BACKGROUND AND OBJECTIVE: Although non-invasive ventilation (NIV) has been shown to be effective in a wide variety of respiratory diseases, its role in severe asthma attacks remains uncertain. The aim of this study was to clarify the effectiveness of NIV in patients experiencing severe attacks of asthma. METHODS: A retrospective ...

The purpose of this study was to define clinical and radiographic variables associated with postoperative mortality after urgent colectomy for fulminant Clostridium difficile colitis. Data were obtained regarding patients undergoing colectomy for fulminant C. difficile colitis at two institutions (1997-2005). Univariate analysis of factors predicting 30-day mortality was performed using ...

PURPOSE: Some severe complications during percutaneous dilatational tracheostomy (PDT) may be related to poor visualization of tracheal structures. Subjectively, the bronchoscopical view obtained via a laryngeal mask airway (LMA) seems to be better than that obtained with an endotracheal tube (ETT). In this prospective, randomized study, we compared LMA and ...

OBJECTIVES: To describe the effectiveness of the Surviving Sepsis Campaign bundles with regard to both implementation and outcome in patients with septic shock and to determine the contribution of the various elements of the bundles to the outcome. DESIGN: Quasi-experimental study with a historical comparison group. SETTING: The three medical-surgical ...

We performed a prospective, quasi-experimental, randomised, interventional study comparing two models of care for patients admitted with osteoporotic hip fractures between February and August 2007 in a tertiary university hospital. The usual model of care was treatment of patients admitted to the orthopaedics ward, with consultation by the geriatrician (CG ...

Out-of-hospital tracheal intubation is controversial because of questions regarding its safety as well as its impact on patient care. Factors contributing to the controversy include failed intubations, number of attempts required, prolonged periods without ventilation, and misplaced tracheal tubes. However, the most important factors are the decision-making and clinical skills ...

OBJECTIVE: The effect of early endoscopic intervention (EI; within 72 hours) remains a controversial subject. This prospective study was aimed to evaluate the efficacy of early EI without fluoroscopy on severe acute biliary pancreatitis (SABP) in the intensive care unit (ICU). METHODS: Fifty-three patients with SABP + ampullary obstruction in ...

BACKGROUND: Little data exist examining the impact of positive pressure ventilation on safe thoracostomy tube removal. We sought to evaluate the impact of positive-pressure ventilation (PPV) on recurrent pneumothoraces (PTX) after removal of thoracostomy tubes (TT). METHODS: A retrospective cohort analysis was performed evaluating all trauma patients requiring TT drainage ...

BACKGROUND: Intensive insulin therapy (IIT) has been shown to reduce morbidity and mortality in critically ill patients. Little investigation has been done to find out whether it improves the prognosis of patients with severe traumatic brain injury (STBI). METHODS: We conducted a prospective controlled study where adult patients with blunt ...

INTRODUCTION: Multiple studies have used administrative datasets to examine the epidemiology of sepsis in general, but the entity of postoperative sepsis has been studied less intensively. Therefore, we undertook an analysis of the epidemiology of postoperative sepsis using the Nationwide Inpatient Sample, the largest in-patient dataset available in the United ...

OBJECTIVES: To (1) reduce deep sedation and delirium to permit mobilization, (2) increase the frequency of rehabilitation consultations and treatments to improve patients' functional mobility, and (3) evaluate effects on length of stay. DESIGN: Seven-month prospective before/after quality improvement project. SETTING: Sixteen-bed medical intensive care unit (MICU) in academic hospital. ...

Despite remarkable progress that has been achieved in the recent years in the diagnosis, prevention, and therapy for ventilator-associated pneumonia (VAP), this disease continues to create complication during the course of treatment in a significant proportion of patients while receiving mechanical ventilation. This study was designed to evaluate the effect ...

