MedWorm: Intensive Care

Alterations during medical interpretation of icu family conferences that interfere with or enhance communication

Medscape Critical Care Headlines — Fri, 10 Oct 2008 21:39:43 +0100

This study characterizes the types, prevalence, and potential effects of alterations in interpretation during ICU family conferences involving end-of-life discussions. CHEST (Source: Medscape Critical Care Headlines)

MedWorm Sponsored Message: MD Consult brings the leading medical resources into one integrated online solution to help clinicians efficiently find answers to pressing clinical questions. Read the latest practice guidelines in Critical Care at MD Consult.

Risk of late-acquired incomplete stent apposition after drug-eluting stent versus bare-metal stent. a meta-analysis from 12 randomized trials

Medscape Critical Care Headlines — Fri, 10 Oct 2008 20:00:06 +0100

Does drug-eluting stent implantation increase the incidence of late-acquired incomplete stent apposition? The Journal of Invasive Cardiology (Source: Medscape Critical Care Headlines)

Complications of awake fibreoptic intubation without sedation in 200 healthy anaesthetists attending a training course

Medscape Critical Care Headlines — Fri, 10 Oct 2008 18:24:13 +0100

Nasendoscopy with lidocaine as a topical anesthetic sounds like it may be a safe bet for intubation, but not if there are significant side effects. Learn how healthy subjects were affected. British Journal of Anaesthesia (Source: Medscape Critical Care Headlines)

Clinical pharmacology 2008: practical information for physicians, nurses and pharmacists

Medscape Critical Care Headlines — Fri, 10 Oct 2008 17:32:45 +0100

Sepsis, pain management, and the safe use of anticoagulants were key topics at this meeting. Expert Review of Clinical Pharmacology (Source: Medscape Critical Care Headlines)

Guidance in sepsis management: navigating uncharted waters?

Critical Care — Fri, 10 Oct 2008 04:00:00 +0100

As our submission has been reduced from a commentary to a letter, I have assumed an abstract is no longer required (Source: Critical Care)

Acute kidney injury is common, parallels organ dysfunction or failure and carries appreciable mortality in patients with major burns: a prospective, exploratory cohort study

Critical Care — Fri, 10 Oct 2008 04:00:00 +0100

IntroductionThe purpose was to find out the incidence, time course, and outcome of acute kidney injury after major burns, and to evaluate the impact of possible predisposing factors (age, sex, depth and extent of injury) and the relation to other dysfunctioning organs and sepsis. Methods: We did an explorative cohort study on patients with a total burned body surface area (TBSA%) of 20% or more who were admitted to a national burn centre. Acute kidney injury was classified according to the international consensus classification Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease (RIFLE). Prospectively collected clinical and laboratory data were used for assessing organ dysfunction, systemic inflammatory response, and sepsis. Results: The incidence of acute kidney injury among major burns was 0.11 per 100,000 people and year. Of 127 patients, 31 (24%) developed acute kidney injury (12% Risk, 8% Injury, 5% Failure). Mean age was 40.6 years (95%CI 36.7 to 44.5), TBSA% 38.6% (95%CI 35.5 to 41.6), 25% were women. Mortality was 14% and increased with increasing RIFLE class (7% normal, 13% Risk, 40% Injury, 83% Failure). Renal dysfunction occurred within 7 days in 55% of the patients, and recovered among all survivors. Age, TBSA%, and extent of full thickness burns were higher among the patients who developed acute kidney injury. Pulmonary dysfunction and systemic inflammatory response syndrome was present in all of the patients with acute kidney injury and developed before the acute kidney injury. Sepsis was a possible aggravating factor in acute kidney injury in 48%. Extensive deep burns (25% or more full thickness burn) increased the risk for developing acute kidney injury early (risk ratio 2.25). Conclusions: Acute kidney injury is common, develops soon after the burn and parallels other dysfunctioning organs. Although acute kidney injury recovered in all survivors, in higher acute kidney injury groups, together with cardiovascular dysfunction, it correlated to mortality. (Source: Critical Care)

Sepsis

Medscape Critical Care Headlines — Thu, 09 Oct 2008 21:16:00 +0100

The latest guidelines provide a logical approach to managing this common infection. Student BMJ (Source: Medscape Critical Care Headlines)

Hyperglycemia may alter cytokine production and phagocytosis by means other than hyperosmotic stress

Critical Care — Thu, 09 Oct 2008 04:00:00 +0100

Using in vitro studies, Otto et al explore the theory that immunomodulation, by correction of hyperglycemia, may be a contributing factor to the reported efficacy of intensive insulin therapy (IIT) in critically ill patients. They suggest that hyperglycemia via hyperosmolarity at supra-physiological levels potentiates the production of cytokines by peripheral blood mononuclear cells (PBMC) in response to lipopolysaccharide (LPS) stimulation and that it also reduces the responses of phagocytosis and oxidative burst in human granulocytes. The efficacy of IIT, they conclude, may be partially due to correction of hyperosmolality. Other studies, however, suggest that immunological responses to LPS in the presence of hyperglycemia are mediated by a mechanism other than hyperosmolality. (Source: Critical Care)

Establishing the irish critical care trials group: 'who wins in battle makes many calculations before the battle is fought'

