Abstract:
PURPOSE:Mechanical ventilation with lower tidal volumes (≤6 ml/kg of predicted body weight, PBW) could benefit patients without acute respiratory distress syndrome (ARDS). However, tidal volume reduction could be associated with increased patient discomfort and sedation needs, and consequent longer duration of ventilation. The aim of this individual patient data meta-analysis was to assess the associations between tidal volume size, duration of mechanical ventilation, and sedation needs in patients without ARDS. METHODS:Studies comparing ventilation with different tidal volume sizes in patients without ARDS were screened for inclusion. Corresponding authors were asked to provide individual participant data. Patients were assigned to three groups based on tidal volume size (≤6 ml/kg PBW, 6-10 ml/kg PBW, or ≥10 ml/kg PBW). Ventilator-free days, alive at day 28, and dose and duration of sedation (propofol and midazolam), analgesia (fentanyl and morphine), and neuromuscular blockade (NMB) were compared. RESULTS:Seven investigations (2,184 patients) were included in the analysis. The number of patients breathing without assistance by day 28 was higher in the group ventilated with tidal volume ≤6 ml/kg PBW compared to those ventilated with tidal volume ≥10 ml/kg PBW (93.1 vs. 88.6%; p = 0.027, respectively). Only two investigations (187 patients) could be included in the meta-analysis of sedation needs. There were neither differences in the percentage of study days that patients received sedatives, opioids, or NMBA nor in the total dose of benzodiazepines, propofol, opioids, and NMBA. CONCLUSIONS:This meta-analysis suggests that use of lower tidal volumes in patients without ARDS at the onset of mechanical ventilation could be associated with shorter duration of ventilation. Use of lower tidal volumes seems not to affect sedation or analgesia needs, but this must be confirmed in a robust, well-powered randomized controlled trial.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Serpa Neto A,Simonis FD,Barbas CS,Biehl M,Determann RM,Elmer J,Friedman G,Gajic O,Goldstein JN,Horn J,Juffermans NP,Linko R,de Oliveira RP,Sundar S,Talmor D,Wolthuis EK,de Abreu MG,Pelosi P,Schultz MJdoi
10.1007/s00134-014-3318-4subject
Has Abstractpub_date
2014-07-01 00:00:00pages
950-7issue
7eissn
0342-4642issn
1432-1238journal_volume
40pub_type
杂志文章,meta分析,评审abstract:OBJECTIVES:To analyse the clinical value of procalcitonin (PCT), C-reactive protein (CRP) and leucocyte count in the diagnosis of paediatric sepsis and in the stratification of patients according to severity. DESIGN:Prospective, observational study. SETTING:Paediatric intensive care unit (PICU). PATIENTS:Ninety-four...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-006-0509-7
更新日期:2007-03-01 00:00:00
abstract:PURPOSE:To describe the course of early organ dysfunction in a cohort of patients admitted in ICU suffering classic heatstroke. METHODS:Prospective observational single-centre cohort study with a 1-year follow-up. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Clinical and biological data of 22 patients were anal...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-009-1500-x
更新日期:2009-08-01 00:00:00
abstract::Status epilepticus is one of the most frequent neurological emergencies in the intensive care unit. Standard treatment includes intravenous barbiturates, benzodiazepines and phenytoin. However, drug coma is sometimes necessary to control refractory status epilepticus. We report such a case, successfully treated by int...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01707672
更新日期:1994-01-01 00:00:00
abstract:OBJECTIVE:Evaluation of low-level PEEP (5 cm H2O) and the two different CPAP trigger modes in the Bennett 7200a ventilator (demand-valve and flow-by trigger modes) on inspiratory work of breathing (Wi) during the weaning phase. DESIGN:Prospective controlled study. SETTING:The intensive care unit of a university hospi...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/BF01712329
更新日期:1995-11-01 00:00:00
abstract::In alcoholic patients, metabolic acidosis can be related to lactate acidosis associated with sepsis or thiamine deficiency, ketoacidosis, methanol or ethylene glycol poisoning. High resolution proton nuclear magnetic resonance (NMR) can be used to detect abnormal organic acid metabolites in urine or serum from patient...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340100892
更新日期:2001-04-01 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness of screening strategy and contact precautions for patients with methicillin-resistant Staphylococcus aureus (MRSA). DESIGN AND SETTING:Prospective observational cohort from 1 February 1995 to 31 December 2001 in three intensive care units (45 beds) in a French teaching hospital....
