Goal-directed mechanical ventilation: are we aiming at the right goals? A proposal for an alternative approach aiming at optimal lung compliance, guided by esophageal pressure in acute respiratory failure.
Authors: Soroksky A, Esquinas A Abstract Patients with acute respiratory failure and decreased respiratory system compliance due to ARDS frequently present a formidable challenge. These patients are often subjected to high inspiratory pressure, and in severe cases in order to improve oxygenation and preserve life, we may need to resort to unconventional measures. The currently accepted ARDSNet guidelines are characterized by a generalized approach in which an algorithm for PEEP application and limited plateau pressure are applied to all mechanically ventilated patients. These guidelines do not make any distinction ...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Echocardiographic Measures of Diastolic Function Are Preload Dependent during Triggered Positive Pressure Ventilation: A Controlled Crossover Study in Healthy Subjects.
Authors: Juhl-Olsen P, Frederiksen CA, Hermansen JF, Jakobsen CJ, Sloth E Abstract Background. The use of echocardiography in intensive care settings impacts decision making. A prerequisite for the use of echocardiography is relative resistance to changes in volume status and levels of positive pressure ventilation (PPV). Studies on indices of diastolic function report conflicting results with regard to dependence on volume status. Evidence is scarce on PPV. Methods. Ten healthy subjects were exposed to 6 levels of positive end-expiratory pressure (PEEP) and pressure support (PS) following a baseline reading. All v...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Characteristics of hemodynamic disorders in patients with severe traumatic brain injury.
Conclusions. Monitoring of parameters of central hemodynamics allows to detect the cause of disorders, to timely carry out the required correction, and to coordinate infusion, inotropic, and vasopressor therapy. PMID: 23056932 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Impact of 6-hour sepsis resuscitation bundle compliance on hospital mortality in a saudi hospital.
Authors: Memon JI, Rehmani RS, Alaithan AM, El Gammal A, Lone TM, Ghorab K, Abdulbasir A Abstract Purpose. To assess the effect of improved compliance with 6-hour sepsis resuscitation bundle on mortality in patients with severe sepsis and septic shock. Materials and Methods. A quasi-experimental prospective study was conducted at a 10-bedded combined medical and surgical intensive care unit. The historical group included all consecutive patients with severe sepsis and septic shock admitted from January 2008 to March 2009. Intervention included evidence-based written sepsis pathway, antibiotic recommendations, and a...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Extravascular lung water does not increase in hypovolemic patients after a fluid-loading protocol guided by the stroke volume variation.
Conclusion. Fluid loading guided by SVV in hypovolemic and fully mechanically ventilated patients in sinus rhythm does not increase ELWI. PMID: 23091710 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Microcirculation.
Authors: Piagnerelli M, Ince C, Dubin A PMID: 23091711 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Prediction of outcome from community-acquired severe sepsis and septic shock in tertiary-care university hospital in a developing country.
Authors: Grozdanovski K, Milenkovic Z, Demiri I, Spasovska K Abstract Our aim was to determine the risk factors on mortality in adult patients with community-acquired severe sepsis and septic shock. The main outcome measure was hospital mortality. This prospective single centre study was conducted from January 1, 2008 to December 31, 2010, and included 184 patients, of whom 135 (73.4%) were with severe sepsis and 49 (26.6%) had septic shock. Overall, ninety-five (51.6%) patients have died, 60 (44.4%) in severe sepsis and 35 (71.4%) patients with septic shock. The lung was the most common site of infection 121 (65.8...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Human versus Computer Controlled Selection of Ventilator Settings: An Evaluation of Adaptive Support Ventilation and Mid-Frequency Ventilation.
Conclusions. There are differences and similarities among initial ventilator settings selected by humans and computers for various clinical scenarios. The ventilation outcomes are the result of the lung physiological characteristics and their interaction with the targeting scheme. PMID: 23119152 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Systemic and urinary neutrophil gelatinase-associated lipocalins are poor predictors of acute kidney injury in unselected critically ill patients.
