collection
https://read.qxmd.com/read/25774306/barotrauma-and-pneumothorax
#1
REVIEW
George Ioannidis, George Lazaridis, Sofia Baka, Ioannis Mpoukovinas, Vasilis Karavasilis, Sofia Lampaki, Ioannis Kioumis, Georgia Pitsiou, Antonis Papaiwannou, Anastasia Karavergou, Nikolaos Katsikogiannis, Eirini Sarika, Kosmas Tsakiridis, Ipokratis Korantzis, Konstantinos Zarogoulidis, Paul Zarogoulidis
Barotrauma is physical damage to body tissues caused by a difference in pressure between a gas space inside, or in contact with the body, and the surrounding fluid. This situation typically occurs when the organism is exposed to a significant change in ambient pressure, such as when a scuba diver, a free-diver or an airplane passenger ascends or descends, or during uncontrolled decompression of a pressure vessel, but it can also happen by a shock wave. Whales and dolphins are also vulnerable to barotrauma if exposed to rapid and excessive changes in diving pressures...
February 2015: Journal of Thoracic Disease
https://read.qxmd.com/read/25693014/driving-pressure-and-survival-in-the-acute-respiratory-distress-syndrome
#2
Marcelo B P Amato, Maureen O Meade, Arthur S Slutsky, Laurent Brochard, Eduardo L V Costa, David A Schoenfeld, Thomas E Stewart, Matthias Briel, Daniel Talmor, Alain Mercat, Jean-Christophe M Richard, Carlos R R Carvalho, Roy G Brower
BACKGROUND: Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (VT), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (CRS) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size), we hypothesized that driving pressure (ΔP=VT/CRS), in which VT is intrinsically normalized to functional lung size (instead of predicted lung size in healthy persons), would be an index more strongly associated with survival than VT or PEEP in patients who are not actively breathing...
February 19, 2015: New England Journal of Medicine
https://read.qxmd.com/read/8304364/use-of-the-alveolar-arterial-oxygen-gradient-in-the-diagnosis-of-pulmonary-embolism
#3
M J McFarlane, T F Imperiale
BACKGROUND: Arterial blood gas (ABG) values and the alveolar-arterial oxygen (A-a) gradient are sensitive indicators of pulmonary pathology. Alone, they are not diagnostic of pulmonary embolism (PE), but they may be useful in excluding the diagnosis of PE if their values fall within the normal range. The purpose of this study was to determine the diagnostic value of a normal A-a gradient in ruling out PE. PATIENTS AND METHODS: The Derivation Set came from the records of all patients at Cleveland MetroHealth Medical Center who received a ventilation/perfusion (V/Q) scan for suspected PE in 1988 or 1989...
January 1994: American Journal of Medicine
https://read.qxmd.com/read/8703169/a-comparison-of-low-dose-heparin-with-low-molecular-weight-heparin-as-prophylaxis-against-venous-thromboembolism-after-major-trauma
#4
RANDOMIZED CONTROLLED TRIAL
W H Geerts, R M Jay, K I Code, E Chen, J P Szalai, E A Saibil, P A Hamilton
BACKGROUND: Patients who have had major trauma are at very high risk for venous thromboembolism if they do not receive thromboprophylaxis. We compared low-dose heparin and a low-molecular-weight heparin with regard to efficacy and safety in a randomized clinical trial in patients with trauma. METHODS: Consecutive adult patients admitted to a trauma center who had Injury Severity Scores of at least 9 and no intracranial bleeding were randomly assigned to heparin (5000 units) or enoxaprin (30 mg), each given subcutaneously every 12 hours in a double-blind manner, beginning within 36 hours after the injury...
