Mechanical ventilation in rural ICUs.


:BACKGROUND: In recent years, rural hospitals have expanded their scope of specialized services, which has led to the development and staffing of rural intensive care units (ICUs). There is little information about the breadth, quality or outcomes of these services. This is particularly true for specialized ICU services such as mechanical ventilation, where little, if any, information exists specifically for rural hospitals. The long-term objectives of this project were to evaluate the quality of medical care provided to mechanically ventilated patients in rural ICUs and to improve patient care through an educational intervention. This paper reports baseline data on patient and hospital characteristics for both rural and rural referral hospitals. RESULTS: Twenty Iowa hospitals were evaluated. Data collected on 224 patients demonstrated a mean age of 70 years and a mean ICU admission Acute Physiology and Chronic Health Evaluation (APACHE) II score of 22, with an associated 36% mortality. Mean length of ICU stay was 10 days, with 7.7 ventilated days. Significant differences were found in both institutional and patient variables between rural referral hospitals and rural hospitals with more limited resources. A subgroup of patients with diagnoses associated with complex ventilation had higher mortality rates than patients without these conditions. Patients who developed nosocomial events had longer mean ventilator and ICU days than patients without nosocomial events. This study also found ICU practices that frequently fell outside the guidelines recommended by a task force describing minimum standards of care for critically ill patients with acute respiratory failure on mechanical ventilation. CONCLUSIONS: Despite distinct differences in the available resources between rural referral and rural hospitals, overall mortality rates of ventilated patients are similar. Considering the higher mortality rates observed in patients with complicated medical conditions requiring complex ventilation management, the data may suggest that this subgroup could benefit from treatment at a tertiary center with greater resources and technology.


Crit Care


Fieselmann JF,Bock MJ,Hendryx MS,Wakefield D,Helms CM,Bentler SE





Has Abstract


1999-01-01 00:00:00












  • Microvascular effects of intravenous esmolol in patients with normal cardiac function undergoing postoperative atrial fibrillation: a prospective pilot study in cardiothoracic surgery.

    abstract:BACKGROUND:Postoperative atrial fibrillation (POAF) is commonplace after cardiothoracic surgery. A rate control strategy using short-acting beta blockers is recommended as a first-line therapy in patients without hemodynamic instability. Microcirculatory effects of POAF and esmolol have not yet been investigated. We hy...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Fornier W,Jacquet-Lagrèze M,Collenot T,Teixeira P,Portran P,Schweizer R,Ovize M,Fellahi JL

    更新日期:2017-12-12 00:00:00

  • Intraoperative renal near-infrared spectroscopy indicates developing acute kidney injury in infants undergoing cardiac surgery with cardiopulmonary bypass: a case-control study.

    abstract:INTRODUCTION:Acute kidney injury (AKI) is a frequent complication after cardiac surgery with cardiopulmonary bypass in infants. Renal near-infrared spectroscopy (NIRS) is used to evaluate regional oximetry in a non-invasive continuous real-time fashion, and reflects tissue perfusion. The aim of this study was to evalua...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Ruf B,Bonelli V,Balling G,Hörer J,Nagdyman N,Braun SL,Ewert P,Reiter K

    更新日期:2015-01-29 00:00:00

  • Antibiotic therapeutic drug monitoring in intensive care patients treated with different modalities of extracorporeal membrane oxygenation (ECMO) and renal replacement therapy: a prospective, observational single-center study.

    abstract:BACKGROUND:Effective antimicrobial treatment is key to reduce mortality associated with bacterial sepsis in patients on intensive care units (ICUs). Dose adjustments are often necessary to account for pathophysiological changes or renal replacement therapy. Extracorporeal membrane oxygenation (ECMO) is increasingly bei...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Kühn D,Metz C,Seiler F,Wehrfritz H,Roth S,Alqudrah M,Becker A,Bracht H,Wagenpfeil S,Hoffmann M,Bals R,Hübner U,Geisel J,Lepper PM,Becker SL

    更新日期:2020-11-25 00:00:00

  • Ventilator-associated pneumonia using a heated humidifier or a heat and moisture exchanger: a randomized controlled trial [ISRCTN88724583].

    abstract:INTRODUCTION:Some guidelines to prevent ventilator-associated pneumonia (VAP) do not establish a recommendation for the preferential use of either heat and moisture exchangers (HMEs) or heated humidifiers (HHs), while other guidelines clearly advocate the use of HMEs. The aim of this study was to determine the incidenc...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,随机对照试验


    authors: Lorente L,Lecuona M,Jiménez A,Mora ML,Sierra A

    更新日期:2006-01-01 00:00:00

  • Reliability of standard pupillometry practice in neurocritical care: an observational, double-blinded study.

