Critical care : the official journal of the Critical Care Forum
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The relationship between potassium regulation and outcome is not known. Our first aim in the present study was to determine the relationship between potassium level and variability in (ICU) stay and outcome. The second aim was to evaluate the impact of a computer-assisted potassium regulation protocol. ⋯ Hypokalemia, hyperkalemia and potassium variability were independently associated with increased mortality. Computerized potassium control clearly resulted in improved potassium metrics.
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Clinical Trial
Neurally adjusted ventilatory assist and proportional assist ventilation both improve patient-ventilator interaction.
The objective was to compare the impact of three assistance levels of different modes of mechanical ventilation; neurally adjusted ventilatory assist (NAVA), proportional assist ventilation (PAV), and pressure support ventilation (PSV) on major features of patient-ventilator interaction. ⋯ PAV and NAVA both prevent overdistention, improve neuromechanical coupling, restore the variability of the breathing pattern, and decrease patient-ventilator asynchrony in fairly similar ways compared with PSV. Further studies are needed to evaluate the possible clinical benefits of NAVA and PAV on clinical outcomes.
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Observational Study
Increase in cerebral oxygenation during advanced life support in out-of-hospital patients is associated with return of spontaneous circulation.
By maintaining sufficient cerebral blood flow and oxygenation, the goal of cardiopulmonary resuscitation (CPR) is to preserve the pre-arrest neurological state. To date, cerebral monitoring abilities during CPR have been limited. Therefore, we investigated the time-course of cerebral oxygen saturation values (rSO₂) during advanced life support in out-of-hospital cardiac arrest. Our primary aim was to compare rSO₂ values during advanced life support from patients with return of spontaneous circulation (ROSC) to patients who did not achieve ROSC. ⋯ During pre-hospital advanced life support, higher increases in rSO₂ are observed in patients attaining ROSC, even before ROSC was clinically determined. Our findings suggest that rSO₂ could be used in the future to guide patient tailored treatment during cardiac arrest and could therefore be a surrogate marker of the systemic oxygenation state of the patient.
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The objective of the study was to describe the pharmacokinetics (PK) of fluconazole, anidulafungin, and caspofungin in critically ill patients and to compare with previously published data. We also sought to determine whether contemporary fluconazole doses achieved PK/pharmacodynamic (PD; PK/PD) targets in this cohort of intensive care unit patients. ⋯ Considerable interindividual variability was observed for fluconazole, anidulafungin, and caspofungin. A large proportion of the patients (33%) receiving fluconazole did not attain the PK/PD target, which might be related to inadequate dosing. For anidulafungin and caspofungin, dose optimization also appears necessary to minimize variability.
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Acute respiratory distress syndrome (ARDS) is a syndrome characterized by diffuse pulmonary edema and severe hypoxemia that usually occurs after an injury such as sepsis, aspiration and pneumonia. Little is known about the relation between the setting where the syndrome developed and outcomes in ARDS patients. ⋯ Community-acquired ARDS have lower short- and long-term mortality rates than hospital-acquired or ICU-acquired ARDS.