Abstract:
OBJECTIVE:This study was undertaken to determine the delay of extubation attributable to ventilator-associated pneumonia (VAP) in comparison to other complications and complexity of surgery after repair of congenital heart lesions in neonates and children. METHODS:Cohort study in a pediatric intensive care unit of a tertiary referral center. All patients who had cardiac operations during a 22-month period and who survived surgery were eligible (n = 272, median age 1.3 years). Primary outcome was time to successful extubation. Primary variable of interest was VAP Surgical procedures were classified according to complexity. Cox proportional hazards models were calculated to adjust for confounding. Potential confounders comprised other known risk factors for delayed extubation. RESULTS:Median time to extubation was 3 days. VAP occurred in 26 patients (9.6%). The rate of VAP was not associated with complexity of surgery (P = 0.22), or cardiopulmonary bypass (P = 0.23). The adjusted analysis revealed as further factors associated with delayed extubation: other respiratory complications (n = 28, chylothorax, airway stenosis, diaphragm paresis), prolonged inotropic support (n = 48, 17.6%), and the need for secondary surgery (n = 51, 18.8%; e.g., re-operation, secondary closure of thorax). Older age promoted early extubation. The median delay of extubation attributable to VAP was 3.7 days (hazards ratio HR = 0.29, 95% CI 0.18-0.49), exceeding the effect size of secondary surgery (HR = 0.48) and other respiratory complications (HR = 0.50). CONCLUSION:VAP accounts for a major delay of extubation in pediatric cardiac surgery.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Fischer JE,Allen P,Fanconi Sdoi
10.1007/s001340051285keywords:
subject
Has Abstractpub_date
2000-07-01 00:00:00pages
942-9issue
7eissn
0342-4642issn
1432-1238journal_volume
26pub_type
杂志文章abstract:OBJECTIVE:Pseudomonas aeruginosa-induced lung injury is characterized not only by the alteration in lung fluid movement but also by apoptosis of lung epithelial and endothelial cells. We studied whether inhibition of apoptosis using a broad spectrum caspase inhibitor, benzyloxycarbonyl-Val-Ala-Asp fluoromethylketone (Z...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-004-2165-0
更新日期:2004-06-01 00:00:00
abstract:INTRODUCTION:The concept of weaning-induced cardiac dysfunction emerged 26 years ago with the publication of a clinical study conducted by François Lemaire and collaborators. OBJECTIVES:One objective of this article is to remember the results and the historical context under which our pivotal study was conducted. Anot...
journal_title:Intensive care medicine
pub_type: 历史文章,杂志文章,评审
doi:10.1007/s00134-014-3334-4
更新日期:2014-08-01 00:00:00
abstract:PURPOSE:To compare characteristics, clinical evolution and outcome in adult patients with influenza A (H1N1) acute respiratory distress syndrome (ARDS) treated with or without extracorporeal membrane oxygenation (ECMO). METHODS:A prospective observational study of patients treated in Marseille South Hospital from Octo...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-010-2021-3
更新日期:2010-11-01 00:00:00
abstract:PURPOSE:The use of heat and moisture exchangers (HME) during noninvasive ventilation (NIV) can increase the work of breathing, decrease alveolar ventilation, and deliver less humidity in comparison with heated humidifiers (HH). We tested the hypothesis that the use of HH during NIV with ICU ventilators for patients wit...
journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1007/s00134-013-3145-z
更新日期:2014-02-01 00:00:00
abstract:OBJECTIVE:Nuclear factor-kappaB (NF-kappaB) is a transcription factor which plays a pivotal role in the induction of genes involved in the response to injury and inflammation. Calpain I inhibitor is a potent antioxidant which is an effective inhibitor of NF-kappaB. This study examined whether the postulate that calpain...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-004-2328-z
更新日期:2004-08-01 00:00:00
abstract:PURPOSE:To determine incidence, risk factors and outcome of tracheal ischemic lesions related to intubation. METHODS:Planned post hoc analysis using patients from a previous randomized controlled study. Fiberoptic tracheoscopy was performed during the 24 h following extubation. In patients with >2 ischemic lesions, ul...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-012-2750-6
更新日期:2013-04-01 00:00:00
abstract:: ...