September 5, 1996: New England Journal of Medicine
https://read.qxmd.com/read/24108515/effects-of-fluid-resuscitation-with-colloids-vs-crystalloids-on-mortality-in-critically-ill-patients-presenting-with-hypovolemic-shock-the-cristal-randomized-trial
#5
RANDOMIZED CONTROLLED TRIAL
Djillali Annane, Shidasp Siami, Samir Jaber, Claude Martin, Souheil Elatrous, Adrien Descorps Declère, Jean Charles Preiser, Hervé Outin, Gilles Troché, Claire Charpentier, Jean Louis Trouillet, Antoine Kimmoun, Xavier Forceville, Michael Darmon, Olivier Lesur, Jean Reignier, Jean Régnier, Fékri Abroug, Philippe Berger, Christophe Clec'h, Christophe Cle'h, Joël Cousson, Laure Thibault, Sylvie Chevret
IMPORTANCE: Evidence supporting the choice of intravenous colloid vs crystalloid solutions for management of hypovolemic shock remains unclear. OBJECTIVE: To test whether use of colloids compared with crystalloids for fluid resuscitation alters mortality in patients admitted to the intensive care unit (ICU) with hypovolemic shock. DESIGN, SETTING, AND PARTICIPANTS: A multicenter, randomized clinical trial stratified by case mix (sepsis, trauma, or hypovolemic shock without sepsis or trauma)...
November 6, 2013: JAMA
https://read.qxmd.com/read/24635770/high-versus-low-blood-pressure-target-in-patients-with-septic-shock
#6
RANDOMIZED CONTROLLED TRIAL
Pierre Asfar, Ferhat Meziani, Jean-François Hamel, Fabien Grelon, Bruno Megarbane, Nadia Anguel, Jean-Paul Mira, Pierre-François Dequin, Soizic Gergaud, Nicolas Weiss, François Legay, Yves Le Tulzo, Marie Conrad, René Robert, Frédéric Gonzalez, Christophe Guitton, Fabienne Tamion, Jean-Marie Tonnelier, Pierre Guezennec, Thierry Van Der Linden, Antoine Vieillard-Baron, Eric Mariotte, Gaël Pradel, Olivier Lesieur, Jean-Damien Ricard, Fabien Hervé, Damien du Cheyron, Claude Guerin, Alain Mercat, Jean-Louis Teboul, Peter Radermacher
BACKGROUND: The Surviving Sepsis Campaign recommends targeting a mean arterial pressure of at least 65 mm Hg during initial resuscitation of patients with septic shock. However, whether this blood-pressure target is more or less effective than a higher target is unknown. METHODS: In a multicenter, open-label trial, we randomly assigned 776 patients with septic shock to undergo resuscitation with a mean arterial pressure target of either 80 to 85 mm Hg (high-target group) or 65 to 70 mm Hg (low-target group)...
April 24, 2014: New England Journal of Medicine
https://read.qxmd.com/read/30935893/reconsidering-vasopressors-for-cardiogenic-shock-everything-should-be-made-as-simple-as-possible-but-not-simpler
#7
REVIEW
Pierre Squara, Steven Hollenberg, Didier Payen
Scientific statements and publications have recommended the use of vasoconstrictors as the first-line pharmacologic choice for most cases of cardiogenic shock (CS), without the abundance of strong clinical evidence. One challenge of guidelines is that the way recommendations are stated can potentially lead to oversimplification of complex situations. Except for acute coronary syndrome with CS, in which maintenance of coronary perfusion pressure seems logical prior to revascularization, physiologic consequences of increasing afterload by use of vasoconstrictors should be analyzed...
August 2019: Chest
https://read.qxmd.com/read/26384835/thromboelastography-and-rotational-thromboelastometry-use-in-trauma
#8
REVIEW
Kareem Abdelfattah, Michael W Cripps
The appropriate resuscitation of patients in hemorrhagic shock is critical to improving survival. Current strategies for massive transfusions utilize fixed ratio protocols to rapidly deliver plasma and platelets to the patient. However, there is some concern that these larger volumes of transfusions can lead to untoward effects. Efforts are ongoing to provide patient-specific transfusion therapy in order to avoid excess transfusions. Thromboelastography (TEG) or Rotational Thromboelastometry (ROTEM) are two viscoelastic analyzers capable of providing Viscoelastic testing...
