Abstract:
PURPOSE:We assessed outcomes in brain-injured patients after implementation of a multi-faceted approach to reduce respiratory complications in intensive care units. METHODS:Prospective nationwide before-after trial. Consecutive adults with acute brain injury requiring mechanical ventilation for ≥24 h in 20 French intensive care units (ICUs) were included. The management of invasive ventilation in brain-injured patients admitted between 1 July 2013 and 31 October 2013 (4 months) was monitored and analysed. After the baseline period (1 November 2013-31 December 2013), ventilator settings and decision to extubate were selected as targets to hasten weaning from invasive ventilation. During the intervention period, low tidal volume (≤7 ml/kg), moderate positive end-expiratory pressure (PEEP, 6-8 cm H2O) and an early extubation protocol were recommended. The primary endpoint was the number of days free of invasive ventilation at day 90. Comparisons were performed between the two periods and between the compliant and non-compliant groups. RESULTS:A total of 744 patients from 20 ICUs were included (391 pre-intervention; 353 intervention). No difference in the number of invasive ventilation-free days at day 90 was observed between the two periods [71 (0-80) vs. 67 (0-80) days; P = 0.746]. Compliance with the complete set of recommendations increased from 8 (2%) to 52 (15%) patients after the intervention (P < 0.001). At day 90, the number of invasive ventilation-free days was higher in the 60 (8%) patients whose care complied with recommendations than in the 684 (92%) patients whose care deviated from recommendations [77 (66-82) and 71 (0-80) days, respectively; P = 0.03]. The mortality rate was 10% in the compliant group and 26% in the non-compliant group (P = 0.023). Both multivariate analysis [hazard ratio (HR) 1.78, 95% confidence interval (95% CI) 1.41-2.26; P < 0.001] and propensity score-adjusted analysis (HR 2.25, 95% CI 1.56-3.26, P < 0.001) revealed that compliance was an independent factor associated with the reduction in the duration of mechanical ventilation. CONCLUSIONS:Adherence to recommendations for low tidal volume, moderate PEEP and early extubation seemed to increase the number of ventilator-free days in brain-injured patients, but inconsistent adoption limited their impact. Trail registration number: NCT01885507.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Asehnoune K,Mrozek S,Perrigault PF,Seguin P,Dahyot-Fizelier C,Lasocki S,Pujol A,Martin M,Chabanne R,Muller L,Hanouz JL,Hammad E,Rozec B,Kerforne T,Ichai C,Cinotti R,Geeraerts T,Elaroussi D,Pelosi P,Jaber S,Dalichadoi
10.1007/s00134-017-4764-6subject
Has Abstractpub_date
2017-07-01 00:00:00pages
957-970issue
7eissn
0342-4642issn
1432-1238pii
10.1007/s00134-017-4764-6journal_volume
43pub_type
杂志文章,多中心研究abstract:PURPOSE:Gastrointestinal motility can be impaired by serious illness or medications, compromising enteral feeding in critical care patients. We compared small bowel transit time and morphology in neurosurgical critical care (ICU) patients with those in healthy subjects. METHODS:We evaluated small intestinal transit ti...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-009-1415-6
更新日期:2009-06-01 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:PURPOSE:We set out to summarize the current challenges in academic conflict of interest. METHODS:This is a narrative review by a multidisciplinary, multinational panel of academic officers including deans of medical/pharmacy schools. RESULTS AND CONCLUSIONS:Disclosing conflict of interest has become the appropriate p...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-018-5458-4
更新日期:2019-01-01 00:00:00
abstract:OBJECTIVE:To evaluate the impact of two different comorbidity measures on the 6-month mortality of severely ill cancer patients. DESIGN AND SETTING:Prospective cohort study in a ten-bed oncological medical-surgical intensive care unit (ICU). PATIENTS:A total of 772 consecutive patients were included over a 45-month p...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-005-2554-z
更新日期:2005-03-01 00:00:00
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:PURPOSE:To determine the global metabolomic profile as measured in circulating plasma from surviving and non-surviving patients with community-acquired pneumonia (CAP) and sepsis. METHODS:Random, outcome-stratified case-control sample from a prospective study of 1,895 patients hospitalized with CAP and sepsis. Cases (...