This study was conducted to identify current practice in provision of enteral nutrition (EN) and to determine effects of early enteral nutrition (EEN) on length of stay in the medical intensive care unit (ICU). In this prospective, observational study, medical ICU patients were evaluated to determine their candidacy for EEN. ...

The optimum septic shock vasopressor support strategy is currently debated. This study was performed to evaluate the efficacy and safety of norepinephrine (NE) and dopamine (DA) as the initial vasopressor in septic shock patients who were managed with a specific treatment protocol. A prospective, randomized, open-label, clinical trial was used ...

Despite improvements in medical care, the mortality of critically ill patients with acute kidney injury (AKI) who require renal replacement therapy (RRT) remains high. We describe a new approach, sustained hemodiafiltration, to treat patients who suffered from acute kidney injury and were admitted to intensive care units (ICUs). In our ...

Few data are available on the long-term outcome of noninvasive positive pressure ventilation (NPPV) for obesity hypoventilation syndrome (OHS). This study was designed to determine long-term survival, treatment adherence, and prognostic factors in patients with OHS in whom NPPV was initiated in an acute setting vs under stable clinical conditions. ...

INTRODUCTION: Although increasing consecutive compressions during cardiopulmonary resuscitation (CPR) is beneficial to patients, it possibly affects the workload and, ultimately, the quality of CPR. This study examines the effects of compression-to-ventilation ratio on external chest compression performance of rescuers. METHODS: Subjects were 17 health care providers. Each participant performed CPR ...

The objective of the study was to evaluate the efficacy of sivelestat, a selective neutrophil elastase inhibitor, on body fluid balance after transthoracic esophagectomy. Esophagectomy with elective lymphadenectomy may induce excessive release of neutrophil elastase, which then promotes vascular permeability and an excessive water shift from the intravascular space to ...

BACKGROUND: Many studies have identified strong correlations between winter months and acute, unintentional carbon monoxide (CO) poisoning. In this study, we aimed to investigate the incidence pattern of acute domicile-related CO poisoning in Beijing and its relation with climatic factors. METHODS: Data on CO poisoning were collected from the emergency ...

OBJECTIVES: To identify risk factors associated with mortality and adverse outcome of community acquired cellulitis/erysipelas requiring hospital admission. METHODS: A retrospective analysis of 395 episodes of cellulitis/erysipelas admitted to a tertiary referral hospital between January 1999 and December 2006. RESULTS: Mortality was 2.5% (10/395). There were 112 complications (28.4%). Median ...

Recent data associated higher mortality with medical rather than surgical intervention in patients with ulcerative colitis who require hospitalization. To examine factors influencing UC-related mortality in Scotland. Using the national record linkage database 1998-2000, 3-year mortality was determined after four admission types: colectomy-elective or emergency; no colectomy-elective or emergency. Of ...

PURPOSE: Selective digestive microbial decontamination (SDD) is hypothesized to benefit patients in intensive care (ICU) by suppressing Gram-negative potential pathogens from the colon without affecting the anaerobic intestinal microbiota. The purpose of this study was to provide more insight to the effects of digestive tract and oropharyngeal decontamination on the ...

Postoperative delirium after cardiac surgery is associated with increased morbidity and mortality as well as prolonged stay in both the intensive care unit and the hospital. The authors sought to identify modifiable risk factors associated with the development of postoperative delirium in elderly patients after elective cardiac surgery in order ...

OBJECTIVE: To establish the incidence and long-term prognosis of iatrogenic gas embolism. METHODS: This was a prospective inception cohort. We included all consecutive adults with proven iatrogenic gas embolism admitted to the sole referral academic hyperbaric center in Paris. Treatment was standardized as one hyperbaric session at 4 ATA for ...

OBJECTIVE: The aim of the present study was to validate the Simplified Acute Physiology Score II (SAPS II) and 3 (SAPS 3), the Mortality Probability Models III (MPM(0)-III), and the Cancer Mortality Model (CMM) in patients with cancer admitted to several intensive care units (ICU). DESIGN: Prospective multicenter cohort study. ...

