BACKGROUND AND OBJECTIVE: Mortality prediction systems have been calculated and validated from large mixed ICU populations. However, in daily practice it is often more important to know how a model performs in a patient subgroup at a specific ICU. Thus, we assessed the performance of three mortality prediction models in ...

OBJECTIVE: The aim of this study was to test the efficacy of a respiratory weaning algorithm (WA) in postoperative cardiac surgery patients. This algorithm was made simple enough to be implemented in medium-end ventilator software. PATIENTS: Twenty consecutive postoperative patients who underwent scheduled cardiac surgery with normal postoperative haemodynamic and ...

OBJECTIVE: To determine the effects of low-dose prolonged methylprednisolone infusion on lung function in patients with early severe ARDS. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: ICUs of five hospitals in Memphis. PARTICIPANTS: Ninety-one patients with severe early ARDS (</= 72 h), 66% with sepsis. INTERVENTIONS: Patients were randomized (2:1 fashion) ...

Late-onset sepsis (LOS) (i.e., sepsis in a neonate after 72 hours of life) is associated with high mortality and significantly prolonged antibiotic exposure and hospital stay in neonates admitted to intensive care units (ICU). In this study, we assessed the reliability of serum C-reactive protein (CRP) as a determinant of ...

BACKGROUND: The efficacy of corticosteroids in reducing the incidence of postextubation laryngeal oedema is controversial. We aimed to test our hypothesis that methylprednisolone started 12 h before a planned extubation could prevent postextubation laryngeal oedema. METHODS: We did a placebo-controlled, double-blind multicentre trial in 761 adults in intensive-care units. Patients ...

Initial antibiotic therapy is an important determinant of clinical outcomes in ventilator-associated pneumonia (VAP). Several studies have investigated this issue, with conflicting results. This study investigated risk factors of inadequate empirical antimicrobial therapy and its impact on outcomes for patients with a clinical diagnosis of VAP. The primary outcome was ...

BACKGROUND/AIMS: In surgical sepsis, the rapid identification of source of infection at an early stage after surgery or serious trauma is crucial for favorable outcome. The discrimination between local and generalized infection is critical for correct treatment. METHODOLOGY: In a randomized, controlled, single-centre study we investigated 72 patients with severe ...

OBJECTIVE: This study was designed to search for risk factors predicting mortality of patients with Wegener's granulomatosis (WG) treated on the intensive care unit (ICU). METHODS: Seventeen patients admitted to the ICU of an University Hospital for an acute illness related to WG were analysed retrospectively over 4 years. A ...

STUDY OBJECTIVE: To determine whether low tidal ventilation in patients without lung injury results in an increase in the amount of atelectasis and a further impairment of gas exchange during general anesthesia. DESIGN: Randomized, single-blind study. SETTING: University hospital. PATIENTS: 16 adult, ASA physical status I and II patients, who ...

BACKGROUND: Hospitalisation periods for the acute exacerbation phase of COPD are a strain on health facilities and entail high rates of hospital mortality. The aim of this study was to ascertain the characteristics of treatment periods resulting in death and the risk factors involved on the basis of treatment registers ...

OBJECTIVE: To determine the change in the statewide incidence of severe acquired subglottic stenosis (SGS) in newborns over the past decade. METHODS: Multicenter, statewide retrospective study of all patients under the age of 12 months who were diagnosed with acquired SGS that required surgical intervention by anterior cricoid split (ACS) ...

OBJECTIVE: To investigate trends in ventilator-associated pneumonia (VAP) rates during participation in the German nosocomial infection surveillance system (Krankenhaus-Infektions-Surveillance-System [KISS]). METHODS: A total of 71 ICUs that began participating in KISS in 1999 or later and continued participation for at least 36 months were selected. Beginning with the first month ...

There are few data on long-term outcomes in mixed groups of intensive care unit (ICU) patients with prolonged stays. We evaluated the relationship between length of stay in the ICU and long-term outcome in all patients admitted to our 31-bed department of medico-surgical intensive care over a one-year period who ...

