Abstract:
PURPOSE:To assess the impact of lung ultrasound (LU) on clinical decision making in mechanically ventilated critically ill patients. METHODS:One hundred and eighty-nine patients took part in this prospective study. The patients were enrolled in the study when LU was requested by the primary physician for (1) unexplained deterioration of arterial blood gases and (2) a suspected pathologic entity [pneumothorax, significant pleural effusion (including parapneumonic effusion, empyema, or hemothorax), unilateral atelectasis (lobar or total), pneumonia and diffuse interstitial syndrome (pulmonary edema)]. RESULTS:Two hundred and fifty-three LU examinations were performed; 108 studies (42.7%) were performed for unexplained deterioration of arterial blood gases, and 145 (57.3%) for a suspected pathologic entity (60 for pneumothorax, 34 for significant pleural effusion, 22 for diffuse interstitial syndrome, 15 for unilateral lobar or total lung atelectasis, and 14 for pneumonia). The net reclassification index was 85.6%, indicating that LU significantly influenced the decision-making process. The management was changed directly as a result of information provided by the LU in 119 out of 253 cases (47%). In 81 cases, the change in patient management involved invasive interventions (chest tube, bronchoscopy, diagnostic thoracentesis/fluid drainage, continuous venous-venous hemofiltration, abdominal decompression, tracheotomy), and in 38 cases, non-invasive (PEEP change/titration, recruitment maneuver, diuretics, physiotherapy, change in bed position, antibiotics initiation/change). In 53 out of 253 cases (21%), LU revealed findings which supported diagnoses not suspected by the primary physician (7 cases of pneumothorax, 9 of significant pleural effusion, 9 of pneumonia, 16 of unilateral atelectasis, and 12 of diffuse interstitial syndrome). CONCLUSION:Our study shows that LU has a significant impact on decision making and therapeutic management.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Xirouchaki N,Kondili E,Prinianakis G,Malliotakis P,Georgopoulos Ddoi
10.1007/s00134-013-3133-3subject
Has Abstractpub_date
2014-01-01 00:00:00pages
57-65issue
1eissn
0342-4642issn
1432-1238journal_volume
40pub_type
杂志文章abstract:PURPOSE:Plasma immunoglobulin concentrations are acutely altered in critically ill patients with sepsis. However, the association between immunoglobulin levels on the day of sepsis diagnosis and subsequent mortality is inconsistent. METHODS:Systematic review of studies that report immunoglobulin measurements and morta...
journal_title:Intensive care medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1007/s00134-015-3845-7
更新日期:2015-08-01 00:00:00
abstract:PURPOSE:Computerized clinical decision support systems (CDSS) for intensive insulin therapy (IIT) generate recommendations using blood glucose (BG) values manually transcribed from testing devices to computers, a potential source of error. We quantified the frequency and effect of blood glucose transcription mismatches...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-010-1868-7
更新日期:2010-09-01 00:00:00
abstract:OBJECTIVE:Comparison of side effects (fever shivering and/or allergic reactions, collapse, symptomatic hypocalcaemia) of the different substitution fluids used during therapeutical plasmapheresis. DESIGN:Multicentric retrospective comparative study designed to explore the side effects due to the replacements fluids (a...
journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s001340050595
更新日期:1998-05-01 00:00:00
abstract:PURPOSE:Extracorporeal membrane oxygenation (ECMO) can support oxygenation and carbon dioxide elimination in severe lung failure. Usually it is accompanied by controlled mechanical ventilation. Neurally adjusted ventilatory assist (NAVA) is a new mode of ventilation triggered by the diaphragmatic electrical activity an...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-010-1982-6
更新日期:2010-12-01 00:00:00
abstract:OBJECTIVE:a) to describe a non-barotraumatic ventilatory setting for independent lung ventilation (ILV); b) to determine the utility of single lung end-tidal CO(2) (EtCO(2)) monitoring to evaluate the ventilation to perfusion (V/Q) matching in each lung during ILV and for ILV weaning. DESIGN:prospective study. SETTIN...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/s00134-001-1149-6
更新日期:2001-12-01 00:00:00
abstract:OBJECTIVES:Processed EEG monitoring has been suggested for sedation depth evaluation in intensive care unit (ICU) patients. The present study investigated the efficacy of two processed EEG monitors using SEF90% or SEF95% and BIS to differentiate between conscious (Ramsay score 4) and unconscious sedation (Ramsay score ...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s001340000761
更新日期:2001-01-01 00:00:00
abstract::Membranous laryngotracheobronchitis is a very serious infection which affects the larynx, trachea and bronchi, requiring aggressive therapeutic measures. It has been recently rediscovered as a cause of disease in children. However, it is a very unusual complication of measles. Two infants with measles and membranous l...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00273547
更新日期:1985-01-01 00:00:00
abstract::Measurements of added inspiratory work (AIW) of breathing imposed by three different CPAP systems were performed in 10 patients. One system was a continuous flow system while the two others were demand flow systems separated from respirators (Ohmeda VD 101 and Draeger CPAP 800 devices). AIW was calculated from pressur...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00292929
更新日期:1986-01-01 00:00:00
abstract:PURPOSE:To provide evidence-based guidelines for early enteral nutrition (EEN) during critical illness. METHODS:We aimed to compare EEN vs. early parenteral nutrition (PN) and vs. delayed EN. We defined "early" EN as EN started within 48 h independent of type or amount. We listed, a priori, conditions in which EN is o...
journal_title:Intensive care medicine
pub_type: 杂志文章,meta分析,实务指引,评审
doi:10.1007/s00134-016-4665-0
更新日期:2017-03-01 00:00:00
abstract::The side effects of positive pressure ventilation on cardiovascular function are well known. However, in most clinical studies its influence on left ventricular function was examined. In the present study right ventricular (RV) performance was studied in 13 patients undergoing coronary artery bypass grafting during me...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00256962
更新日期:1988-01-01 00:00:00
abstract:OBJECTIVE:To analyze the actual cost of pediatric intensive care and its different components, particularly the differences between various patient groups, with special reference to the variable cost and the elements included in it. DESIGN:Prospective, observational study. SETTING:Multidisciplinary 12-bed pediatric i...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050320
更新日期:1997-02-01 00:00:00
abstract:OBJECTIVES:To determine the effects of an intravenous bolus dose of a vasopressin analogue, terlipressin (1 mg), on systemic haemodynamic parameters and gastric mucosal perfusion (GMP) in patients with catecholamine-treated septic shock using a gastric tonometry and laser-Doppler flowmetry technique. DESIGN:Prospectiv...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/s00134-003-2094-3
更新日期:2004-04-01 00:00:00
abstract::The effects of 142 intravenous boluses of althesin (0.05 ml/kg) on cerebral perfusion pressure (CPP) were studied in twelve head injured comatose patients. The data were divided into those where the mean pre-bolus intracranial pressure (ICP) was above or below 20 mmHg and then subdivided into those where the minimum p...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00257469
更新日期:1988-01-01 00:00:00
abstract::The aim of this investigation was to evaluate the role of ultrasonography in avoiding cranial misplacement of the tracheostomy tube and tracheal ring fractures during percutaneous dilatational tracheostomy (PDT). The tracheas of 26 consecutive ICU patients who had undergone PDT but who later died were removed en bloc ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340000589
更新日期:2000-09-01 00:00:00
abstract:OBJECTIVE:Biomarkers allowing accurate early staging of septic shock patients are lacking despite their obvious interest for patient management. Experimental models of septic shock in mouse previously noted a decrease in dendritic cell numbers. The aim of the study was to find a rapid reproducible biological test for a...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-006-0436-7
