Critical care : the official journal of the Critical Care Forum
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Randomized Controlled Trial
Influence of support on intra-abdominal pressure, hepatic kinetics of indocyanine green and extravascular lung water during prone positioning in patients with ARDS: a randomized crossover study.
Prone positioning (PP) on an air-cushioned mattress is associated with a limited increase in intra-abdominal pressure (IAP) and an absence of organ dysfunction. The respective influence of posture by itself and the type of mattress on these limited modifications during the PP procedure remains unclear. The aim of this study was to evaluate whether the type of support modifies IAP, extravascular lung water (EVLW) and the plasma disappearance rate of indocyanine green (PDRICG) during PP. ⋯ In comparison with a conventional foam mattress, the use of an air-cushioned mattress limited the increase in IAP and prevented the decrease in PDRICG related to PP in patients with ARDS. Conversely, the type of support did not influence EVLW or oxygenation.
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Prone positioning may even in patients without abdominal hypertension result in an increased intra-abdominal pressure (IAP). Previous research could not demonstrate a marked increase in IAP associated with cardiovascular, renal, or hepato-splanchnic dysfunction when patients were proned in air-cushioned beds. Michelet and colleagues in this issue of Critical Care report that the increase in IAP in the prone position depends on the used mattress type. Compared with air-cushion beds, conventional foam mattresses resulted in a greater increase in IAP which was associated with a decrease in the plasma disappearance rate of indocyanin green (PDRICG) indicating inadequate heptosplanchnic function.
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Systemic lupus erythematosus (SLE) is an archetypal autoimmune disease, involving multiple organ systems with varying course and prognosis. However, there is a paucity of clinical data regarding prognostic factors in SLE patients admitted to the intensive care unit (ICU). ⋯ The mortality rate in critically ill SLE patients was high. Gastrointestinal bleeding, intracranial haemorrhage and septic shock were significant prognostic factors in SLE patients admitted to the ICU.
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The delivery of critical care is no longer limited to the intensive care unit. The information gained by utilization of new technologies has proven beneficial in some populations. Research into earlier and more widespread use of these modalities may prove to be of even greater benefit to critically ill patients.
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Anemia is a common problem in critically ill patients. The etiology of anemia of critical illness is often determined to be multifactorial in the clinical setting, but the pathophysiology remains to be elucidated. Erythropoietin (EPO) is an endogenous glycoprotein hormone that serves as the primary stimulus for erythropoiesis. Recent evidence has demonstrated a blunted EPO response as a factor contributing to anemia of critical illness in specific subsets of patients. Critically ill patients requiring mechanical ventilation who exhibit anemia have not been the subject of previous studies. Our goal was to evaluate the erythropoietic response to anemia in the critically ill mechanically ventilated patient. ⋯ Mechanically ventilated patients demonstrate a blunted EPO response to anemia. Further study of therapies directed at treating anemia of critical illness and evaluating its potential impact on mechanical ventilation outcomes and mortality is warranted.