Intensive care medicine
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Intensive care medicine · Oct 2012
Randomized Controlled TrialEffects of propofol on sleep quality in mechanically ventilated critically ill patients: a physiological study.
To access the effect of propofol administration on sleep quality in critically ill patients ventilated on assisted modes. ⋯ In critically ill patients ventilated on assisted modes, propofol administration to achieve the recommended level of sedation suppresses the REM sleep stage and further worsens the poor sleep quality of these patients.
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Intensive care medicine · Oct 2012
Association between physicians' beliefs and the option of comfort care for critically ill patients.
For critically ill patients at high risk of death, reasonable treatment options include attempts at life prolongation and treatment focused on comfort. Little is known about whether and how physicians present the option of comfort care to surrogates. This study assessed how comfort care is presented to surrogates and whether physicians' beliefs are associated with whether comfort care is presented as an option. ⋯ Clinicians did not explicitly inform surrogates about the option of comfort-oriented treatment in roughly half of clinician-family meetings. Physicians who more strongly believe that the appropriate goal of care is life prolongation are less likely to inform surrogates about the option of comfort care.
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Intensive care medicine · Oct 2012
Safety of nicotine replacement therapy in critically ill smokers: a retrospective cohort study.
Nicotine replacement therapy (NRT) has been used to ameliorate nicotine withdrawal in the intensive care unit (ICU). Previous cohort studies have suggested an increased mortality with NRT use: methodological problems may call into question the validity of these findings. We undertook a retrospective cohort study to determine if NRT use was associated with adverse outcomes. ⋯ We were unable to demonstrate any harm associated with NRT, with the ICU model actually trending towards benefit. We conclude that a randomised, blinded, placebo controlled trial is required to assess adequately the safety and efficacy of NRT as a treatment in critically ill smokers.
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Intensive care medicine · Oct 2012
Elevated preoperative serum asymmetrical dimethylarginine (ADMA) is associated with poor outcomes after pediatric cardiac surgery.
Asymmetrical dimethylarginine (ADMA), an endogenous competitive inhibitor of nitric oxide synthase, is elevated in vascular pathologies such as hypertension and chronic kidney disease. Children undergoing cardiac surgery are at high risk of poor hemodynamic and renal outcomes secondary to cardiopulmonary bypass (CPB). This study tested the hypothesis that elevated preoperative ADMA levels are associated with overall worse clinical outcomes after pediatric CPB. ⋯ Patients with elevated ADMA before surgery were more likely to have prolonged mechanical ventilation, develop LCOS, require an extended length of stay, and require reoperation. ADMA levels inversely correlated with eGFR, but did not predict AKI. Preoperative serum ADMA appears to identify pediatric cardiac surgery patients at risk of poor postoperative outcomes following CPB.
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Intensive care medicine · Oct 2012
Comparative StudyComparison of volumetric capnography and mixed expired gas methods to calculate physiological dead space in mechanically ventilated ICU patients.
Physiological dead space should be a routine measurement in ventilated patients but measuring dead space using the Douglas bag (DB) method is cumbersome and requires corrections for compressed ventilator gas. These factors make this method impractical in the critical care setting. Volumetric capnography (VCAP) offers a relatively simple solution to calculating dead space. Few studies have been conducted to directly compare dead space measured by VCAP and the DB method in critically unwell adults. ⋯ VCAP shows good agreement with Douglas Bag method in measuring physiological V(D)/V(T) over a wide range of dead space fractions.