Critical care : the official journal of the Critical Care Forum
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Randomized Controlled Trial Comparative Study
Prediction of extubation outcome: a randomised, controlled trial with automatic tube compensation vs. pressure support ventilation.
Tolerance of a spontaneous breathing trial is an evidence-based strategy to predict successful weaning from mechanical ventilation. Some patients may not tolerate the trial because of the respiratory load imposed by the endotracheal tube, so varying levels of respiratory support are widely used during the trial. Automatic tube compensation (ATC), specifically developed to overcome the imposed work of breathing because of artificial airways, appears ideally suited for the weaning process. We further evaluated the use of ATC in this setting. ⋯ This study confirms the usefulness of ATC during the weaning process, being at least as effective as PSV in predicting successful extubation outcome and significantly improving the predictive value of the f/VT.
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Sepsis, despite recent therapeutic progress, still carries unacceptably high mortality rates. The adrenergic system, a key modulator of organ function and cardiovascular homeostasis, could be an interesting new therapeutic target for septic shock. Beta-adrenergic regulation of the immune function in sepsis is complex and is time dependent. ⋯ Therefore, beta1 blockade as well as beta2 activation improves sepsis-induced immune, cardiovascular and coagulation dysfunctions. Beta2 blocking, however, seems beneficial in the metabolic field. Enough evidence has been accumulated in the literature to propose beta-adrenergic modulation, beta1 blockade and beta2 activation in particular, as new promising therapeutic targets for septic dyshomeostasis, modulating favorably immune, cardiovascular, metabolic and coagulation systems.
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Multicenter Study
Impact of emergency intubation on central venous oxygen saturation in critically ill patients: a multicenter observational study.
Central venous oxygen saturation (ScvO2) has emerged as an important resuscitation goal for critically ill patients. Nevertheless, growing concerns about its limitations as a perfusion parameter have been expressed recently, including the uncommon finding of low ScvO2 values in patients in the intensive care unit (ICU). Emergency intubation may induce strong and eventually divergent effects on the physiologic determinants of oxygen transport (DO2) and oxygen consumption (VO2) and, thus, on ScvO2. Therefore, we conducted a study to determine the impact of emergency intubation on ScvO2. ⋯ ScvO2 increases significantly in response to emergency intubation in the majority of septic and non-septic patients. When interpreting ScvO2 during early resuscitation, it is crucial to consider whether the patient has been recently intubated or is spontaneously breathing.
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Comparative Study
Comparison of three methods of extravascular lung water volume measurement in patients after cardiac surgery.
Measurement of extravascular lung water (EVLW) by using the lithium-thermal (Li-thermal) and single-thermal indicator dilution methods was compared with the indocyanine green-thermal (ICG-thermal) method in humans. ⋯ The principal finding of this study was that the prototype Li-thermal method did not provide reliable measurements of EVLW volume when compared with the ICG-thermal reference technique. Although minimal bias was associated with the single-thermal method, limits of agreement were approximately 45% of the normal value of EVLW volume. The Li-thermal method performed very poorly because of the overestimation of mean indicator transit time by using an external lithium ion electrode. These findings suggest that the assessment of lung water content by lithium-indicator dilution is not sufficiently reliable for clinical use in individual patients.
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Nitric oxide (NO) is an endogenous mediator of vascular tone and host defence. Inhaled nitric oxide (iNO) results in preferential pulmonary vasodilatation and lowers pulmonary vascular resistance. ⋯ This 'Bench-to-bedside' review focuses on the mechanisms of action of iNO and its clinical applications, with emphasis on acute lung injury and the acute respiratory distress syndrome. Developments in our understanding of the cellular and molecular actions of NO may help to explain the hitherto disappointing results of randomised controlled trials of iNO.