Despite diagnostic advances, delays in the diagnosis of pulmonary embolism (PE) are common. In this study, we aimed to investigate the relationship between delays in the diagnosis of PE and underlying risk factors for PE. We retrospectively evaluated the records of 408 patients with acute PE. Patients were divided into ...

Different pathogens cause different outcomes for patients with sepsis. They influence intensive care unit (ICU) mortality, ICU length of stay (ICU LOS) and the need for mechanical ventilation (MV). We undertook a retrospective data-based analysis over a 6-y period. Seventy-eight patients with methicillin-sensitive Staphylococcus aureus (MSSA) and 74 patients with ...

AIM: The classic laryngeal mask airway (cLMATM) can be used in place of an endotracheal tube (ETT) as the ventilatory device during percutaneous dilational tracheostomy (PDT). We aimed to investigate the possible loss of efficacy of cLMATM after tracheal intubation. METHODS: Severity of laryngeal lesions and efficacy of cLMATM were ...

In this study, we compared the effects of 3% hypertonic saline (HTS) and 20% mannitol on brain relaxation during supratentorial brain tumor surgery, intensive care unit (ICU) stays, and hospital days. This prospective, randomized, and double-blind study included patients who were selected for elective craniotomy for supratentorial brain tumors. Patients ...

Varicella-zoster virus (VZV) pneumonia is one of the most serious complications of this infection in adults. The objective of this study was to analyze the epidemiological and clinical characteristics in a large sample of patients with VZV pneumonia. This was a 10-y retrospective, descriptive, observational study. We studied 46 patients ...

We observed the clinical and microbiological characteristics of several stages of bloodstream infections (BSI), as well as the mortality attributed to it in a tertiary hospital in the northeast of Brazil (in the city of Maceió, Alagoas). A prospective cohort of 143 patients who had at least one positive blood ...

OBJECTIVE: The aim of this study was to update the state of knowledge of unplanned extubations in the pediatric population. The main topics addressed in the current literature on unplanned extubations were: 1) incidence; 2) risk factors; 3) risk factors for reintubation after unplanned extubations; and 4) strategies to prevent ...

AIM: Retrospective study on the changing position impact on respiratory events in 14 rehabilitation tracheotomized tetraplegic patients, during 25 months. METHODS: Three positions were compared: permanently supine (16 periods), seated on <or=5 days/week (20 periods), or seated on >or=6 days/week (10 periods). The end-point was the incidence of the following ...

BACKGROUND AND OBJECTIVE: Few data are available on the efficacy of noninvasive ventilation (NIV) in postoperative patients with acute respiratory failure (ARF). METHODS: Seventy-two patients coming from the surgical wards with postoperative ARF were retrospectively evaluated. The major characteristics of patients who were intubated were compared with the characteristics of ...

BACKGROUND: Long-segment tracheobronchial malacia may cause life-threatening dysfunction of the airway system at different levels. This study presents the long-term follow-up (1992 through 2008) of patients who received surgical treatment with external tracheal stabilization in our institution. METHODS: Eleven patients fulfilled the inclusion criteria. In surviving patients who presented for ...

BACKGROUND: The advent of preformed silos has facilitated routine bedside placement often without any attempt of intestinal reduction. It is unclear whether a strategy of routine silo (RS) placement with delayed fascial repair is beneficial over attempted primary repair (aPR) and silo placement only for those patients who cannot be ...

BACKGROUND/AIMS: Ventilating patients with acute respiratory distress syndrome (ARDS) in the prone position has been shown to improve arterial oxygenation, but prolonged prone positioning frequently requires continuous deep sedation, which may be harmful to patients. We evaluated the meaning of early gas exchange in patients with severe ARDS under prolonged ...

To assess the effects of preoperative administration of allopurinol in patients undergoing open-heart surgery (OHS) for valvular heart diseases. In this prospective randomised double-blind study, 50 consecutive patients undergoing OHS for valvular heart disease were randomised into two groups of 25 patients each: (a) control group received placebo and (b) ...

