Du Cane Road London UK Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

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Effectiveness of acetazolamide for reversal of metabolic alkalosis in weaning COPD patients from mechanical ventilation

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:11 +0100

Conclusions ACET used at the dosage of 500 mg per day reduces metabolic alkalosis but has no benefit in terms of improving PaCO2 or respiratory parameters in weaning COPD patients from mechanical ventilation. Content Type Journal ArticleCategory Brief ReportDOI 10.1007/s00134-010-1795-7Authors Christophe Faisy, Hôpital Européen Georges Pompidou, Université Paris-Descartes Medical Intensive Care Unit 20 rue Leblanc 75908 Paris Cedex 15 FranceAmel Mokline, Hôpital Européen Georges Pompidou, Université Paris-Descartes Medical Intensive Care Unit 20 rue Leblanc 75908 Paris Cedex 15 FranceOlivier Sanchez, Hôpital Européen Georges Pompidou, Université Paris-Descartes Department of Pulmonary Medicine 20 rue Leblanc 75908 Paris Cedex 15 FranceJean-Marc Tadié, H...

Microbiogical data, but not procalcitonin improve the accuracy of the clinical pulmonary infection score

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:11 +0100

Conclusion This study showed that alveolar procalcitonin performed by BAL does not help the clinician to identify VAP. It confirmed that serum procalcitonin is not an accurate marker of VAP. In contrast, microbiological resources available at the time of VAP suspicion (BAL gram staining, last available endotracheal aspirate) combined or not with CPIS are helpful in distinguishing VAP diagnosed by BAL from patients with a negative BAL. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1833-5Authors Boris Jung, Centre Hospitalier Universitaire (CHU) Montpellier, INSERM ERI 25 Intensive Care Unit, Department of Anesthesiology and Critical Care B (DAR B) Montpellier 34295 Cedex 5 FranceNathalie Embriaco, Université de la Méditerranée Medical Intens...

Are home ventilators able to guarantee a minimal tidal volume?

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:10 +0100

Conclusions The six home ventilators tested in the study were able to maintain a minimal tidal volume during an increase in airway resistance and a decrease in lung compliance, but not during a non-intentional leak. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-010-1785-9Authors Brigitte Fauroux, INSERM, UMR S-938, AP-HP, Hôpital Armand-Trousseau, Université Pierre et Marie Curie-Paris 6 Pediatric Pulmonary Department, Research Unit, National Reference Center for Rare Lung Diseases 26 avenue du Docteur Arnold-Netter 75012 Paris FranceKarl Leroux, ADEP Assistance Puteaux Paris FranceJean-Louis Pépin, INSERM ERI17, Grenoble University Hospital HP2 Laboratory (Hypoxia: Pathophysiology), Department of Physiology and Rehabilitation 38042 Grenoble Fran...

Clinical relevance of 13 cytokine gene polymorphisms in Chinese major trauma patients

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:10 +0100

Conclusions Polymorphisms of IL-1β/-1470, IL-1β/-511, IL-1β/-31, IL-4/-589, IL-6/-572, IL-8/-251, IL-10/-819, and TNFα/-308 are susceptibility loci for the development of sepsis and organ dysfunction in major trauma patients. Content Type Journal ArticleCategory Brief ReportDOI 10.1007/s00134-010-1797-5Authors Wei Gu, Daping Hospital, Third Military Medical University State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery Daping Chongqing 400042 ChinaLing Zeng, Daping Hospital, Third Military Medical University State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery Daping Chongqing 400042 ChinaJian Zhou, Daping Hospital, Third Military Medical University Department of Traumatic Surgery Chongqing ...

Successful management of full-length obstructing esophageal bezoars in an intensive care unit

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:09 +0100

Content Type Journal ArticleCategory CorrespondenceDOI 10.1007/s00134-010-1791-yAuthors Konstantinos H. Katsanos, University Hospital of Ioannina Hepato-Gasterology Unit, Department of Internal Medicine Ioannina GreeceVasileios Koulouras, University Hospital of Ioannina Intensive Care Unit Ioannina GreeceGeorgios Nakos, University Hospital of Ioannina Intensive Care Unit Ioannina GreeceEpameinondas V. Tsianos, University Hospital of Ioannina Hepato-Gasterology Unit, Department of Internal Medicine Ioannina Greece Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

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Iatrogenic events contributing to ICU admission: a prospective study

