Journal of critical care
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Journal of critical care · Dec 2012
Clinical TrialChronic heart failure modifies the response to positive end-expiratory pressure in patients with chronic obstructive pulmonary disease.
Potentially beneficial effects of positive end-expiratory pressure (PEEP) in patients with chronic obstructive pulmonary disease (COPD) must be balanced against further overinflation and increased alveolar dead space. Concurrent chronic heart failure (CHF) is common and can lead to changes in lung that can reduce the detrimental effects of PEEP. ⋯ In subjects with severe COPD alone, caution must be used when administering PEEP 10 cm H(2)O or greater. Subjects with COPD + CHF may benefit from higher levels of PEEP.
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Journal of critical care · Dec 2012
Prediction of pulmonary edema by plasma protein levels in patients with sepsis.
The difficulties of fluid therapy in patients with septic shock are to maintain sufficient vascular volume while preventing pulmonary edema formation. Thus, it is important to find a biomarker that can reliably predict pulmonary edema formation after fluid loading. We evaluated the association of plasma protein levels with the increase in extravascular lung water index (ΔEVLWI) after fluid loading. ⋯ Plasma transferrin and albumin levels were associated with ΔEVLWI 10% or higher after fluid loading. The high sensitivity of both biomarkers indicated that patients with normal values were less likely to develop pulmonary edema after fluid loading.
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Journal of critical care · Dec 2012
Multicenter StudyBarriers to feeding critically ill patients: a multicenter survey of critical care nurses.
The aims of this study were to describe the barriers to enterally feeding critically ill patients from a nursing perspective and to examine whether these barriers differ across centers. ⋯ Nurses in our multicenter survey identified important barriers to providing adequate enteral nutrition to their critically ill patients. The importance of these barriers does not appear to differ significantly across different clinical settings. Future research is required to evaluate if tailoring interventions to overcome these identified barriers is an effective strategy of improving nutrition practice.