Critical Care — Thu, 09 Oct 2008 04:00:00 +0100

Quality research, requiring large numbers of participants, in the intensive care unit (ICU) population requires multi-centre collaboration. Although logistically challenging, this methodology reduces the influence of individual units, has greater validity and broader relevance to patients and practitioners. The nascent Irish Critical Care trials group opens additional such opportunities. In the accompanying epidemiologic study they present data gathered over 10 weeks of 2006 describing 1029 patients, from10 Irish ICUs representing over half of the island of Ireland's critical care bed capacity. The data depict a busy service with 78 % of admissions being emergent and a moderately high (7%) readmission rate. While recognising that there were missing data, the outcomes in organ failure and sepsis, where international definitions exist, and the ICU survival rate (83%), were consistent with international standards. The achievement of this planned first epidemiological step lays the foundation for the conduct of prospective scientific studies. These might occur in Ireland or in cooperation with other audit / scientific groups such as the United Kingdom's Intensive Care National Audit and Research Centre, the European Critical Care Research Network or others. This brings us a small step closer to the prospect of global, high volume studies in Critical Care. (Source: Critical Care)

Influenza

Medscape Critical Care Headlines — Wed, 08 Oct 2008 13:56:33 +0100

Is your knowledge of influenza up to date? Current diagnostics, therapeutics, and infection control measures associated with this deadly disease are reviewed. Critical Care Medicine (Source: Medscape Critical Care Headlines)

Cooling and reduced risk of clotting within the extracorporeal continuous renal replacement circuit

Intensive Care Medicine — Wed, 08 Oct 2008 12:18:46 +0100

Cooling and reduced risk of clotting within the extracorporeal continuous renal replacement circuit Content Type Journal ArticleCategory EditorialDOI 10.1007/s00134-008-1309-zAuthors Sean M. Bagshaw, University of Alberta Hospital, University of Alberta Division of Critical Care Medicine 3C1.16 Walter C. Mackenzie Centre, 8440-122 Street Edmonton AB T6G2B7 CanadaAndrew Davenport, Royal Free and University College Medical School UCL Center for Nephrology London UK Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Incidence and prognostic value of right ventricular failure in acute respiratory distress syndrome

Intensive Care Medicine — Wed, 08 Oct 2008 09:49:39 +0100

Abstract Objective To analyse the incidence and the impact on outcome of right ventricular failure (RVF) in patients with acute respiratory distress syndrome (ARDS). Patients and methods A total of 145 ARDS patients included in the previously published French Pulmonary Artery Catheter (PAC) study were randomly assigned to receive a PAC. All patients were ventilated according to a strategy aimed at limiting plateau pressure. The RVF was defined by the concomitant presence of: (1) a mean pulmonary artery pressure (MPAP) > 25 mmHg, (2) a central venous pressure (CVP) higher than pulmonary artery occlusion pressure (PAOP) and (3) a stroke volume index < 30 mL m−2. Results Right ventricular failure was present in 9.6% of patients. Mortality was 68% at day-90 with no difference between patients with RVF (RVF+) and without RVF (71 vs. 67%, respectively). SAPS II, PaO2/FiO2 and PaCO2 were similar in both groups. Tidal volume and I/E ratio were significantly higher in RVF+ (9.7 ± 2.8 vs. 8.6 ± 1.8 ml m−2 and 0.7 ± 0.5 vs. 0.5 ± 0.2). Plateau pressure tended to be higher in RVF+ (28 ± 6 vs. 25 ± 6 cmH2O, NS). In multivariate analysis, PaO2/FiO2, mean arterial pressure, arterial pH, SvO2, MPAP and presence of CVP > PAOP, but not RVF, were independently associated with day-90 mortality. Conclusion In this group of patients investigated early in the course of ARDS and ventilated according to a strategy aimed at limiting plateau pressure, the presence of RVF was about 10%. Unlike MPAP and the presence of CVP > PAOP, RVF at this early stage did not appear as an independent factor of mortality. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-008-1307-1Authors David Osman, Université Paris-11 Sud Service de Réanimation Médicale, Hôpital de Bicêtre, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris Le Kremlin-Bicêtre FranceXavier Monnet, Université Paris-11 Sud Service de Réanimation Médicale, Hôpital de Bicêtre, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris Le Kremlin-Bicêtre FranceVincent Castelain, Université Louis Pasteur Service de Réanimation Médicale, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg Strasbourg FranceNadia Anguel, Université Paris-11 Sud Service de Réanimation Médicale, Hôpital de Bicêtre, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris Le Kremlin-Bicêtre FranceJosiane Warszawski, Université Paris-11 Sud Service d’Epidémiologie et Biostatistiques, Hôpital de Bicêtre, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris Le Kremlin-Bicêtre FranceJean-Louis Teboul, Université Paris-11 Sud Service de Réanimation Médicale, Hôpital de Bicêtre, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris Le Kremlin-Bicêtre FranceChristian Richard, Université Paris-11 Sud Service de Réanimation Médicale, Hôpital de Bicêtre, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris Le Kremlin-Bicêtre Francefor the French Pulmonary Artery Catheter Study Group Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Science, medicine and industry: are we getting out of the black hole in sepsis research?