Conclusions. In unselected critically ill patients, sNGAL and uNGAL are poor predictors of AKI or RRT. PMID: 23119153 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Goal-directed therapy: new trends and horizons.
Authors: Kirov M, Bjertnaes L, Molnar Z, Sakka S PMID: 23125922 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Pulmonary complications in patients with severe brain injury.
Authors: Lee K, Rincon F Abstract Pulmonary complications are prevalent in the critically ill neurological population. Respiratory failure, pneumonia, acute lung injury and the acute respiratory distress syndrome (ALI/ARDS), pulmonary edema, pulmonary contusions and pneumo/hemothorax, and pulmonary embolism are frequently encountered in the setting of severe brain injury. Direct brain injury, depressed level of consciousness and inability to protect the airway, disruption of natural defense barriers, decreased mobility, and secondary neurological insults inherent to severe brain injury are the main cause of pulmona...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Bedside ultrasound in resuscitation and the rapid ultrasound in shock protocol.
Authors: Seif D, Perera P, Mailhot T, Riley D, Mandavia D Abstract Assessment of hemodynamic status in a shock state remains a challenging issue in Emergency Medicine and Critical Care. As the use of invasive hemodynamic monitoring declines, bedside-focused ultrasound has become a valuable tool in the evaluation and management of patients in shock. No longer a means to simply evaluate organ anatomy, ultrasound has expanded to become a rapid and noninvasive method for the assessment of patient physiology. Clinicians caring for critical patients should strongly consider integrating ultrasound into their resuscitation...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Mindsight: diagnostics in disorders of consciousness.
Authors: Guldenmund P, Stender J, Heine L, Laureys S Abstract Diagnosis of patients with disorders of consciousness (comprising coma, vegetative state/unresponsive wakefulness syndrome, and minimally conscious state) has long been dependent on unstandardized behavioral tests. The arrival of standardized behavioral tools, and especially the Coma Recovery Scale revised, uncovered a high rate of misdiagnosis. Ancillary techniques, such as brain imaging and electrophysiological examinations, are ever more often being deployed to aid in the search for remaining consciousness. They are used to look for brain activity pat...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Flow-synchronized nasal intermittent positive pressure ventilation for infants
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Risk factors for development of acute kidney injury in critically ill patients: a systematic review and meta-analysis of observational studies.
Conclusion. The best available evidence suggests an association of AKI with 13 different risk factors in subjects admitted to the ICU. Predictive models for identification of high risk individuals for developing AKI in all types of ICU are required. PMID: 23227318 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Novel approaches to surfactant administration.
Authors: Gupta S, Donn SM Abstract Surfactant replacement therapy has been the mainstay of treatment for preterm infants with respiratory distress syndrome for more than twenty years. For the most part, surfactant is administered intratracheally, followed by mechanical ventilation. In recent years, the growing interest in noninvasive ventilation has led to novel approaches of administration. This paper will review these techniques and the associated clinical evidence. PMID: 23243504 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Value of Chest Radiographic Pattern in RSV Disease of the Newborn: A Multicenter Retrospective Cohort Study.
Authors: Gonçalves A, Rocha G, Guimarães H, Fernandes PC, Proença E, Oliveira D, Rocha P, Quintas C, Martins T, Freitas A, Dias CP, Ramires A Abstract Respiratory syncytial virus (RSV) lower respiratory tract infection is the most common viral respiratory infection in infants. Several authors have sought to determine which risk factors are the best predictors for severe RSV disease. Our aim was to evaluate if a specific chest radiographic pattern in RSV disease can predict the disease severity. We conducted a multicenter retrospective cohort study in term and preterm neonates with confirmed low...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

The antibiotic resistance profiles of bacterial strains isolated from patients with hospital-acquired bloodstream and urinary tract infections.