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-005-2679-0
更新日期:2005-08-01 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::Arterial blood ketone body ratio, reflecting hepatic mitochondrial redox state, was measured in 26 brain-dead patients who were hypotensive but hemodynamically stable. All of them had substantially normal hepatic function. In 18 of the patients, blood ketone body ratio was maintained within the normal range in spite o...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01691432
更新日期:1991-01-01 00:00:00
abstract:OBJECTIVE:Erythrocytes influence the magnitude of hypoxia-induced pulmonary artery pressure increase. It is, however, unknown to what extent haemoconcentration and haemodilution affect this response and whether intrapulmonary blood volume (and thus vessel dimensions) alters the magnitude of pressure increase. Furthermo...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340051327
更新日期:2000-08-01 00:00:00
abstract:OBJECTIVE:There is considerable heterogeneity among randomized trials comparing high-frequency ventilation (HFV) with conventional mechanical ventilation (CMV) in premature neonates with respiratory distress syndrome. We investigated what factors explained differences in outcome among these trials. DESIGN:Meta-regress...
journal_title:Intensive care medicine
pub_type: 杂志文章,meta分析
doi:10.1007/s00134-007-0545-y
更新日期:2007-04-01 00:00:00
abstract:OBJECTIVE:To investigate the effectiveness of an enhanced software Model Predictive Control (eMPC) algorithm for intravenous insulin infusion, targeted at tight glucose control in critically ill patients, over 72 h, in two intensive care units with different management protocols. DESIGN:Comparison with standard care i...
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/s00134-008-1236-z
更新日期:2009-01-01 00:00:00
abstract::Neuromuscular blocking agents (NMBAs) inhibit patient-initiated active breath and the risk of high tidal volumes and consequent high transpulmonary pressure swings, and minimize patient/ ventilator asynchrony in acute respiratory distress syndrome (ARDS). Minimization of volutrauma and ventilator-induced lung injury (...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-020-06297-8
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVE:Pulmonary flow resistance is mainly determined by vessel calibres, resulting from the interaction of volume-passive distension and active vasomotion. However, quantitative information on the interplay between these counteracting forces in the lung is lacking. Therefore, we aimed at quantifying (1) the effects...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340051090
更新日期:1999-12-01 00:00:00
abstract:OBJECTIVE:A case-control comparison of Doppler guidance on the success rate of central venous cannulation in patients with normal or reduced intracranial compliance. DESIGN:A single operator performed central venous access procedures with continuous wave Doppler guidance. It was used on patients on a ventilator. The p...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/s00134-003-1862-4
更新日期:2003-09-01 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:OBJECTIVE:To determine the relationship between the clinically evaluated depth of midazolam-induced sedation and the cardiac beat-to-beat variability (RR variability) in ICU patients in the intensive care unit (ICU). DESIGN:Prospective study. SETTING:ICU of a university hospital. PATIENTS:20 consecutive patients stu...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01709555
更新日期:1996-12-01 00:00:00
abstract::Nosocomial pneumonia continues to represent a significant cause of morbidity and mortality in hospitalized patients. Bacteria are responsible for greater than 90% of the pneumonias, the most common isolates being aerobic Gram-negative bacilli and S. aureus. Cornerstones of treatment are intravenous antibiotics and sup...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/BF01752974
更新日期:1992-01-01 00:00:00
abstract:INTRODUCTION:Most anxiolytics and sedative regimens in the intensive care unit (ICU) impair intellectual function, reducing patient autonomy, and often add to patient morbidity. Using an ICU-validated cognitive assessment tool Adapted Cognitive Exam (ACE), we performed a comparison between dexmedetomidine (DEX) and pro...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s00134-010-1874-9
更新日期:2010-09-01 00:00:00
abstract:PURPOSE:To systematically review clinical and preclinical data on hydroxyethyl starch (HES) tissue storage. METHODS:MEDLINE (PubMed) was searched and abstracts were screened using defined criteria to identify articles containing original data on HES tissue accumulation. RESULTS:Forty-eight studies were included: 37 h...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-013-3156-9
更新日期:2014-02-01 00:00:00
abstract:OBJECTIVE:Pulmonary hypertension is a characteristic feature of acute respiratory distress syndrome (ARDS) and contributes to mortality. Administration of sildenafil in ambulatory patients with pulmonary hypertension improves oxygenation and ameliorates pulmonary hypertension. Our aim was to determine whether sildenafi...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1007/s00134-010-1754-3
更新日期:2010-05-01 00:00:00
abstract:PURPOSE:Reporting neurodevelopmental outcome of 8-year-old children treated with neonatal extracorporeal membrane oxygenation (ECMO). METHODS:In a follow-up study in 135 8-year-old children who received neonatal ECMO between 1996 and 2001 we assessed intelligence (Revised Amsterdam Intelligence Test), concentration (B...
journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s00134-013-2973-1
更新日期:2013-09-01 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:INTRODUCTION:Faecal peritonitis (FP) is a common cause of sepsis and admission to the intensive care unit (ICU). The Genetics of Sepsis and Septic Shock in Europe (GenOSept) project is investigating the influence of genetic variation on the host response and outcomes in a large cohort of patients with sepsis admitted t...
journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s00134-013-3158-7
更新日期:2014-02-01 00:00:00
abstract:OBJECTIVE:Percutaneous dilatational tracheostomy is increasingly practiced in intensive care units and has a low incidence of early complications. The late effects of this procedure are still poorly known and were the focus of this study. DESIGN:Prospective descriptive clinical study. SETTING:Interdisciplinary intens...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01706200
更新日期:1995-06-01 00:00:00
abstract:OBJECTIVE:To examine the attitudes of the general public regarding who should decide about the withdrawal of life support and to compare these attitudes with those of intensive care personnel. DESIGN:Nationwide postal questionnaire survey. SETTING:Sweden. PARTICIPANTS:One thousand one hundred ninety-six randomly sel...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050987
更新日期:1999-09-01 00:00:00
abstract:INTRODUCTION:Approximately 20 years have passed since we reported our results of histologically proven cytomegalovirus (CMV) pneumonia in non-immunocompromised ICU patients. Even if there are more recent reports suggesting that CMV may worsen the outcomes for ICU patients, there is no definite answer to this question: ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-015-4066-9
更新日期:2016-01-01 00:00:00
abstract:: ...
journal_title:Intensive care medicine
pub_type: 社论
doi:10.1007/s00134-018-5468-2
更新日期:2018-12-01 00:00:00
abstract:OBJECTIVE:To quantify the variability in the concentration of drug infusions prepared on an intensive care unit and establish whether there was a relationship between the quality of syringe labeling and drug preparation. DESIGN:Audit carried out over 3 weeks in May 2006 and completed in May 2007. SETTING:The adult ne...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-008-1113-9
更新日期:2008-08-01 00:00:00
abstract:PURPOSE:To study the incidence and clinical characteristics of delayed cerebral thrombosis in bacterial meningitis patients. METHODS:We assessed the incidence and clinical characteristics of delayed cerebral thrombosis in adults with cerebrospinal fluid (CSF) culture-proven community-acquired bacterial meningitis incl...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-012-2792-9
更新日期:2013-05-01 00:00:00
abstract:OBJECTIVE:To compare the effectiveness of 70-mg and 200-mg doses of intravenous erythromycin in improving gastric emptying in critically ill patients. DESIGN:Gastric emptying was measured on consecutive days; day 1 (pre-treatment), day 2 (post-treatment) after an intravenous infusion of either 70 or 200 mg erythromyci...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s00134-005-2663-8
更新日期:2005-07-01 00:00:00