Intensive Care Medicine — Wed, 08 Oct 2008 09:49:39 +0100

Science, medicine and industry: are we getting out of the black hole in sepsis research? Content Type Journal ArticleCategory EditorialDOI 10.1007/s00134-008-1302-6Authors Peter M. Suter, University of Geneva Swiss Academy of Medical Sciences, CMU Geneva SwitzerlandJukka Takala, Bern University Hospital, University of Bern Department of Intensive Care Medicine Inselspital 3010 Bern Switzerland Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Once is not enough: clinical trials in sepsis

Intensive Care Medicine — Wed, 08 Oct 2008 09:49:38 +0100

Once is not enough: clinical trials in sepsis Content Type Journal ArticleCategory EditorialDOI 10.1007/s00134-008-1274-6Authors Daniel A. Sweeney, National Institutes of Health Critical Care Medicine Department, Clinical Center Building 10, Room 2C145 Bethesda MD 20892-1662 USARobert L. Danner, National Institutes of Health Critical Care Medicine Department, Clinical Center Building 10, Room 2C145 Bethesda MD 20892-1662 USAPeter Q. Eichacker, National Institutes of Health Critical Care Medicine Department, Clinical Center Building 10, Room 2C145 Bethesda MD 20892-1662 USACharles Natanson, National Institutes of Health Critical Care Medicine Department, Clinical Center Building 10, Room 2C145 Bethesda MD 20892-1662 USA Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Is right ventricular function the one that matters in ards patients? definitely yes

Intensive Care Medicine — Wed, 08 Oct 2008 09:49:38 +0100

Is right ventricular function the one that matters in ARDS patients? Definitely yes Content Type Journal ArticleCategory EditorialDOI 10.1007/s00134-008-1308-0Authors Antoine Vieillard-Baron, University Hospital Ambroise Paré Intensive Care Unit, Assistance Publique des Hôpitaux de Paris 9, Avenue Charles-de-Gaulle 92104 Boulogne France Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Editors’ comments on a new trial of activated protein c for persistent septic shock

Intensive Care Medicine — Wed, 08 Oct 2008 09:49:38 +0100

Editors’ comments on a new trial of activated protein C for persistent septic shock Content Type Journal ArticleCategory EditorialDOI 10.1007/s00134-008-1303-5Authors Jordi Mancebo, Hospital de Sant Pau Servei de Medicina Intensiva Av. S.A.M. Claret 167 08025 Barcelona SpainMassimo Antonelli, Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore Department of Intensive Care and Anesthesiology Largo A. Gemelli, 8 00168 Rome Italy Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Design, conduct, analysis and reporting of a multi-national placebo-controlled trial of activated protein c for persistent septic shock

Intensive Care Medicine — Wed, 08 Oct 2008 09:49:37 +0100

Abstract The role of drotrecogin alfa (activated) (DAA) in severe sepsis remains controversial and clinicians are unsure whether or not to treat their patients with DAA. In response to a request from the European Medicines Agency, Eli Lilly will sponsor a new placebo-controlled trial and history suggests the results will be subject to great scrutiny. An academic steering committee will oversee the conduct of the study and will write the study manuscripts. The steering committee intends that the study will be conducted with the maximum possible transparency; this includes publication of the study protocol and a memorandum of understanding which delineates the role of the sponsor. The trial has the potential to provide clinicians with valuable data but patients will only benefit if clinicians have confidence in the conduct, analysis and reporting of the trial. This special article describes the process by which the trial was developed, major decisions regarding trial design, and plans for independent analysis, interpretation and reporting of the data. Content Type Journal ArticleCategory Special ArticleDOI 10.1007/s00134-008-1266-6Authors Simon Finfer, University of Sydney Critical Care and Trauma, The George Institute for International Health PO Box M201 Missenden Road Sydney NSW 2050 AustraliaV. Marco Ranieri, Università di Torino Ospedale S. Giovanni Battista-Molinette Torino ItalyB. Taylor Thompson, Massachusetts General Hospital Pulmonary and Critical Care Unit, Bullfinch Building, Room 148 55 Fruit Street Boston MA 02114 USAPhilip S. Barie, Weill Cornell Medical College Department of Surgery, P713A 525 East 68 St New York NY 10065 USAJean-François Dhainaut, Cochin Port Royal Hospital-Paris Descartes University Paris FranceIvor S. Douglas, Denver Health and University of Colorado Denver USABengt Gårdlund, Karolinska University Hospital Department of Infectious Diseases 14186 Stockholm SwedenJohn C. Marshall, St Michael’s Hospital Departments of Surgery and Critical Care Medicine 4th Floor Bond Wing, Rm. 4-007, 30 Bond Street Toronto ON M5B 1W8 CanadaAndrew Rhodes, St George’s Hospital Department of Intensive Care Medicine and Anaesthesia London SW17 0QT UK Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Anaesthesia and morbid obesity

Medscape Critical Care Headlines — Tue, 07 Oct 2008 23:04:12 +0100

Morbid obesity has a grave effect on health and is increasing in prevalence among children and adults. This review explains the effects of anaesthesia on patients who are morbidly obese. Continuting Education in Anaesthesia, Critical Care & Pain (Source: Medscape Critical Care Headlines)

A comprehensive review of pediatric endotracheal suctioning: effects, indications, and clinical practice

Medscape Critical Care Headlines — Tue, 07 Oct 2008 22:06:38 +0100

What gaps exist in the evidence base for pediatric endotracheal suctioning? These authors survey the literature to try and identify best practice standards. Pediatric Critical Care Medicine (Source: Medscape Critical Care Headlines)