Authors: Ghadiri H, Vaez H, Khosravi S, Soleymani E Abstract Treatment of nosocomial infections is becoming difficult due to the increasing trend of antibiotics resistance. Current knowledge on antibiotic resistance pattern is essential for appropriate therapy. We aimed to evaluate antibiotic resistance profiles in nosocomial bloodstream and urinary tract pathogens. A total of 129 blood stream and 300 urinary tract positive samples were obtained from patients referring to Besat hospital over a two-year period (2009 and 2010). Antibiotic sensitivity was ascertained using the Kirby-Bauer disk diffusion technique acco...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

A high ductal flow velocity is associated with successful pharmacological closure of patent ductus arteriosus in infants 22-27 weeks gestational age.
Conclusion. Maximal ductal flow velocity was independently associated with success of PDA treatment. PMID: 23316351 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Impact of changes in perinatal care on neonatal respiratory outcome and survival of preterm newborns: an overview of 15 years.
Authors: Flor-de-Lima F, Rocha G, Guimarães H Abstract Survival and outcomes for preterm infants with respiratory distress syndrome (RDS) have improved over the past 30 years. We conducted a study to assess the changes in perinatal care and delivery room management and their impact on respiratory outcome of very low birth weight newborns, over the last 15 years. A comparison between two epochs was performed, the periods before and after 2005, when early nasal continuous positive airway pressure (NCPAP) and Intubation-SURfactant-Extubation (INSURE) were introduced in our center. Three hundred ninety-five clin...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Developing a mobility protocol for early mobilization of patients in a surgical/trauma ICU.
Authors: Zomorodi M, Topley D, McAnaw M Abstract As technology and medications have improved and increased, survival rates are also increasing in intensive care units (ICUs), so it is now important to focus on improving the patient outcomes and recovery. To do this, ICU patients need to be assessed and started on an early mobility program, if stable. While the early mobilization of the ICU patients is not without risk, the current literature has demonstrated that patients can be safely and feasibly mobilized, even while requiring mechanical ventilation. These patients are at a high risk for muscle deconditioning du...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

High Frequency Jet Ventilation during Initial Management, Stabilization, and Transport of Newborn Infants with Congenital Diaphragmatic Hernia: A Case Series.
Authors: Zhang Q, Macartney J, Sampaio L, O'Brien K Abstract Objective. To review experience of the transport and stabilization of infants with CDH who were treated with high frequency jet ventilation (HFJV). Study Design. Retrospective chart review was performed of infants with antenatal diagnosis of CDH born between 2004 and 2009, at Mount Sinai Hospital Toronto, Ontario, Canada. Detailed information was abstracted from the charts of all infants who received HFJV. Results. Of the 55 infants, 25 were managed with HFJV at some point during resuscitation and stabilization prior to transport. HFJV was the initial ven...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Telemedicine intervention improves ICU outcomes.
Authors: Sadaka F, Palagiri A, Trottier S, Deibert W, Gudmestad D, Sommer SE, Veremakis C Abstract Telemedicine for the intensive care unit (Tele-ICU) was founded as a means of delivering the clinical expertise of intensivists located remotely to hospitals with inadequate access to intensive care specialists. This was a retrospective pre- and postintervention study of adult patients admitted to a community hospital ICU. The patients in the preintervention period (n = 630) and during the Tele-ICU period (n = 2193) were controlled for baseline characteristics, acute physiologic scores (APS), and acute physiologic and...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Retinol and retinyl palmitate in foetal lung mice: sexual dimorphism.
In conclusion, there is a sexual dimorphism in the lung retinoids content and in its metabolism during mice development. PMID: 23365730 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Chorioamnionitis and lung injury in preterm newborns.
Authors: Rocha G Abstract There is a strong evidence that histologic chorioamnionitis is associated with a reduction of incidence and severity of respiratory distress syndrome (RDS). Short-term maturational effects on the lungs of extremely premature infants seem to be, however, accompanied by a greater susceptibility of the lung, eventually contributing to an increased risk of bronchopulmonary dysplasia (BPD). Genetic susceptibility to BPD is an evolving area of research and several studies have directly related the risk of BPD to genomic variants. There is a substantial heterogeneity across the studies in the mag...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Short- and intermediate-term outcomes of preterm infants receiving positive pressure ventilation in the delivery room.
