Intensive care medicine
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Intensive care medicine · Aug 2006
Controlled Clinical TrialPhysiological responses to arm exercise in difficult to wean patients with chronic obstructive pulmonary disease.
To evaluate the effects of arm exercise with or without support of mechanical ventilation on breathing pattern, respiratory muscle pressure output, and ratings of dyspnea and arm discomfort in difficult-to-wean patients with COPD. ⋯ In tracheostomized difficult-to-wean patients with COPD arm exercise performed during unassisted respiration (trach collar) causes greater increases in respiratory rate and in respiratory muscle pressure output than arm exercise performed during pressure support ventilation. Exercise-induced dyspnea and arm discomfort are similar during assisted and nonassisted respiration.
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Intensive care medicine · Aug 2006
Practice GuidelineConsensus guidelines on sedation and analgesia in critically ill children.
The United Kingdom Paediatric Intensive Care Society Sedation, Analgesia and Neuromuscular Blockade Working Group is a multi-disciplinary expert panel created to produce consensus guidelines on sedation and analgesia in critically ill children and forward knowledge in these areas. Sedation and analgesia are recognised as important areas of critical care practice and adult clinical practice guidelines in these fields remain amongst the most popular of those produced by the Society of Critical Care Medicine. However, similar clinical practice guidelines have not previously been produced for the critically ill paediatric patient. ⋯ Multi-disciplinary consensus guidelines for maintenance sedation and analgesia in critically ill children have been successfully produced and are supported by levels of evidence (excluding sedation and analgesia for procedures and excluding neonates). The working group has highlighted the paucity of high-quality evidence in these important clinical areas and this emphasises the need for further randomised clinical trials in this area.
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Intensive care medicine · Aug 2006
Persisting low monocyte human leukocyte antigen-DR expression predicts mortality in septic shock.
The immediate overwhelming release of inflammatory mediators in septic shock is rapidly followed by strong anti-inflammatory responses inducing a state of immunosuppression. The patients who survive the initial hyper-inflammatory step of septic shock but subsequently die may be those who do not recover from immunosuppression. We assessed whether a low monocyte human leukocyte antigen-DR (mHLA-DR) expression, proposed as a marker of immunosuppression, is an independent predictor of mortality in patients who survived the initial 48 h of septic shock. ⋯ The present preliminary results show that mHLA-DR is an independent predictor of mortality in septic shock patients. Being a marker of immune failure, low mHLA-DR may provide a rationale for initiating therapy to reverse immunosuppression. After validation of the current results in multicenter studies, mHLA-DR may help to stratify patients when designing a mediator-directed therapy in a time-dependent manner.
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Intensive care medicine · Aug 2006
Low incidence of nephropathy in surgical ICU patients receiving intravenous contrast: a retrospective analysis.
Various studies have documented a markedly high incidence of contrast-induced nephropathy (CIN). Most of these studies were conducted in patients not in the ICU. In ICU patients intravenous contrast may be withheld for fear of CIN. We investigated the incidence of CIN in ICU patients. ⋯ CT with modern contrast is associated with a very low incidence of nephropathy in predominantly nondiabetic surgical ICU patients. Intravenous contrast should only rarely be withheld in these patients.
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Intensive care medicine · Aug 2006
Bilateral diaphragm paralysis following cardiac surgery in children: 10-years' experience.
To review the incidence and complications of conservative management of bilateral diaphragm paralysis following pediatric cardiac surgery. ⋯ Bilateral diaphragm paralysis can be managed conservatively with good prognosis and minor complications. The recovery time is relatively short, less than 7 weeks.