Articles: prospective-studies.
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Pediatr Crit Care Me · Jun 2014
Observational StudyPatient Safety in South Africa: PICU Adverse Event Registration.
Adverse event registration is a means to improve patient safety in a PICU. So far it has been used in European and North American countries mainly. We studied adverse events in a South African setting with the aims to 1) assess rates and types of adverse events with two different registration methods and 2) describe characteristics of patients experiencing adverse events. ⋯ The trigger tool method identifies a higher adverse event rate compared with real-time registration. Each method has a unique contribution to yield types of adverse events.
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Otolaryngol Head Neck Surg · Jun 2014
Comparative StudyWater Uptake Performance of Hygroscopic Heat and Moisture Exchangers after 24-Hour Tracheostoma Application.
After total laryngectomy, patients suffer from pulmonary complaints due to the shortcut of the upper airways that results in decreased warming and humidification of inspired air. Laryngectomized patients are advised to use a heat and moisture exchanger (HME) to optimize the inspired air. According to manufacturers' guidelines, these medical devices should be replaced every 24 hours. The aim of this study is to determine whether HMEs still function after 24-hour tracheostoma application. ⋯ The water uptake capacity of hygroscopic HEMs is clinically acceptable although no longer optimal after 24-hour tracheostoma application. From a functional point of view, the guideline for daily device replacement is therefore justified.
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Observational Study
Oxygen Challenge Test in Septic Shock Patients: Prognostic Value and Influence of Respiratory Status.
Transcutaneous oxygen pressure (PtcO2) value in response to an increase of FiO2 or oxygen challenge test (OCT) in ventilated patients has been reported to be related to peripheral perfusion and outcome during septic shock. However, patients with sepsis-related acute respiratory distress syndrome could demonstrate compromised arterial oxygenation with OCT impairment decoupled to circulatory failure. The aims of this study were to confirm the prognostic value of OCT and to explore the influence of respiratory status on OCT results. ⋯ Moreover, patients with low OCT results at T24 exhibited more severe respiratory failure (P < 0.01). The OCT at T24 is related to outcome but is influenced by the severity of respiratory failure. Our results suggest considering with caution hemodynamic management based on OCT in septic shock patients with altered pulmonary function.
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Pediatr Crit Care Me · Jun 2014
Observational StudyHemodynamic Changes in Preterm Neonates With Septic Shock: A Prospective Observational Study.
We evaluated hemodynamic changes in preterm neonates with septic shock using functional echocardiography and studied the effects of vasoactive drugs on hemodynamic variables. ⋯ We found an elevated left ventricular output but normal ejection fraction in preterm neonates with septic shock. This suggests that septic shock in preterm neonates is predominantly due to vasoregulatory failure. Vasoactive drugs significantly increased right ventricular output, which was predominantly due to increase in heart rate.
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Observational Study
Influence of Arterial Dissolved Oxygen Level on Venous Oxygen Saturation: Don't Forget the Pao2!
Dissolved oxygen (i.e., unbound to hemoglobin) is often neglected as a determinant of central venous oxygen saturation (ScvO2) in review articles and textbooks. These statements may lead to potential misinterpretation of SCvO2 value across FiO2 changes. In this study, we aimed to explore the influence of PaO2 and FiO2 on ScvO2 in ventilated critically ill patients. ⋯ Arterial dissolved oxygen level can significantly influence the ScvO2 value. Therefore, PaO2 should not be overlooked while considering the ScvO2 value as a therapeutic goal. Interpretation of ScvO2 variations in response to a therapeutic challenge (i.e., fluid challenge, inotropic drug initiation) should be performed at constant FiO2.