journal_title:Intensive care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s00134-013-2935-7
更新日期:2013-08-01 00:00:00
abstract:PURPOSE:Ventricular-arterial (V-A) decoupling decreases myocardial efficiency and is exacerbated by tachycardia that increases static arterial elastance (Ea). We thus investigated the effects of heart rate (HR) reduction on Ea in septic shock patients using the beta-blocker esmolol. We hypothesized that esmolol improve...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-016-4351-2
更新日期:2016-10-01 00:00:00
abstract::The metabolic changes associated with critical illness involve several pathways acting at different steps of the utilization of nutritive substrates. The understanding of the role of these pathways and of their complex regulation has led to the development of new strategies for the metabolic and nutritional management...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-002-1512-2
更新日期:2002-11-01 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::Streptococcus pneumoniae is responsible for two-thirds of ICU admissions due to community-acquired pneumonia (CAP) and is the leading cause of CAP-related death. Early death is principally due to cardiovascular collapse, whereas late death is associated with hypoxemic respiratory failure. Outcome depends on interactio...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-006-0182-x
更新日期:2006-07-01 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:OBJECTIVE:To evaluate the efficiency of a new device developed to remove obstructions from endotracheal tubes (ETT) in mechanically ventilated patients. DESIGN:Open study in mechanically ventilated sedated and paralyzed ICU patients. SETTING:General ICU and Laboratory of Respiratory Mechanics of the University of Rom...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/BF01705724
更新日期:1994-11-01 00:00:00
abstract:OBJECTIVE:We describe a patient with a prolonged and severe hypercapnia occurring during an episode of status asthmaticus induced by ophthalmic instillation of carteolol. SETTING:Prehospital Emergency Medical Service and Pulmonary Intensive Care Unit in a university hospital. PATIENT:A 35-year-old female developed an...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050772
更新日期:1998-12-01 00:00:00
abstract:PURPOSE:Severe acute pancreatitis (SAP) remains a life-threatening disease with classic etiology of systemic inflammatory response and mortality between 30 and 50 %. The aim of the present study is to compare two different treatment strategies of goal-directed hemodynamic management and evaluate their impact on surviva...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-012-2775-x
更新日期:2013-04-01 00:00:00
abstract::The purpose of this study was noninvasive assessment of respiratory compliance and resistance in mechanically ventilated patients with acute respiratory failure (ARF). To this end, flow, change in lung volume, and airway pressure were measured at the proximal tip of the endotracheal tubes in twenty nine critically ill...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00263528
更新日期:1988-01-01 00:00:00
abstract:OBJECTIVE:To investigate whether serum procalcitonin (PCT) levels could be useful to differentiate between systemic infection and the activity of the underlying disease in autoimmune disease. METHODS:In 18 patients with systemic lupus erythematodes (SLE) and 35 patients with systemic antineutrophil cytoplasmic antibod...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF02900738
更新日期:2000-03-01 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:OBJECTIVE:To evaluate whether soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) in CSF can serve as a biomarker for the presence of bacterial meningitis and outcome in patients with this disease. DESIGN:Retrospective study of diagnostic accuracy. SETTING AND PATIENTS:CSF was collected from 92 adults ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-006-0240-4
更新日期:2006-08-01 00:00:00
abstract:OBJECTIVE:Definition of the changes in the activators of plasminogen, u-PA and t-PA, and examination of the possible generation of plasmin in the circulation in overwhelming sepsis. DESIGN:Serial blood analysis starting 4 h after development of symptoms of toxic shock syndrome. SETTING:Intensive care unit. PATIENT:A...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050561
更新日期:1998-03-01 00:00:00
abstract:OBJECTIVES:Critical illness increases the tendency to both coagulation and bleeding, complicating anticoagulation for continuous renal replacement therapy (CRRT). We analyzed strategies for anticoagulation in CRRT concerning implementation, efficacy and safety to provide evidence-based recommendations for clinical prac...
