Order this document
Anaesthesia 2002 Oct;57(10):1047
Specialist Registrar and Consultant, Intensive Care Unit, Selly Oak Hospital, University Hospital Birmingham NHS Trust, Birmingham B29 6JD.
[Medline record in process]
PMID: 12358989, UI: 22246039
Other Formats:
Chest 2002 Sep;122(3):1073-6
Division of Pulmonary and Critical Care Medicine, Evanston Northwestern Healthcare, IL, USA. g-mutlu@northwestern.edu
PMID: 12226056, UI: 22213182
Chest 2002 Sep;122(3):990-7
Division of Critical Care Medicine, Vancouver Hospital and Health Sciences Center, University of British Columbia, Vancouver, BC, Canada. vdhingra@vanhosp.bc.ca
STUDY OBJECTIVE:s: Individual comparison of cardiac output via intermittent thermodilution and Fick technique over a wide range of cardiac outputs. DESIGN: Prospective clinical investigation. SETTING: Multidisciplinary ICUs of two teaching hospitals in Vancouver, British Columbia. PARTICIPANTS: Eighteen critically ill patients who had pulmonary and systemic arterial catheters and in whom active support was being withdrawn. INTERVENTIONS: Measurement of thermodilution cardiac output and calculation of Fick cardiac output while support was withdrawn. Active support was withdrawn in a three-step process: removal of vasopressors followed by decrease in fraction of inspired oxygen to 0.21, and finally removal of mechanical ventilation. MEASUREMENTS AND RESULTS: Simultaneous Fick and thermodilution cardiac outputs were obtained over a wide range. Fick calculated cardiac outputs were obtained using the Fick equation with oxygen uptake (O(2)) being measured with indirect calorimetry. O(2) determinations were made using five measurements over 5 min, with the mean being used for subsequent analysis. Thermodilution cardiac outputs were determined by the mean of five measurements, with the first being discarded. Coefficient of variation was calculated for the O(2) and thermodilution cardiac outputs. One hundred thirty-six simultaneous cardiac outputs were obtained in 18 patients with a mean APACHE (acute physiology and chronic health evaluation) II score of 25.5. The range of cardiac outputs was 1.39 to 16.95 L/min. Linear regression analysis found a good correlation of the data sets, with an R of 0.85. Bias and precision calculations found a bias of - 0.17 L/min with the upper and lower limits of agreement being 2.96 L/min and - 3.30 L/min, respectively. In patients with high cardiac outputs (> 7 L/min), the bias was - 1.90 with the limits of agreement being 1.87 L/min and - 5.67 L/min. The coefficient of variation for O(2) was 4.6% and for thermodilution cardiac output was 7.75%. CONCLUSIONS: There was good consistency of each of the measurements with a low coefficient of variation. The bias for the whole group was small, but the limits of agreement extended into a clinically relevant area, resulting in a lack of agreement. In patients with high cardiac outputs, the Fick tended to consistently produce higher cardiac outputs compared to thermodilution, suggesting a systematic error.
PMID: 12226045, UI: 22213171
Chest 2002 Sep;122(3):973-9
Department for Intensive Internal Medicine, General Hospital Celje, Oblakova, Slovenia. Matej.Podbregar@guest.arnes.si
STUDY OBJECTIVE: To assess the impact of morphologically different central pulmonary artery thromboemboli in patients with massive pulmonary emboli (MPEs) on short-term outcome. DESIGN: A prospective registry of consecutive patients. SETTING: An 11-bed closed medical ICU at a 860-bed community general hospital PATIENTS: Forty-seven patients with shock or hypotension due to MPE and central pulmonary thromboemboli detected by transesophageal echocardiography who were treated with thrombolysis between January 1994 and April 2000. PROCEDURES: Patients were divided into two groups according to the following characteristics of the detected thromboemboli: group 1, thrombi with one or more long, mobile parts; and group 2, immobile thrombi. Right heart catheterization was performed. RESULTS: The incidence of both types of thromboemboli was comparable. Groups 1 and 2 showed no differences in demographic data, risk factors for pulmonary embolism, length of preceding clinical symptoms, percentage of patients in shock, hemodynamic variables, serum lactate levels on hospital admission, and treatment. Seven fatal cases due to obstructive shock and right heart failure were present in group 2, but none were present in group 1 (7 of 23 patients vs 0 of 24 patients, respectively; p < 0.05). At 12 h, the cardiac index was lower in group 2 than in group 1 (2.6 +/- 1.0 vs 3.1 +/- 0.9 L/min/m(2), respectively; p < 0.05), and the central venous pressure (15.0 +/- 6.2 vs 12.5 +/- 3.7 mm Hg, respectively; p < 0.05) and total pulmonary resistance (12.9 +/- 5.9 vs 8.6 +/- 2.7 mm Hg/L/min/m(2), respectively; p < 0.001) were higher in group 2 compared to group 1. On hospital admission, inclusion in group 2 (p < 0.03; hazard ratio, 9.53; 95% confidence interval [CI], 1.19 to 76.47) and preexisting chronic medical or neurologic disease (p < 0.01; hazard ratio, 16.4; 95% CI, 1.97 to 136.3) were independent predictors of 30-day mortality. CONCLUSION: On hospital admission, morphology of the thromboemboli and the presence of pre-existing chronic medical or neurologic disease are independent predictors of 30-day mortality. Patients with immobile central pulmonary thromboemboli have a worse short-term outcome than those with mobile central pulmonary thromboemboli.
PMID: 12226042, UI: 22213168
Chest 2002 Sep;122(3):771-4
Publication Types:
PMID: 12226011, UI: 22213137
Intensive Care Med 2002 May;28(5):547-53
Neurosciences Critical Care Unit, Addenbrooke's Hospital, Cambridge, UK.