Clinical guidelines, audits and hemovigilance in managing blood transfusion needs

Medscape Critical Care Headlines — Tue, 07 Oct 2008 21:20:07 +0100

Tools for improving blood supply safety are described and justified in this article. Transfusion Alternatives in Transfusion Medicine (Source: Medscape Critical Care Headlines)

Sccm pod-94 increased mortality of ventilated patients with endotracheal pseudomonas aeruginosa

SCCM PodCast - iCritical Care — Tue, 07 Oct 2008 18:21:00 +0100

Jeanine Wiener-Kronish, MD, discusses an article published in the September 2008 issue of Critical Care Medicine, titled "Increased mortality of ventilated patients with endotracheal Pseudomonas aeruginosa without clinical signs of infection." Dr. Wiener-Kronish is a professor of research and teaching in anaesthetics and anaesthesia at Harvard Medical School, and Chief of Anesthesia, Massachusetts General Hospital in Boston, (Crit Car Med 2008.36(9): 2495) (Source: SCCM PodCast - iCritical Care)

Effect of preprocedural statin use on procedural myocardial infarction and major cardiac adverse events in percutaneous coronary intervention: a meta-analysis

Medscape Critical Care Headlines — Mon, 06 Oct 2008 20:27:26 +0100

Does statin use prior to percutaneous coronary intervention improve outcomes by reducing the risk of major adverse cardiac events? The Journal of Invasive Cardiology (Source: Medscape Critical Care Headlines)

Readmission to a surgical intensive care unit: incidence, outcome, and risk factors

Critical Care — Mon, 06 Oct 2008 04:00:00 +0100

IntroductionWe investigated the incidence of, outcome from, and possible risk factors for readmission to our surgical intensive care unit (ICU). Methods: Analysis of prospectively collected data from all patients admitted to the postoperative ICU between September 2004 and July 2006. Results: Of 3169 patients admitted to our ICU during the study period, 2852 were discharged to the hospital floor and constituted the study group (1828 male (64.1%), mean age 62 years). The readmission rate was 13.4% (n = 381): 314 (82.4%) readmitted once, 39 (10.2%) readmitted twice, and 28 (7.3%) readmitted more than twice. The first readmission to the ICU occurred within a median of 7 (5-14) days. Patients who were readmitted to the ICU had higher simplified acute physiology II (37+/-16 versus 33+/-16, p (Source: Critical Care)

Smartcare™ closed-loop system and the altitude problem

Intensive Care Medicine — Sat, 04 Oct 2008 09:25:26 +0100

SmartCare™ closed-loop system and the altitude problem Content Type Journal ArticleCategory CorrespondenceDOI 10.1007/s00134-008-1306-2Authors Pablo Alvarez Maldonado, Hospital Español de México Department of Intensive Care México D.F. MexicoUlises Cerón Díaz, Hospital Español de México Department of Intensive Care México D.F. MexicoAlfredo Sierra Unzueta, Hospital Español de México Department of Intensive Care México D.F. Mexico Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Opioids and the control of respiration

Medscape Critical Care Headlines — Fri, 03 Oct 2008 19:55:07 +0100

What are the mechanisms of opioid-induced respiratory depression and how can safer opioid analgesia be achieved? Future research avenues are proposed. British Journal of Anaesthesia (Source: Medscape Critical Care Headlines)

Am j respir crit care med; +20 new citations

Am J Respir Crit Car... — Fri, 03 Oct 2008 09:11:46 +0100

20 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 2008/10/03

PubMed, 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...)

Workplace distress and ethical dilemmas in neuroscience nursing

Medscape Critical Care Headlines — Thu, 02 Oct 2008 18:02:50 +0100

This study describes nurses' experiences of workplace stress and the occurrence of ethical dilemmas in a neurological setting. The Journal of Neuroscience Nursing (Source: Medscape Critical Care Headlines)

Last chance: give input on the next international delegation

SCCM RSS News — Thu, 02 Oct 2008 14:42:10 +0100

The deadline to offer input about the next international delegation destination for the Society of Critical Care Medicine is October 10, 2008. Several Society members recently traveled to Russia to tour hospitals, meet with Russian colleagues and experience the country's culture. The trip was highlighted in the August 2008 issue of Critical Connections... (Source: SCCM RSS News)

Statins may be linked to postoperative delirium

SCCM RSS News — Thu, 02 Oct 2008 14:42:10 +0100

Patients who take cholesterol-lowering statin drugs may be more likely to suffer delirium after surgery, according to a study published in the Canadian Medical Association Journal... (Source: SCCM RSS News)

Icc conference to focus on therapeutic hypothermia

SCCM RSS News — Thu, 02 Oct 2008 14:41:27 +0100

Registration now is open for the 11th International Consensus Conference (ICC) in Intensive Care Medicine, Therapeutic Hypothermia - To Cool or Not To Cool?, which will be held in San Juan, Puerto Rico, April 23 and 24, 2009... (Source: SCCM RSS News)

Maximize your fellows' strengths and eliminate their weaknesses

SCCM RSS News — Thu, 02 Oct 2008 14:40:59 +0100

Help your fellows prepare for the critical care subspecialty exam! Determine knowledge gaps and receive an objective measurement of your critical care fellowship program and its participants with the Multidisciplinary Critical Care Knowledge Assessment Program (MCCKAP)... (Source: SCCM RSS News)