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:09 +0100

Conclusion Of admissions to the ICU, 19.5% resulted from IE, with high proportion of shock, leading to greater need for invasive treatments and longer stay in the ICU. Most cases of IE seemed preventable. Content Type Journal ArticleCategory Brief ReportDOI 10.1007/s00134-010-1793-9Authors Emmanuelle Mercier, Université François Rabelais and Hôpital Bretonneau, CHRU Service de Réanimation Médicale 37044 Tours Cedex 9 FranceBruno Giraudeau, Université François Rabelais and Hôpital Bretonneau, CHRU Centre d’Investigation Clinique Inserm CIC 0202 37044 Tours Cedex 9 FranceGuy Giniès, Université François Rabelais and Hôpital Bretonneau, CHRU Service de Réanimation Médicale 37044 Tours Cedex 9 FranceDominique Perrotin, Université François Rabelais and H�...

A critical appraisal of the quality of critical care pharmacotherapy clinical practice guidelines and their strength of recommendations

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:09 +0100

Conclusion Variation in AGREE domain scores explain why one-third of critical care pharmacotherapy CPGs cannot be recommended. Only one-third of strong pharmacotherapy recommendations were supported by high quality evidence. We recommend appraisal of guideline quality and the caliber of supporting evidence prior to applying recommendations. Content Type Journal ArticleCategory ReviewDOI 10.1007/s00134-010-1786-8Authors Sean K. Gorman, Dalhousie University Department of Pharmacy, Capital District Health Authority, College of Pharmacy c/o Rm 2043 Victoria Building, 1276 South Park Street Halifax NS B3H 2Y9 CanadaMichelle Ho Chung, St. Paul’s Hospital Department of Pharmacy 1081 Burrard Street Vancouver BC V6Z 1Y6 CanadaRichard S. Slavik, University of British Columb...

Early enteral nutrition in critically ill patients: authors’ response

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:06 +0100

Content Type Journal ArticleCategory CorrespondenceDOI 10.1007/s00134-010-1792-xAuthors Gordon S. Doig, University of Sydney Intensive Care Unit, Northern Clinical School, Royal North Shore Hospital Pacific Hwy, St Leonards Sydney NSW 2006 AustraliaFiona Simpson, University of Sydney Intensive Care Unit, Northern Clinical School, Royal North Shore Hospital Pacific Hwy, St Leonards Sydney NSW 2006 Australia Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Bedside detection of acute epidural hematoma by transcranial sonography in a head-injured patient

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:05 +0100

Content Type Journal ArticleCategory CorrespondenceDOI 10.1007/s00134-010-1801-0Authors A. Caricato, Catholic University School of Medicine Largo A. Gemelli, 8 00167 Rome ItalyV. Mignani, Catholic University School of Medicine Largo A. Gemelli, 8 00167 Rome ItalyC. Sandroni, Catholic University School of Medicine Largo A. Gemelli, 8 00167 Rome ItalyD. Pietrini, Catholic University School of Medicine Largo A. Gemelli, 8 00167 Rome Italy Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Effect of the AutoPulse™ automated band chest compression device on hemodynamics in out-of-hospital cardiac arrest resuscitation

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:05 +0100

Conclusions In patients with out-of-hospital CA, the use of AutoPulse™ is associated with an increased diastolic BP compared to manual chest compressions. While its benefit to survival has yet to be demonstrated, the increase in diastolic and mean BP is a promising outcome for AutoPulse™ use. Content Type Journal ArticleCategory Brief ReportDOI 10.1007/s00134-010-1784-xAuthors François-Xavier Duchateau, Beaujon University Hospital Department of Anaesthesiology and Intensive Care 100 bd du Général Leclerc 92110 Clichy FrancePapa Gueye, Lariboisiere University Hospital Department of Anesthesiology and Critical Care Paris FranceSonja Curac, Beaujon University Hospital Department of Anaesthesiology and Intensive Care 100 bd du Général Leclerc 92110 Clichy Franc...

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Early enteral nutrition in the ICU

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:04 +0100

Content Type Journal ArticleCategory CorrespondenceDOI 10.1007/s00134-010-1788-6Authors Ronald Lee Koretz, Olive View-UCLA Medical Center Department of Medicine 14445 Olive View Drive Sylmar CA 91342 USA Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Inter-rater reliability of manual muscle strength testing in ICU survivors and simulated patients

Intensive Care Medicine — Wed, 10 Mar 2010 12:47:04 +0100

Conclusions MMT has excellent inter-rater reliability in trained examiners and is a reliable method of comprehensively assessing muscle strength. Content Type Journal ArticleCategory Brief ReportDOI 10.1007/s00134-010-1796-6Authors Eddy Fan, Johns Hopkins University Division of Pulmonary and Critical Care Medicine 1830 East Monument Street, 5th Floor Baltimore MD 21205 USANancy D. Ciesla, Johns Hopkins Hospital Department of Physical Medicine and Rehabilitation Baltimore MD USAAlex D. Truong, Johns Hopkins University Division of Pulmonary and Critical Care Medicine 1830 East Monument Street, 5th Floor Baltimore MD 21205 USAVinodh Bhoopathi, Boston University Division of Dental Public Health Boston MA USAScott L. Zeger, Johns Hopkins University Department of Biostatis...

