Laurent Papazian, Jean-Marie Forel, Arnaud Gacouin, Christine Penot-Ragon, Gilles Perrin, Anderson Loundou, Samir Jaber, Jean-Michel Arnal, Didier Perez, Jean-Marie Seghboyan, Jean-Michel Constantin, Pierre Courant, Jean-Yves Lefrant, Claude Guérin, Gwenaël Prat, Sophie Morange, Antoine Roch
BACKGROUND: In patients undergoing mechanical ventilation for the acute respiratory distress syndrome (ARDS), neuromuscular blocking agents may improve oxygenation and decrease ventilator-induced lung injury but may also cause muscle weakness. We evaluated clinical outcomes after 2 days of therapy with neuromuscular blocking agents in patients with early, severe ARDS. METHODS: In this multicenter, double-blind trial, 340 patients presenting to the intensive care unit (ICU) with an onset of severe ARDS within the previous 48 hours were randomly assigned to receive, for 48 hours, either cisatracurium besylate (178 patients) or placebo (162 patients)...
September 16, 2010: New England Journal of Medicine
Nita Khandelwal, Catherine L Hough, Aasthaa Bansal, David L Veenstra, Miriam M Treggiari
OBJECTIVES: To describe long-term survival in patients with severe acute respiratory distress syndrome and assess differences in patient characteristics and outcomes among those who receive rescue therapies (prone position ventilation, inhaled nitric oxide, or inhaled epoprostenol) versus conventional treatment. DESIGN: Cohort study of patients with severe hypoxemia. SETTING: University-affiliated level 1 trauma center. PATIENTS: Patients diagnosed with severe acute respiratory distress syndrome within 72 hours of ICU admission between January 1, 2008, and December 31, 2011...
July 2014: Critical Care Medicine
Benno Lansdorp, Charlotte Hofhuizen, Martijn van Lavieren, Henri van Swieten, Joris Lemson, Michel J A M van Putten, Johannes G van der Hoeven, Peter Pickkers
OBJECTIVE: Mechanical ventilation causes cyclic changes in the heart's preload and afterload, thereby influencing the circulation. However, our understanding of the exact physiology of this cardiopulmonary interaction is limited. We aimed to thoroughly determine airway pressure distribution, how this is influenced by tidal volume and chest compliance, and its interaction with the circulation in humans during mechanical ventilation. DESIGN: Intervention study. SETTING: ICU of a university hospital...
September 2014: Critical Care Medicine
Dale M Needham, Amy W Wozniak, Catherine L Hough, Peter E Morris, Victor D Dinglas, James C Jackson, Pedro A Mendez-Tellez, Carl Shanholtz, E Wesley Ely, Elizabeth Colantuoni, Ramona O Hopkins
RATIONALE: Existing studies of risk factors for physical impairments in acute lung injury (ALI) survivors were potentially limited by single-center design or relatively small sample size. OBJECTIVES: To evaluate risk factors for three measures of physical impairments commonly experienced by survivors of ALI in the first year after hospitalization. METHODS: A prospective, longitudinal study of 6- and 12-month physical outcomes (muscle strength, 6-minute-walk distance, and Short Form [SF]-36 Physical Function score) for 203 survivors of ALI enrolled from 12 hospitals participating in the ARDS Network randomized trials...
May 15, 2014: American Journal of Respiratory and Critical Care Medicine
M E Beth Smith, Annette Totten, David H Hickam, Rongwei Fu, Ngoc Wasson, Basmah Rahman, Makalapua Motu'apuaka, Somnath Saha
BACKGROUND: Pressure ulcers affect as many as 3 million Americans and are major sources of morbidity, mortality, and health care costs. PURPOSE: To summarize evidence comparing the effectiveness and safety of treatment strategies for adults with pressure ulcers. DATA SOURCES: MEDLINE, EMBASE, CINAHL, Evidence-Based Medicine Reviews, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and Health Technology Assessment Database for English- or foreign-language studies; reference lists; gray literature; and individual product packets from manufacturers (January 1985 to October 2012)...
July 2, 2013: Annals of Internal Medicine
Robert H Thiele, Marcel E Durieux
Qualitative arterial waveform analysis has been in existence for millennia; quantitative arterial waveform analysis techniques, which can be traced back to Euler's work in the 18th century, have not been widely used by anesthesiologists and other clinicians. This is likely attributable, in part, to the widespread use of the sphygmomanometer, which allows the practitioner to assess arterial blood pressure without having to develop a sense for the higher-order characteristics of the arterial waveform. The 20-year delay in the development of devices that measure these traits is a testament to the primitiveness of our appreciation for this information...
