Intensive care medicine
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Intensive care medicine · Apr 2012
Interfaces for long-term noninvasive positive pressure ventilation in children.
The aim of the study was to report the type and tolerance of the interface chosen for long-term noninvasive positive pressure ventilation (NPPV) in children. ⋯ The choice of the interface for NPPV in children is determined by the patient's age and the underlying disease. Discomfort is the main reason for mask change.
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Intensive care medicine · Apr 2012
Pattern of end-of-life decisions in two Tunisian intensive care units: the role of culture and intensivists' training.
End-of-life (EOL) decisions are not well studied in developing countries. We report EOL decision patterns in two Tunisian intensive care units [ICUs, medical (MICU) and surgical (SICU)] belonging to the same teaching hospital. ⋯ Withholding and withdrawing life support are common in medical and surgical ICUs of a Tunisian hospital. Withholding is more frequent than withdrawing life support. These decisions appear to be effected by functional status and underlying conditions.
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Intensive care medicine · Apr 2012
Validation of pediatric index of mortality 2 (PIM2) in a single pediatric intensive care unit in Japan.
The Pediatric Index of Mortality 2 (PIM2), one of the key mortality prediction models for children in intensive care units, has not been validated in Japan. The purpose of this study was to validate the performance of PIM2 in a population of patients admitted to one pediatric intensive care unit (PICU) in Japan. ⋯ At the largest PICU center in Japan, the PIM2 was found to have excellent discriminatory power and good calibration, although it over-predicted deaths. Based on these results, PIM2 can be used as a good prediction model for pediatric mortality, which is a tool used to assess the overall quality of care in a PICU.
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Diaphragm weakness induced by mechanical ventilation may contribute to difficult weaning from the ventilator. For optimal force generation the muscle proteins myosin and titin are indispensable. The present study investigated if myosin and titin loss or dysfunction are involved in mechanical ventilation-induced diaphragm weakness. ⋯ Mechanical ventilation leads to impaired diaphragm fiber active force-generating capacity and passive force generation upon stretch. Loss of myosin contributes to reduced active force generation, whereas reduced passive force generation is likely to result from a decreased phosphorylation status of titin. These impairments were not discernable in the soleus muscle of 18 h mechanically ventilated rats.