Dvt coalition supports surgeon general's call to action

SCCM RSS News — Thu, 02 Oct 2008 14:40:29 +0100

Acting Surgeon General Steven K. Galson, MD, MPH, on September 15 issued a Call to Action to reduce the number of cases of deep vein thrombosis (DVT) and pulmonary embolism (PE) in the United States at the second annual meeting of the Venous Disease Coalition (VDC) in Washington, DC... (Source: SCCM RSS News)

Congratulations to paragon coaches

SCCM RSS News — Thu, 02 Oct 2008 14:40:04 +0100

As the Society of Critical Care Medicine (SCCM) launches the Paragon Critical Care Quality Implementation ProgramTM, it is pleased to announce the program's newest coaches. These SCCM members possess the skills needed to be effective Paragon coaches; they are experienced investigators, mentors and problem solvers... (Source: SCCM RSS News)

Palliative care programs may help the bottom line

SCCM RSS News — Thu, 02 Oct 2008 14:39:40 +0100

Palliative care programs can save hospitals more than $300 a day, according to a study conducted by the National Palliative Care Research Center and the Center to Advance Palliative Care. The study examined eight hospitals and found that the units saved from $279 to $374 per day when the hospital used a palliative care team to treat patients rather than discharging them. Hospitals saved $1,700 to $4,900 on each admission of a palliative care patient... (Source: SCCM RSS News)

Arterial pressure changes during the valsalva maneuver to predict fluid responsiveness in spontaneously breathing patients

Intensive Care Medicine — Thu, 02 Oct 2008 09:35:18 +0100

Abstract Objective To evaluate whether arterial pressure response during a Valsalva maneuver could predict fluid responsiveness in spontaneously breathing patients. Design and setting Prospective clinical study in a 17-bed multidisciplinary intensive care unit. Patients Thirty patients without mechanical ventilation and equipped with a radial arterial catheter for whom the decision to give fluids was taken due to suspected hypovolemia. Intervention A 10-s Valsalva maneuver was performed before and after volume expansion (VE). Patients were classified as responders if stroke volume index (SVi) increased ≥15% after VE. Measurements and results Pulse pressure changes during the Valsalva maneuver (∆VPP) were calculated as the difference between maximal pulse pressure during phase 1 and minimal pulse pressure during phase 2 of the Valsalva maneuver divided by the mean of the two values and expressed as a percentage. Valsalva changes in systolic pressure (∆VSP) were calculated in similar way. SVi changes induced by VE was correlated with baseline values of ∆VPP and ∆VSP (r 2 = 0.71 and r 2 = 0.60; P < 0.0001, respectively), and with VE-induced changes in ∆VPP and ∆VSP (r 2 = 0.56 and r 2 = 0.44; P < 0.0001 and P < 0.001, respectively). A ∆VPP value of 52% and ∆VSP of 30% predicted fluid responsiveness with a sensitivity of 91% and 73% and a specificity of 95 and 90%, respectively. Conclusions Arterial response during the Valsalva maneuver is a feasible tool for predicting fluid responsiveness in patients without mechanical ventilatory support. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-008-1295-1Authors Manuel Ignacio Monge García, Hospital del SAS Jerez Servicio de Cuidados Críticos y Urgencias, Unidad de Investigación Experimental C/ Circunvalación s/n 11407 Jerez de la Frontera SpainAnselmo Gil Cano, Hospital del SAS Jerez Servicio de Cuidados Críticos y Urgencias, Unidad de Investigación Experimental C/ Circunvalación s/n 11407 Jerez de la Frontera SpainJuan Carlos Díaz Monrové, Hospital del SAS Jerez Servicio de Cuidados Críticos y Urgencias, Unidad de Investigación Experimental C/ Circunvalación s/n 11407 Jerez de la Frontera Spain Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Valsalva, valsalva, may you give me a clue, who needs fluids in my icu?

Intensive Care Medicine — Thu, 02 Oct 2008 09:35:18 +0100

Valsalva, Valsalva, may you give me a clue, who needs fluids in my ICU? Content Type Journal ArticleCategory EditorialDOI 10.1007/s00134-008-1294-2Authors Sebastian Rehberg, University Hospital of Muenster Department of Anesthesiology and Intensive Care Albert-Schweitzer-Str. 33 48149 Münster GermanyChristian Ertmer, University Hospital of Muenster Department of Anesthesiology and Intensive Care Albert-Schweitzer-Str. 33 48149 Münster GermanyMartin Westphal, University Hospital of Muenster Department of Anesthesiology and Intensive Care Albert-Schweitzer-Str. 33 48149 Münster Germany Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Physician-assisted death in the united states: are the existing "last resorts" enough?

