Critical care medicine
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Critical care medicine · Feb 2008
Effects of hypertonic/hyperoncotic treatment and surgical evacuation after acute subdural hematoma in rats.
The treatment of acute subdural hematoma (ASDH) consists mainly of surgical evacuation of the hematoma. It is conceivable that early preoperative neuroprotection with hypertonic/hyperoncotic treatment (HHT) can improve survival rates. The present study investigated the benefit of treatment with hypertonic/hyperoncotic solution on functional and histologic outcome as supportive therapy accompanying surgical intervention. ⋯ In this rat model, HHT led to a decrease of ICP after ASDH. This significantly improved functional and histologic outcome, which was comparable to the effects after blood evacuation alone. The combination of evacuation of subdural blood and early HHT improved histologic outcome further but not significantly, which was due to the strong effects of single treatments and a ceiling effect of the combined treatment in this model.
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Critical care medicine · Feb 2008
Meta AnalysisEffect of prone positioning in patients with acute respiratory distress syndrome: a meta-analysis.
To review the effectiveness of prone position as compared with supine position, with respect to mortality, improvement in oxygenation, number of days on mechanical ventilation, and ventilator-associated pneumonia. ⋯ Based on the results of this meta-analysis, prone position improves oxygenation in patients with adult respiratory distress syndrome, and in patients with higher illness severity, it also may reduce mortality.
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Critical care medicine · Feb 2008
Comparative StudyPersistent villi hypoperfusion explains intramucosal acidosis in sheep endotoxemia.
To test the hypothesis that persistent villi hypoperfusion explains intramucosal acidosis after endotoxemic shock resuscitation. ⋯ In this model of endotoxemia, fluid resuscitation corrected both serosal intestinal and sublingual microcirculation but was unable to restore intestinal mucosal perfusion. Intramucosal acidosis might be due to persistent villi hypoperfusion.
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Critical care medicine · Feb 2008
Comparative StudyProspective study of peripheral arterial catheter infection and comparison with concurrently sited central venous catheters.
Peripheral arterial catheters are perceived as having low infective potential compared with other catheters and may be overlooked as a cause of catheter-related bloodstream infection. We aimed to measure colonization and rates of catheter-related bloodstream infection in arterial catheters, to investigate risk factors for arterial catheter colonization, and to compare arterial catheter infection rates with those in concurrently sited and managed central venous catheters. ⋯ The incidence of catheter-related bloodstream infection from arterial catheters was low. However, both arterial catheter colonization and rates of catheter-related bloodstream infection were similar to those in concurrently sited and identically managed central venous catheters. By inference, the arterial catheter should be accorded the same degree of importance as the central venous catheter as a potential source of sepsis.
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Critical care medicine · Feb 2008
Controlled Clinical TrialDetecting ineffective triggering in the expiratory phase in mechanically ventilated patients based on airway flow and pressure deflection: feasibility of using a computer algorithm.
Ineffective triggering (IT) is the most common manifestation of patient-ventilator asynchrony in mechanically ventilated patients. IT in the expiratory phase (ITE) accounts for the majority of IT and is associated with characteristic features of flow and airway pressure deflection, caused by ineffective effort from the patient. The purpose of this study was to quantify the characteristics of flow and airway pressure deflections of ITE and, using a computerized algorithm, to evaluate their usefulness in the detection of ITEs. ⋯ We conclude that accurately detecting and quantifying ITEs is feasible using a computerized algorithm based on F(def) and P(def). Such a computerized estimation of patient-ventilator interaction might be helpful for adjusting ventilator settings in an intensive care unit.