Journal of critical care
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Journal of critical care · Mar 2010
Vasopressin use is associated with death in acute trauma patients with shock.
Traumatic hemodynamic instability is associated with high mortality if not expeditiously corrected. Hypotension despite adequate volume resuscitation is treated with vasopressors. Although catecholamines are typically the first agent used, arginine vasopressin (AVP) is increasingly been used as an adjuvant agent. Mortality with refractory hypotension and vasopressin use in trauma patients is unknown. ⋯ Arginine vasopressin is associated with increased mortality in trauma patients with refractory hypotension. Arginine vasopressin may be a marker of illness or possibly play a causal role in adverse outcomes. Clinicians should reconsider expanding the indications of AVP use.
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Journal of critical care · Mar 2010
Usefulness of intra-abdominal pressure in a predominantly medical intensive care unit.
The deleterious effects of elevated intra-abdominal pressure (IAP) have been known for more than a century. The proposed objectives were to measure changes in IAP and analyze increase-related factors and complications and whether high IAP and its persistence are related to complications and mortality in a predominantly medical intensive care unit. ⋯ In this study, a threshold IAP of 20 mm Hg and its permanence over time were the best predictive factors of complications and mortality. Among other relationships, we also observed that older patients had higher IAP. High IAP was a cause of intolerance to enteral nutrition.
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Journal of critical care · Dec 2009
Multicenter StudyBehavioral and physiologic indicators during a nociceptive procedure in conscious and unconscious mechanically ventilated adults: similar or different?
The purpose of this study was to describe behavioral and physiologic indicators to a nociceptive procedure in conscious and unconscious mechanically ventilated adults and to examine their association with the patients' self-reports of pain. ⋯ The use of behaviors is strongly recommended for pain assessment in unconscious patients, and results from this study support this clinical guideline. Vital signs should be used with caution for the detection of pain as they can be influenced by other factors besides pain.
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Journal of critical care · Dec 2009
Clinical TrialInfluence of hypercapnia on cardiovascular responses to tracheal intubation.
Laryngoscopy and tracheal intubation are often associated with tachycardia, hypertension, and arrhythmias. There is a risk of hypercapnia in the case of difficult mask ventilation. The circulatory response to hypercapnia is increases in arterial pressure and heart rate. We evaluated the difference of cardiovascular responses to tracheal intubation between normocapnia and hypercapnia during mask ventilation before tracheal intubation. ⋯ Hypercapnia during mask ventilation before tracheal intubation may exaggerate the increase of SAP during intubation compared to normocapnia. Ventilation was important in minimizing hemodynamic responses during induction regardless of using drugs.
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Journal of critical care · Dec 2009
Comparative StudyEffects of propofol and dexmedetomidine on indocyanine green elimination assessed with LIMON to patients with early septic shock: a pilot study.
We aimed to select the sedative drug with the least impact on hepatic blood flow in sedation-administered patients. In our study, we aimed to establish whether dexmedetomidine and propofol affect liver function during early septic shock. The hepatic blood flow is evaluated by the transcutaneous assessment of indocyanine green plasma disappearance rate (ICG-PDR) in critically ill patients. ⋯ In our study, we found that neither propofol nor dexmedetomidine infusion affected hepatic blood flow.