Medscape Critical Care Headlines — Wed, 01 Oct 2008 20:24:05 +0100

A citizens' initiative in Washington is proposing an Oregon-style law for legal access to potentially lethal meds for the terminally ill. What progress has been made in palliative/end-of-life care? The Hastings Center Report (Source: Medscape Critical Care Headlines)

Pacemaker and defibrillator therapy in pediatrics and congenital heart disease

Medscape Critical Care Headlines — Wed, 01 Oct 2008 18:16:56 +0100

Device therapy in pediatric populations is becoming more tenable, but modifications are needed when using adult devices for children. Current guidelines are reviewed. Future Cardiology (Source: Medscape Critical Care Headlines)

Short-term mortality and cost associated with cardiac device implantation in patients hospitalized with heart failure

Medscape Critical Care Headlines — Tue, 30 Sep 2008 21:43:39 +0100

Cardiac device implantation has increased the lifespan for many, but how can selection criteria be optimized to determine the best candidates for therapy? American Heart Journal (Source: Medscape Critical Care Headlines)

Older adults and burns

Medscape Critical Care Headlines — Tue, 30 Sep 2008 20:11:18 +0100

This article reviews the literature on specific issues for older adults that need to be considered when treating older adults with burn injury. Geriatrics & Aging (Source: Medscape Critical Care Headlines)

The vasopressin and copeptin response in patients with vasodilatory shock after cardiac surgery: a prospective, controlled study

Intensive Care Medicine — Tue, 30 Sep 2008 09:03:42 +0100

Abstract Objective To evaluate arginine vasopressin (AVP) and copeptin plasma concentrations in patients with vasodilatory shock after cardiac surgery. Design Prospective, controlled, clinical study. Setting Surgical intensive care unit and cardiac surgery ward in a tertiary university teaching hospital. Patients and participants Thirty-three critically ill patients with vasodilatory shock after cardiac surgery and ten control patients undergoing uncomplicated aorto-coronary bypass surgery. Measurements and results Hemodynamic, laboratory and clinical data were recorded daily in all patients during the first 7 days after cardiac surgery. At the same time, points blood was withdrawn to determine plasma concentrations of AVP (radioimmunoassay) and copeptin (immunoluminometric assy). Standard tests, a mixed effects model and regression analyses were used for statistical analysis. The course of AVP was significantly different between groups (P < 0.001). While AVP concentrations were lower in the study group on the first postoperative day, they were higher than that in the control group from postoperative day 3 on. There was no difference in the postoperative AVP response between study patients with or without chronic angiotensin-converting enzyme inhibitor therapy. Except during continuous veno-venous hemofiltration, AVP and copeptin correlated significantly with each other (P < 0.001; r = 0.749). Conclusions The AVP response to cardiac surgery is significantly different between patients with vasodilatory shock and patients undergoing uncomplicated aorto-coronary bypass surgery. Although no causative relationship between AVP concentrations and cardiovascular instability can be drawn from these results, our data support the hypothesis that inadequately low AVP plasma levels contribute to the failure to restore vascular tone in vasodilatory shock after cardiac surgery. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00134-008-1279-1Authors Stefan Jochberger, Innsbruck Medical University Department of Anesthesiology and Critical Care Medicine Anichstrasse 35 6020 Innsbruck AustriaCorinna Velik-Salchner, Innsbruck Medical University Department of Anesthesiology and Critical Care Medicine Anichstrasse 35 6020 Innsbruck AustriaViktoria D. Mayr, Innsbruck Medical University Department of Anesthesiology and Critical Care Medicine Anichstrasse 35 6020 Innsbruck AustriaGünter Luckner, Innsbruck Medical University Department of Anesthesiology and Critical Care Medicine Anichstrasse 35 6020 Innsbruck AustriaVolker Wenzel, Innsbruck Medical University Department of Anesthesiology and Critical Care Medicine Anichstrasse 35 6020 Innsbruck AustriaGerda Falkensammer, Innsbruck Medical University Institute for Medical and Chemical Laboratory Diagnostics Innsbruck AustriaHanno Ulmer, Innsbruck Medical University Department of Medical Statistics, Informatics and Health Economics (MSIG) Innsbruck AustriaNils Morgenthaler, B.R.A.H.M.S. Aktiengesellschaft Department of Research Hennigsdorf GermanyWalter Hasibeder, Krankenhaus der Barmherzigen Schwestern Department of Anesthesiology and Critical Care Medicine Ried im Innkreis AustriaMartin W. Dünser, Innsbruck Medical University Department of Anesthesiology and Critical Care Medicine Anichstrasse 35 6020 Innsbruck Austria Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

The epidemiology of acute respiratory distress syndrome in pediatric intensive care units in china

