Journal of critical care
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Journal of critical care · Jun 2016
Using the brain criterion in organ donation after the circulatory determination of death.
The UK, France, and Switzerland determine death using the brain criterion even in organ donation after the circulatory determination of death (DCDD), in which the United States and Canada use the circulatory-respiratory criterion. In our analysis of the scientific validity of the brain criterion in DCDD, we concluded that although it may be attractive in theory because it conceptualizes death as a unitary phenomenon, its use in practice is invalid. The preconditions (ie, the absence of reversible causes, such as toxic or metabolic disorders) for determining brain death cannot be met in DCDD. ⋯ A stand-off period of 5 to 10 minutes is insufficient to achieve the irreversibility requirement of brain death. Because circulatory cessation inevitably leads to cessation of brain functions, first permanently and then irreversibly, the use of brain criterion is unnecessary to determine death in DCDD. Expanding brain death to permit it to be satisfied by permanent cessation of brain functions is controversial but has been considered as a possible means to declare death in uncontrolled DCDD.
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Journal of critical care · Jun 2016
Observational StudyEarly prediction of extracorporeal membrane oxygenation eligibility for severe acute respiratory distress syndrome in adults.
Appropriately identifying and triaging patients with newly diagnosed acute respiratory distress syndrome (ARDS) who may progress to severe ARDS is a common clinical challenge without any existing tools for assistance. ⋯ The data-driven early prediction ECMO eligibility for severe ARDS score uses commonly measured variables of ARDS patients within 12 hours of intubation and could be used to identify those patients who may merit early transfer to an ECMO-capable medical center.
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Journal of critical care · Jun 2016
Effect of theophylline on ventilator-induced diaphragmatic dysfunction.
To evaluate the effect of theophylline in patients with ventilator-induced diaphragmatic dysfunction (VIDD). ⋯ Theophylline significantly improved diaphragmatic movements in patients with VIDD. Our results warrant a larger study to determine whether theophylline use has benefits during weaning from mechanical ventilation.
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Journal of critical care · Jun 2016
Comparison of cough reflex testing with videoendoscopy in recently extubated intensive care unit patients.
Orotracheal intubation is known to impair cough reflex, but the validity of cough reflex testing (CRT) as a screening tool for silent aspiration in this population is unknown. ⋯ Intensive care unit patients are at increased risk of aspiration in the 24 hours following extubation, and an impaired cough reflex is common. However, CRT overidentifies risk of silent aspiration in this population.
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Journal of critical care · Jun 2016
Lactate and combined parameters for triaging sepsis patients into intensive care facilities.
To find predictors of intensive care unit (ICU) requirement within the first 48 hours in newly diagnosed sepsis patients presenting at the emergency department. ⋯ We suggested a way to predict ICU requirement in sepsis patients and proposed a combined score that might be better than individual parameters. Further validation should be performed before using them clinically.