Critical care medicine
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Critical care medicine · Feb 2004
Comparative StudyIntensive care unit survivors have fewer hospital readmissions and readmission days than other hospitalized patients in British Columbia.
Intensive care unit (ICU) patients who survive their hospital admission have a long-term survival that is similar to that of hospitalized patients who do not require ICU admission. The risk of future readmission to the hospital for these two patient groups is unknown. The objective of this study was to determine the association between ICU admission and number of readmissions to the hospital and number of readmission days. ⋯ Survivors of a hospital stay that includes admission to an ICU have fewer hospital readmissions and readmission days after their discharge than do survivors of a hospital stay without intensive care.
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Critical care medicine · Feb 2004
ReviewSuspended animation for resuscitation from exsanguinating hemorrhage.
In dogs, isotonic saline at 0-4 degrees C, flushed into the aorta at a rate of 1-2 L/min, with drainage of the vena cava, can achieve deep to profound hypothermia of vital organs at a cooling rate of up to 3 degrees C per minute. This achieves preservation of viability of the organism during predictable durations of no flow: cardiac arrest of 15-20 mins at Tty of 30-35 degrees C, cardiac arrest of 30 mins at Tty of 25 degrees C, cardiac arrest of 60 mins at Tty of 15 degrees C, and cardiac arrest of 90 mins at Tty of 10 degrees C. So far, pharmacologic approaches have not resulted in any breakthrough effect on outcome above that achieved with hypothermia, except perhaps the antioxidant tempol. ⋯ The optimal fluids to have in the circulation during circulatory arrest and reperfusions need to be determined. As laboratory studies to optimize suspended animation proceed, clinical trials should be initiated. In addition, devices should be developed to facilitate induction of suspended animation, eventually in the field.
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Critical care medicine · Feb 2004
Randomized Controlled Trial Comparative Study Clinical TrialProportional-assist ventilation compared with pressure-support ventilation during exercise in volunteers with external thoracic restriction.
Proportional-assist ventilation (PAV) is able to unload respiratory muscles in proportion to the subject's inspiratory effort. However, leak-related alterations in the flow signal, effort-induced modifications in respiratory mechanics, or approximate adjustment of PAV could jeopardize such a theory. The aim of this study was to compare noninvasive PAV and pressure-support ventilation (PSV) in healthy volunteers with external thoracic restriction at rest and during exercise. ⋯ In volunteers with external thoracic restriction mimicking a patient with increased elastic work of breathing, the breathing pattern at rest and during exercise were comparable with PSV and PAV, whereas inspiratory muscle effort was lower with PAV during exercise because of the significant automatic increase in assistance with PAV.
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Critical care medicine · Feb 2004
Abnormal permeability of inner and outer mitochondrial membranes contributes independently to mitochondrial dysfunction in the liver during acute endotoxemia.
This study was designed to determine the role played by the mitochondrial permeability transition in the pathogenesis of mitochondrial damage and dysfunction in a representative systemic organ during the acute phase of endotoxemia. ⋯ These studies confirm that liver mitochondria are early targets of injury during endotoxemia and that inner and outer mitochondrial membrane damage occurs through different mechanisms. Inner mitochondrial membrane damage appears to relate to the mitochondrial permeability transition, whereas outer mitochondrial membrane damage can occur independent of the mitochondrial permeability transition. Preliminary evidence suggests that Bax may participate in lipopolysaccharide-induced outer mitochondrial membrane damage, but further investigations are needed to confirm this.
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Critical care medicine · Feb 2004
Limitation of life support: frequency and practice in a Hong Kong intensive care unit.
To examine the frequency and the decision-making processes involved in limiting (withdrawing and withholding) life support therapy in critically ill Chinese patients in the intensive care unit. ⋯ Limitation of therapy in dying Chinese patients occurs frequently in intensive care patients, and both patients and relatives concur with medical decisions to limit therapy in these patients. Withholding therapy rather than withdrawing therapy occurs more frequently than in Western populations.