Journal of critical care
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Journal of critical care · Dec 2011
Randomized Controlled Trial Multicenter StudySevere protein C deficiency is associated with organ dysfunction in patients with severe sepsis.
The aim of this study was to assess the relationship between protein C levels and temporal changes in organ dysfunction. ⋯ Severe protein C deficiency in patients with severe sepsis is associated with both the incidence and severity of organ dysfunction and subsequent worsening of organ function and may be a useful predictor of organ failure in severe sepsis.
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Journal of critical care · Dec 2011
Randomized Controlled TrialHydrocortisone at stress-associated concentrations helps maintain human heart rate variability during subsequent endotoxin challenge.
We evaluated the differential impact of stress-associated vs high pharmacologic concentrations of hydrocortisone pretreatment on heart rate variability (HRV) during a subsequent systemic inflammatory stimulus. ⋯ Pretreatment with a stress dose of hydrocortisone but not a higher pharmacologic dose maintained a significantly higher ApEn after endotoxin exposure when compared to a placebo. In addition, decreases in ApEn preceded increases in heart rate.
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Journal of critical care · Oct 2011
Randomized Controlled Trial Comparative StudyAn open-labelled randomized controlled trial comparing costs and clinical outcomes of open endotracheal suctioning with closed endotracheal suctioning in mechanically ventilated medical intensive care patients.
Closed endotracheal suctioning (CES) may impact ventilator-associated pneumonia (VAP) risk by reducing environmental contamination. In developing countries where resource limitations constrain the provision of optimal bed space for critically ill patients, CES assumes greater importance. ⋯ In the ICU setting in a developing country, CES may be advantageous in reducing the incidence of VAP, particularly late-onset VAP. These results mandate further studies in this setting before specific guidelines regarding the routine use of CES are proposed.
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Journal of critical care · Oct 2011
Randomized Controlled TrialClinical factors affecting inspired gas humidification and oral dryness during noninvasive ventilation.
Oral dryness is a common complication during noninvasive ventilation (NIV). We measured the oral dryness of patients and performed a bench study to investigate factors related to humidification during NIV. ⋯ Oral dryness was a common problem in our patients. The HH setting significantly affected humidification and oral dryness during NIV.
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Journal of critical care · Aug 2011
Randomized Controlled Trial Multicenter Study Comparative StudyThe Toronto prehospital hypertonic resuscitation--head injury and multiorgan dysfunction trial: feasibility study of a randomized controlled trial.
The aim of the study was to evaluate the feasibility of a prehospital trial comparing hypertonic saline and dextran (HSD) with normal saline (NS) in blunt head injury patients. ⋯ It is feasible to conduct a prehospital randomized controlled trial with HSD for treatment of blunt trauma patients with head injuries; however, consent for neurofunctional outcomes in this cohort is problematic and threatens the feasibility of definitive trials using these potentially meaningful end points.