Critical care medicine
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In the management of patients with severe acute lung injury and acute respiratory distress syndrome, clinicians are sometimes challenged to maintain acceptable gas exchange while avoiding harmful mechanical ventilation practices. In some of these patients, physicians may consider the use of "rescue therapies" to sustain life. Our goal is to provide a practical, evidence-based review to assist critical care physicians' care for patients with severe acute lung injury and acute respiratory distress syndrome. ⋯ This article is designed to provide clinicians with a simple bedside definition for the diagnosis of severe acute respiratory distress syndrome; to describe several therapies that can be used for severe acute respiratory distress syndrome with an emphasis on the potential risks and the indications and benefits; and to offer practical guidelines for implementation of these therapies.
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Critical care medicine · Aug 2010
ReviewRecognition and prevention of nosocomial pneumonia in the intensive care unit and infection control in mechanical ventilation.
Nosocomial pneumonia (NP) is a difficult diagnosis to establish in the critically ill patient due to the presence of underlying cardiopulmonary disorders (e.g., pulmonary contusion, acute respiratory distress syndrome, atelectasis) and the nonspecific radiographic and clinical signs associated with this infection. Additionally, the classification of NP in the intensive care unit setting has become increasingly complex, as the types of patients who develop NP become more diverse. ⋯ This manuscript will provide a brief overview of the current approaches for the diagnosis of NP and focus on strategies for prevention. Finally, we will provide some guidance on how standardized or protocolized care of mechanically ventilated patients can reduce the occurrence of and morbidity associated with complications like NP.
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Critical care medicine · Aug 2010
Comparative StudyCold aortic flush and chest compressions enable good neurologic outcome after 15 mins of ventricular fibrillation in cardiac arrest in pigs.
The induction of deep cerebral hypothermia via ice-cold saline aortic flush during prolonged ventricular fibrillation cardiac arrest, followed by hypothermic stasis and delayed resuscitation (emergency preservation and resuscitation), improved neurologic outcome after cardiac arrest in pigs, as compared to conventional resuscitation. We hypothesized that emergency preservation and resuscitation with chest compressions would further improve outcome in the same model. ⋯ Emergency preservation and resuscitation by deep cerebral hypothermia combined with chest compressions during prolonged cardiac arrest in pigs are feasible and improve neurologic outcome.
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Critical care medicine · Aug 2010
Comparative StudyIs heart period variability associated with the administration of lifesaving interventions in individual prehospital trauma patients with normal standard vital signs?
To determine whether heart period variability provides added value in identifying the need for lifesaving interventions (LSI) in individual trauma patients with normal standard vital signs upon early medical assessment. ⋯ Only FD-L was uniquely able to distinguish patient groups based on mean values when standard vital signs were normal. However, the accuracy of FD-L in distinguishing between patients was only slightly better than the baseline prediction rate. There was also very high overlap of individual heart period variability values between groups, so many LSI patients could be incorrectly classified as not requiring an LSI if a single heart period variability value was used as a triage tool. Based on this analysis, heart period variability seems to have limited value for prediction of LSIs in prehospital trauma patients with normal standard vital signs.