Fish oil-containing lipid emulsions in patients with sepsis

Critical Care — Wed, 10 Mar 2010 00:00:00 +0100

Lipid emulsions based on soybean oil have been an integral part of parenteral nutrition supplying n-6 fatty acids with possible negative effects in critically ill patients. Newer lipid emulsions supply less n-6 fatty acids. In addition, fish oil-based lipids may be included into the lipid component of parenteral nutrition. While clinical benefits of lipids emulsions with a reduced fraction in n-6 lipids and the addition of fish oil have been described in post-operative patients data are less clear in critically ill or septic patients. Recent data suggests that beneficial effects may be achieved when used early but clearly more data are needed to come to a definitive conclusion. This commentary will highlight current data in critically ill and septic patients and the use of fish oil as a pa...

Goal-directed or goal-misdirected - how should we interpret the literature?

Critical Care — Wed, 10 Mar 2010 00:00:00 +0100

Goal-directed therapy (GDT) can be a vague term, meaning different things to different people, and depending on the clinical environment, sometimes even different things to the same person. It can refer to perioperative fluid management, or clinicians driving oxygen delivery to supramaximal values, early treatment of sepsis in the emergency department, and even to restriction of perioperative crystalloids with the goal of maintaining pre-admission body weight. Understandably, strong opinions range from GDT being considered essential for perioperative care, to it being completely ineffective in critically ill patients. This commentary aims to further position the excellent review by Lees et al in the context of the critical care and perioperative setting. (Source: Critical Care)

The IPFnet Strategy: Creating a Comprehensive Approach in the Treatment of Idiopathic Pulmonary Fibrosis.

Am J Respir Crit Car... — Tue, 09 Mar 2010 16:52:21 +0100

Authors: PMID: 20208036 [PubMed - as supplied by publisher] (Source: Am J Respir Crit Car...)

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New Goals for Positive End-Expiratory Pressure in Acute Respiratory Distress Syndrome: A Paradigm Shift or the End of an Area of Uncertainty?

Am J Respir Crit Car... — Tue, 09 Mar 2010 16:52:19 +0100

Authors: Brochard L PMID: 20208037 [PubMed - as supplied by publisher] (Source: Am J Respir Crit Car...)

Challenges in Translating Preclinical Studies to Effective Drug Therapies in Idiopathic Pulmonary Fibrosis.

Am J Respir Crit Car... — Tue, 09 Mar 2010 16:52:16 +0100

Authors: Thannickal VJ, Roman J PMID: 20208038 [PubMed - as supplied by publisher] (Source: Am J Respir Crit Car...)

Update in Cystic Fibrosis 2009.

Am J Respir Crit Car... — Tue, 09 Mar 2010 16:52:13 +0100

Authors: Mogayzel PJ, Flume PA PMID: 20208039 [PubMed - as supplied by publisher] (Source: Am J Respir Crit Car...)

Update in Sleep Medicine 2009.

Am J Respir Crit Car... — Tue, 09 Mar 2010 16:52:11 +0100

Authors: Mokhlesi B, Gozal D PMID: 20208040 [PubMed - as supplied by publisher] (Source: Am J Respir Crit Car...)

Update in Tuberculosis 2009.

Am J Respir Crit Car... — Tue, 09 Mar 2010 16:52:08 +0100

Authors: Daley CL PMID: 20208041 [PubMed - as supplied by publisher] (Source: Am J Respir Crit Car...)

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An Official ATS Clinical Policy Statement: Congenital Central Hypoventilation Syndrome: Genetic Basis, Diagnosis, and Management.

