Intensive care medicine
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Intensive care medicine · Oct 2010
Transfusion-related acute lung injury in ICU patients admitted with gastrointestinal bleeding.
Transfusion of blood components is common in patients admitted to the intensive care unit (ICU) for gastrointestinal (GI) bleeding, yet the incidence and risk factors for development of transfusion-related acute lung injury (TRALI) in these patients are unknown. ⋯ TRALI is common in critically ill ESLD patients with gastrointestinal bleeding. Nonleukoreduced red blood cells and FFP are significant transfusion-specific risk factors and their use should be re-evaluated in bleeding patients with ESLD.
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Intensive care medicine · Oct 2010
Target-controlled infusion of propofol for sedation in patients with non-invasive ventilation failure due to low tolerance: a preliminary study.
Non-invasive ventilation (NIV) in critically ill patients is associated with a high failure rate. This prospective study assessed the feasibility and safety of target-controlled infusion (TCI) of propofol for conscious sedation during NIV in patients with NIV failure due to low tolerance. ⋯ This preliminary study shows that in a selected population, TCI of propofol can facilitate acceptance of NIV. Within the limits of a pilot study, TCI of propofol seems to be safe and effective for the treatment of NIV failure due to low tolerance.
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Intensive care medicine · Oct 2010
Do hypooncotic fluids for shock increase the risk of late-onset acute respiratory distress syndrome?
In patients with shock, late-onset acute respiratory distress syndrome (ARDS) carries poor prognosis. Hypooncotic fluids may improve kidney function preservation, whereas hyperoncotic fluids may in theory decrease the risk of late-onset ARDS. Our objective was to determine whether predominant or exclusive use of crystalloids and/or hypooncotic colloids for shock resuscitation influenced the risk of late-onset ARDS. PARTICIPANT AND SETTINGS: International prospective cohort of consecutive adults who were free of ARDS on admission and who received fluid resuscitation for shock in 115 intensive care units (ICUs) during a 4-week period. ⋯ Based on this observational study, there is no evidence that in patients with shock the use of hypooncotic fluids increases the risk of late-onset ARDS. This finding needs to be confirmed.
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Intensive care medicine · Oct 2010
Critical care management of patients with hemophagocytic lymphohistiocytosis.
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening condition associated with multiple organ dysfunction. We sought to describe ICU management and outcomes in HLH patients meeting HLH-2004 criteria and to identify determinants of mortality. ⋯ Aggressive supportive care combined with specific treatment of the precipitating factor can produce meaningful survival in patients with HLH responsible for multiple organ failures. Survival is highest in patients with HLH related to Castleman's disease or B cell lymphoma.
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Intensive care medicine · Oct 2010
Impact of organ dysfunction on mortality in ICU patients with hematologic malignancies.
To compare evolution in organ dysfunction (OD) between hematologic malignancy patients with and without bacterial infection (BI) precipitating intensive care unit (ICU) admission, and to assess its impact on mortality. ⋯ BI is associated with a more severe initial but a more rapidly reversible OD and a subsequent lower mortality compared to other complications in ICU patients with hematologic malignancies. These findings further support the recommendation that these patients should certainly benefit from advanced life support, and in the case of an uncertain long-term prognosis due to the underlying malignancy, at least from a 3-day ICU trial.