A 52-year-old patient with Klippel-Feil syndrome was scheduled for elective C1 dorsal laminectomy and occipito-cervical stabilisation under general anaesthesia. Preoperatively she had bulbar symptoms and a history of recurrent aspiration pneumonia, but no evidence of cardiovascular disease. When she was turned prone she developed persistent tachycardia, hypotension and ST segment ...

BACKGROUND: In some hospitals, patients are mechanically ventilated on the wards in addition to the intensive care unit (ICU) because of the shortage of ICU beds. OBJECTIVE: The aim of the study was to compare the outcome and ventilatory management of medical patients mechanically ventilated on the medical wards and ...

BACKGROUND: The primary objective of this study was to determine the long-term outcomes of all patients requiring prolonged intensive care unit (ICU) stay following coronary bypass surgery (CABG) surgery. METHODS: All patients undergoing CABG surgery between 1998 and 2002 were reviewed. Prolonged ICU stay was defined as more than 48 ...

OBJECTIVE: To determine the incidence and outcome of severe sepsis in the adult Finnish population and to evaluate how treatment guidelines in severe sepsis are applied in clinical practice. STUDY DESIGN: A prospective study in 24 closed multidisciplinary ICUs in 21 hospitals (4 university and 17 tertiary hospitals) in Finland. ...

BACKGROUND AND OBJECTIVE: Tracheostomy is one of the most common procedures in intensive care units worldwide. In this study we aimed to compare three different tracheostomy techniques with respect to duration of procedure and complications. METHODS: One hundred and thirty patients requiring endotracheal intubation for more than 10 days due ...

<b>Purpose:</b> The esophageal Doppler monitoring (EDM) has emerged as an alternative to the pulmonary artery catheter (PAC). The purpose of this study is to better define its role in the ICU. <b> Materials and Methods:</b> Retrospective review of Hemosonic™ 100 EDM probe use between 2003 and 2005. Patient- and EDM-related ...

<b>Study Objectives: </b> To compare the survival benefits and cost effectiveness of cefepime-levofloxacin (C-L) as an alternative empirical antibiotic therapy for ventilator associated pneumonia (VAP) with the most widely recommended combination of piperacillin-tazobactam and amikacin (P-T-A). <b> Design:</b> Prospective, observational, cohort study. <b> Materials and Methods:</b> A total number of ...

Thirteen patients with severe neuroparalytic snake envenomation admitted in intensive care unit with respiratory failure over a four months period. Initially ptosis and ophthalmoplegia, followed by bulbar palsy and respiratory muscle weakness was the common sequele. All of them received cardio-respiratory support with mechanical ventilation, anti-snake venom (median dose of ...

Sivelestat sodium hydrate is a selective inhibitor of neutrophil elastase (NE), and is effective in acute lung injury associated with systemic inflammatory response syndrome (SIRS). The effect of Sivelestat for postoperative clinical courses after transthoracic esophagectomy was investigated. Consecutive patients with carcinoma of the thoracic esophagus who underwent transthoracic esophagectomy ...

BACKGROUND: The aim of this study was to assess the incidence of organ failure in trauma patients treated in an intensive care unit (ICU), and to study the relationship between organ failure and long-term survival and functional status. METHODS: This is a cohort study of all adult ICU trauma patients ...

INTRODUCTION: Several studies have shown that maximizing stroke volume (or increasing it until a plateau is reached) by volume loading during high-risk surgery may improve post-operative outcome. This goal could be achieved simply by minimizing the variation in arterial pulse pressure (deltaPP) induced by mechanical ventilation. We tested this hypothesis ...

Thoracic epidural anesthesia (TEA) combined with general anesthesia in cardiac surgery has the potential to initiate earlier spontaneous ventilation and extubation, improved hemodynamics, less arrhythmia or myocardial ischemia, and an attenuated neurohormonal response. The aim of the current study was to characterize the correlation between TEA and postoperative resource use ...

