Critical care medicine
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Critical care medicine · May 2002
Osmolar gap hyponatremia in critically ill patients: evidence for the sick cell syndrome?
Accumulation of nondiffusible solutes in plasma leads to redistribution hyponatremia with an increased osmolar gap (i.e., the difference between measured and calculated osmolality). In critically ill patients, intracellular solutes may leak out of the cell because of an increased membrane permeability and may lead to redistribution hyponatremia with increased osmolar gap, a concept called the "sick cell syndrome." The aims of this prospective study were to determine whether an increased osmolar gap related to endogenous solutes accumulation was present in intensive care patients with true hyponatremia and to identify the solutes accounting for this increased osmolar gap. ⋯ Hyponatremia with increased osmolar gap related to endogenous solutes accumulation is observed frequently in hyponatremic intensive care patients, especially in patients with the most severe organ dysfunctions. The nature of the endogenous solutes accounting for the increased osmolar gap remains to be determined. Simultaneous correction of sodium and osmolar gap suggests a causal link between increased osmolar gap and hyponatremia and may support the concept of sick cell syndrome.
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Critical care medicine · May 2002
Repeat bedside percutaneous dilational tracheostomy is a safe procedure.
Previous tracheostomy has been considered a relative contraindication for percutaneous dilational tracheostomy. The objective of this study was to assess the safety of percutaneous dilational tracheostomy in critically ill patients with a history of previous tracheostomy. ⋯ Trained physicians can safely perform bedside percutaneous dilational tracheostomy after previous tracheostomy. Percutaneous dilational tracheostomy offers an alternative to surgical tracheostomy in this particular patient population and should not be considered contraindicated.
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To evaluate the safety and utility of transesophageal echocardiography performed by intensive care physicians in critically ill patients. ⋯ Transesophageal echocardiography when performed by intensive care physicians is a safe procedure and provides useful information for the evaluation and management of critically ill patients.
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Critical care medicine · May 2002
Optimization of high-frequency oscillatory ventilation for the treatment of experimental pneumothorax.
To determine the effect of frequency, amplitude, inspiratory time, and mean airway pressure on gas flow through a chest tube in an animal model of pneumothorax treated with high-frequency oscillatory ventilation (HFOV). ⋯ In a neonatal piglet model of pneumothorax treated with HFOV, with amplitude adjusted to maintain constant alveolar ventilation, gas flow through the chest tube was significantly lower at 15 Hz compared with either 10 Hz or 5 Hz. Chest tube gas flow increased with increasing inspiratory time, amplitude, and mean airway pressure. These findings support the use of higher frequencies, short inspiratory times, low amplitudes, and low mean airway pressures for healing air leak with HFOV.
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Critical care medicine · May 2002
Neutrophil elastase and acute lung injury: prospects for sivelestat and other neutrophil elastase inhibitors as therapeutics.
To review the evidence and rationale that suggest that neutrophil elastase (NE) may contribute to the development of acute lung injury (ALI) and the acute respiratory distress syndrome. To review selected preliminary data regarding the effectiveness of NE inhibition in animals, in in vitro models, and in patients with ALI. ⋯ Further study of the role of NE inhibition as a treatment for ALI is warranted. Additional clinical and preclinical studies with sivelestat and various other NE inhibitors should not only clarify the clinical potential of this intervention strategy, but also better define the activities of NE in inflammatory disorders such as ALI and multiple organ failure.