Intensive care medicine
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Intensive care medicine · Sep 2013
ReviewOptimal sedation in pediatric intensive care patients: a systematic review.
Sedatives administered to critically ill children should be titrated to effect, because both under- and oversedation may have negative effects. We conducted a systematic review to examine reported incidences of under-, optimal, and oversedation in critically ill children receiving intensive care. ⋯ This study suggests that sedation in the PICU is often suboptimal and seldom systematically evaluated. Oversedation is more common than undersedation. As oversedation may lead to longer hospitalization, tolerance, and withdrawal, preventing oversedation in pediatric intensive care deserves greater attention.
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Intensive care medicine · Sep 2013
Multicenter StudyNeurodevelopmental, educational and behavioral outcome at 8 years after neonatal ECMO: a nationwide multicenter study.
Reporting neurodevelopmental outcome of 8-year-old children treated with neonatal extracorporeal membrane oxygenation (ECMO). ⋯ Eight-year-old children treated with neonatal ECMO fall in the normal range of intelligence with problems with concentration and behavior. Long-term follow-up for children treated with neonatal ECMO should focus on early detection of (subtle) learning deficits.
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Intensive care medicine · Sep 2013
Randomized Controlled TrialPre-emptive broad-spectrum treatment for ventilator-associated pneumonia in high-risk patients.
Patients requiring mechanical ventilation (MV) for >48 h after major heart surgery (MHS) are at a high risk of acquiring ventilator-associated pneumonia (VAP) and tracheobronchitis (VAT). Most non-pharmacological interventions to prevent VAP in such patients are usually already implemented. The objective of this study was to evaluate the efficacy in preventing lower respiratory infections of antibiotics active against multidrug-resistant pathogens in this very high-risk population. ⋯ A pre-emptive approach with broad-spectrum antibiotics may be effective in reducing the incidence and delaying the onset of VAP + VAT after MHS. The ecological consequences have to be carefully evaluated in future trials.
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Intensive care medicine · Sep 2013
Comparative Study Observational StudyIncreased MerTK expression in circulating innate immune cells of patients with septic shock.
A new pathway of three protein tyrosine kinase receptors, namely, the TAM receptor family [Tyro-3, Axl and Mer tyrosine kinase (MerTK)], has recently been described to negatively control immune responses. The objective of this prospective, observational, clinical study was to investigate the expression patterns of TAM receptors in circulating white blood cells collected from patients with septic shock. ⋯ MerTK expression in circulating innate immune cells is increased in patients with septic shock in comparison with healthy volunteers and trauma patients. Persistent MerTK overexpression after septic shock is associated with adverse outcome. The role of this family of receptors in the pathophysiology of injury-induced immune dysfunctions deserves to be specifically investigated.
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Intensive care medicine · Sep 2013
Innovative continuous non-invasive cuffless blood pressure monitoring based on photoplethysmography technology.
To develop and validate a continuous non-invasive blood pressure (BP) monitoring system using photoplethysmography (PPG) technology through pulse oximetry (PO). ⋯ BP can be inferred from PPG using DBN-RBM modeling techniques. The results obtained with this technology are promising, but its intrinsic variability and its wide limits of agreement do not allow clinical application at this time.