October 2011: Anesthesia and Analgesia
Ankie Kleinjan, Marcello Di Nisio, Jan Beyer-Westendorf, Giuseppe Camporese, Benilde Cosmi, Angelo Ghirarduzzi, Pieter W Kamphuisen, Hans-Martin Otten, Ettore Porreca, Anita Aggarwal, Marianne Brodmann, Maria Domenica Guglielmi, Matteo Iotti, Karin Kaasjager, Virginia Kamvissi, Teresa Lerede, Peter Marschang, Karina Meijer, Gualtiero Palareti, Frederick R Rickles, Marc Righini, Anne W S Rutjes, Chiara Tonello, Peter Verhamme, Sebastian Werth, Sanne van Wissen, Harry R Büller
BACKGROUND: Although well-established for suspected lower limb deep venous thrombosis, an algorithm combining a clinical decision score, d-dimer testing, and ultrasonography has not been evaluated for suspected upper extremity deep venous thrombosis (UEDVT). OBJECTIVE: To assess the safety and feasibility of a new diagnostic algorithm in patients with clinically suspected UEDVT. DESIGN: Diagnostic management study. ( NCT01324037) SETTING: 16 hospitals in Europe and the United States...
April 1, 2014: Annals of Internal Medicine
Holger Thiele, Uwe Zeymer, Franz-Josef Neumann, Miroslaw Ferenc, Hans-Georg Olbrich, Jörg Hausleiter, Antoinette de Waha, Gert Richardt, Marcus Hennersdorf, Klaus Empen, Georg Fuernau, Steffen Desch, Ingo Eitel, Rainer Hambrecht, Bernward Lauer, Michael Böhm, Henning Ebelt, Steffen Schneider, Karl Werdan, Gerhard Schuler
BACKGROUND: In current international guidelines the recommendation for intra-aortic balloon pump (IABP) use has been downgraded in cardiogenic shock complicating acute myocardial infarction on the basis of registry data. In the largest randomised trial (IABP-SHOCK II), IABP support did not reduce 30 day mortality compared with control. However, previous trials in cardiogenic shock showed a mortality benefit only at extended follow-up. The present analysis therefore reports 6 and 12 month results...
November 16, 2013: Lancet
Ingrid Elise Hoff, Lars Øivind Høiseth, Jonny Hisdal, Jo Røislien, Svein Aslak Landsverk, Knut Arvid Kirkebøen
Background. Correct volume management is essential in patients with respiratory failure. We investigated the ability of respiratory variations in noninvasive pulse pressure (ΔPP), photoplethysmographic waveform amplitude (ΔPOP), and pleth variability index (PVI) to reflect hypovolemia during noninvasive positive pressure ventilation by inducing hypovolemia with progressive lower body negative pressure (LBNP). Methods. Fourteen volunteers underwent LBNP of 0, -20, -40, -60, and -80 mmHg for 4.5 min at each level or until presyncope...
2014: Critical Care Research and Practice
Michael Klompas, Kathleen Speck, Michael D Howell, Linda R Greene, Sean M Berenholtz
IMPORTANCE: Regular oral care with chlorhexidine gluconate is standard of care for patients receiving mechanical ventilation in most hospitals. This policy is predicated on meta-analyses suggesting decreased risk of ventilator-associated pneumonia, but these meta-analyses may be misleading because of lack of distinction between cardiac surgery and non-cardiac surgery studies, conflation of open-label vs double-blind investigations, and insufficient emphasis on patient-centered outcomes such as duration of mechanical ventilation, length of stay, and mortality...
May 2014: JAMA Internal Medicine
Marc J M Bonten
No abstract text is available yet for this article.
May 2014: JAMA Internal Medicine
Simon Finfer, Dean R Chittock, Steve Yu-Shuo Su, Deborah Blair, Denise Foster, Vinay Dhingra, Rinaldo Bellomo, Deborah Cook, Peter Dodek, William R Henderson, Paul C Hébert, Stephane Heritier, Daren K Heyland, Colin McArthur, Ellen McDonald, Imogen Mitchell, John A Myburgh, Robyn Norton, Julie Potter, Bruce G Robinson, Juan J Ronco
BACKGROUND: The optimal target range for blood glucose in critically ill patients remains unclear. METHODS: Within 24 hours after admission to an intensive care unit (ICU), adults who were expected to require treatment in the ICU on 3 or more consecutive days were randomly assigned to undergo either intensive glucose control, with a target blood glucose range of 81 to 108 mg per deciliter (4.5 to 6.0 mmol per liter), or conventional glucose control, with a target of 180 mg or less per deciliter (10...
