Intensive care medicine
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Intensive care medicine · Jun 2014
ReviewRespiratory variations in the arterial pressure during mechanical ventilation reflect volume status and fluid responsiveness.
Optimal fluid management is one of the main challenges in the care of the critically ill. However, the physiological parameters that are commonly monitored and used to guide fluid management are often inadequate and even misleading. From 1987 to 1989 we published four experimental studies which described a method for predicting the response of the cardiac output to fluid administration during mechanical ventilation. ⋯ The clinical usefulness of these 'dynamic' parameters is limited by many confounding factors, the recognition of which is absolutely necessary for their proper use. With more than 20 years of hindsight we believe that our early studies helped pave the way for the recognition that fluid administration should ideally be preceded by the assessment of "fluid responsiveness". The introduction of dynamic parameters into clinical practice can therefore be viewed as a significant step towards a more rational approach to fluid management.
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Intensive care medicine · Jun 2014
Multicenter StudyA multicenter study of septic shock due to candidemia: outcomes and predictors of mortality.
Candida is the most common cause of severe yeast infections worldwide, especially in critically ill patients. In this setting, septic shock attributable to Candida is characterized by high mortality rates. The aim of this multicenter study was to investigate the determinants of outcome in critically ill patients with septic shock due to candidemia. ⋯ A total of 216 patients (mean age 63.4 ± 18.5 years; 58.3 % males) were included in the study. Of these, 163 (75 %) were admitted to the intensive care unit. Overall 30-day mortality was 54 %. Significantly higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, dysfunctional organs, and inadequate antifungal therapy were compared in nonsurvivors and survivors. No differences in survivors versus nonsurvivors were found in terms of the time from positive blood culture to initiation of adequate antifungal therapy. Multivariate logistic regression identified inadequate source control, inadequate antifungal therapy, and 1-point increments in the APACHE II score as independent variables associated with a higher 30-day mortality rate.
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Intensive care medicine · Jun 2014
Use of tracheostomy in the PICU among patients requiring prolonged mechanical ventilation.
The purpose of the present study is to describe the use of tracheostomy, specifically frequency, timing (in relation to initiation of mechanical ventilation), and associated factors, in a large cohort of children admitted to North American pediatric intensive care units (PICUs) and requiring prolonged mechanical ventilation. ⋯ There is significant variation in both the frequency and time to tracheostomy between the studied PICUs for patients requiring prolonged mechanical ventilation; among those who received a tracheostomy, the majority did so after two or more weeks of mechanical ventilation. Future studies examining tracheostomy benefits, disadvantages, outcomes, and resource utilization of this patient subgroup are indicated.
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Intensive care medicine · Jun 2014
Characteristics and prognosis of sudden cardiac death in Greater Paris : Population-based approach from the Paris Sudden Death Expertise Center (Paris-SDEC).
Sudden cardiac death (SCD) is a major public health concern, but data regarding epidemiology of this disease in Western European countries are outdated. This study reports the first results from a large registry of SCD. ⋯ Despite being conducted in the therapeutic hypothermia and early coronary angiogram era, hospital discharge survival rate of resuscitated SCD remains poor. The current registry suggests ways to improve pre-hospital and in-hospital care of these patients.
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Intensive care medicine · Jun 2014
Erratum to: Clinical practice guideline on diagnosis and treatment of hyponatraemia.
Sudden cardiac death (SCD) is a major public health concern, but data regarding epidemiology of this disease in Western European countries are outdated.This study reports the first results from a large registry of SCD. ⋯ Despite being conducted in the therapeutic hypothermia and early coronary angiogram era,hospital discharge survival rate of resuscitated SCD remains poor. The current registry suggests ways to improve pre-hospital and in-hospital care of these patients.