journal_title:Intensive care medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1007/s00134-005-0044-y
更新日期:2006-02-01 00:00:00
abstract:OBJECTIVE:To analyze the effects of polymyxin B-immobilized fiber (PMX-F) on bone resorption in septic patients. DESIGN AND SETTING:Observational prospective study in intensive care units of a general hospital. PATIENTS AND PARTICIPANTS:25 patients with severe sepsis and 20 healthy controls. MEASUREMENTS AND RESULTS...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2004-09-01 00:00:00
abstract:PURPOSE:The aim of our study was to explore, using an innovative method, the effect of temporal changes in the mortality prediction performance of an existing model on the quality of care assessment. The prognostic model (rSAPS-II) was a recalibrated Simplified Acute Physiology Score-II model developed for very elderly...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-011-2390-2
更新日期:2012-01-01 00:00:00
abstract:OBJECTIVE:To investigate the effect of respiratory physiotherapy on the prevention and treatment of ventilator-associated pneumonia (VAP) for adults in an intensive care unit (ICU) with an acquired brain injury (ABI). DESIGN AND SETTING:Two-part, prospective, randomised controlled trial. PATIENTS:A total of 144 subje...
journal_title:Intensive care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s00134-008-1278-2
更新日期:2009-02-01 00:00:00
abstract::A case of bilateral pseudoaneurysms of the pulmonary arteries caused by blunt chest injury is presented. Although this is a very rare complication, this entity should always be suspected in a patient with hemoptysis and a radiodensity on chest radiograph following chest injury. Selection of operative procedures should...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/BF01706428
更新日期:1992-01-01 00:00:00
abstract:OBJECTIVE:To evaluate trends in mortality and related factors among trauma patients who developed acute respiratory distress syndrome (ARDS). STUDY:Observational study based on data prospectively gathered in computerized trauma registry. SETTING:Trauma intensive care unit (ICU) of 48 beds in level I trauma center. P...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340100955
更新日期:2001-07-01 00:00:00
abstract:RATIONALE:Acute respiratory distress syndrome (ARDS) is frequently associated with hemodynamic instability which appears as the main factor associated with mortality. Shock is driven by pulmonary hypertension, deleterious effects of mechanical ventilation (MV) on right ventricular (RV) function, and associated-sepsis. ...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-016-4326-3
更新日期:2016-05-01 00:00:00
abstract:OBJECTIVE:To examine the phenomenon of inappropriate triggering caused by an in-line suction catheter. DESIGN:We used a test lung to assess inappropriate triggering in four ventilators with both pressure and flow triggering. RESULTS:With pressure triggering, inappropriate triggering occurred only in the presence of P...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-002-1239-0
更新日期:2002-04-01 00:00:00
abstract:OBJECTIVE:To clarify the risk of secondary exposure of medical staff to sarin vapor in the emergency room, and to warn emergency room staffs of the hazard. DESIGN:Retrospective observational survey. SETTING:Emergency department of a university hospital in a metropolitan area of Japan. PARTICIPANTS:Fifteen doctors tr...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01700667
更新日期:1995-12-01 00:00:00
abstract:PURPOSE:Clinical examination is often the first step to diagnose shock and estimate cardiac index. In the Simple Intensive Care Studies-I, we assessed the association and diagnostic performance of clinical signs for estimation of cardiac index in critically ill patients. METHODS:In this prospective, single-centre coho...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-019-05527-y
更新日期:2019-02-01 00:00:00
abstract::The effects of continuous and supplementary bolus dose administration of etomidate have been investigated in ten artificially ventilated patients in traumatic coma. Continuous infusion of etomidate (5-25 micrograms/kg/min) proved to be a practical and safe means of sedating these patients and appeared to control moder...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01692549
更新日期:1983-01-01 00:00:00