    abstract:BACKGROUND:In critical care units, pupil examination is an important clinical parameter for patient monitoring. Current practice is to use a penlight to observe the pupillary light reflex. The result seems to be a subjective measurement, with low precision and reproducibility. Several quantitative pupillometer devices ...

    journal_title:Critical care (London, England)

    pub_type: 临床试验,杂志文章


    authors: Couret D,Boumaza D,Grisotto C,Triglia T,Pellegrini L,Ocquidant P,Bruder NJ,Velly LJ

    更新日期:2016-03-13 00:00:00

  • Normal adrenocortical function on initial testing in the intensive care unit: not a long-term warranty.

    abstract::There has been a lot of debate about the concept of relative adrenocortical insufficiency (often defined as a reduced response to corticotropin) as a pathophysiological explanation of steroid effects in septic shock. Less is known about the prevalence of absolute adrenocortical insufficiency based on more usual defini...

    journal_title:Critical care (London, England)

    pub_type: 评论,社论


    authors: Bollaert PE

    更新日期:2008-01-01 00:00:00

  • High-mobility group box 1 and the receptor for advanced glycation end products contribute to lung injury during Staphylococcus aureus pneumonia.

    abstract:INTRODUCTION:Staphylococcus (S.) aureus has emerged as an important cause of necrotizing pneumonia. Lung injury during S. aureus pneumonia may be enhanced by local release of damage associated molecular patterns such as high-mobility group box 1 (HMGB1). In the current study we sought to determine the functional role o...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Achouiti A,van der Meer AJ,Florquin S,Yang H,Tracey KJ,van 't Veer C,de Vos AF,van der Poll T

    更新日期:2013-12-16 00:00:00

  • Impact of transpulmonary thermodilution-based cardiac contractility and extravascular lung water measurements on clinical outcome of patients with Takotsubo cardiomyopathy after subarachnoid hemorrhage: a retrospective observational study.

    abstract:INTRODUCTION:Takotsubo cardiomyopathy (TCM) is a life-threatening systemic consequence early after subarachnoid hemorrhage (SAH), but precise hemodynamics and related outcome have not been studied. The purpose of this study was to investigate the TCM-induced cardiac function by transpulmonary thermodilution and its imp...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Mutoh T,Kazumata K,Terasaka S,Taki Y,Suzuki A,Ishikawa T

    更新日期:2014-08-12 00:00:00

  • Hyperglycaemia in critically ill patients: marker or mediator of mortality?

    abstract::Acute hyperglycaemia has been associated with complications, prolonged intensive care unit and hospital stay, and increased mortality. We made an inventory of the prevalence and prognostic value of hyperglycaemia, and of the effects of glucose control in different groups of critically ill patients. The prevalence of h...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Corstjens AM,van der Horst IC,Zijlstra JG,Groeneveld AB,Zijlstra F,Tulleken JE,Ligtenberg JJ

    更新日期:2006-01-01 00:00:00

  • Impact of post-traumatic stress symptoms on the health-related quality of life in a cohort study with chronically critically ill patients and their partners: age matters.

    abstract:BACKGROUND:Survivors of an acute critical illness with continuing organ dysfunction and uncontrolled inflammatory responses are prone to become chronically critically ill. As mental sequelae, a post-traumatic stress disorder and an associated decrease in the health-related quality of life (QoL) may occur, not only in t...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Wintermann GB,Petrowski K,Weidner K,Strauß B,Rosendahl J

    更新日期:2019-02-08 00:00:00

  • Nutrition of the COVID-19 patient in the intensive care unit (ICU): a practical guidance.

    abstract::Five to 10% of the coronavirus SARS-CoV-2-infected patients, i.e., with new coronavirus disease 2019 (COVID-19), are presenting with an acute respiratory distress syndrome (ARDS) requiring urgent respiratory and hemodynamic support in the intensive care unit (ICU). However, nutrition is an important element of care. T...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Thibault R,Seguin P,Tamion F,Pichard C,Singer P

    更新日期:2020-07-19 00:00:00

  • In vivo calibration of esophageal pressure in the mechanically ventilated patient makes measurements reliable.

