Journal of critical care
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Journal of critical care · Mar 2010
Randomized Controlled TrialEffect of frequency of ventilator circuit changes (3 vs 7 days) on the rate of ventilator-associated pneumonia in PICU.
Ventilator-associated pneumonia (VAP) is associated with significant morbidity and mortality in pediatric intensive care unit (PICU). Our purpose was to evaluate the effects of ventilator circuit change on the rate of VAP in the PICU. ⋯ The 7-day ventilator circuit change did not contribute to increased rates of VAP in our PICU. Thus, it may be used as a guide to save workload and supply costs.
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Journal of critical care · Mar 2010
Pharmacodynamic-based clinical pathway for empiric antibiotic choice in patients with ventilator-associated pneumonia.
Because of the high frequency of multidrug resistant bacteria in our intensive care units (ICUs), we implemented a ventilator-associated pneumonia (VAP) clinical pathway based on unit-specific minimum inhibitory concentration (MIC) distributions and pharmacodynamic modeling in 3 of our ICUs. ⋯ In our ICUs where multidrug resistant bacteria are common, an approach considering ICU-specific antibiotic MICs coupled with pharmacodynamic dosing strategies resulted in improved outcomes and shorter duration of treatments.
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Journal of critical care · Mar 2010
ReviewBiosignal analysis techniques for weaning outcome assessment.
Discontinuation of mechanical ventilation in critically ill patients is a challenging task and involves a careful weighting of the benefits of early extubation and the risks of premature spontaneous breathing trial. Recently, apart from studying different physiological variables by means of descriptive statistical tests, breathing pattern variability analysis has been performed for the assessment of weaning readiness. A limited number of clinical studies implementing different weaning protocols in heterogeneous groups of patients and using a variable set of signal processing techniques have appeared in the critical care literature, with varying results. The purpose of this review article is 3-fold: (1) to describe the different signal processing techniques being implemented for the assessment of weaning readiness, (2) to provide insight into the pathophysiological mechanisms that may govern breath-to-breath variability/complexity in health and disease, and (3) to present results from the critical care literature derived from the application of biosignal analysis tools for the identification of possible weaning indices.
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Journal of critical care · Mar 2010
Plasma neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in adult critically ill patients: a prospective study.
The aim of the study was to assess the ability of plasma neutrophil gelatinase-associated lipocalin (pNGAL) to predict acute kidney injury (AKI) in adult intensive care unit (ICU) patients. ⋯ Plasma neutrophil gelatinase-associated lipocalin at ICU admission is an early biomarker of AKI in adult ICU patients. Plasma neutrophil gelatinase-associated lipocalin increased 48 hours before RIFLE criteria.