Critical care medicine
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Critical care medicine · Mar 2007
A contributive result of open-lung biopsy improves survival in acute respiratory distress syndrome patients.
The impact of a contributive result of open-lung biopsy on the outcome of patients with acute respiratory distress syndrome (ARDS) has not been extensively investigated. The aim of this study was therefore to determine the rate of contributive open-lung biopsy and whether it improved the prognosis of ARDS patients. ⋯ The present study shows that open-lung biopsy provided a contributive result in 78% of ARDS patients with a negative bronchoalveolar lavage. Survival of ARDS patients improved when open-lung biopsy was contributive.
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Critical care medicine · Mar 2007
A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens.
Patients with severe alcohol withdrawal and delirium tremens are frequently resistant to standard doses of benzodiazepines. Case reports suggest that these patients have a high incidence of requiring intensive care and many require mechanical ventilation. However, few data exist on treatment strategies and outcomes for these subjects in the medical intensive care unit (ICU). Our goal was a) to describe the outcomes of patients admitted to the medical ICU solely for treatment of severe alcohol withdrawal and b) to determine whether a strategy of escalating doses of benzodiazepines in combination with phenobarbital would improve outcomes. ⋯ Patients admitted to a medical ICU solely for treatment of severe alcohol withdrawal have a high incidence of requiring mechanical ventilation. Guidelines emphasizing escalating bolus doses of diazepam, and barbiturates if necessary, significantly reduced the need for mechanical ventilation and showed trends toward reductions in ICU length of stay and nosocomial infections.
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Critical care medicine · Mar 2007
Effect of the venous catheter site on transpulmonary thermodilution measurement variables.
Transpulmonary thermodilution is increasingly used for hemodynamic monitoring of critically ill patients. Injection of a cold saline bolus in the central venous circulation is a prerequisite for transpulmonary thermodilution measurements. Superior vena cava access is typically used for injection. This access, however, is not feasible or available in all intensive care patients (e.g., in burn victims or due to contraindications for Trendelenburg position). The present study investigates whether femoral vein access can be used to obtain clinically acceptable values. ⋯ Transpulmonary thermodilution measurements with a cold saline bolus via a femoral catheter provide clinically reliable cardiac output and extravascular lung water index values. Concerning global end-diastolic volume index, there is a good correlation as well, but in the interpretation of the results, an overestimation has to be taken into account.
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Critical care medicine · Mar 2007
Is tracheostomy associated with better outcomes for patients requiring long-term mechanical ventilation?
To evaluate the effect of tracheostomy on intensive care unit (ICU) and in-hospital mortality for patients requiring prolonged (> 3 days) mechanical ventilation (MV). ⋯ Tracheostomy performed in our ICU for long-term MV patients was associated with lower ICU and in-hospital mortality rates, even after carefully controlling for ICU admission and day-3 clinical and physiologic differences between groups. Whether these results reflect that physicians were able to adequately select for tracheostomy patients who, despite having similar physiologic and demographic variables, had the highest probabilities of survival or that the procedure itself really affected the outcomes of these patients will remain speculative.
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Critical care medicine · Mar 2007
Case ReportsPumpless extracorporeal carbon dioxide removal for life-threatening asthma.
To report the use of pumpless extracorporeal carbon dioxide removal in two cases of acute severe asthma. ⋯ Extracorporeal carbon dioxide removal proved to be a valuable adjunct to mechanical ventilation and other medical treatment.