Articles: critical-illness.
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Critical care medicine · Nov 2010
Randomized Controlled TrialFeasibility of physical and occupational therapy beginning from initiation of mechanical ventilation.
Physical and occupational therapy are possible immediately after intubation in mechanically ventilated medical intensive care unit patients. The objective of this study was to describe a protocol of daily sedative interruption and early physical and occupational therapy and to specify details of intensive care unit-based therapy, including neurocognitive state, potential barriers, and adverse events related to this intervention. ⋯ Early physical and occupational therapy is feasible from the onset of mechanical ventilation despite high illness acuity and presence of life support devices. Adverse events are uncommon, even in this high-risk group.
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Randomized Controlled Trial
Neurally adjusted ventilatory assist in critically ill postoperative patients: a crossover randomized study.
Neurally adjusted ventilatory assist (NAVA) is a new mode of mechanical ventilation that delivers ventilatory assist in proportion to the electrical activity of the diaphragm. This study aimed to compare the ventilatory and gas exchange effects between NAVA and pressure support ventilation (PSV) during the weaning phase of critically ill patients who required mechanical ventilation subsequent to surgery. ⋯ Compared with PSV, respiratory parameter variability was greater with NAVA, probably leading in part to the significant improvement in patient oxygenation.
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J. Clin. Endocrinol. Metab. · Oct 2010
Randomized Controlled TrialGlucose dysregulation and neurological injury biomarkers in critically ill children.
Targeting normoglycemia with intensive insulin therapy (IIT) improved short-term outcome of pediatric intensive care unit (PICU) patients but increased the incidence of hypoglycemia. Both hyperglycemia and hypoglycemia may adversely affect the developing brain. ⋯ IIT in PICU did not evoke neurological damage detectable by circulating S100B and NSE, despite increased incidence of hypoglycemia. Elevated markers in patients with hypoglycemia were not caused by hypoglycemia itself but rather reflect an increased incidence of hypoglycemia in the most severely ill. This hypoglycemia risk appears difficult to capture by classical illness severity scores.
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Am. J. Respir. Crit. Care Med. · Sep 2010
Randomized Controlled Trial Multicenter StudyEarly lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial.
It is unknown whether lactate monitoring aimed to decrease levels during initial treatment in critically ill patients improves outcome. ⋯ In patients with hyperlactatemia on ICU admission, lactate-guided therapy significantly reduced hospital mortality when adjusting for predefined risk factors. As this was consistent with important secondary endpoints, this study suggests that initial lactate monitoring has clinical benefit. Clinical trial registered with www.clinicaltrials.gov (NCT00270673).
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Intensive care medicine · Sep 2010
Randomized Controlled TrialProbiotics in the critically ill patient: a double blind, randomized, placebo-controlled trial.
Probiotics have been shown to be able to restore a non-pathogenic digestive flora, to prevent digestive colonization by pathogenic bacteria, and to modulate immunity. The aim of this study was to assess the effects of prophylactic probiotic administration in patients ventilated for up to 2 days. ⋯ Although numerous uncertainties remain (type and the number of strains to use, delay and length of administration), and despite an acceptable safety profile, the daily prophylactic administration of probiotics cannot be encouraged in the critically ill patient.