September 2016: International Journal of Surgery
https://read.qxmd.com/read/23688302/prone-positioning-in-severe-acute-respiratory-distress-syndrome
#9
RANDOMIZED CONTROLLED TRIAL
Claude Guérin, Jean Reignier, Jean-Christophe Richard, Pascal Beuret, Arnaud Gacouin, Thierry Boulain, Emmanuelle Mercier, Michel Badet, Alain Mercat, Olivier Baudin, Marc Clavel, Delphine Chatellier, Samir Jaber, Sylvène Rosselli, Jordi Mancebo, Michel Sirodot, Gilles Hilbert, Christian Bengler, Jack Richecoeur, Marc Gainnier, Frédérique Bayle, Gael Bourdin, Véronique Leray, Raphaele Girard, Loredana Baboi, Louis Ayzac
BACKGROUND: Previous trials involving patients with the acute respiratory distress syndrome (ARDS) have failed to show a beneficial effect of prone positioning during mechanical ventilatory support on outcomes. We evaluated the effect of early application of prone positioning on outcomes in patients with severe ARDS. METHODS: In this multicenter, prospective, randomized, controlled trial, we randomly assigned 466 patients with severe ARDS to undergo prone-positioning sessions of at least 16 hours or to be left in the supine position...
June 6, 2013: New England Journal of Medicine
https://read.qxmd.com/read/11794168/intensive-insulin-therapy-in-critically-ill-patients
#10
RANDOMIZED CONTROLLED TRIAL
G van den Berghe, P Wouters, F Weekers, C Verwaest, F Bruyninckx, M Schetz, D Vlasselaers, P Ferdinande, P Lauwers, R Bouillon
BACKGROUND: Hyperglycemia and insulin resistance are common in critically ill patients, even if they have not previously had diabetes. Whether the normalization of blood glucose levels with insulin therapy improves the prognosis for such patients is not known. METHODS: We performed a prospective, randomized, controlled study involving adults admitted to our surgical intensive care unit who were receiving mechanical ventilation. On admission, patients were randomly assigned to receive intensive insulin therapy (maintenance of blood glucose at a level between 80 and 110 mg per deciliter [4...
November 8, 2001: New England Journal of Medicine
https://read.qxmd.com/read/29471884/should-we-measure-the-central-venous-pressure-to-guide-fluid-management-ten-answers-to-10-questions
#11
Daniel De Backer, Jean-Louis Vincent
The central venous pressure (CVP) is the most frequently used variable to guide fluid resuscitation in critically ill patients, although its use has been challenged. In this viewpoint, we use a question and answer format to highlight the potential advantages and limitations of using CVP measurements to guide fluid resuscitation.
February 23, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://read.qxmd.com/read/22436955/dexmedetomidine-vs-midazolam-or-propofol-for-sedation-during-prolonged-mechanical-ventilation-two-randomized-controlled-trials
#12
RANDOMIZED CONTROLLED TRIAL
Stephan M Jakob, Esko Ruokonen, R Michael Grounds, Toni Sarapohja, Chris Garratt, Stuart J Pocock, J Raymond Bratty, Jukka Takala
CONTEXT: Long-term sedation with midazolam or propofol in intensive care units (ICUs) has serious adverse effects. Dexmedetomidine, an α(2)-agonist available for ICU sedation, may reduce the duration of mechanical ventilation and enhance patient comfort. OBJECTIVE: To determine the efficacy of dexmedetomidine vs midazolam or propofol (preferred usual care) in maintaining sedation; reducing duration of mechanical ventilation; and improving patients' interaction with nursing care...
