Critical care : the official journal of the Critical Care Forum
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Comparative Study Clinical Trial
Intravenous colistin in the treatment of sepsis from multiresistant Gram-negative bacilli in critically ill patients.
The increasing prevalence of multiresistant Gram-negative strains in intensive care units (ICUs) has recently rekindled interest in colistin, a bactericidal antibiotic that was used in the 1960s for treatment of infections caused by Gram-negative bacilli. We conducted the present observational study to evaluate the efficacy of intravenous colistin in the treatment of critically ill patients with sepsis caused by Gram-negative bacilli resistant to all other antibiotics. ⋯ The lack of a control group in the present study does not allow any definite conclusions to be drawn regarding the clinical effectiveness of colistin. On the other hand, this drug has an acceptable safety profile and its use should be considered in severe infections with multiresistant Gram-negative bacilli.
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Comparative Study
Does the tube-compensation function of two modern mechanical ventilators provide effective work of breathing relief?
An endotracheal tube (ETT) imposes work of breathing on mechanically ventilated patients. Using a bellows-in-a-box model lung, we compared the tube compensation (TC) performances of the Nellcor Puritan-Bennett 840 ventilator and of the Dräger Evita 4 ventilator. ⋯ Although both ventilators provided effective TC, even when set to 100% TC they could not entirely compensate for a ventilator and ETT-imposed work of breathing. The effect of TC is less than that of pressure support ventilation. Physicians should be aware of this when using TC in weaning trials.
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We describe a case of systemic inflammatory response syndrome associated with air embolism following the removal of a central line catheter, coupled with a deep inspiratory maneuver. The presence of a patent foramen ovale allowed the passage of a clinically significant amount of air from the venous circulation to the systemic circulation. The interaction of air with the systemic arterial endothelium may have triggered the release of endothelium-derived cytokines, resulting in the physiologic response of systemic inflammatory response syndrome.
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The encouraging results of recent clinical trials on therapy of severe sepsis and septic shock are paralleled by ongoing studies on the epidemiology of sepsis and infection in intensive care unit patients all over the world. The development of network-based systems for assessing morbidity and mortality in intensive care unit patients has contributed to a significant improvement in quality of care. Data from the SOAP (Sepsis Occurrence in the Acutely Ill Patient) study demonstrate that the treatment of septic patients varies widely, and that even those strategies that have been evaluated are not yet implemented in routine practice. Hence, activities on surveillance and education still merit further attention.
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There is very little information on what is considered an adequate energy intake for mechanically ventilated, critically ill patients. The purpose of the present study was to determine this energy requirement by making use of patients' nutritional status. ⋯ AF patients had more improvement in nutritional status than patients in the other feeding groups. To provide at least 120% of the resting energy expenditure seemed adequate to meet the caloric energy needs of hemodynamically stable, mechanically ventilated, critically ill patients.