Critical care medicine
-
Critical care medicine · Jun 2009
Randomized Controlled Trial Comparative StudyHelmet with specific settings versus facemask for noninvasive ventilation.
To compare the physiologic effects of noninvasive pressure-support ventilation (NPSV) delivered by a facemask, a helmet with the same settings, and a helmet with specific settings. Inspiratory muscle effort, gas exchange, patient-ventilator synchrony, and comfort were evaluated. ⋯ Our results suggest that increasing both the pressure-support level and positive end-expiratory pressure and using the highest pressurization rate may be advisable when providing NPSV via a helmet.
-
Critical care medicine · Jun 2009
Multicenter StudyA simple clinical predictive index for objective estimates of mortality in acute lung injury.
We sought to develop a simple point score that would accurately capture the risk of hospital death for patients with acute lung injury (ALI). ⋯ Mortality in patients with ALI can be predicted using an index of four readily available clinical variables with good calibration. This index may help inform prognostic discussions, but validation in nonclinical trial populations is necessary before widespread use.
-
Critical care medicine · Jun 2009
Randomized Controlled TrialN-acetylcysteine is associated with increased blood loss and blood product utilization during cardiac surgery.
When used to prevent perioperative inflammation and ischemia-reperfusion injury, N-acetylcysteine may inadvertently impair hemostasis. We, therefore, performed a post hoc analysis of a recent randomized controlled trial in cardiac surgery to determine whether N-acetylcysteine was associated with increased blood loss and blood product transfusion. ⋯ In patients who have preexisting moderate renal insufficiency and are undergoing cardiac surgery, N-acetylcysteine was associated with important effects on blood loss and blood product transfusion. Clinicians and researchers should, therefore, consider the potential for impaired hemostasis when using N-acetylcysteine in the perioperative setting. Further research is needed to elucidate mechanisms by which N-acetylcysteine may impair hemostasis, and the risk-benefit profile of N-acetylcysteine for perioperative organ protection.
-
Critical care medicine · Jun 2009
Metabolic benefits of surface counter warming during therapeutic temperature modulation.
To determine the impact of counter warming (CW) with an air circulating blanket on shivering and metabolic profile during therapeutic temperature modulation (TTM). ⋯ Surface CW provides beneficial control of shivering and improves the metabolic profile during TTM.