Arch Pediatr 2001 Dec;8(12):1373-8
Maternite, hotel-Dieu, 1, place de l'hopital, 69002 Lyon, France. anne.stephant@chu-lyon.fr
Delivery room management of neonatal respiratory disorders must be adapted to gestational age, etiology and clinical status at birth. Depending on these factors, management will require pharyngeal or tracheal aspiration, mask or mechanical ventilation, continuous positive pressure or oxygen alone. Its aim is to prevent or correct airway obstruction and inadequate oxygenation, and secondary metabolic disorders, prior to the transfer of the neonate in neonatal unit.
PMID: 11811036, UI: 21670595
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BMJ 2002 Mar 9;324(7337):615
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PMID: 11884341, UI: 21881346
Intensive Care Med 2002 Jan;28(1):29-37
Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh Medical Center, Division of Critical Care Medicine, 200 Lothrop Street, Pittsburgh, PA 15213-2582, USA. kellumja@anes.upmc.edu
OBJECTIVE: Patients with critical illness commonly develop acute renal failure requiring mechanical support in the form of either continuous renal replacement therapy (CRRT) or intermittent hemodialysis (IRRT). As controversy exists regarding which modality should be used for most patients with critically illness, we sought to determine whether CRRT or IRRT is associated with better survival. DESIGN: We performed a meta-analysis of all prior randomized and observational studies that compared CRRT with IRRT. Studies were identified through a MEDLINE search, the authors' files, bibliographies of review articles, abstracts and proceedings of scientific meetings. Studies were assessed for baseline characteristics, intervention, outcome and overall quality through blinded review. The primary end-point was hospital mortality, assessed by cumulative relative risk (RR). MEASUREMENTS AND RESULTS: We identified 13 studies ( n=1400), only three of which were randomized. Overall there was no difference in mortality (RR 0.93 (0.79-1.09), p=0.29). However, study quality was poor and only six studies compared groups of equal severity of illness at baseline (time of enrollment). Adjusting for study quality and severity of illness, mortality was lower in patients treated with CRRT (RR 0.72 (0.60-0.87), p<0.01). In the six studies with similar baseline severity, unadjusted mortality was also lower with CRRT (RR 0.48 (0.34 -0.69), p<0.0005). CONCLUSIONS: Current evidence is insufficient to draw strong conclusions regarding the mode of replacement therapy for acute renal failure in the critically ill. However, the life-saving potential with CRRT suggested in our secondary analyses warrants further investigation by a large, randomized trial.
PMID: 11818996, UI: 21676495
Intensive Care Med 2002 Jan;28(1):1-17
Department of Intensive Care, University Medical Centre, Vrije Universiteit, PO Box 7057, 1007 MB Amsterdam, The Netherlands. k.polderman@tip.nl
Central venous catheters are being increasingly used in both intensive care units and general wards. Their use is associated with both mechanical and infectious complications. This review will focus on short- and medium-term mechanical complications of catheter placement; infectious complications will be discussed in a separate article. The most important risk factors are patient characteristics (morbidity, underlying disease and local anatomy), the expertise of the doctor performing the procedure, and nursing care. Placement aids, such as ultrasound-guided catheter insertion, are also discussed.
PMID: 11818994, UI: 21676493
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