Authors: O'Reilly M, Cheung PY, Aziz K, Schmölzer GM Abstract Although recent advances in neonatal care have improved survival rates, rates of bronchopulmonary dysplasia remain unchanged. Although neonatologists are increasingly applying gentle ventilation strategies in the neonatal intensive care unit, the same emphasis has not been applied immediately after birth. A lung-protective strategy should start with the first breath to help in the establishment of functional residual capacity, facilitate gas exchange, and reduce volutrauma and atelectotrauma. This paper will discuss techniques and equipment during b...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

A retrospective review of the use of regional citrate anticoagulation in continuous venovenous hemofiltration for critically ill patients.
Conclusion. The commercially prepared citrate solution could be used safely in critically ill patients who required CVVH with no major adverse events. PMID: 23424680 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Changes in the expression of vascular endothelial growth factor after fetal tracheal occlusion in an experimental model of congenital diaphragmatic hernia.
Conclusions. VEGF protein was significantly lower in fetuses with CDH. TO induced a significant increase in VEGF compared to the fetuses that did not undergo TO. Although not statistically significant, we observed higher VEGF levels in fetuses with CDH and TO compared to fetuses with CDH and no further intervention. PMID: 23424681 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Role of new biomarkers: functional and structural damage.
Authors: Tsigou E, Psallida V, Demponeras C, Boutzouka E, Baltopoulos G Abstract Traditional diagnosis of acute kidney injury (AKI) depends on detection of oliguria and rise of serum creatinine level, which is an unreliable and delayed marker of kidney damage. Delayed diagnosis of AKI in the critically ill patient is related to increased morbidity and mortality, prolonged length of stay, and cost escalation. The discovery of a reliable biomarker for early diagnosis of AKI would be very helpful in facilitating early intervention, evaluating the effectiveness of therapy, and eventually reducing cost and improving out...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Estimated glomerular filtration rate correlates poorly with four-hour creatinine clearance in critically ill patients with acute kidney injury.
Conclusions. eGFR equations are not sufficiently accurate for use in critically ill patients with AKI. Incorporating serum cystatin C does not improve estimates. eGFR should not be used to describe renal function in patients with AKI. Standards of accuracy for validating eGFR need to be set. PMID: 23476756 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Volume management in the critically ill patient with acute kidney injury.
Authors: Labib M, Khalid R, Khan A, Khan S Abstract Acute kidney injury (AKI) frequently occurs in the setting of critical illness and its management poses a challenge for the intensivist. Optimal management of volume status is critical in the setting of AKI in the ICU patient. The use of urine sodium, the fractional excretion of sodium (FeNa), and the fractional excretion of urea (FeUrea) are common clinical tools used to help guide fluid management especially further volume expansion but should be used in the context of the patient's overall clinical scenario as they are not completely sensitive or specific for t...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Interest of monitoring diaphragmatic electrical activity in the pediatric intensive care unit.
Authors: Ducharme-Crevier L, Du Pont-Thibodeau G, Emeriaud G Abstract The monitoring of electrical activity of the diaphragm (EAdi) is a new minimally invasive bedside technology that was developed for the neurally adjusted ventilatory assist (NAVA) mode of ventilation. In addition to its role in NAVA ventilation, this technology provides the clinician with previously unavailable and essential information on diaphragm activity. In this paper, we review the clinical interests of EAdi in the pediatric intensive care setting. Firstly, the monitoring of EAdi allows the clinician to tailor the ventilatory settings on an...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Noninvasive Monitoring during Interhospital Transport of Newborn Infants.
