Critical care medicine
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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.
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Critical care medicine · Feb 2008
Characteristics and outcomes of patients receiving a medical emergency team review for acute change in conscious state or arrhythmias.
To describe the characteristics and outcomes of patients receiving a medical emergency team (MET) review for the MET syndromes of acute change in conscious state or arrhythmia and to assess the effect of delayed MET activation on their outcomes. ⋯ An acute change in conscious state leading to a MET call carried a greater risk of death than activation due to arrhythmias. Delayed activation was common for both syndromes and was independently associated with an increased risk of death.
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Critical care medicine · Feb 2008
Following tracheal intubation, mucus flow is reversed in the semirecumbent position: possible role in the pathogenesis of ventilator-associated pneumonia.
Critically ill intubated patients are positioned in the semirecumbent position to prevent pneumonia. In tracheally intubated sheep, we investigated the effects of gravitational force on tracheal mucus transport and on bacterial colonization of the respiratory system. ⋯ The study indicates that following tracheal intubation gravitational force influences tracheal mucus clearance. When the trachea is oriented above horizontal, a flow of mucus from the proximal trachea toward the lungs is highly associated with bacterial colonization of the airways and pneumonia.