BACKGROUND: Acidosis, hypothermia, and coagulopathy were identified more than 20 years ago as a deadly triad for patients presenting with exsanguinating hemorrhage. This led to fundamental changes in initial management of severely injured patients. Despite major advances, hemorrhage remains a leading cause of early death in trauma patients. Recent studies ...

BACKGROUND: Mitochondrial dysfunction may be causally related to the pathogenesis of organ failure in critically ill patients. Decreased mitochondrial DNA (mtDNA) levels have been associated with mitochondrial dysfunction and were investigated here in relation to short-term (31-day) survival. METHODS: This was a prospective longitudinal cohort study of 28 mechanically ventilated ...

INTRODUCTION: For patients with critical conditions including severe sepsis, minimizing the time from presentation to treatment is important to improving outcomes. Understanding the factors influencing high hospital mortality and resource utilization in severe sepsis continues to interest clinicians and researchers. This study examined the associations between timing of drotrecogin alfa ...

INTRODUCTION: It has been shown that early central venous oxygen saturation (ScvO2)-guided optimization of hemodynamics can improve outcome in septic patients. The early ScvO2 profile of other patient groups is unknown. The aim of this study was to characterize unplanned admissions in a multidisciplinary intensive care unit (ICU) with respect ...

BACKGROUND: Coronary artery bypass grafting (CABG) is associated with high morbidity in patients with chronic obstructive pulmonary disease (COPD).We examine the effect of preoperative systemic corticosteroids on morbidity in this setting. METHODS: Ninety candidates for elective CABG participated in a prospective, open randomized trial, including 30 patients with COPD who ...

AIM: To evaluate the influence of Acute Physiology and Chronic Health Evaluation (APACHE II) score on the choice of mechanical ventilation method and treatment outcome. METHODS: A prospective, randomized trial was carried out at the multidisciplinary Intensive Care Unit over 22 months. Research sample consisted of 129 patients who required ...

The purpose of this study was to evaluate the impact of recombinant human erythropoietin (rHuEPO) use for anemia of critical illness at a practice site where delayed initiation is common. Retrospective medical record review involving patients treated with rHuEPO for anemia of critical illness. Those patients given rHuEPO or diagnosed ...

BACKGROUND: As infection with vancomycin-resistant enterococci (VRE) increases in hospitals, knowledge about VRE reservoirs and improved accuracy of epidemiologic measures are needed. Many assessments underestimate incidence by including prevalent carriers in at-risk populations. Routine surveillance cultures can substantially improve prevalence and incidence estimates, and assessing the range of improvement across ...

Severe sepsis remains a common cause of death in surgical patients. Eradication of the septic source and supportive care has long been the mainstay of treatment. In recent years, however, early goal-directed therapy, tighter glucose control, administration of drotrecogin alfa (activated), and steroid replacement have produced improved morbidity and mortality. ...

BACKGROUND: Nitric oxide (NO) is present in the gas phase of the normal human stomach at a high concentration (1-10 ppm). The majority of this NO is produced from the reduction of dietary nitrate to nitrite and finally NO. Generation of this nonenzymatically produced gastric NO occurs only in an ...

OBJECTIVE: We examined long-term outcome of pulmonary function, exercise capacity and health-related quality of life (HRQoL) in patients with acute respiratory distress syndrome (ARDS) caused by severe acute respiratory syndrome (SARS). METHODS: 59 critically ill patients with ARDS caused by SARS between March and July 2003 were studied prospectively and ...

BACKGROUND: Acute intestinal ischemic disorder (AIID) is an uncommon vascular disease with high mortality. According to etiology, it can be categorized into three groups: arterial occlusive mesenteric ischemia (AOMI), mesenteric venous thrombosis (MVT), and nonocclusive mesenteric ischemia (NOMI). This study analyzes the effect of classification on surgical outcome. PATIENTS AND ...

STUDY OBJECTIVES: To analyze the short- and long-term effects of domiciliary non-invasive ventilation (NIV) in the elderly. METHODS: From 1990 to 2005 all patients who initiated NIV at age 75 or older were included in the study. The mean follow-up period was 36 (24) months. Data were obtained from a ...

