Journal of intensive care medicine
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J Intensive Care Med · Mar 2009
Randomized Controlled TrialThe effects of ventilatory mode on lung aeration assessed with computer tomography: a randomized controlled study.
Maintenance of spontaneous breathing superimposed on mechanical ventilation is suggested to improve gas exchange in patients with acute lung injury. The aim of this study was to evaluate the long-term effects of airway pressure release ventilation with maintained unsupported spontaneous breathing (APRV) and synchronized intermittent mandatory ventilation with pressure support (SIMV) on the amount of lung collapse in acute lung injury patients. ⋯ The change in the amount of nonaerated lung was comparable between groups; 14.7% (3.8-17.4) in APRV group (n = 13) and 9.6% (-1.4 to 18.62) in the SIMV group (n = 10), (P = .65, difference in mean 4.9%, 95% confidence interval -9.0% to 19.0%). The effects of APRV and SIMV on lung aeration are similar after 7 days of mechanical ventilation.
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J Intensive Care Med · Mar 2009
Bedside insertion of inferior vena cava filters by a medical intensivist: preliminary results.
The development of percutaneous techniques has allowed vena cava filters to be safely placed at the bedside. Such procedures appear uniquely suited for critically ill patients as they avoid the inherent risks associated with transportation. ⋯ These results suggest that with appropriate training and supervision, medical intensivists can safely insert vena cava filters in the intensive care unit setting. Such a practice appears safe, reduces patient risk associated with intrahospital transport, and may promote cost containment.
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J Intensive Care Med · Jan 2009
Randomized Controlled TrialA new immunomodulatory therapy for severe sepsis: Ulinastatin Plus Thymosin {alpha} 1.
To study the effect of immunomodulatory therapy with ulinastatin plus thymosin alpha( 1) on septic patients. ⋯ Combined immunomodulatory therapy with ulinastatin plus thymosin alpha(1) appears to yield improved survival for patients with sepsis; this finding should be verified in larger clinical trials.
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The most common infectious complication in critically ill patients is ventilator-associated pneumonia. Ventilator-associated pneumonia has significant morbidity and mortality, prolongs mechanical ventilation, and extends length of hospitalization. Despite its prevalence and impact, uniform diagnostic standards are lacking. ⋯ The purpose of this article is to review the evidence supporting the clinical pulmonary infection score as an adjunct to distinguish and detect clinically relevant ventilator-associated pneumonia and its use to guide length of therapy. This score combines clinical diagnostic criteria (tracheal secretion quantification and body temperature) with routinely obtained laboratory data (white blood cell count and oxygenation parameters), radiographic data, and bacteriological culture results. Limitations of clinical pulmonary infection score will be discussed.
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J Intensive Care Med · Jan 2009
Multicenter StudyReview of a large clinical series: association of cumulative fluid balance on outcome in acute lung injury: a retrospective review of the ARDSnet tidal volume study cohort.
To evaluate the independent influence of fluid balance on outcomes for patients with acute lung injury. ⋯ Negative cumulative fluid balance at day 4 of acute lung injury is associated with significantly lower mortality, independent of other measures of severity of illness.