March 26, 2009: New England Journal of Medicine
Lucy B Palmer, Gerald C Smaldone
RATIONALE: Multidrug-resistant organisms (MDRO) are the dominant airway pathogens in the intensive care unit (ICU) and present a major treatment challenge to intensivists. Aerosolized antibiotics (AA) result in airway concentrations of drug 100-fold greater than the minimal inhibitory concentration of most bacteria including MDRO. These levels, without systemic toxicity, may eradicate MDRO and reduce the pressure for selection of new resistant organisms. OBJECTIVES: To determine if AA effectively eradicate MDRO in the intubated patient without promoting new resistance...
May 15, 2014: American Journal of Respiratory and Critical Care Medicine
Moisés Selman, Annie Pardo
A growing body of evidence indicates that aberrant activation of alveolar epithelial cells and fibroblasts in an aging lung plays a critical role in the pathogenesis of idiopathic pulmonary fibrosis (IPF). However, the biopathological processes linking aging with IPF and the mechanisms responsible for the abnormal activation of epithelial cells and fibroblasts have not been elucidated. Many of the hallmarks of aging (e.g., genomic instability, telomere attrition, epigenetic alterations, mitochondrial dysfunction, and cellular senescence) have been proposed as essential mechanisms for the development of IPF; however, these disturbances are not restricted to IPF and also occur in other aging-related lung disorders, primarily chronic obstructive pulmonary disease (COPD)...
May 15, 2014: American Journal of Respiratory and Critical Care Medicine
Robert F Kelm, Jürgen Wagenführer, Henrike Bauer, Irene Schmidtmann, Kristin Engelhard, Rüdiger R Noppens
OBJECTIVES: Despite advances in cardiac arrest treatment, high mortality and morbidity rates after successful cardiopulmonary resuscitation are still a major clinical relevant problem. The post cardiac arrest syndrome subsumes myocardial dysfunction, impaired microcirculation, systemic inflammatory response, and neurological impairment. The calcium-sensitizer levosimendan was able to improve myocardial function and initial resuscitation success after experimental cardiac arrest/cardiopulmonary resuscitation...
June 2014: Critical Care Medicine
G R Scott Budinger, Gökhan M Mutlu
No abstract text is available yet for this article.
March 15, 2014: American Journal of Respiratory and Critical Care Medicine
Gulbin Aygencel, Melda Turkoglu, Ayse Fitnat Tuncel, Burcu Arslan Candır, Yelda Deligoz Bildacı, Hatice Pasaoglu
Objective. To evaluate the vitamin D status of our critically ill patients and its relevance to mortality. Patients and Methods. We performed a prospective observational study in the medical intensive care unit of a university hospital between October 2009 and March 2011. Vitamin D levels were measured and insufficiency was defined as <20 ng/mL. Results. Two hundred and one patients were included in the study. The median age was 66 (56-77) and the majority of patients were male (56%). The median serum level of vitamin D was 14,9 ng/mL and 139 (69%) patients were vitamin D insufficient on admission...
2013: Critical Care Research and Practice
Szilvia Kocsi, Gabor Demeter, Daniel Erces, Eniko Nagy, Jozsef Kaszaki, Zsolt Molnar
Monitoring hypovolemia is an everyday challenge in critical care, with no consensus on the best indicator or what is the clinically relevant level of hypovolemia. The aim of this experiment was to determine how central venous oxygen saturation (ScvO2) and central venous-to-arterial carbon dioxide difference (CO2 gap) reflect hypovolemia-caused changes in the balance of oxygen delivery and consumption. Anesthetized, ventilated Vietnamese minipigs (n = 10) were given a bolus followed by a continuous infusion of furosemide...
2013: Critical Care Research and Practice
Daniel De Backer, Patrick Biston, Jacques Devriendt, Christian Madl, Didier Chochrad, Cesar Aldecoa, Alexandre Brasseur, Pierre Defrance, Philippe Gottignies, Jean-Louis Vincent
BACKGROUND: Both dopamine and norepinephrine are recommended as first-line vasopressor agents in the treatment of shock. There is a continuing controversy about whether one agent is superior to the other. METHODS: In this multicenter, randomized trial, we assigned patients with shock to receive either dopamine or norepinephrine as first-line vasopressor therapy to restore and maintain blood pressure. When blood pressure could not be maintained with a dose of 20 microg per kilogram of body weight per minute for dopamine or a dose of 0...
March 4, 2010: New England Journal of Medicine
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