Critical care : the official journal of the Critical Care Forum
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Randomized Controlled Trial Comparative Study Clinical Trial
Enteral feeding in the critically ill: comparison between the supine and prone positions: a prospective crossover study in mechanically ventilated patients.
Prone position is effective in mechanically ventilated patients to improve oxygenation. It is unknown if prone position affects gastric emptying and the ability of continued enteral feeding. ⋯ Our results suggest that enteral feeding can be continued when a patient is turned from supine to prone position or vice versa. The results indicate that patients with a clinically significant gastric residual volume in one position are likely to have a clinically significant gastric residual volume in the other position.
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Ventilating patients with acute respiratory failure according to standardized recommendations can lead to varying volume-pressure (V-P) relationships and overdistension. Young children may be more susceptible than adults to overdistension, and individual evaluation of the effects of ventilator settings is therefore required. Three studies have applied indices for the detection of overdistension to dynamic V-P curves in ventilated children. Two of those studies compared these indices to those obtained using a reference technique ([quasi]-static V-P curves), and suggested that the c coefficient of a second order polynomial equation (SOPE) and the ratio of the volume-dependent elastance to total dynamic elastance (%E2) were suitable indices for estimating overdistension.
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The purpose of the present study is to determine whether airway pressure release ventilation (APRV) can safely enhance hemodynamics in patients with acute lung injury (ALI) and/or adult respiratory distress syndrome (ARDS), relative to pressure control ventilation (PCV). ⋯ APRV may be used safely in patients with ALI/ARDS, and decreases the need for paralysis and sedation as compared with PCV-inverse ratio ventilation (IRV). APRV increases cardiac performance, with decreased pressor use and decreased airway pressure, in patients with ALI/ARDS.
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Computing technology has the potential to improve health care management but is often underutilized. Handheld computers are versatile and relatively inexpensive, bringing the benefits of computers to the bedside. We evaluated the role of this technology for managing patient data and accessing medical reference information, in an academic intensive-care unit (ICU). ⋯ The introduction of this technology was well received despite differences in users' familiarity with the devices. Handheld computers have potential in the ICU, but systems need to be developed specifically for the critical-care environment.
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Accessibility to tertiary intensive care resources differs among hospitals within a rural region. Determining whether accessibility is associated with outcome is important for understanding the role of regionalization when providing critical care to a rural population. ⋯ Patients at community hospitals in this area who develop need for tertiary critical care are just as likely to survive as patients who develop ICU needs on the wards of this rural tertiary-care hospital, despite different accessibility to tertiary intensive-care services.