Intensive care medicine
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Intensive care medicine · Apr 2013
Assessment of the inflammatory effect of low-dose oxygen in mechanically ventilated patients.
Although low doses of oxygen (FiO2 <0.50) are considered nontoxic, recent studies have shown that even lower doses increase pulmonary inflammatory mediators. We aimed to evaluate the acute effects of reducing FiO2 on pulmonary inflammation in mechanically ventilated patients without respiratory failure. ⋯ FiO2 0.40 in mechanically ventilated patients without severe respiratory failure did not increase systemic or pulmonary inflammation.
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Intensive care medicine · Apr 2013
Comparative StudyAdaptive support ventilation with and without end-tidal CO2 closed loop control versus conventional ventilation.
Our aim was to compare adaptive support ventilation with and without closed loop control by end tidal CO2 (ASVCO2, ASV) with pressure (PC) and volume control ventilation (VC) during simulated clinical scenarios [normal lungs (N), COPD, ARDS, brain injury (BI)]. ⋯ All modes performed similarly in most cases. Minor differences observed were in favor of the closed loop modes. Overall, ASVCO2 maintained tighter CO2 control. The ASVCO2 had the greatest impact during ARDS allowing etCO2 to increase and protecting against hypocapnia evident with other modes while ensuring lower P plat and tidal volumes.
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Intensive care medicine · Apr 2013
Colistin resistance in gram-negative bacteria during prophylactic topical colistin use in intensive care units.
Topical use of colistin as part of selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) has been associated with improved patient outcome in intensive care units (ICU), yet little is known about the risks of colistin resistance. We quantified effects of selective decontamination on acquisition of colistin-resistant gram-negative bacteria (GNB) using data from a cluster-randomized study and a single-centre cohort. ⋯ Acquisition rates with colistin-resistant GNB in the respiratory tract were low and comparable with and without topical use of colistin. Rates of acquisition of colistin-resistant GNB during SDD were--in ICUs with low endemicity of antibiotic resistance--<2.5/1,000 days at risk, but were fivefold higher during persistent GNB colonization and 15-fold higher during carriage with tobramycin-resistant GNB.
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Intensive care medicine · Apr 2013
Effects of infection control measures on acquisition of five antimicrobial drug-resistant microorganisms in a tetanus intensive care unit in Vietnam.
To quantify the effects of barrier precautions and antibiotic mixing on prevalence and acquisition of five drug-resistant microorganisms within a single tetanus intensive care unit at a tertiary referral hospital in Ho Chi Minh City, Vietnam. ⋯ The combination of simple infection control measures and antibiotic mixing was highly effective in reducing the prevalence of MRSA, but not of Gram-negative microorganisms.
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Intensive care medicine · Apr 2013
Vasopressin and copeptin levels in children with sepsis and septic shock.
Levels of vasopressin and its precursor copeptin in pediatric sepsis and septic shock are not well defined. The main aim of this study is to compare the serum levels of vasopressin and copeptin in children with septic shock or sepsis and in healthy children. We hypothesized that vasopressin and copeptin levels are elevated in early and late stages of pediatric septic shock. ⋯ Baseline vasopressin levels were different between the three groups. In pediatric septic shock, vasopressin and copeptin levels are not robust markers for severity and clinical outcomes.