Intensive Care Medicine — Tue, 30 Sep 2008 09:03:41 +0100

Abstract Objective To assess the incidence of, predisposing factors for, and the rates and relative risks of mortality from acute respiratory distress syndrome (ARDS) in pediatric patients. Design A prospective study in 12 consecutive months from 2004 to 2005 in 25 pediatric intensive care units (PICUs). Patients and setting ARDS was diagnosed according to the 1994 American–European Consensus Conference definitions, applied to all severely ill admissions between 1 month and 14 years of age. The PICUs were in major municipalities and provincial cities, and half were university affiliated. Measurements and results From a total of 12,018 admissions, 7,269 were severely ill. One hundred and five (1.44%) patients developed ARDS and 64 (61.0%) died, which accounts for 13.2%, of the total ICU death (n = 485, 6.7%) or a nine times relative risk of dying. The median age at onset of ARDS was 24 months and 40% were less than 12 month old. Median time from PICU admission to the onset of ARDS was 16 h, and in 63% <24 h. Pneumonia (55.2%) and sepsis (22.9%) were the major predisposing factors for ARDS. These were respectively 14 and 5 times as high a death rate as those of the severely ill patients without ARDS. Conclusions ARDS has a high mortality in these Chinese PICUs, especially in those with pneumonia and sepsis, and adequate management including lung protective ventilation strategy is required. Content Type Journal ArticleCategory Pediatric OriginalDOI 10.1007/s00134-008-1254-xAuthors Wen-Liang Yu, Children’s Hospital of Fudan University 183 Feng Lin Road 200032 Shanghai People’s Republic of ChinaZhu-Jin Lu, Children’s Hospital of Fudan University 183 Feng Lin Road 200032 Shanghai People’s Republic of ChinaYing Wang, Shanghai Children’s Medical Center of Shanghai Jiaotong University Shanghai People’s Republic of ChinaLi-Ping Shi, Children’s Hospital of Zhejiang University Zhejiang People’s Republic of ChinaFeng-Wu Kuang, Children’s Hospital of Chongqing Medical University Chongqing People’s Republic of ChinaSu-Yun Qian, Beijing Children’s Hospital of Capital University of Medical Sciences Beijing People’s Republic of ChinaQi-Yi Zeng, Guangzhou Children’s Hospital Guangdong People’s Republic of ChinaMin-Hui Xie, Children’s Hospital of Suzhou University Jiangsu People’s Republic of ChinaGuo-Ying Zhang, Chengdu Children’s Hospital Sichuan People’s Republic of ChinaDe-Yi Zhuang, Quanzhou Children’s Hospital Fujian People’s Republic of ChinaXun-Mei Fan, Beijing Children’s Hospital of Capital University of Medical Sciences Beijing People’s Republic of ChinaBo Sun, Children’s Hospital of Fudan University 183 Feng Lin Road 200032 Shanghai People’s Republic of ChinaCollaborative Study Group of Pediatric Respiratory Failure Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Ability of dynamic airway pressure curve profile and elastance for positive end-expiratory pressure titration

Intensive Care Medicine — Tue, 30 Sep 2008 09:03:41 +0100

Abstract Objective To evaluate the ability of three indices derived from the airway pressure curve for titrating positive end-expiratory pressure (PEEP) to minimize mechanical stress while improving lung aeration assessed by computed tomography (CT). Design Prospective, experimental study. Setting University research facilities. Subjects Twelve pigs. Interventions Animals were anesthetized and mechanically ventilated with tidal volume of 7 ml kg−1. In non-injured lungs (n = 6), PEEP was set at 16 cmH2O and stepwise decreased until zero. Acute lung injury was then induced either with oleic acid (n = 6) or surfactant depletion (n = 6). A recruitment maneuver was performed, the PEEP set at 26 cmH2O and decreased stepwise until zero. CT scans were obtained at end-expiratory and end-inspiratory pauses. The elastance of the respiratory system (Ers), the stress index and the percentage of volume-dependent elastance (%E 2) were estimated. Measurements and main results In non-injured and injured lungs, the PEEP at which Ers was lowest (8–4 and 16–12 cmH2O, respectively) corresponded to the best compromise between recruitment/hyperinflation. In non-injured lungs, stress index and %E 2 correlated with tidal recruitment and hyperinflation. In injured lungs, stress index and %E 2 suggested overdistension at all PEEP levels, whereas the CT scans evidenced tidal recruitment and hyperinflation simultaneously. Conclusion During ventilation with low tidal volumes, Ers seems to be useful for guiding PEEP titration in non-injured and injured lungs, while stress index and %E 2 are useful in non-injured lungs only. Our results suggest that Ers can be superior to the stress index and %E 2 to guide PEEP titration in focal loss of lung aeration. Content Type Journal ArticleCategory ExperimentalDOI 10.1007/s00134-008-1301-7Authors Alysson R. Carvalho, University Hospital Carl Gustav Carus Clinic of Anesthesiology and Intensive Care Therapy, Medical Faculty Dresden GermanyPeter M. Spieth, University Hospital Carl Gustav Carus Clinic of Anesthesiology and Intensive Care Therapy, Medical Faculty Dresden GermanyPaolo Pelosi, University of Insubria Department of Ambient, Health and Safety Varese ItalyMarcos F. Vidal Melo, Massachusetts General Hospital, Harvard Medical School Department of Anesthesia and Critical Care Boston MA USAThea Koch, University Hospital Carl Gustav Carus Clinic of Anesthesiology and Intensive Care Therapy, Medical Faculty Dresden GermanyFrederico C. Jandre, COPPE, Federal University of Rio de Janeiro Program of Biomedical Engineering Rio de Janeiro BrazilAntonio Giannella-Neto, COPPE, Federal University of Rio de Janeiro Program of Biomedical Engineering Rio de Janeiro BrazilMarcelo Gama de Abreu, University Hospital Carl Gustav Carus Clinic of Anesthesiology and Intensive Care Therapy, Medical Faculty Dresden Germany Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Interactions between respiration and systemic hemodynamics. part ii: practical implications in critical care

