Journal of intensive care medicine
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J Intensive Care Med · Nov 2008
Review of a large clinical series: sedation and analgesia usage with airway pressure release and assist-control ventilation for acute lung injury.
Our objective was to compare sedative and analgesic doses, agents, and sedation status in patients with airway pressure release ventilation (APRV) versus assist-control (AC) ventilation on the first day after acute lung injury diagnosis. ⋯ APRV may be associated with decreased sedation and analgesia medications and improved sedation status. Differences in the patients receiving APRV versus AC ventilation may have contributed to this conclusion. Further investigation is needed.
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J Intensive Care Med · Nov 2008
Clinical TrialCerebral oximetry monitoring with near infrared spectroscopy detects alterations in oxygenation before pulse oximetry.
The monitoring of oxygenation may be imperative to ensure patient safety and optimal outcome. We anecdotally noted that monitoring cerebral oxygenation (rSO2) using near infrared spectroscopy may provide an earlier warning of changes in oxygenation than pulse oximetry. ⋯ Cerebral oxygenation monitoring using near infrared spectroscopy detects changes in oxygenation earlier than standard pulse oximetry.
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J Intensive Care Med · Nov 2008
Case ReportsBradycardia during dexmedetomidine and therapeutic hypothermia.
Dexmedetomidine is a centrally acting alpha2-adrenergic agonist which is currently Food and Drug Administration-approved for the short-term (less than 24 hours) sedation of adults during mechanical ventilation. Given its beneficial physiologic effects and limited adverse effect profile, there is growing interest regarding its potential applications in the Pediatric intensive care unit patient including sedation during mechanical ventilation, procedural sedation, the treatment of withdrawal, and prevention of emergence agitation. ⋯ We report 2 pediatric patients with traumatic brain injury who had good long-term neurologic outcomes, but developed clinically significant bradycardia when therapeutic hypothermia was added to a sedation regimen that included dexmedetomidine and remifentanil. The role of dexmedetomidine as a neuroprotective agent is explored as well as a review presented of previous reports of bradycardia related to dexmedetomidine.
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Anemia is seen frequently in critically ill patients and has several etiologies. This article reviews the causes with an emphasis on the effects of inflammation, examines the risks and benefits of current therapies, and discusses novel treatment options.
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J Intensive Care Med · Sep 2008
Argatroban anticoagulation in intensive care patients: effects of heart failure and multiple organ system failure.
We retrospectively evaluated argatroban dosing patterns, clinical outcomes, and the effects of heart failure and multiple organ system failure on dosing requirements in 65 adult, intensive care patients administered argatroban anticoagulation for clinically suspected heparin-induced thrombocytopenia (n=56) or history of heparin-induced thrombocytopenia (n=9). Argatroban was initiated then titrated to achieve target activated partial thromboplastin times 1.5 to 3 times normal control (ie, 42-84 seconds). Overall, argatroban was initiated at 1.14+/-0.62 microg/kg/min (mean+/-SD) and administered for 11.4+/-9.5 days, with comparable dosing patterns between patients with suspected, versus previous, heparin-induced thrombocytopenia. ⋯ Nine patients (13.8%) experienced bleeding, none fatal. This experience suggests that argatroban administered at approximately 1 micro/kg/min provides adequate levels of anticoagulation in many intensive care unit patients with suspected or previous heparin-induced thrombocytopenia. Reduced doses are needed when heart failure or multiple organ system failure is present.