Journal of critical care
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Journal of critical care · Oct 2011
Core temperature variation is associated with heart rate variability independent of cardiac index: a study of 278 trauma patients.
The purpose of this study is to determine if temperature extremes are associated with reduced heart rate variability (HRV) and "cardiac uncoupling." ⋯ The conclusions of this study are (1) temperature extremes are associated with low HRV, potentially reflecting cardiac autonomic dysfunction; (2) CI increases with temperature; and (3) HRV provides additional physiologic information unobtainable via current invasive cardiac monitoring and current vital signs.
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Journal of critical care · Oct 2011
Prevention of extubation failure in high-risk patients with neuromuscular disease.
A substantial proportion of patients with neuromuscular disease (NMD) who undergo positive pressure ventilation via endotracheal intubation for acute respiratory failure fail to pass spontaneous breathing trials and should be considered at high risk for extubation failure. In our study, we prospectively investigated the efficacy of early application of noninvasive ventilation (NIV) combined with assisted coughing as an intervention aimed at preventing extubation failure in patients with NMD. ⋯ Preventive application of NIV combined with assisted coughing after extubation provides a clinically important advantage to patients with NMD by averting the need for reintubation or tracheostomy and shortening their stay in the RICU; its use should be included in the routine approach to patients with NMD at high risk for postextubation respiratory failure.
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Journal of critical care · Oct 2011
Clinical profile, intensive care unit course, and outcome of patients admitted in intensive care unit with dengue.
The purpose of the study was to assess the clinical profile and course of dengue patients admitted to the intensive care unit (ICU) and to identify factors related to poor outcome. ⋯ Patients with dengue fever may require ICU admission for organ failure. Outcome is good if appropriate aggressive care and organ support are instituted. Admission APACHE II score may predict patients at higher risk of death.
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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 · Oct 2011
Clinical TrialReduction in ventilator associated pneumonia in a mixed intensive care unit after initiation of a novel hand hygiene program.
Healthcare-associated infections (HCAIs) impact 10% of hospitalized patients. Some of these infections result from bacterial cross contamination and poor compliance with guidelines (Pittet D: Compliance with hand disinfection and its impact on hospital-acquired infections. J HospInfect 48 Suppl A:S40-S46, 2001); (Watanakunakorn C, Wang C, Hazy J: An observational study of hand washing and infection control practices by healthcare workers. Infect Control Hosp Epidemiol 19:858-860, 1998). Contamination of provider hands may be a modifiable risk factor. We instituted a novel multimodal system designed to improve hand hygiene by ICU providers. ⋯ A novel multi-modal hand hygiene system resulted in a reduction in VAP. Provider hand contamination during patient care in the ICU is a modifiable risk factor for reducing ventilator associated pneumonias.