journal_title:Intensive care medicine
pub_type: 评论,社论
doi:10.1007/s00134-018-5399-y
更新日期:2018-11-01 00:00:00
abstract::The recording of intratracheal pressure in patients breathing through a tracheostomy tube is marred by methodological problems. In model experiments it has been shown that the introduction of a recording catheter into the tracheostomy tube alters the recorded pressure by as much as 20-40%. To avoid such inaccuracy, a ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01735176
更新日期:1990-01-01 00:00:00
abstract::In critically ill patients, it is frequently challenging to identify who will benefit from admission to the intensive care unit and life-sustaining interventions when the chances of a meaningful outcome are unclear. In addition, the acute illness not only affects the patients but also family members or surrogates who ...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-018-5339-x
更新日期:2018-09-01 00:00:00
abstract:PURPOSE:Inflammatory markers may have a role in predicting severity of illness of intensive care unit (ICU) patients. The aim of this study is to determine whether low eosinophil count can predict 28-day mortality in medical ICU. METHODS:A prospective study over a 4-month period. To evaluate the prognosis information ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-011-2170-z
更新日期:2011-07-01 00:00:00
abstract::Myxoedema coma is a medical emergency with high mortality. In this study, clinical response and plasma variations of thyroid hormones were analysed in 7 patients, 6 presenting with myxoedema coma and one with myxoedema ileus. These patients were treated with intravenous or oral l-thyroxine (l-T4). 1000 mu l-T4 iv were...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01708403
更新日期:1991-01-01 00:00:00
abstract:OBJECTIVE:To describe Enterococcus faecalis colonisation and endocarditis in 5 intensive care patients after treatment with selective decontamination (SDD). SETTING:Intensive care unit (ICU) in a general hospital. PATIENTS:The patients were admitted to the ICU because of adult respiratory distress syndrome, polytraum...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01701478
更新日期:1995-03-01 00:00:00
abstract:OBJECTIVE:The role of critical care pharmacists in the United States has recently been documented; however, little information exists about the role of international critical care pharmacists. The objective of this study was to describe the duties and activities of international pharmacists who practice in critical car...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-007-0918-2
更新日期:2008-03-01 00:00:00
abstract::Central venous catheters (CVCs) are widely used in critically ill patients in intensive care units. However, infectious complications are common and may limit their utility. We critically review the literature to determine the impact of CVC design and composition, insertion site selection, insertion procedures, care a...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/BF01726542
更新日期:1995-02-01 00:00:00
abstract:OBJECTIVE:To evaluate the physiological effects of decannulation on breathing patterns and respiratory mechanics by comparing mouth breathing (MB) to tracheal breathing (TB) in tracheostomized patients. DESIGN AND SETTING:Prospective cross-over study in a critical and neuromuscular care unit. PATIENTS AND METHODS:Nin...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-002-1545-6
更新日期:2002-12-01 00:00:00
abstract:OBJECTIVE:To evaluate major similarities and major differences between Western European countries in intensive care unit (ICU) nurse staffing, education, training, responsibilities, and initiative. DESIGN:A questionnaire was sent to Western European doctor members of the European Society of Intensive Care Medicine, to...
journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s001340050693
更新日期:1998-09-01 00:00:00
abstract:OBJECTIVE:To identify factors that predict outcome in patients receiving a Medical Emergency Team review. DESIGN:Prospective observational study. SETTING:Tertiary hospital. PATIENTS:Cohort of 228 patients receiving one or more Medical Emergency Team reviews during daytime hours over a 1-year-period. Control cohort o...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-008-1229-y
更新日期:2008-11-01 00:00:00
abstract:PURPOSE:Family members of patients who die in the intensive care unit (ICU) may experience symptoms of stress, anxiety, depression, posttraumatic stress disorder (PTSD), and/or prolonged grief. We evaluated whether grief symptoms were alleviated if the physician and the nurse in charge at the time of death sent the clo...
journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1007/s00134-016-4669-9
更新日期:2017-04-01 00:00:00
abstract::The process of fluidisation involves blowing warm air through small solid microspheres thus creating a liquid, without wetness. The warmth provides some important properties including reducing the metabolic rate in thermal injury which has a beneficial effect on mortality, modifying catabolism after surgery, providing...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/BF01701488
更新日期:1995-03-01 00:00:00
abstract:OBJECTIVE:To determine the clinical impact of bedside colonoscopy for critically ill patients with acute lower gastrointestinal (GI) bleeding. DESIGN AND SETTING:A 3-year retrospective analysis (chart review). Medical intensive care unit (ICU) of a 1,312-bed tertiary-care center in Taiwan. PATIENTS AND PARTICIPANTS:F...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-005-2604-6
更新日期:2005-05-01 00:00:00
abstract:OBJECTIVE:Hospital mortality of patients with septic multiorgan failure (MOF) is still around 95%. The present study investigates whether this high mortality could be significantly reduced by the addition of sequential hemofiltration (SH) with bicarbonate hemodialysis (HD) to the currently used life supportive measures...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01726531
更新日期:1995-02-01 00:00:00
abstract:OBJECTIVE:To investigate the theoretical interactions between ventilator settings, tracheal gas insufflation (TGI), and alveolar ventilation. DESIGN:We derived differential equations governing compartmental volume changes in a one-compartment model of TGI-assisted ventilation and equations governing gas dilution in th...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01699238
更新日期:1996-10-01 00:00:00
abstract::Achievement of a mean blood pressure (MBP) target is one of the hemodynamic goals to ensure an adequate blood perfusion pressure in critically ill patients. Arterial catheter allows for a continuous and precise monitoring of arterial pressure signal. In addition to giving a precise MBP monitoring, analysis of the bloo...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-010-2092-1
更新日期:2011-03-01 00:00:00
abstract::The treatment of severe tetanus with autonomic dysfunction is discussed, with emphasis on the use of magnesium sulphate. An exemplary case is reported, describing the inadequate response to magnesium, but the previously unreported and successful use of clonidine to control sympathetic overactivity. The properties of c...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/BF02575297
更新日期:1990-01-01 00:00:00
abstract::Conventional PEEP ventilation has been recently reported to be deleterious in some cases of ARF with unilateral pneumonia. In such respect, two cases of unilateral bacterial pneumonia were intubated with a Carlens tracheal tube. Measurement of tidal volume, static compliance, and functional residual capacity of each l...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01683935
更新日期:1979-11-01 00:00:00
abstract:OBJECTIVES:To measure the extent of dilution of helium-oxygen (heliox) by room air when given via high concentration reservoir mask to spontaneously breathing subjects. Substantial dilution of heliox by room air under these circumstances might alter its physical properties sufficiently to negate any potential clinical ...
journal_title:Intensive care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s00134-008-1064-1
更新日期:2008-08-01 00:00:00
abstract:OBJECTIVES:(a) To measure gastric tonometry values in critically ill patients with peritonitis and to assess the impact of epidural analgesia on these values. (b) To assess the impact of epidural analgesia on gastro-intestinal motility by abdominal ultrasound and paracetamol absorption. (c) To observe any change in cli...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s001340000671
更新日期:2000-11-01 00:00:00
abstract:OBJECTIVE:To assess the effects of intravenous fish oil fat emulsion on the metabolic alterations induced by lipopolysaccharide (LPS) challenge in healthy volunteers. DESIGN:Two groups of eight healthy subjects were randomized to receive either two pharmacological doses of intravenous FO fat emulsion or no treatment. ...
journal_title:Intensive care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s00134-007-0591-5
更新日期:2007-05-01 00:00:00
abstract:PURPOSE:To investigate the relationship between hemoglobin (Hgb) and brain tissue oxygen tension (PbtO(2)) after severe traumatic brain injury (TBI) and to examine its impact on outcome. METHODS:This was a retrospective analysis of a prospective cohort of severe TBI patients whose PbtO(2) was monitored. The relationsh...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-012-2593-1
更新日期:2012-09-01 00:00:00
abstract::A randomized study of 30 patients undergoing uncomplicated surgery under spinal anesthesia was conducted to assess the influence of colloids on the kinetics of plasma fibronectin and complement. Both are opsonins of the reticuloendothelial system; moreover fibronectin is concerned with host resistance against septic c...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/BF01691428
更新日期:1991-01-01 00:00:00