PURPOSE: This study aimed to determine differences in neutrophil levels between those receiving long-course neoadjuvant chemoradiotherapy (nCXRT) and those proceeding straight to surgery (StS) for rectal cancer, and in those who developed serious septic events within 30 post-operative days within each group. METHOD: Patients undergoing elective surgery between 2006 and ...

OBJECTIVE: To validate Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality (PIM) score. METHODS: All consecutive patients over a six month period were included in the study except patients with a PICU stay of less than 2 hours, those transferred to other PICUs, pediatric surgical cases, trauma patients ...

The purpose of this study was to evaluate the effect of ginger extract on delayed gastric emptying, developing ventilator-associated pneumonia, and clinical outcomes in adult respiratory distress syndrome (ARDS). Thirty-two ARDS patients who were dependent on mechanical ventilation and fed via nasogastric tube were studied. After enrollment, patients were randomized ...

Cricothyroidotomy is the final rescue maneuver in difficult airway management. We compared 4 techniques of oxygenation via the cricothyroid membrane in a manikin. The techniques were wire guided, trocar, cannula with jet ventilation, and blade technique (scalpel with endotracheal tube). In the wire-guided group, the time taken to ventilation was ...

Prone position ventilation for acute hypoxemic respiratory failure (AHRF) improves oxygenation but not survival, except possibly when AHRF is severe. To determine effects of prone versus supine ventilation in AHRF and severe hypoxemia [partial pressure of arterial oxygen (PaO(2))/inspired fraction of oxygen (FiO(2)) <100 mmHg] compared with moderate hypoxemia (100 ...

OBJECTIVE: To investigate the impact of prophylactic continuous lateral rotation therapy on the prevalence of ventilator-associated pneumonia, duration of mechanical ventilation, length of stay, and mortality in critically ill medical patients. DESIGN: Prospective, randomized, clinical study. SETTING: Three medical intensive care units of an university tertiary care hospital. PATIENTS: Patients ...

BACKGROUND AND AIMS: The reduced alpha1-antitrypsin (AAT) activities of some phenotypes have been suggested as contributing to the development of respiratory diseases. MATERIALS AND METHODS: One hundred patients with respiratory disease following exposure to sulfur mustard were divided into two groups of 50 based on their respiratory symptoms and compared ...

BACKGROUND: Percutaneous dilatational tracheostomy (PDT) is a common procedure in critically ill patients, but the correct timing is still controversial. This study was designed to establish whether an early timing in video-guided Ciaglia Blue Rhino PDT affects the duration of mechanical ventilation (MV) and the length of stay (LOS) in ...

Standard treatment of critically ill patients undergoing mechanical ventilation is continuous sedation. Daily interruption of sedation has a beneficial effect, and in the general intesive care unit of Odense University Hospital, Denmark, standard practice is a protocol of no sedation. We aimed to establish whether duration of mechanical ventilation could ...

The WHO classification of pesticides by hazard is based primarily on the acute oral and dermal toxicity to rats. In several Asian countries there is no legislation against the sale of Class I insecticides. We evaluated if there was an association between the WHO hazard Class I, II or III ...

Respiratory complications are the most frequent concern following oesophagectomy. We aimed to assess the postoperative inflammatory response after oesophagectomy and to determine its reliability to predict the occurrence of pulmonary complications. A total of 97 patients were enrolled in this prospective observational study. All patients underwent a transthoracic oesophagectomy for ...

The combination of high-frequency oscillatory ventilation (HFOV) and extracorporeal carbon dioxide removal with the interventional lung assist (iLA) in severe acute respiratory distress syndrome (ARDS) represents a novel treatment option. The study used a retrospective single-center analysis of 21 consecutive adult patients with severe ARDS, ventilated with HFOV/iLA. Efficiency, side ...