Critical care medicine
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Critical care medicine · Mar 2009
Randomized Controlled Trial Multicenter StudyImpact of continuous venovenous hemofiltration on organ failure during the early phase of severe sepsis: a randomized controlled trial.
The impact of continuous venovenous hemofiltration on sepsis-induced multiple organ failure severity is controversial. We sought to assess the effect of early application of hemofiltration on the degree of organ dysfunction and plasma cytokine levels in patients with severe sepsis or septic shock. ⋯ These data suggest that early application of standard continuous venovenous hemofiltration is deleterious in severe sepsis and septic shock. This study does not rule out an effect of high-volume hemofiltration (>35 mL/kg/hr) on the course of sepsis.
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Critical care medicine · Mar 2009
Randomized Controlled Trial Comparative StudyPiperacillin penetration into tissue of critically ill patients with sepsis--bolus versus continuous administration?
To describe a pharmacokinetic model of piperacillin concentrations in plasma and subcutaneous tissue when administered by bolus dosing and continuous infusion in critically ill patients with sepsis on days 1 and 2 of antibiotic therapy and to compare results against previous results for piperacillin from a cohort of patients with septic shock. ⋯ Patients with sepsis do not seem to have the same level of impairment of tissue distribution as described for patients with septic shock. A 25% lower dose of piperacillin administered by continuous infusion seems to maintain higher trough concentrations compared with standard bolus dosing. It is likely that the clinical advantages of continuous infusion are most likely to be evident when treating pathogens with high minimum inhibitory concentration, although without therapeutic drug monitoring and subsequent dose adjustment, infusions may never achieve target concentrations of organisms with very high minimum inhibitory concentrations in a small number of patients.
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Critical care medicine · Mar 2009
Predicting volume responsiveness by using the end-expiratory occlusion in mechanically ventilated intensive care unit patients.
During mechanical ventilation, inspiration cyclically decreases the left cardiac preload. Thus, an end-expiratory occlusion may prevent the cyclic impediment in left cardiac preload and may act like a fluid challenge. We tested whether this could serve as a functional test for fluid responsiveness in patients with circulatory failure. ⋯ The hemodynamic response to an end-expiratory occlusion can predict volume responsiveness in mechanically ventilated patients.
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Critical care medicine · Mar 2009
Randomized Controlled Trial Comparative StudyPhysiological effects of different interfaces during noninvasive ventilation for acute respiratory failure.
To test the short-term physiologic effects (indexes of respiratory effort, ventilation, and gas exchange), leaks, patient-ventilator asynchrony, and comfort of four noninvasive ventilation (NIV) facial, oronasal, or oral interfaces with major differences in internal volume. ⋯ The internal volume of the masks had no apparent short-term dead space effect on gas exchange, minute ventilation, or patient's effort, suggesting that, with the exception of mouthpiece, interfaces may be interchangeable in clinical practice provided adjustment of the ventilatory device parameters are performed.