Am J Respir Crit Car... — Tue, 09 Mar 2010 16:52:05 +0100

Conclusions: A PHOX2B mutation is required to confirm the diagnosis of CCHS. Knowledge of the specific PHOX2B mutation aids in anticipating the CCHS phenotype severity. Parents of patients with CCHS should be tested for PHOX2B mutations. Maintaining a high index of suspicion in cases of unexplained alveolar hypoventilation will likely identify a higher incidence of milder cases of CCHS. Recommended management options aimed toward maximizing safety and optimizing neurocognitive outcome include: (1) biannual then annual in-hospital comprehensive evaluation with (i) physiologic studies during awake and asleep states to assess ventilatory needs during varying levels of activity and concentration, in all stages of sleep, with spontaneous breathing, and with artificial ventilation, and to assess...

Choosing patient-tailored hemodynamic monitoring

Critical Care — Tue, 09 Mar 2010 00:00:00 +0100

This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855. (Source: Critical Care)

Role of CD14 in lung inflammation and infection

Critical Care — Tue, 09 Mar 2010 00:00:00 +0100

This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855. (Source: Critical Care)

New and conventional strategies for lung recruitment in acute respiratory distress syndrome

Critical Care — Tue, 09 Mar 2010 00:00:00 +0100

This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855. (Source: Critical Care)

Weaning failure of cardiac origin: recent advances

Critical Care — Tue, 09 Mar 2010 00:00:00 +0100

This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855. (Source: Critical Care)

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Prevention of central venous catheter-related infection in the intensive care unit

Critical Care — Tue, 09 Mar 2010 00:00:00 +0100

This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855. (Source: Critical Care)

Venous oxygen saturation as a physiologic transfusion trigger

Critical Care — Tue, 09 Mar 2010 00:00:00 +0100

This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855. (Source: Critical Care)

Renal dysfunction in chronic liver disease

Critical Care — Tue, 09 Mar 2010 00:00:00 +0100

This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855. (Source: Critical Care)

Cerebral perfusion in sepsis

Critical Care — Tue, 09 Mar 2010 00:00:00 +0100

This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855 (Source: Critical Care)

Laparostomy: why and when?

Critical Care — Tue, 09 Mar 2010 00:00:00 +0100

This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855. (Source: Critical Care)

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Patient safety and acute care medicine: lessons for the future, insights from the past

Critical Care — Tue, 09 Mar 2010 00:00:00 +0100

This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855. (Source: Critical Care)

Study Touts the Importance of the Multiprofessional Team

SCCM RSS News — Fri, 05 Mar 2010 15:39:08 +0100

The intensivist workforce shortage within the United States has left many intensive care units (ICUs) struggling to implement the intensivist-directed multiprofessional team model. However, researchers from the University of Pennsylvania have found a multiprofessional approach to care teams, with or without an intensivist on staff, can help reduce mortality rates... (Source: SCCM RSS News)

Join the Creative Community

SCCM RSS News — Fri, 05 Mar 2010 15:38:42 +0100

The Society of Critical Care Medicine’s Creative Community is more than 600 strong. These dedicated members play a key role in helping the Society achieve its mission – to improve the care of critically ill and injured patients worldwide. Join a task force or committee this year. Applications are due by May 15, 2010... (Source: SCCM RSS News)

Get the Best of Two Board Reviews in One Powerful Course

SCCM RSS News — Fri, 05 Mar 2010 15:38:21 +0100

New this year, the Society of Critical Care Medicine's adult and pediatric review courses have combined with other review programs to offer the most comprehensive field overview in the diagnosis, monitoring and management of intensive care patients... (Source: SCCM RSS News)

Prevent Ventilator-Associated Pneumonia in Your ICU

SCCM RSS News — Fri, 05 Mar 2010 15:37:59 +0100

Ventilator-associated pneumonia (VAP) is one of the most common preventable conditions in intensive care units, yet the incidence remains high. The Society of Critical Care Medicine’s (SCCM) new Webcast, Ventilator-Associated Pneumonia: An Ounce of Prevention Is Worth a Pound of Cure, will provide clinicians and quality improvement hospital personnel with information related to risk factors and prevention strategies for VAP in both adult and pediatric populations... (Source: SCCM RSS News)

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Learn How to Successfully Implement Hypothermia Protocols

SCCM RSS News — Fri, 05 Mar 2010 15:37:37 +0100

Although therapeutic hypothermia has many potential uses in critical care, from the adult to the newborn, it also poses many challenges. Optimized management of critically ill and injured patients who are cooled requires discussions related to timing, duration, re-warming, and the impact on coagulation, infection control, and drug metabolism and interactions... (Source: SCCM RSS News)

FCCS Plays Important Long-Term Role in Dominican Healthcare

SCCM RSS News — Fri, 05 Mar 2010 15:37:19 +0100

The Society of Critical Care Medicine's Fundamental Critical Care Support (FCCS) course continues to play a positive role as the Dominican Republic responds to the surge of Haitian patients seeking care after the January 12 earthquake... (Source: SCCM RSS News)