Intensive Care Medicine — Tue, 30 Sep 2008 09:03:41 +0100

Abstract In Part I of this review, we have covered basic concepts regarding cardiorespiratory interactions. Here, we put this theoretical framework to practical use. We describe mechanisms underlying Kussmaul’s sign and pulsus paradoxus. We review the literature on the use of respiratory variations of blood pressure to evaluate volume status. We show the possibilities of attaining the latter aim by investigating with ultrasonography how the geometry of great veins fluctuates with respiration. We provide a Guytonian analysis of the effects of PEEP on cardiac output. We terminate with some remarks on the potential of positive pressure breathing to induce acute cor pulmonale, and on the cardiovascular mechanisms that at times may underly the failure to wean a patient from the ventilator. Content Type Journal ArticleCategory ReviewDOI 10.1007/s00134-008-1298-yAuthors François Feihl, University Hospital (CHUV) and Lausanne University (UNIL) Division of Clinical Pathophysiology 1011 Lausanne SwitzerlandAlain F. Broccard, Regions Hospital Medical Intensive Care Unit, Regions Hospital Pulmonary and Critical Care Division St Paul MN 55101-2595 USA Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

Interactions between respiration and systemic hemodynamics. part i: basic concepts

Intensive Care Medicine — Tue, 30 Sep 2008 09:03:41 +0100

Abstract The topic of cardiorespiratory interactions is of extreme importance to the practicing intensivist. It also has a reputation for being intellectually challenging, due in part to the enormous volume of relevant, at times contradictory literature. Another source of difficulty is the need to simultaneously consider the interrelated functioning of several organ systems (not necessarily limited to the heart and lung), in other words, to adopt a systemic (as opposed to analytic) point of view. We believe that the proper understanding of a few simple physiological concepts is of great help in organizing knowledge in this field. The first part of this review will be devoted to demonstrating this point. The second part, to be published in a coming issue of Intensive Care Medicine, will apply these concepts to clinical situations. We hope that this text will be of some use, especially to intensivists in training, to demystify a field that many find intimidating. Content Type Journal ArticleCategory ReviewDOI 10.1007/s00134-008-1297-zAuthors François Feihl, University Hospital (CHUV) and Lausanne University (UNIL) Division of Clinical Pathophysiology 1011 Lausanne SwitzerlandAlain F. Broccard, Regions Hospital Medical Intensive Care Unit, Regions Hospital Pulmonary and Critical Care Division St Paul MN 55101-2595 USA Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

The "cardiac-lung mass" artifact: an echocardiographic sign of lung atelectasis and/or pleural effusion

Critical Care — Tue, 30 Sep 2008 04:00:00 +0100

IntroductionWe performed an ultrasound study to investigate echocardiographic artifacts in mechanically ventilated patients with lung pathology. Methods: Two hundred and five mechanically ventilated patients who exhibited lung atelectasis and/or pleural effusion participated in this 36-month study. Subjects underwent lung echography and transthoracic echocardiography with a linear 5 to 10 MHz and with a 1.5 to 3.6 MHz wide-angle phased-array transducer, respectively. Patients were examined by two experienced observers blinded to each other's interpretation. Results: One hundred and twenty four patients (60,48%) were hospitalised due to multiple trauma; 60 patients (29,26%) due to respiratory insufficiency, and 21 (10,24%) due to recent postoperative surgery. The mean period of hospitalisation was 35+/-27 days. An intracardiac artifact was documented in 17 out of 205 patients (8,29%) by echocardiography. It was visible only in the apical views, while subsequent transesophageal echocardiography revealed no abnormalities. The artifact consisted of a mobile component that demonstrated, on M-mode, a pattern of respiratory variation similar to the lung 'sinusoid sign'. Lung echography revealed lung atelectasis, and/or pleural effusion adjacent to the heart, and a similar M-mode pattern was observed. The artifact was recorded within the left cardiac chambers (11 cases) and within the right cardiac chambers (6 cases). Conclusions: Lung atelectasis and/or pleural effusion may create a mirror image, intracardiac artifact in mechanically ventilated patients. The latter was named as the "cardiac-lung mass" artifact to underline the important diagnostic role of both echocardiography and lung echography in these patients. (Source: Critical Care)

A meta-analysis of 17 randomized trials of a percutaneous coronary intervention-based strategy in patients with stable coronary artery disease

Medscape Critical Care Headlines — Mon, 29 Sep 2008 21:47:00 +0100

Stable coronary artery disease may be effectively treated with medication alone, but does percutaneous coronary intervention improve long term survival when compared with medical management? Journal of the American College of Cardiology (Source: Medscape Critical Care Headlines)

Pharmaceutical interventions for the management of no-reflow

Medscape Critical Care Headlines — Fri, 26 Sep 2008 20:59:40 +0100

No-reflow is a post PCI complication that often occurs in saphenous vein grafts. Its causes and treatments are outlined in this review. The Journal of Invasive Cardiology (Source: Medscape Critical Care Headlines)

Intravascular temperature modulation as an adjunct to secondary brain injury prevention in a patient with an epidural hematoma

Medscape Critical Care Headlines — Thu, 25 Sep 2008 22:53:57 +0100

A nurse developed an epidural hematoma after being struck by a car. Learn about the use of thermoregulation in a situation like this. The Journal of Neuroscience Nursing (Source: Medscape Critical Care Headlines)

Adaptive support ventilation is a patented technology

Intensive Care Medicine — Thu, 25 Sep 2008 07:23:54 +0100

Adaptive support ventilation is a patented technology Content Type Journal ArticleCategory CorrespondenceDOI 10.1007/s00134-008-1290-6Authors Fleur T. Tehrani, California State University Department of Electrical Engineering 800 North State College Boulevard Fullerton CA 92831 USA Journal Intensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)