Authors: Schmölzer GM, O'Reilly M, Cheung PY Abstract The main indications for interhospital neonatal transports are radiographic studies (e.g., magnet resonance imaging) and surgical interventions. Specialized neonatal transport teams need to be skilled in patient care, communication, and equipment management and extensively trained in resuscitation, stabilization, and transport of critically ill infants. However, there is increasing evidence that clinical assessment of heart rate, color, or chest wall movements is imprecise and can be misleading even in experienced hands. The aim of the paper was to review t...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Anemia among Pediatric Critical Care Survivors: Prevalence and Resolution.
Authors: Ngo QN, Matsui DM, Singh RN, Zelcer S, Kornecki A Abstract To determine the incidence of anemia among pediatric critical care survivors and to determine whether it resolves within 6 months of discharge. Design. A prospective observational study. Patients with anemia upon discharge from the pediatric critical care unit (PCCU) underwent in hospital and post hospital discharge followup (4-6 months) for hemoglobin (Hb) levels. Setting. A medical-surgical PCCU in a tertiary care center. Patients. Patients aged 28 days to 18 years who were treated in the PCCU for over 24 hours. Measurements and Main Results. 94 ...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Outcomes of severe sepsis and septic shock patients on chronic antiplatelet treatment: a historical cohort study.
Conclusions. The use of antiplatelet therapy before the diagnosis of severe sepsis or septic shock was not associated with decreased hospital mortality. Antiplatelet therapy was associated with a decreased incidence of acute lung injury/acute respiratory distress syndrome. PMID: 23509620 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

From macrohemodynamic to the microcirculation.
Authors: Donati A, Domizi R, Damiani E, Adrario E, Pelaia P, Ince C Abstract ICU patients need a prompt normalization of macrohemodynamic parameters. Unfortunately, this optimization sometimes does not protect patients from organ failure development. Prevention or treatment of organ failure needs another target to be pursued: the microcirculatory restoration. Microcirculation is the ensemble of vessels of maximum 100 μm in diameter. Nowadays the Sidestream Dark Field (SDF) imaging technique allows its bedside investigation and a recent round-table conference established the criteria for its evaluation. Fi...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Simulations for mechanical ventilation in children: review and future prospects.
Authors: Flechelles O, Ho A, Hernert P, Emeriaud G, Zaglam N, Cheriet F, Jouvet PA Abstract Mechanical ventilation is a very effective therapy, but with many complications. Simulators are used in many fields, including medicine, to enhance safety issues. In the intensive care unit, they are used for teaching cardiorespiratory physiology and ventilation, for testing ventilator performance, for forecasting the effect of ventilatory support, and to determine optimal ventilatory management. They are also used in research and development of clinical decision support systems (CDSSs) and explicit computerized protocols in...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Neonatal lung disease and respiratory failure.
Authors: Guimarães H, van Kaam A, Rocha G, Sánchez Luna M PMID: 23573419 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Epidemiology of acute kidney injury in the intensive care unit.
Authors: Case J, Khan S, Khalid R, Khan A Abstract The incidence of acute kidney injury (AKI) in the intensive care unit (ICU) has increased during the past decade due to increased acuity as well as increased recognition. Early epidemiology studies were confounded by erratic definitions of AKI until recent consensus guidelines (RIFLE and AKIN) standardized its definition. This paper discusses the incidence of AKI in the ICU with focuses on specific patient populations. The overall incidence of AKI in ICU patients ranges from 20% to 50% with lower incidence seen in elective surgical patients and higher incidence in ...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Improved outcome of severe acute pancreatitis in the intensive care unit.
Conclusions. The outcome of patients with SAP in ICU was better than previously reported but associated with a resource demanding hospital stay and long-term morbidity. PMID: 23662207 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

The extent of ventilator-induced lung injury in mice partly depends on duration of mechanical ventilation.
Conclusions. Deleterious effects of MV are partly dependent on its duration. Even lower tidal volumes with PEEP may initiate aspects of VILI after 12 hours of MV. PMID: 23691294 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Outcomes of chronic hemodialysis patients in the intensive care unit.