OBJECTIVES: To document the effect of neurocritical care, delivered by specialist staff and based on protocol-driven therapy aimed at intracranial pressure (ICP) and cerebral perfusion pressure (CPP) targets, on outcome in acute head injury. DESIGN: Retrospective record review to compare presentation, therapy and outcome in patients with head injury referred to a regional neurosurgical centre, before and after establishment of protocol-driven therapy. SETTING: Neurosciences Critical Care Unit (NCCU). PARTICIPANTS: Two hundred and eighty-five patients aged 18-65 years with at least one reactive pupil, referred with a diagnosis of head injury, requiring tracheal intubation and mechanical ventilation. INTERVENTIONS: Measurement of Glasgow Outcome Scale 6 months after injury. RESULTS: Patients from the two epochs were well matched for admission Glasgow Coma Scale and extracranial injuries. When all referred patients were considered, institution of protocol-driven therapy was not associated with a statistically significant increase in favourable outcomes (56.0% vs. 66.4%). However, we observed a significant increase in favourable outcomes in the severely head injured patients studied (40.4% vs. 59.6%). The proportion of favourable outcomes was also high (66.6%) in those presenting with evidence of raised ICP in the absence of a mass lesion and (60.0%) in those that required complex interventions to optimise ICP/CPP. CONCLUSIONS: Specialist neurocritical care with protocol-driven therapy is associated with a significant improvement in outcome for all patients with severe head injury. Such management may also benefit patients requiring no surgical therapy, some of whom may need complex therapeutic interventions. We found it impossible to predict need for such interventions from clinical features at presentation. These data suggest that specialist critical care with ICP/CPP guided therapy may benefit patients with severe head injury.
PMID: 12029400, UI: 22024543
Intensive Care Med 2002 May;28(5):532-4
PMID: 12029398, UI: 22024541
Intensive Care Med 2002 May;28(5):529-31
PMID: 12029397, UI: 22024540
Other Formats: Links:
Pediatrics 2002 Oct;110(4):E45-5
Schneider Children's Hospital, North Shore-Long Island Jewish Health System, Long Island, New York. Children's Hospital of New York, Columbia University, New York, New York.
BACKGROUND: Ureaplasma urealyticum and its association with chronic lung disease (CLD) of prematurity has remained a controversial topic. To readdress this question, we performed a longitudinal study using culture and polymerase chain reaction to detect U urealyticum in the respiratory tract of very low birthweight infants throughout their neonatal intensive care unit hospitalizations. METHODS: We screened 125 infants weighing <1500 g and/or <32 weeks' gestational age over a 12-month period, collecting endotracheal, nasopharyngeal, and throat specimens on days of age 1, 3, 7, and weekly thereafter. CLD was defined as dependency on supplemental oxygen at 28 days and at 36 weeks' postconceptional age. RESULTS: Forty infants (32%) had 1 or more positive specimens by culture or polymerase chain reaction. We identified 3 patterns of U urealyticum colonization: persistently positive (n = 18), early transient (n = 14), and late acquisition (n = 8). We compared the rates of CLD in each of the 3 colonized groups with the rate of CLD in the noncolonized group. We found a significantly higher rate of CLD at 28 days of age (odds ratio: 8.7; 95% confidence interval: 3.3, 23) and at 36 weeks' postconception (odds ratio: 38.5, 95% confidence interval: 4.0, 374) only for infants with persistently positive colonization. CONCLUSIONS: This study demonstrates that the risk of developing CLD varies with the pattern of U urealyticum colonization. Only the persistently positive colonization pattern, which accounted for 45% of the U urealyticum-positive infants, was associated with a significantly increased risk of development of CLD.
PMID: 12359818, UI: 22247551
Pediatrics 2002 Oct;110(4):707-11
Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital of the University Hospitals of Cleveland, Cleveland, Ohio.
OBJECTIVE: This study was designed to test whether rotation of antibiotics can reduce colonization with resistant Gram-negative bacilli in a neonatal intensive care unit (NICU). METHODS: A monthly rotation of gentamicin, piperacillin-tazobactam, and ceftazidime was compared with unrestricted antibiotic use in side-by-side NICU populations (rotation team vs control team). Pharyngeal and rectal samples were obtained 3 times a week and tested for Gram-negative bacilli resistant to each of the rotation antibiotics. Pulsed-field gel electrophoresis analysis determined the numbers of genetically discordant resistant organisms on each team. The association between colonization with a resistant bacillus (the primary outcome) and team assignment was tested. RESULTS: A total of 1062 infants were studied during a 1-year period. A total of 10.7% infants on the rotation team versus 7.7% on the control team were colonized with a resistant bacillus. No interteam differences were distinguishable when the numbers of genetically discordant resistant organisms were normalized to the total number of team admissions. The incidence of nosocomial infection and mortality also were similar across teams. CONCLUSION: These data indicate that rotation of parenteral antibiotics according to the applied protocol has no detectable effect in decreasing the reservoir of resistant Gram-negative bacilli in a tertiary-care NICU.
PMID: 12359783, UI: 22247516
Thorax 2002 Sep;57(9):823-9
Unit of Critical Care, NHLI Division, Imperial College of Science, Technology & Medicine and Royal Brompton Hospital, London SW3 6NP, UK.
Pharmacological approaches to the treatment of ARDS are reviewed. Future treatments should be targeted at elements of the pathological process that produce specific clinical problems.
PMID: 12200529, UI: 22189196
the above reports in Macintosh PC UNIX Text HTML format documents on this page through Loansome Doc