Intensive care medicine
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Intensive care medicine · Jul 2007
Sleep during proportional-assist ventilation with load-adjustable gain factors in critically ill patients.
Proportional-assist ventilation with load-adjustable gain factors (PAV+) automatically adjusts the flow and volume assist to represent constant fractions of resistance and elastance of the respiratory system, respectively. Resistance and elastance are calculated at random intervals of 4-10 breaths, by applying a 300 ms pause maneuver at the end of selected inspirations. ⋯ In patients exhibiting good patient-ventilator synchrony during PS, the large number of short-term end-inspiratory occlusions with PAV+ operation did not adversely influence sleep quality. With both modes high assist may cause unstable breathing during sleep.
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Intensive care medicine · Jul 2007
Pseudomonas aeruginosa carriage, colonization, and infection in ICU patients.
We evaluated whether Pseudomonas aeruginosa associated nosocomial infections in our ICU originate mainly from patients' endogenous flora or from exogenous cross-transmission. ⋯ Our results suggest that the ICU personnel and environment served as reservoirs for cross-transmission and emphasize the importance of exogenous acquisition of multidrug-resistant P. aeruginosa, of reduction in antibiotic pressure, and prompt enforcement of infection control measures.
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Suspected central hypovolemia is a frequent clinical situation in hospitalized patients, and no simple bedside diagnostic test in spontaneously breathing patients is available. We tested the value of passive leg raising to predict hemodynamic improvement after fluid expansion in patients with suspected central hypovolemia. ⋯ Bedside measurement of cardiac output or stroke volume by Doppler techniques during passive leg raising was predictive of a positive hemodynamic effect of fluid expansion in spontaneously breathing patients with suspected central hypovolemia.
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Intensive care medicine · Jul 2007
Comparative StudySafety and efficacy of colistin compared with imipenem in the treatment of ventilator-associated pneumonia: a matched case-control study.
Our study aimed to determine the efficacy and safety of colistin in the treatment of ventilator-associated pneumonia (VAP) caused by pan-drug-resistant Pseudomonas aeruginosa or Acinetobacter baumanii. ⋯ We conclude that colistin can be a safe and effective option in the treatments of VAP caused by pan-drug-resistant P. aeruginosa or A. baumanii.
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Intensive care medicine · Jul 2007
Reproducibility of bladder pressure measurements in critically ill patients.
Intra-abdominal hypertension is an independent cause of multiorgan failure and directly effects other physiological measurements, making it an important factor in the management of critically ill patients, but no clinical studies have investigated the reproducibility of intra-abdominal pressure (IAP) measurement to ensure diagnostic accuracy. This study evaluated the intraobserver and interobserver variability of bladder pressure measurements. ⋯ Intra-abdominal pressure can be accurately and reliably measured in critically ill patients by utilizing a standardized measurement device combined with a standardized clinical protocol.