Authors: Chan M, Ostermann M Abstract Patients with end-stage renal disease (ESRD) experience higher rates of hospitalisation, cardiovascular events, and all-cause mortality and are more likely to require admission to the intensive care unit (ICU) than patients with normal renal function. Sepsis and cardiovascular diseases are the most common reasons for ICU admission. ICU mortality rates in patients requiring chronic hemodialysis are significantly higher than for patients without ESRD; however, dialysis patients have a better ICU outcome than those with acute kidney injury (AKI) requiring renal replacement therapy...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Estimating kidney function in the critically ill patients.
Authors: Seller-Pérez G, Herrera-Gutiérrez ME, Maynar-Moliner J, Sánchez-Izquierdo-Riera JA, Marinho A, do Pico JL Abstract Glomerular filtration rate (GFR) is an accepted measure for assessment of kidney function. For the critically ill patient, creatinine clearance is the method of reference for the estimation of the GFR, although this is often not measured but estimated by equations (i.e., Cockroft-Gault or MDRD) not well suited for the critically ill patient. Functional evaluation of the kidney rests in serum creatinine (Crs) that is subjected to multiple external factors, especially releva...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Acute kidney injury in the critically ill patient.
Authors: Herrera-Gutiérrez ME, Seller-Pérez G, Maynar-Moliner J, Sánchez-Izquierdo-Riera JA, Marinho A, Do Pico JL PMID: 23864945 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Validation of computerized automatic calculation of the sequential organ failure assessment score.
Conclusion. This EMR-based automatic tool accurately calculates SOFA scores and can facilitate ICU decisions without the need for manual data collection. This tool can also be employed in a real-time electronic environment. PMID: 23936639 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

High-frequency oscillatory ventilation combined with volume guarantee in a neonatal animal model of respiratory distress syndrome.
Conclusions. In this animal model, using HFOV combined with VG, changes in the VThf settings induced significant modifications in PaCO2. After changing the lung condition by depletion of surfactant, PaCO2 remained unchanged, as the VThf setting was maintained constant by modifications in the ΔPhf done by the ventilator. PMID: 23970963 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Central Venous-to-Arterial CO2 Gap Is a Useful Parameter in Monitoring Hypovolemia-Caused Altered Oxygen Balance: Animal Study.
Authors: Kocsi S, Demeter G, Erces D, Nagy E, Kaszaki J, Molnar Z Abstract 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. At baseline and then...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Therapeutic strategies for high-dose vasopressor-dependent shock.
Authors: Bassi E, Park M, Azevedo LC Abstract There is no consensual definition of refractory shock. The use of more than 0.5 mcg/kg/min of norepinephrine or epinephrine to maintain target blood pressure is often used in clinical trials as a threshold. Nearly 6% of critically ill patients will develop refractory shock, which accounts for 18% of deaths in intensive care unit. Mortality rates are usually greater than 50%. The assessment of fluid responsiveness and cardiac function can help to guide therapy, and inotropes may be used if hypoperfusion signs persist after initial resuscitation. Arginine vasopress...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Job Satisfaction and Burnout among Intensive Care Unit Nurses and Physicians.
Authors: Myhren H, Ekeberg O, Stokland O Abstract Introduction. Nurses and physicians working in the intensive care unit (ICU) may be exposed to considerable job stress. The study aim was to assess the level of and the relationship between (1) job satisfaction, (2) job stress, and (3) burnout symptoms. Methods. A cross-sectional study was performed at ICUs at Oslo University Hospital. 145 of 196 (74%) staff members (16 physicians and 129 nurses) answered the questionnaire. The following tools were used: job satisfaction scale (scores 10-70), modified Cooper's job stress questionnaire (scores 1-5), and Maslach burno...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Is vitamin d insufficiency associated with mortality of critically ill patients?
Authors: Aygencel G, Turkoglu M, Tuncel AF, Candır BA, Bildacı YD, Pasaoglu H Abstract 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
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research