Critical care medicine
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Critical care medicine · Jan 2005
Multicenter Study Comparative StudyAirway pressures, tidal volumes, and mortality in patients with acute respiratory distress syndrome.
To determine the usual practice for setting tidal volume and other ventilatory parameters in patients with acute respiratory distress syndrome (ARDS) in the late 1990s and to determine the independent effects of these practices on intensive care unit mortality. ⋯ This descriptive study demonstrated considerable interpatient variability in tidal volumes during the study period. In addition to traditional prognostic indicators, timing of ARDS onset and the use of low levels of positive end-expiratory pressure or no positive end-expiratory pressure during the first week may adversely influence outcome in ARDS patients.
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Critical care medicine · Jan 2005
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialLower tidal volume ventilation and plasma cytokine markers of inflammation in patients with acute lung injury.
To evaluate the association between interleukin-6, interleukin-8, and interleukin-10 and clinical outcomes including mortality in patients with acute lung injury and to determine whether lower tidal volume ventilation was associated with a decrease in plasma cytokines in patients with acute lung injury. ⋯ In patients with acute lung injury, plasma interleukin-6 and interleukin-8 levels are associated with morbidity and mortality. The severity of inflammation varies with clinical risk factor, suggesting that clinical risk factor should be considered when both developing and testing therapeutic interventions. Low tidal volume ventilation is associated with a more rapid attenuation of the inflammatory response.
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Critical care medicine · Jan 2005
Multicenter StudyIncidence of acute respiratory distress syndrome in German children and adolescents: a population-based study.
The objective of this study was to determine the epidemiology of acute respiratory distress syndrome (ARDS) in children and adolescents aged 1 mo to 18 yrs. ⋯ This is the first population-based evaluation of the incidence of ARDS in the pediatric age group. It shows that the incidence of ARDS in this age group is low. This makes randomized studies on pediatric ARDS aiming on the end point "outcome" nearly impossible.
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Critical care medicine · Jan 2005
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialAcute effects of tidal volume strategy on hemodynamics, fluid balance, and sedation in acute lung injury.
To examine the effects of mechanical ventilation with a tidal volume of 6 mL/kg compared with 12 mL/kg predicted body weight on hemodynamics, vasopressor use, fluid balance, diuretics, sedation, and neuromuscular blockade within 48 hrs in patients with acute lung injury and acute respiratory distress syndrome. ⋯ When compared with ventilation with 12 mL/kg predicted body weight, patients treated with the lung-protective 6 mL/kg predicted body weight tidal volume protocol had no difference in their supportive care requirements. Therefore, concerns regarding potential adverse effects of this protocol should not preclude its use in patients with acute lung injury or the acute respiratory distress syndrome.
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Critical care medicine · Jan 2005
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialEffect of airway pressure display on interobserver agreement in the assessment of vascular pressures in patients with acute lung injury and acute respiratory distress syndrome.
Previous investigations have identified significant interobserver variability in the measurements of central venous pressure and pulmonary artery occlusion pressure in critically ill patients. Large interobserver variability in the measurement of vascular pressures could potentially lead to inappropriate treatment decisions. ⋯ Paw display is a simple, inexpensive method to facilitate the identification of end-expiration that can significantly improve interobserver agreement.