Difficult Pediatric Palliative Care Decisions for Parents

SCCM RSS News — Fri, 05 Mar 2010 15:37:00 +0100

A survey of parents who had a child die of cancer found that one in eight considered hastening their child's death, a deliberation influenced by the amount of pain the child experienced during the last month of life, report Dana-Farber Cancer Institute researchers in the March issue of Archives of Pediatrics & Adolescent Medicine... (Source: SCCM RSS News)

Pitfalls in haemodynamic monitoring based on the arterial pressure waveform

Critical Care — Fri, 05 Mar 2010 00:00:00 +0100

The accuracy of the arterial pressure-based cardiac output (APCO) FloTrac-Vigileo(R) system remains unacceptably low during haemodynamic instability. Data show that the measurement of cardiac output (CO) is strongly influenced by changes in factors that affect arterial blood pressure (ABP) - e.g., vascular tone and compliance, and the arterial site - independently of true changes in CO. Although in theory the autocalibration algorithm of FloTrac-Vigileo(R) should adjust for those changes, the model under- (or over-) compensates for prominent increases (or decreases) in vascular tone and compliance, making the system largely dependent on changes in ABP. These limitations make FloTrac-Vigileo(R) accurate only in stable haemodynamic conditions and until more robust algorithms and further vali...

Influence of Factor V Leiden on susceptibility to and outcome from critical illness: a genetic association study

Critical Care — Fri, 05 Mar 2010 00:00:00 +0100

Conclusions: Overall, the FVL mutation did not appear to increase the risk of admission due to severe invasive infections. Nevertheless, in the subgroup of patients admitted to intensive care an increased risk and a poorer long-term outcome for individuals with critical illness were observed for FVL mutation carriers. (Source: Critical Care)

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Revista Brasileira de Terapia Intensiva — Thu, 04 Mar 2010 17:26:01 +0100

(Source: Revista Brasileira de Terapia Intensiva)

Tumoral pulmonary mass secondary to Schistosoma mansoni infection resembling neoplasia: case report

Revista Brasileira de Terapia Intensiva — Thu, 04 Mar 2010 17:26:01 +0100

Indivíduos infectados com Schistosoma mansoni na fase crônica da doença podem apresentar comprometimento pulmonar com sintomatologia e alterações radiológicas variáveis. Os pulmões podem ser acometidos pela migração anômala de ovos do sistema porta para o sistema arterial pulmonar (através de anastomoses porto-sistêmicas) e menos comumente por migrações ectópicas de vermes adultos. Há casos com extenso comprometimento parenquimatoso e outros com predomínio de arterites, com hipertensão pulmonar e cor pulmonale. Paciente jovem, residente em área endêmica de esquistossomose, com massa pulmonar sugestiva de neoplasia foi submetida a toracotomia exploradora sem possibilidade de ressecção da massa. Exame histopatológico mostrou vários granulomas esquistossomóticos e hi...

Alveolar recruitment maneuver in mechanic ventilation pediatric intensive care unit children

Revista Brasileira de Terapia Intensiva — Thu, 04 Mar 2010 17:26:01 +0100

Recentes mudanças foram introduzidas na forma de ventilar crianças com doenças que determinam o quadro de insuficiência respiratória aguda hipoxêmica. Há evidências que estratégias ventilatórias menos agressivas, melhoram a sobrevida de pacientes com grave lesão pulmonar. Estudos experimentais evidenciaram relação entre modalidades ventilatórias inapropriadas e retardo na melhora e até mesmo piora da lesão pulmonar aguda. A partir desta concepção, surge uma estratégia ventilatória protetora, combinada à manobra de recrutamento alveolar. Acredita-se, que esta associação na prática clínica, determina importante redução da morbidade e mortalidade, bem como, prevenção das lesões induzidas pela ventilação mecânica. Sua indicação relaciona-se com quadros de les...

Motor physiotherapy in intensive care adult patients

Revista Brasileira de Terapia Intensiva — Thu, 04 Mar 2010 17:26:01 +0100

This study aimed to review the literature addressing motor physical therapy for intensive care unit adult patients. A literature search was conducted in the databases, PubMed, MedLine (International Literature and Health), LILACS (Latin American and Caribbean Health Sciences) and Cochrane between 1995 and December 2008 using the keywords: physical therapy, mobilization and intensive care unit. For comparison purposes we selected randomized controlled trials and prospective studies, addressing the subject motor physical therapy for intensive care unit adult patients. Pediatric and experimental studies, systematic reviews and meta-analysis were excluded. Of the 121 articles identified, only 4 met the inclusion criteria. Among these, three focused early motor physical therapy in patients with...

