Critical care medicine
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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.
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Critical care medicine · Mar 2009
ReviewPharmacokinetic issues for antibiotics in the critically ill patient.
To discuss the altered pharmacokinetic properties of selected antibiotics in critically ill patients and to develop basic dose adjustment principles for this patient population. ⋯ Knowledge of antibiotic pharmacodynamic properties and the potential altered antibiotic pharmacokinetics in critically ill patients can allow the intensivist to develop individualized dosing regimens. Specifically, for renally cleared drugs, measured creatinine clearance can be used to drive many dose adjustments. Maximizing clinical outcomes and minimizing antibiotic resistance using individualized doses may be best achieved with therapeutic drug monitoring.
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Critical care medicine · Mar 2009
Randomized Controlled TrialThe effect of red blood cell transfusion on cerebral oxygenation and metabolism after severe traumatic brain injury.
There is evidence to suggest that anemia after severe traumatic brain injury (sTBI) is detrimental. However, there is a paucity of evidence supporting the use of transfusion of packed red blood cells in patients with sTBI. To understand the acute effect of packed red blood cell transfusion on cerebral oxygenation and metabolism in patients with sTBI. ⋯ Transfusion of packed red blood cells acutely results in improved brain tissue oxygen without appreciable effect on cerebral metabolism.