Journal of critical care
-
Journal of critical care · Aug 2016
Observational StudyEarly procalcitonin kinetics and appropriateness of empirical antimicrobial therapy in critically ill patients: A prospective observational study.
The purpose was to investigate the value of procalcitonin (PCT) kinetics in predicting the appropriateness of empirical antimicrobial treatment in critically ill patients. ⋯ Early response of PCT in the first 24 hours of commencing empirical antimicrobials in critically ill patients may help the clinician to evaluate the appropriateness of therapy.
-
Journal of critical care · Aug 2016
Safety of peripheral administration of phenylephrine in a neurologic intensive care unit: A pilot study.
Integral to the management of the neurocritically injured patient are the prevention and treatment of hypotension, maintenance of cerebral perfusion pressure, and occasionally blood pressure augmentation. When adequate volume resuscitation fails to meet perfusion needs, vasopressors are often used to restore end-organ perfusion. This has historically necessitated central venous access given well-documented incidence of extravasation injuries associated with peripheral administration of vasopressors. ⋯ We were able to administer peripheral phenylephrine, up to a dose of 2 μg/(kg min), for an average of 14.29hours (1-54.3) in 20 patients with only 1 possible minor complication and no major complications. This was achieved by adding additional safety measures in our computerized physician order entry system and additional nurse-driven safety protocols. Thus, with careful monitoring and safety precautions, peripheral administration of phenylephrine at an optimized concentration appears to have an acceptable safety profile for use in the neurocritical care unit up to a mean infusion time of 14hours.
-
Journal of critical care · Aug 2016
EditorialNeuroscience and awareness in the dying human brain: Implications for organ donation practices.
Consciousness has 2 components: wakefulness (arousal) and awareness (perception of the self and the external environment). Functional neuroimaging has identified 2 distinctive functional networks that mediate external awareness of the surrounding environment and internal awareness of the self. Recent studies suggest that awareness is not always associated with wakefulness. ⋯ This aligns with the 5-minute no-touch time after the loss of arterial pulse, the current circulatory standard of death determination in non-heart-beating organ donation. We argue that the capacity for awareness may not be irreversibly lost after a relatively brief period of cessation of systemic circulation, and outline empirical data in support of the claim that awareness without wakefulness may be present. Obviously, if correct, this will have practical and ethical implications on organ donation practices.
-
Journal of critical care · Aug 2016
Pressure attenuation during high-frequency airway clearance therapy across different size endotracheal tubes: An in vitro study.
High-frequency airway clearance therapy is a positive pressure secretion clearance modality used in pediatric and adult applications. However, pressure attenuation across different size endotracheal tubes (ETT) has not been adequately described. This study quantifies attenuation in an in vitro model. ⋯ In an in vitro model, pressure attenuation was linearly related to the inner diameter of the endotracheal tube; with decreasing attenuation as the ETT size increased.
-
Journal of critical care · Aug 2016
Randomized Controlled TrialIs inhaled prophylactic heparin useful for prevention and Management of Pneumonia in ventilated ICU patients?: The IPHIVAP investigators of the Australian and New Zealand Intensive Care Society Clinical Trials Group.
To determine whether prophylactic inhaled heparin is effective for the prevention and treatment of pneumonia patients receiving mechanical ventilation (MV) in the intensive care unit. ⋯ A phase 2, double blind randomized controlled trial stratified for study center and patient type (non-operative, post-operative) was conducted in three university-affiliated intensive care units. Patients aged ≥18years and requiring invasive MV for more than 48hours were randomized to usual care, nebulization of unfractionated sodium heparin (5000 units in 2mL) or placebo nebulization with 0.9% sodium chloride (2mL) four times daily with the main outcome measures of the development of ventilator associated pneumonia (VAP), ventilator associated complication (VAC) and sequential organ failure assessment scores in patients with pneumonia on admission or who developed VAP.