Intensive care medicine
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Intensive care medicine · Apr 2007
Hemodynamic monitoring in shock and implications for management. International Consensus Conference, Paris, France, 27-28 April 2006.
Shock is a severe syndrome resulting in multiple organ dysfunction and a high mortality rate. The goal of this consensus statement is to provide recommendations regarding the monitoring and management of the critically ill patient with shock. ⋯ This consensus statement provides 17 different recommendations pertaining to the monitoring and caring of patients with shock. There were some important questions that could not be fully addressed using an evidence-based approach, and areas needing further research were identified.
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Intensive care medicine · Apr 2007
Reproducibility of physiological track-and-trigger warning systems for identifying at-risk patients on the ward.
Physiological track-and-trigger warning systems are used to identify patients on acute wards at risk of deterioration, as early as possible. The objective of this study was to assess the inter-rater and intra-rater reliability of the physiological measurements, aggregate scores and triggering events of three such systems. ⋯ There was significant variation in the reproducibility of different track-and-trigger warning systems. The systems examined showed better levels of agreement on triggers than on aggregate scores. Simpler systems had better reliability. Inter-rater agreement might improve by using electronic calculations of scores.
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Intensive care medicine · Apr 2007
Clinical TrialProlonged lateral steep position impairs respiratory mechanics during continuous lateral rotation therapy in respiratory failure.
To establish whether prolonged lateral steep position during continuous rotation therapy leads to improvement on pulmonary gas exchange, respiratory mechanics and hemodynamics. ⋯ Lateral steep positioning impairs the compliance of the respiratory system. Prolonged lateral steep position does not lead to benefits with respect to oxygenation or hemodynamics. Individual response to the different positions is unpredictable. The pauses in "extreme" positions should be as short as possible.
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Intensive care medicine · Apr 2007
Clinical TrialAutomatic adjustment of noninvasive pressure support with a bilevel home ventilator in patients with acute respiratory failure: a feasibility study.
To test the feasibility of applying noninvasive ventilation (NIV) using a prototype algorithm implemented in a bilevel ventilation device designed to adjust pressure support (PS) to maintain a clinician-set alveolar ventilation in patients with acute respiratory failure after initial stabilization. ⋯ These results suggest that the alveolar ventilation based automatic control of PS during NIV with a bilevel device is feasible and leads to beneficial effects in patients with acute respiratory failure comparable to those of manually set PS. Further studies should now explore the potential of this system over longer periods in patients with acute and chronic respiratory failure.
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Intensive care medicine · Apr 2007
Effects of open endotracheal suction on lung volume in infants receiving HFOV.
To describe the pattern and magnitude of lung volume change during open endotracheal tube (ETT) suction in infants receiving high-frequency oscillatory ventilation (HFOV). ⋯ Open ETT suction caused a significant but transient loss of lung volume in muscle-relaxed newborn infants receiving HFOV.