OBJECTIVE: We examined whether guiding therapy by an algorithm based on optimizing the global end-diastolic volume index (GEDVI) reduces the need for vasopressor and inotropic support and helps to shorten ICU stay in cardiac surgery patients. DESIGN AND SETTING: Single-center clinical study with a historical control group at an university ...

PURPOSE: Traditional treatment of giant omphaloceles with silo closure has been associated with respiratory insufficiency, hemodynamic compromise, dehiscence, and inability to close the abdomen with subsequent death. To minimize such complications, initial nonoperative management with delayed closure of the defect has been used. METHODS: Between January 1981 and December 2002, ...

The aim of this study was to determine the etiology and appropriate surgical treatment for acquired tracheal stenosis that developed in patients who had undergone prolonged endotracheal mechanical ventilation as premature neonates. During the period 2000-2004, four patients aged 1-16 years were referred for tracheal stenosis characterized by stridor, choking, ...

OBJECTIVE: To evaluate the effects of neuromuscular blocking agents (NMBAs) on pulmonary and systemic inflammation in patients with acute respiratory distress syndrome ventilated with a lung-protective strategy. DESIGN: Multiple-center, prospective, controlled, and randomized trial. SETTING: One medical and two medical-surgical intensive care units. PATIENTS: A total of 36 patients with ...

Acute organophosphate poisoning (OPP) such as dichlorvos may be monitored by the measurement of the erythrocyte acetyl cholinesterase (EAChE) and the serum cholinesterase (SChE) activities. The aim of this study was to look at correlation between the severity of the OPP judged by certain parameters such as coma, hemodynamic disturbances, ...

BACKGROUND: Emergency department short-stay units (EDSSUs) are currently emerging worldwide as an alternative to standard inpatient hospitalisation. In our hospital, a 960-bed teaching tertiary institution in Barcelona, Spain, an EDSSU has been in operation during winter periods (November-March) since 1997. AIM: To determine the efficacy and safety of our EDSSU. ...

OBJECTIVES: We determined the historical trends at our institution in the extubation success rate, defined as avoiding tracheostomy, for infants with acquired laryngotracheal stenosis (LTS) who undergo anterior cricoid split (ACS) as primary treatment. METHODS: We performed a retrospective chart review of all neonates with acquired LTS treated with ACS ...

OBJECTIVE: To evaluate the efficacy of a simple mechanical device to maintain constant endotracheal cuff pressure (Pcuff) during mechanical ventilation (large encased inflatable cuff connected to the endotracheal cuff and receiving constant pressure from a heavy mass attached to an articulated arm). DESIGN AND SETTING: Single-center, prospective, randomized, crossover, pilot ...

BACKGROUND: The perioperative management of children with non-idiopathic scoliosis undergoing spinal deformity surgery has not been standardized and the current practice is to routinely ventilate these patients in the postoperative period. This study reports the experience from a single institution and evaluates the need and reasons for postoperative ventilation. Details ...

Mechanical ventilation can be lifesaving, but > 50% of complications in conditions that require intensive care are related to ventilatory support, particularly if it is prolonged. We retrospectively evaluated the medical records of patients who had mechanical ventilation in the Pediatric Intensive Care Unit (PICU) during a follow-up period between ...

Our objective was to describe the incidence of perioperative complications of lung transplantation among patients with emphysema and fibrosis and the morbidity and mortality risk factors. MATERIALS AND METHODS: We performed a retrospective study of 111 lung transplant patients engrafted from 1992 to 2002 for emphysema (n = 65) or ...

Arterial hypotension with vasopressor dependence is a major problem after cardiac surgery. We evaluated the early postoperative course of 1558 consecutive patients scheduled for cardiac surgery, and compared the outcome of patients with and without vasopressor dependence (defined as the need for > 0.1 microg x kg(-1) x h(-1) noradrenaline ...