Journal of critical care
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Journal of critical care · Dec 2012
Randomized Controlled TrialEnd-expiratory lung volume recovers more slowly after closed endotracheal suctioning than after open suctioning: a randomized crossover study.
Endotracheal suctioning causes significant lung derecruitment. Closed suction (CS) minimizes lung volume loss during suction, and therefore, volumes are presumed to recover more quickly postsuctioning. Conflicting evidence exists regarding this. We examined the effects of open suction (OS) and CS on lung volume loss during suctioning, and recovery of end-expiratory lung volume (EELV) up to 30 minutes postsuction. ⋯ Closed suctioning minimized lung volume loss during suctioning but, counterintuitively, resulted in slower recovery of EELV postsuction compared with OS. Therefore, the use of CS cannot be assumed to be protective of lung volumes postsuctioning. Consideration should be given to restoring EELV after either suction method via a recruitment maneuver.
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Journal of critical care · Dec 2012
Multicenter StudyChanges in heart rate, mean arterial pressure, and oxygen saturation after open and closed endotracheal suctioning: a prospective observational study.
It is widely assumed that closed suction systems (CSSs), as compared with open suction systems (OSSs), better guarantee optimal oxygenation with less disturbance of physiologic parameters in mechanically ventilated intensive care patients. We, therefore, quantified changes in heart rate (HR), mean arterial pressure (MAP), and peripheral oxygen saturation (Spo(2)) in patients undergoing endotracheal suctioning (ES) with CSS and OSS. ⋯ Changes in HR, MAP, and Spo(2) were comparable and mild during and after CSS and OSS. Both systems can be considered equally safe.
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Journal of critical care · Dec 2012
Uric acid, allopurinol therapy, and mortality in patients with acute heart failure--results of the Acute HEart FAilure Database registry.
The aim of this study was to explore the prognostic role of serum uric acid (UA) measurement in the hospital and long-term mortality assessment in subjects with acute heart failure (AHF) from the Acute HEart FAilure Database registry (AHEAD). The AHEAD registry comprised 4153 patients with AHF syndromes hospitalized at the AHEAD participating centers. ⋯ In patients with AHF, increased UA levels and documented allopurinol therapy for hyperuricemia were associated with increased hospital and long-term mortality. Allopurinol therapy is not a cause but the identifier of the subjects at risk.
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Journal of critical care · Dec 2012
The effects of hemodialysis on blood glutamate levels in chronic renal failure: implementation for neuroprotection.
The purpose of the present study is to investigate whether hemodialysis (HD) is effective in lowering blood glutamate levels. In addition, we examined the effect of HD on glutamate oxaloacetate transaminase (GOT) and glutamate pyruvate transaminase (GPT) levels in the blood and described the rate and pattern of blood glutamate clearance during HD. ⋯ Hemodialysis may be a promising method of reducing blood glutamate levels.
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Journal of critical care · Dec 2012
ReviewRisks of packed red blood cell transfusion in patients undergoing cardiac surgery.
Packed red blood cell (PRBC) transfusion is common in patients undergoing cardiac surgery. Evidence has accumulated demonstrating that such patients can tolerate relatively low hemoglobins, and an extensive body of literature has developed demonstrating that patients undergoing such surgery who receive PRBC are at risk for several adverse outcomes including increased mortality, atrial fibrillation, and more postoperative infections, as well as numerous other complications. The PubMed database was searched for the English language literature on the topic of PRBC transfusion and outcomes in patients undergoing cardiac surgery, as well as alternatives to this intervention. ⋯ The limited prospective data were consistent with the retrospective data, which comprised most of the literature. The preponderance of the literature suggests that patients undergoing cardiac surgery can tolerate lower hemoglobin/hematocrit values than traditionally appreciated. Most published data also indicate that PRBC transfusion should be reserved for patients with an identifiable clinical/physiologic indication fir this intervention, consistent with recent specialty society guidelines.