Intensive care bedside echocardiography: true or a distant dream?

Revista Brasileira de Terapia Intensiva — Thu, 04 Mar 2010 17:26:01 +0100

Nos últimos anos, com o avanço tecnológico e a experiência adquirida, o ecocardiograma tem se tornado uma ferramenta importante e cada vez mais utilizada no ambiente de terapia intensiva. As informações obtidas, através da ecocardiografia transtorácica e da ecocardiografia transesofágica corroboraram com o monitoramento e o cuidado centrado no paciente. Seu papel como ferramenta de diagnóstico, prognóstico e monitoramento da resposta à infusão de fluidos (fluído-responsividade) tornaram-se disponíveis nos dias de hoje, em razão da portabilidade e diminuição dos custos na aquisição dos equipamentos. O treinamento adequado, assim como o desenvolvimento de diretrizes relacionadas à utilização do ecocardiograma na unidade de terapia intensiva, possibilitarão a padroniza...

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The morality of allocating resources to the elderly care in intensive care unit

Revista Brasileira de Terapia Intensiva — Thu, 04 Mar 2010 17:26:01 +0100

O mundo está envelhecendo. No Brasil e em vários outros países do mundo, mudanças na composição etária da população vêm acompanhadas por um aumento da demanda por tipos de assistência à saúde cujo custo é elevado. Atualmente, alguns conflitos morais são decorrentes da alocação dos recursos públicos em saúde, pois a magnitude das desigualdades sociais e os recursos escassos impõem que as prioridades da gestão pública se fundamentem no conhecimento da situação de saúde e do impacto de políticas, programas, projetos e ações sobre a saúde. Nesse contexto, a medicina intensiva, os gestores e os médicos em terapia intensiva estão sujeitos a conflitos morais, principalmente quanto à justa microalocação de recursos para os idosos no centro de tratamento intensivo....

Understanding the PIRO concept: from theory to clinical practice - Part 1

Revista Brasileira de Terapia Intensiva — Thu, 04 Mar 2010 17:26:01 +0100

Apesar dos avanços recentes no diagnóstico e manejo de pacientes criticamente enfermos, a taxa de mortalidade relacionada à sepse continua inaceitavelmente alta. Assim, são necessários novos métodos de avaliação para proporcionar uma caracterização mais precoce e precisa de pacientes sépticos. Com base no sistema TNM (oncológico), o conceito PIRO foi apresentado como um novo sistema de estadiamento para sepse com a finalidade de avaliar o risco e predizer o prognóstico, com potencial de auxiliar na inclusão de pacientes em estudos clínicos e estimar a probabilidade de resposta a intervenções terapêuticas específicas.Despite recent advances in diagnosis and care of critically ill patients sepsis related mortality rate remains unacceptably high. Therefore, new methods of e...

Genetic susceptibility in acute lung injury and acute respiratory distress syndrome

Revista Brasileira de Terapia Intensiva — Thu, 04 Mar 2010 17:26:01 +0100

This study aims to review the role of the main genes involved in acute lung injury and acute respiratory distress syndrome susceptibility, morbidity and mortality. By search on PubMed and LiLACS databases, using the key words acute lung injury, acute respiratory distress syndrome and adult acute respiratory distress syndrome in combination with genetic polymorphisms, 69 papers were selected, from which 38 were included in this review. Were also considered relevant articles extracted from the reference lists in the articles selected from the databases. Genetic polymorphisms are gene variations in at least 1% population. These gene variations may influence the inflammatory response mediators' expression, directly affecting the susceptibility to acute lung injury, the intensity of lung parenc...

Controversies involving hypercapnic acidosis in acute respiratory distress syndrome

Revista Brasileira de Terapia Intensiva — Thu, 04 Mar 2010 17:26:01 +0100

A síndrome do desconforto respiratório agudo é caracterizada por uma reação inflamatória difusa do parênquima pulmonar induzida por um insulto direto ao epitélio alveolar (síndrome do desconforto respiratório agudo pulmonar) ou indireto por meio do endotélio vascular (síndrome do desconforto respiratório agudo extrapulmonar). A principal estratégia terapêutica da síndrome do desconforto respiratório agudo é o suporte ventilatório. Entretanto, a ventilação mecânica pode agravar a lesão pulmonar. Nesse contexto, uma estratégia ventilatória protetora com baixo volume corrente foi proposta. Tal estratégia reduziu a taxa de mortalidade dos pacientes com síndrome do desconforto respiratório agudo, porém acarretou acidose hipercápnica. O presente artigo apresenta uma...