March 21, 2012: JAMA
https://read.qxmd.com/read/21714640/early-versus-late-parenteral-nutrition-in-critically-ill-adults
#13
RANDOMIZED CONTROLLED TRIAL
Michael P Casaer, Dieter Mesotten, Greet Hermans, Pieter J Wouters, Miet Schetz, Geert Meyfroidt, Sophie Van Cromphaut, Catherine Ingels, Philippe Meersseman, Jan Muller, Dirk Vlasselaers, Yves Debaveye, Lars Desmet, Jasperina Dubois, Aime Van Assche, Simon Vanderheyden, Alexander Wilmer, Greet Van den Berghe
BACKGROUND: Controversy exists about the timing of the initiation of parenteral nutrition in critically ill adults in whom caloric targets cannot be met by enteral nutrition alone. METHODS: In this randomized, multicenter trial, we compared early initiation of parenteral nutrition (European guidelines) with late initiation (American and Canadian guidelines) in adults in the intensive care unit (ICU) to supplement insufficient enteral nutrition. In 2312 patients, parenteral nutrition was initiated within 48 hours after ICU admission (early-initiation group), whereas in 2328 patients, parenteral nutrition was not initiated before day 8 (late-initiation group)...
August 11, 2011: New England Journal of Medicine
https://read.qxmd.com/read/30211850/trauma-and-emergency-general-surgery-patients-should-be-extubated-with-an-open-abdomen
#14
Luis R Taveras, Jonathan B Imran, Holly B Cunningham, Tarik D Madni, Roberto Taarea, Allison Tompeck, Audra T Clark, Natalie Provenzale, Folarin M Adeyemi, Christian T Minshall, Alexander L Eastman, Michael W Cripps
BACKGROUND: Open abdomen (OA) and temporary abdominal closure (TAC) are common techniques to manage several surgical problems in trauma and emergency general surgery (EGS). Patients with an OA are subjected to prolonged mechanical ventilation. This can lead to increased rates of ventilator-associated pneumonia (VAP). We hypothesized that patients who were extubated with an OA would have a decrease in ventilator hours and as a result would have a lower rate of VAP without an increase in extubation failures...
December 2018: Journal of Trauma and Acute Care Surgery
https://read.qxmd.com/read/29485925/balanced-crystalloids-versus-saline-in-critically-ill-adults
#15
RANDOMIZED CONTROLLED TRIAL
Matthew W Semler, Wesley H Self, Jonathan P Wanderer, Jesse M Ehrenfeld, Li Wang, Daniel W Byrne, Joanna L Stollings, Avinash B Kumar, Christopher G Hughes, Antonio Hernandez, Oscar D Guillamondegui, Addison K May, Liza Weavind, Jonathan D Casey, Edward D Siew, Andrew D Shaw, Gordon R Bernard, Todd W Rice
BACKGROUND: Both balanced crystalloids and saline are used for intravenous fluid administration in critically ill adults, but it is not known which results in better clinical outcomes. METHODS: In a pragmatic, cluster-randomized, multiple-crossover trial conducted in five intensive care units at an academic center, we assigned 15,802 adults to receive saline (0.9% sodium chloride) or balanced crystalloids (lactated Ringer's solution or Plasma-Lyte A) according to the randomization of the unit to which they were admitted...
March 1, 2018: New England Journal of Medicine
https://read.qxmd.com/read/24072931/infectious-diseases-specialty-intervention-is-associated-with-decreased-mortality-and-lower-healthcare-costs
#16
Steven Schmitt, Daniel P McQuillen, Ronald Nahass, Lawrence Martinelli, Michael Rubin, Kay Schwebke, Russell Petrak, J Trees Ritter, David Chansolme, Thomas Slama, Edward M Drozd, Shamonda F Braithwaite, Michael Johnsrud, Eric Hammelman
BACKGROUND: Previous studies, largely based on chart reviews with small sample sizes, have demonstrated that infectious diseases (ID) specialists positively impact patient outcomes. We investigated how ID specialists impact mortality, utilization, and costs using a large claims dataset. METHODS: We used administrative fee-for-service Medicare claims to identify beneficiaries hospitalized from 2008 to 2009 with at least 1 of 11 infections. There were 101 991 stays with and 170 336 stays without ID interventions...
