Journal of critical care
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Journal of critical care · Apr 2014
Observational StudyIncidence and outcome of metabolic disarrangements consistent with citrate accumulation in critically ill patients undergoing continuous venovenous hemodialysis with regional citrate anticoagulation.
Systemic citrate accumulation is a complication of regional citrate anticoagulation (RCA) during continuous renal replacement therapy (CRRT). Our objective was to determine the incidence of clinical signs consistent with citrate accumulation in a large and representative cohort of intensive care unit patients undergoing RCA-CRRT. ⋯ The incidence of disarrangements consistent with citrate accumulation in patients undergoing RCA-continuous venovenous hemodialysis was low, taking place exclusively in patients with severe lactic acidosis due to multiorgan failure. This suggests that the appearance of citrate accumulation is secondary to a severe failure of cellular respiration.
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Journal of critical care · Apr 2014
Indocyanine green clearance as an outcome prediction tool in cardiac surgery: A prospective study.
To evaluate the role of plasma disappearance rate of indocyanine green (PDR-ICG) as an outcome prediction tool in cardiac surgery. ⋯ In addition to the established scores, PDR-ICG may provide valuable information for the assessment of perioperative morbidity and mortality in cardiac surgery. Pre- and early postoperative measurements may help to identify patients at risk for developing perioperative complications.
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Journal of critical care · Apr 2014
Plasma l-citrulline concentrations and its relationship with inflammation at the onset of septic shock: A pilot study.
Hypocitrullinemia has been suggested to be a prognostic factor for patients in intensive care. The aim of this ancillary study of the Corticosteroids and Intensive Insulin Therapy for Septic Shock prospective study was to investigate plasma L-citrulline concentrations and its relationship with inflammation and digestive bacterial translocation in patients with septic shock multiorgan failure and without primary intestinal disease or chronic renal failure. ⋯ At the onset of septic shock, plasma citrulline decreases and varies inversely with C-reactive protein and is lower when digestive bacterial translocation occurs. This finding could reflect an early acute intestinal dysfunction, but measurement of citrulline concentration does not appear to be able to predict the patients' mortality.
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Journal of critical care · Apr 2014
Observational StudyHigh-frequency percussive ventilation improves oxygenation and ventilation in pediatric patients with acute respiratory failure.
High-frequency percussive ventilation (HFPV) in pediatrics has been described predominantly in burned patients. We aimed to describe its effectiveness and safety in noninhalational pediatric acute respiratory failure (ARF). ⋯ In a heterogeneous population of pediatric ARF failing conventional ventilation, HFPV efficiently improves gas exchange in a lung-protective manner.
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Journal of critical care · Apr 2014
Neurally adjusted ventilatory assist vs pressure support ventilation in infants recovering from severe acute respiratory distress syndrome: Nested study.
Neurally adjusted ventilatory assist (NAVA) is a new ventilator modality with an innovative synchronization technique. Our aim is to verify if NAVA is feasible and safe in terms of physiological and clinical variables in infants recovering from severe acute respiratory distress syndrome (ARDS). ⋯ Neurally adjusted ventilatory assist is safe and suitable in infants recovering from severe ARDS. It could provide better results than PSV and is worth to be investigated in a multicenter randomized trial.