Profile and long-term prognosis of glucose tight control in intensive care unit - patients: a cohort study

Revista Brasileira de Terapia Intensiva — Thu, 04 Mar 2010 17:26:01 +0100

OBJETIVOS: Hiperglicemia induzida por estresse ocorre com freqüência em pacientes criticamente doentes e tem sido associada a aumento de mortalidade e morbidade tanto em pacientes diabéticos, quanto em não diabéticos. O objetivo deste estudo foi avaliar o perfil e prognóstico a longo prazo dos pacientes críticos que recebem terapia insulínica contínua na unidade de terapia intensiva. MÉTODOS: Coorte prospectiva, em que foram estudados os pacientes internados na unidade de terapia intensiva no período de 1 ano. Foram analisadas variáveis demográficas, escores de gravidade e o prognóstico a curto na unidade de terapia intensiva, e a longo prazo (2 anos da alta da unidade de terapia intensiva). Os pacientes foram classificados em 2 grupos: pacientes que receberam terapia insulí...

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Red blood cells transfusion in intensive care unit

Revista Brasileira de Terapia Intensiva — Thu, 04 Mar 2010 17:26:01 +0100

CONCLUSIONS: Politrauma and sepsis/sepsis chock were the pre diagnosis criteria. A low hemoglobin level is the main clinical criteria with average hemoglobin pre - transfusion was 8,11 g/dL. (Source: Revista Brasileira de Terapia Intensiva)

Epidemiologic analysis of clinical isolates of Pseudomonas aeruginosa from an university hospital

Revista Brasileira de Terapia Intensiva — Thu, 04 Mar 2010 17:26:01 +0100

CONCLUSIONS: These results show a high prevalence of P. aeruginosa in the Hospital das Clínicas of the Universidade Federal de Pernambuco. Despite featuring high resistance rates to older antimicrobials, as cephalosporins first and second generations and chloramphenicol, this pathogen showed good susceptibility to agents routinely used in this hospital. (Source: Revista Brasileira de Terapia Intensiva)

Enteral nutritional therapy: application of quality indicators

Revista Brasileira de Terapia Intensiva — Thu, 04 Mar 2010 17:26:01 +0100

OBJETIVOS: Monitorar a adequação da terapia nutricional enteral na unidade de terapia intensiva visando à melhoria da qualidade da assistência nutricional. MÉTODOS: Estudo prospectivo e observacional desenvolvido na unidade de terapia intensiva adulto entre 2005 e 2008. Participaram da amostra pacientes maiores de 18 anos com terapia nutricional enteral exclusiva por mais de 72h. Analisou-se os valores médios e a adequação percentual de energia e proteínas calculados, prescritos e administrados em cada ano. Os fatores responsáveis pela não conformidade na administração planejada foram classificados em causas externas ou internas à unidade de terapia intensiva. Foram aplicados os indicadores de qualidade propostos pelo International Life Sciences Institute (ILSI) Brasil, sendo...

Study of resuscitated in- and out-hospital cardiorespiratory arrest patients undergoing therapeutic hypothermia

Revista Brasileira de Terapia Intensiva — Thu, 04 Mar 2010 17:26:01 +0100

OBJETIVO: Conhecer as características dos pacientes submetidos a um protocolo operacional padrão institucional de atendimento a pacientes reanimados após episódio de parada cardiorrespiratória incluindo a aplicação de hipotermia terapêutica. MÉTODOS: Foram analisados retrospectivamente 26 pacientes consecutivos após episódio de parada cardiorrespiratória de janeiro de 2007 a novembro de 2008. RESULTADOS: Todos os casos foram submetidos a hipotermia terapêutica. Idade média de 63 anos, predominantemente do sexo masculino. O local da parada cardiorrespiratória foi extra-hospitalar em 8 casos, pronto socorro em 3, durante internação fora da unidade de terapia intensiva em 13 casos e o bloco cirúrgico em 2 casos. O ritmo de parada foi fibrilação ventricular em sete paciente...