January 2014: Clinical Infectious Diseases
https://read.qxmd.com/read/20711074/stress-ulcer-prophylaxis-in-the-new-millennium-a-systematic-review-and-meta-analysis
#17
REVIEW
Paul E Marik, Tajender Vasu, Amyn Hirani, Monvasi Pachinburavan
BACKGROUND: Recent observational studies suggest that bleeding from stress ulceration is extremely uncommon in intensive care unit patients. Furthermore, the risk of bleeding may not be altered by the use of acid suppressive therapy. Early enteral tube feeding (initiated within 48 hrs of intensive care unit admission) may account for this observation. Stress ulcer prophylaxis may, however, increase the risk of hospital-acquired pneumonia and Clostridia difficile infection. OBJECTIVE: A systematic review of the literature to determine the benefit and risks of stress ulcer prophylaxis and the moderating effect of enteral nutrition...
November 2010: Critical Care Medicine
https://read.qxmd.com/read/9971864/a-multicenter-randomized-controlled-clinical-trial-of-transfusion-requirements-in-critical-care-transfusion-requirements-in-critical-care-investigators-canadian-critical-care-trials-group
#18
RANDOMIZED CONTROLLED TRIAL
P C Hébert, G Wells, M A Blajchman, J Marshall, C Martin, G Pagliarello, M Tweeddale, I Schweitzer, E Yetisir
BACKGROUND: To determine whether a restrictive strategy of red-cell transfusion and a liberal strategy produced equivalent results in critically ill patients, we compared the rates of death from all causes at 30 days and the severity of organ dysfunction. METHODS: We enrolled 838 critically ill patients with euvolemia after initial treatment who had hemoglobin concentrations of less than 9.0 g per deciliter within 72 hours after admission to the intensive care unit and randomly assigned 418 patients to a restrictive strategy of transfusion, in which red cells were transfused if the hemoglobin concentration dropped below 7...
February 11, 1999: New England Journal of Medicine
https://read.qxmd.com/read/15163774/a-comparison-of-albumin-and-saline-for-fluid-resuscitation-in-the-intensive-care-unit
#19
RANDOMIZED CONTROLLED TRIAL
Simon Finfer, Rinaldo Bellomo, Neil Boyce, Julie French, John Myburgh, Robyn Norton
BACKGROUND: It remains uncertain whether the choice of resuscitation fluid for patients in intensive care units (ICUs) affects survival. We conducted a multicenter, randomized, double-blind trial to compare the effect of fluid resuscitation with albumin or saline on mortality in a heterogeneous population of patients in the ICU. METHODS: We randomly assigned patients who had been admitted to the ICU to receive either 4 percent albumin or normal saline for intravascular-fluid resuscitation during the next 28 days...
May 27, 2004: New England Journal of Medicine
https://read.qxmd.com/read/26556918/mechanical-ventilation-in-patients-with-chronic-obstructive-pulmonary-disease-and-bronchial-asthma
#20
REVIEW
Syed Moied Ahmed, Manazir Athar
Chronic obstructive pulmonary disease (COPD) and bronchial asthma often complicate the surgical patients, leading to post-operative morbidity and mortality. Many authors have tried to predict post-operative pulmonary complications but not specifically in COPD. The aim of this review is to provide recent evidence-based guidelines regarding predictors and ventilatory strategies for mechanical ventilation in COPD and bronchial asthma patients. Using Google search for indexing databases, a search for articles published was performed using various combinations of the following search terms: 'Predictors'; 'mechanical ventilation'; COPD'; 'COPD'; 'bronchial asthma'; 'recent strategies'...
September 2015: Indian Journal of Anaesthesia
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