Intensive care medicine
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Intensive care medicine · Nov 2009
Multicenter Study Comparative Study Controlled Clinical TrialImpact of acute hypercapnia and augmented positive end-expiratory pressure on right ventricle function in severe acute respiratory distress syndrome.
To evaluate the effects of acute hypercapnia induced by positive end-expiratory pressure (PEEP) variations at constant plateau pressure (P (plat)) in patients with severe acute respiratory distress syndrome (ARDS) on right ventricular (RV) function. ⋯ Acidosis and hypercapnia induced by tidal volume reduction and increase in PEEP at constant P (plat) were associated with impaired RV function and hemodynamics despite positive effects on oxygenation and alveolar recruitment ( ClinicalTrials.gov #NCT00236262).
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Intensive care medicine · Nov 2009
ReviewDeterminants of regional ventilation and blood flow in the lung.
The principles of ventilation and perfusion distribution in the lung form the foundation of pulmonary physiology and remain cornerstones in caring for critically ill patients. Due to improved imaging technologies with greater spatial resolution, our understanding of the determinants of local ventilation and blood flow have evolved over the past five decades. This review provides a brief history of how the concepts governing regional ventilation and perfusion have developed and presents the most recent studies that are shaping new perspectives on the determinants of ventilation and perfusion. How these new principles apply to acute lung injury and gas exchange in the intensive care unit(ICU) are reviewed.
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Intensive care medicine · Nov 2009
Comparative StudyDetection of carbon dioxide thresholds using low-flow sidestream capnography in ventilated preterm infants.
Monitoring CO2 levels in preterm infants receiving mechanical ventilation is designed to avoid the harmful consequences of hypocapnia or hypercapnia. Capnography is of questionable accuracy for monitoring PCO2 in preterm infants. ⋯ Despite an insufficient correlation between EtCO2 and PvCO2, capnography was able to detect low and high CO2 warning levels with a similar efficacy to that of TcPCO2, and may therefore be of clinical interest.
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Intensive care medicine · Nov 2009
ReviewDiagnostic considerations regarding pediatric delirium: a review and a proposal for an algorithm for pediatric intensive care units.
If delirium is not diagnosed, it is unlikely that any effort will be made to reverse it. Given evidence for under-diagnosis, tools that aid recognition are required. ⋯ This is the first proposal for a PD diagnostic algorithm. Given the high prevalence of predelirious states at the PICU, daily evaluation is mandatory. Future algorithmic refinement is urgently required.
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Intensive care medicine · Nov 2009
Comparative StudyNeutrophil and monocyte CD64 indexes, lipopolysaccharide-binding protein, procalcitonin and C-reactive protein in sepsis of critically ill neonates and children.
To compare the diagnostic accuracy of neutrophil and monocyte CD64 indexes (CD64in and CD64im) for sepsis in critically ill neonates and children with that of lipopolysaccharide-binding protein (LBP), procalcitonin (PCT) and C-reactive protein (CRP). ⋯ Neutrophil CD64 index (CD64in) is the best individual marker for bacterial sepsis in children, while in neonates the highest diagnostic accuracy at the time of suspected sepsis was achieved by LBP and 24 h later by CD64in.