更新日期:2007-01-01 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:OBJECTIVE:Do-not-resuscitate orders (DNR orders) and advance directives (AD) have been developed and their use by patients is increasing. The objective of the study was to evaluate the compliance with patient's wishes and doctors' and nurses' agreement on decision-making in the treatment of elderly patients from a cros...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340000602
更新日期:2000-09-01 00:00:00
abstract:OBJECTIVE:Pulmonary endothelial activation caused by high pulmonary capillary pressures may be involved in the pathogenesis of cardiogenic pulmonary edema (CPE). We studied soluble selectins and soluble ICAM-1 as markers of cell activation in the systemic and pulmonary circulation of patients with respiratory failure (...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340000843
更新日期:2001-03-01 00:00:00
abstract:OBJECTIVE:To validate a simple method avoiding discard volumes in pediatric patients with indwelling arterial and venous lines. DESIGN:Zero-discarding was achieved by passive extracorporeal arteriovenous backflow via standard single pressure transducer equipment. We tested backflow distances (10, 20 and 30 cm beyond t...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s001340100951
更新日期:2001-06-01 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::A 46-year-old man was diagnosed clinically brain dead after sustaining head trauma. The patient was in deep coma, brain nerves were unresponsive and spontaneous breathing was absent. However, EEG showed well preserved activity, but no reactivity to external stimuli. EEG activity disappeared within 40 h. BAEP were high...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF02425159
更新日期:1995-01-01 00:00:00
abstract::The influence of varying cardiac output (CO) on thermal-dye extravascular lung water (EVLW) was investigated in a total of 40 cardiac surgery patients before the onset of the operation. EVLW was measured by means of the double indicator dilution technique with indocyanine green as the non-diffusible indicator and a mi...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00255785
更新日期:1987-01-01 00:00:00
abstract:OBJECTIVE:To study plasma concentrations of interleukin 6 (IL-6) and interleukin 8 (IL-8) in patients with splanchnic hypoxia, as documented by gastric intramucosal measurements (pH-i), during major abdominal surgery and the relationship between IL-6 and IL-8 concentrations and postoperative complications as well as cl...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050575
更新日期:1998-04-01 00:00:00
abstract:OBJECTIVES:To establish a preliminary list of critical incidents (CIs) associated with mechanical ventilation and to describe a CI reporting method. DESIGN:A list of CIs was established based on a consensus among ICU caregivers. The list was compared to CIs collected prospectively during a predefined study period. SE...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s00134-002-1251-4
更新日期:2002-04-01 00:00:00
abstract:OBJECTIVE:A closed suction system (CS) maintains connection with the mechanical ventilator during tracheal suctioning and is claimed to limit loss in lung volume and oxygenation. We compared changes in lung volume, oxygenation, airway pressure and hemodynamics during endotracheal suctioning performed with CS and with a...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s001340100897
更新日期:2001-04-01 00:00:00
abstract:OBJECTIVE:Capillary leakage syndrome (CLS) is a frequent complication in sepsis, characterized by loss of intravasal fluids leading to generalized edema and hemodynamic instability despite massive fluid therapy. In spite of its importance no standardized diagnostic criteria are available for CLS. DESIGN:Prospective cl...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340000601
更新日期:2000-09-01 00:00:00
abstract::Physicians are increasingly involved in how their critically ill patients die [72]. The more this happens, the more physicians will have to understand not only how their own backgrounds and biases influence their medical management, but also the cultural and religious backgrounds of the patient and surrogate [72, 73]....
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s001340000641
更新日期:2000-10-01 00:00:00
abstract:OBJECTIVES:Critically ill patients often develop anaemia which can be related to a number of factors. However, the exact causes of anaemia in many patients remain unexplained. We hypothesized that the relationship between erythropoietin (EPO) and haematocrit may be altered in critically ill patients. DESIGN:Serum conc...
journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s001340050310
更新日期:1997-02-01 00:00:00
abstract::This article was originally published under a CC BY-NC 4.0 license, but has now been made available under a CC BY 4.0 license. The PDF and HTML versions of the paper have been modified accordingly. ...
journal_title:Intensive care medicine
pub_type: 杂志文章,已发布勘误
doi:10.1007/s00134-018-5254-1
更新日期:2018-05-01 00:00:00
abstract:OBJECTIVES:To study the pattern of lung emptying and expiratory resistance in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD). DESIGN:A prospective physiological study. SETTING:A 12-bed Intensive Care Unit. PATIENTS:Ten patients with acute exacerbation of COPD. INTERVENTIONS:At th...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s00134-004-2255-z
更新日期:2004-07-01 00:00:00