Articles: patients.
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Critical care medicine · Jun 2013
Pleural Pressure and Optimal Positive End-Expiratory Pressure Based on Esophageal Pressure Versus Chest Wall Elastance: Incompatible Results.
1) To compare two published methods for estimating pleural pressure, one based on directly measured esophageal pressure and the other based on chest wall elastance. 2) To evaluate the agreement between two published positive end-expiratory pressure optimization strategies based on these methods, one targeting an end-expiratory esophageal pressure-based transpulmonary pressure of 0 cm H2O and the other targeting an end-inspiratory elastance-based transpulmonary pressure of 26 cm H2O. DESIGN:: Retrospective study using clinical data. SETTING:: Medical and surgical ICUs. PATIENTS:: Sixty-four patients mechanically ventilated for acute respiratory failure with esophageal balloons placed for clinical management. ⋯ Esophageal pressure and chest wall elastance-based methods for estimating pleural pressure do not yield similar results. The strategies of targeting an end-expiratory esophageal pressure-based transpulmonary pressure of 0 cm H2O and targeting an end-inspiratory elastance-based transpulmonary pressure of 26 cm H2O cannot be considered interchangeable. Finally, chest wall and respiratory system elastances may vary unpredictably with changes in positive end-expiratory pressure. (Crit Care Med 201;41:0-0).
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Critical care medicine · Jun 2013
Atypical Sleep in Ventilated Patients: Empirical Electroencephalography Findings and the Path Toward Revised ICU Sleep Scoring Criteria.
Standard sleep scoring criteria may be unreliable when applied to critically ill patients. We sought to quantify typical and atypical polysomnographic findings in critically ill patients and to begin development and reliability testing of methodology to characterize the atypical polysomnographic tracings that confound standard sleep scoring criteria. DESIGN:: Prospective convenience sample. SETTING:: Two academic, tertiary care medical centers. PATIENTS:: Thirty-seven critically ill, mechanically ventilated, medical ICU patients. INTERVENTIONS:: None. MEASUREMENTS AND MAIN ⋯ Analysis of polysomnographic data revealed profound deficiencies in standard scoring criteria due to a predominance of atypical polysomnographic findings in ventilated patients. The revised scoring scheme proved reliable in sleep staging and may serve as a building block in future work.
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Critical care medicine · Jun 2013
Bacteremia in the Patients With Acute Pancreatitis as Revealed by 16S Ribosomal RNA Gene-Based Techniques.
To define the characteristic of bacteremia in the patients with acute pancreatitis and determine its possible association with the disease severity. DESIGN:: A prospective controlled study. SETTING:: ICU of Jinling Hospital, China. PATIENTS:: A total of 48 patients with mild or severe acute pancreatitis were enrolled in this study. INTERVENTIONS:: None. MEASUREMENTS AND MAIN ⋯ This study provides a detailed description on the prevalence of bacteremia and characteristic of bacterial species in patients with acute pancreatitis. We demonstrate an association between the bacteremia and the disease severity, which enables us to better understand a potential role of bacterial translocation in the pathogenesis of septic complication in acute pancreatitis.
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Addict Sci Clin Pract · Jun 2013
ReviewCare for hospitalized patients with unhealthy alcohol use: a narrative review.
There is increasing emphasis on screening, brief intervention, and referral to treatment (SBIRT) for unhealthy alcohol use in the general hospital, as highlighted by new Joint Commission recommendations on SBIRT. However, the evidence supporting this approach is not as robust relative to primary care settings. ⋯ The review summarizes the major issues involved in caring for patients with unhealthy alcohol use in the general hospital setting, including prevalence, detection, assessment of severity, reduction in drinking with brief intervention, common acute management scenarios for heavy drinkers, and discharge planning. The review concludes with consideration of Joint Commission recommendations on SBIRT for unhealthy alcohol use, integration of these recommendations into hospital work flows, and directions for future research.