Critical care medicine
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Critical care medicine · Oct 2011
Multicenter Study Comparative StudyDefinition of mortality for trauma center performance evaluation: a comparative study.
Mortality is widely used as a performance indicator to evaluate the quality of trauma care, but there is no consensus on the most appropriate definition. Our objective was to evaluate the influence of the definition of mortality in terms of the place (in-hospital or postdischarge) and time (30 days and 3, 6, and 12 months) of death on the results of trauma center performance evaluations according to the patients' ages. ⋯ We observed an important variation in performance evaluation results across definitions of mortality, specifically in patients aged≥65 yrs. Half of the deaths among elders occurred later than 30 days following admission, including a significant number postdischarge. Results suggest that if performance evaluations include elderly patients, data on postdischarge mortality up to 6 months following admission are required.
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Critical care medicine · Oct 2011
Multicenter StudyIntensive care unit discharge to the ward with a tracheostomy cannula as a risk factor for mortality: a prospective, multicenter propensity analysis.
To analyze the impact of decannulation before intensive care unit discharge on ward survival in nonexperimental conditions. ⋯ In our multicenter setting, intensive care unit discharge before decannulation is not a risk factor.
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Critical care medicine · Oct 2011
Randomized Controlled TrialEffect of pressure support on end-expiratory lung volume and lung diffusion for carbon monoxide.
The level of pressure-support ventilation can affect mean airway pressure and potentially lung volume, but its increase is usually associated with a reduced respiratory rate, and the net effects on the gas exchange process and its components, including end-expiratory lung volume, have not been carefully studied. We measured pulmonary conductance for gas exchange based on lung diffusion for carbon monoxide in patients receiving pressure-support ventilation. ⋯ A 5-cm H2O increase in pressure-support ventilation neither affected end-expiratory lung volume nor increased the pulmonary volume participating in gas exchange. A target tidal volume closer to 6 mL/kg of predicted body weight than to 8 mL/kg during pressure-support ventilation was associated with better gas exchange.
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Critical care medicine · Oct 2011
Metabolic effects of albumin therapy in acute lung injury measured by proton nuclear magnetic resonance spectroscopy of plasma: a pilot study.
Improved means to monitor and guide interventions could be useful in the intensive care unit. Metabolomic analysis with bioinformatics is used to understand mechanisms and identify biomarkers of disease development and progression. This pilot study evaluated plasma proton nuclear magnetic resonance spectroscopy as a means to monitor metabolism following albumin administration in acute lung injury patients. ⋯ The data suggest that metabolic changes detected by proton nuclear magnetic resonance spectroscopy and the bioinformatics tool may be a useful approach to clinical research, especially in acute lung injury.
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Critical care medicine · Oct 2011
Comparative StudyComparisons of predictive performance of breathing pattern variability measured during T-piece, automatic tube compensation, and pressure support ventilation for weaning intensive care unit patients from mechanical ventilation.
To investigate the influence of different ventilatory supports on the predictive performance of breathing pattern variability for extubation outcomes in intensive care unit patients. ⋯ Since 100% inspiratory automatic tube compensation with 5 cm H2O positive end-expiratory pressure and 5 cm H2O pressure support ventilation with 5 cm H2O positive end-expiratory pressure reduce the predictive performance of breathing pattern variability, breathing pattern variability measurement during the T-piece trial is the best choice for predicting extubation outcome in intensive care unit patients patients.