RIFLE: association with mortality and length of stay in critically ill acute kidney injury patients

Revista Brasileira de Terapia Intensiva — Thu, 04 Mar 2010 17:26:01 +0100

OBJETIVO: Correlacionar a classificação do RIFLE com a letalidade e tempo de internação na unidade de terapia intensiva e no hospital. MÉTODOS: Estudo de coorte prospectivo, observacional e longitudinal aprovado pelo Comitê de Ética da Instituição. Foram coletados os dados de todos os pacientes internados por mais de 24 horas na unidade de terapia intensiva do Hospital Universitário Polydoro Ernani de São Thiago da Universidade Federal de Santa Catarina de setembro de 2007 a março de 2008 e com seguimento até a alta ou óbito. Os pacientes foram divididos em dois grupos: com lesão renal aguda e sem lesão renal aguda. O grupo com lesão renal aguda foi classificado conforme o RIFLE e subdividido de acordo com a classe máxima alcançada: risco, injúria ou falência. Não for...

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Early predictive factors for intensive care unit readmission

Revista Brasileira de Terapia Intensiva — Thu, 04 Mar 2010 17:26:01 +0100

OBJETIVOS: Prever reinternação na unidade de terapia intensiva, analisando as primeiras 24 horas de pacientes após admissão em unidade de terapia intensiva. MÉTODOS: A primeira internação de pacientes de janeiro a maio de 2009 em UTI geral foi estudada. Considerou-se reinternação em unidade de terapia intensiva na mesma permanência hospitalar ou retorno em até 3 meses após alta da unidade. Pacientes que faleceram na 1ª admissão foram excluídos. Fatores demográficos, uso de assistência ventilatória e permanência na unidade de terapia intensiva por mais de 3 dias foram analisadas de forma uni e multivariada de acordo com desfecho reinternação. RESULTADOS: Quinhentos e setenta e sete pacientes foram incluídos (33 óbitos excluídos). O grupo de reinternação foi 59 paci...

Comparison between respiratory pulse oximetry plethysmographic waveform amplitude and arterial pulse pressure variations among patients with and without norepinephrine use

Revista Brasileira de Terapia Intensiva — Thu, 04 Mar 2010 17:26:01 +0100

OBJETIVOS: A variação respiratória da pressão arterial é um bom preditor da resposta a fluidos em pacientes ventilados. Foi recentemente demonstrado que a variação respiratória na pressão arterial de pulso se correlaciona com a variação da amplitude da onda pletismográfica da oximetria de pulso. Nossa intenção foi avaliar a correlação entre a variação respiratória da pressão arterial de pulso e a variação respiratória na amplitude da onda pletismográfica da oximetria de pulso, e determinar se esta correlação foi influenciada pela administração de norepinefrina. MÉTODOS: Estudo prospectivo de sessenta pacientes com ritmo sinusal normal sob ventilação mecânica, profundamente sedados e hemodinamicamente estáveis. Foram monitorados o índice de oxigenação e p...

Lack of association between interleukin-1 gene polymorphism and prognosis in severe traumatic brain injury patients

Revista Brasileira de Terapia Intensiva — Thu, 04 Mar 2010 17:26:01 +0100

CONCLUSION: Our findings suggest that -31C/T IL-1B gene polymorphism have no significant impact on the outcome of patients after acute severe traumatic brain injury. (Source: Revista Brasileira de Terapia Intensiva)

Fairness, not maleficence, in terminal critical patients care

Revista Brasileira de Terapia Intensiva — Thu, 04 Mar 2010 17:26:01 +0100

(Source: Revista Brasileira de Terapia Intensiva)

Chest Pain Plus Left Bundle Branch Block: Out With the New and in With the Old

Medscape Critical Care Headlines — Thu, 04 Mar 2010 15:36:16 +0100

Is it time to reevaluate guidelines for fibrinolytic therapy for patients presenting with new LBBB? Medscape Emergency Medicine (Source: Medscape Critical Care Headlines)

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Am J Respir Crit Care Med; +28 new citations

Am J Respir Crit Car... — Thu, 04 Mar 2010 01:58:02 +0100

28 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results: Am J Respir Crit Care Med These pubmed results were generated on 2010/03/03PubMed, a service of the National Library of Medicine, includes over 15 million citations for biomedical articles back to the 1950's. These citations are from MEDLINE and additional life science journals. PubMed includes links to many sites providing full text articles and other related resources. (Source: Am J Respir Crit Car...)

Information for Readers

Heart & Lung — Thu, 04 Mar 2010 00:00:00 +0100

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Heart & Lung — Thu, 04 Mar 2010 00:00:00 +0100

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Heart & Lung — Thu, 04 Mar 2010 00:00:00 +0100

(Source: Heart & Lung)