    abstract:BACKGROUND:Esophageal pressure (Pes) can provide information to guide mechanical ventilation in acute respiratory failure. However, both relative changes and absolute values of Pes can be affected by inappropriate filling of the esophageal balloon and by the elastance of the esophagus wall. We evaluated the feasibility...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Mojoli F,Iotti GA,Torriglia F,Pozzi M,Volta CA,Bianzina S,Braschi A,Brochard L

    更新日期:2016-04-11 00:00:00

  • Burn wound healing and treatment: review and advancements.

    abstract::Burns are a prevalent and burdensome critical care problem. The priorities of specialized facilities focus on stabilizing the patient, preventing infection, and optimizing functional recovery. Research on burns has generated sustained interest over the past few decades, and several important advancements have resulted...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Rowan MP,Cancio LC,Elster EA,Burmeister DM,Rose LF,Natesan S,Chan RK,Christy RJ,Chung KK

    更新日期:2015-06-12 00:00:00

  • Transcranial Doppler combined with quantitative EEG brain function monitoring and outcome prediction in patients with severe acute intracerebral hemorrhage.

    abstract:BACKGROUND:Neurological deterioration after intracerebral hemorrhage (ICH) is thought to be closely related to increased intracranial pressure (ICP), decreased cerebral blood flow (CBF), and brain metabolism. Transcranial Doppler (TCD) is increasingly used as an indirect measure of ICP, and quantitative EEG (QEEG) can ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Chen Y,Xu W,Wang L,Yin X,Cao J,Deng F,Xing Y,Feng J

    更新日期:2018-02-20 00:00:00

  • Point accuracy and reliability of an interstitial continuous glucose-monitoring device in critically ill patients: a prospective study.

    abstract:INTRODUCTION:There is a need for continuous glucose monitoring in critically ill patients. The objective of this trial was to determine the point accuracy and reliability of a device designed for continuous monitoring of interstitial glucose levels in intensive care unit patients. METHODS:We evaluated point accuracy b...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: van Hooijdonk RT,Leopold JH,Winters T,Binnekade JM,Juffermans NP,Horn J,Fischer JC,van Dongen-Lases EC,Schultz MJ

    更新日期:2015-02-05 00:00:00

  • Alveolar microstrain and the dark side of the lung.

    abstract::Mechanical ventilation associated lung injury (VALI) negatively impacts the outcomes of critically ill patients. Research during the past two decades has led to a better understanding of key physiologic mechanisms of injury, yet uncertainty over the topographical distribution of these mechanisms continues to fuel cont...

    journal_title:Critical care (London, England)

    pub_type: 评论,杂志文章,评审


    authors: Oeckler RA,Hubmayr RD

    更新日期:2007-01-01 00:00:00

  • Bench-to-bedside review: circulating microparticles--a new player in sepsis?

    abstract::In sepsis, inflammation and thrombosis are both the cause and the result of interactions between circulating (for example, leukocytes and platelets), endothelial and smooth muscle cells. Microparticles are proinflammatory and procoagulant fragments originating from plasma membrane generated after cellular activation a...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Meziani F,Delabranche X,Asfar P,Toti F

    更新日期:2010-01-01 00:00:00

  • Gastric versus post-pyloric feeding: a systematic review.

    abstract:BACKGROUND:Our objective was to evaluate the impact of gastric versus post-pyloric feeding on the incidence of pneumonia, caloric intake, intensive care unit (ICU) length of stay (LOS), and mortality in critically ill and injured ICU patients. METHOD:Data sources were Medline, Embase, Healthstar, citation review of re...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,meta分析,评审


    authors: Marik PE,Zaloga GP

    更新日期:2003-06-01 00:00:00

  • Roundtable debate: Controversies in the management of the septic patient--desperately seeking consensus.

    abstract::Despite continuous advances in technologic and pharmacologic management, the mortality rate from septic shock remains high. Care of patients with sepsis includes measures to support the circulatory system and treat the underlying infection. There is a substantial body of knowledge indicating that fluid resuscitation, ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Waxman AB,Ward N,Thompson T,Lilly CM,Lisbon A,Hill N,Nasraway SA,Heard S,Corwin H,Levy M

    更新日期:2005-08-20 00:00:00

  • Heart-kidney crosstalk and role of humoral signaling in critical illness.

    abstract::Organ failure in the heart or kidney can initiate various complex metabolic, cell-mediated and humoral pathways affecting distant organs, contributing to the high therapeutic costs and significantly higher morbidity and mortality. The universal outreach of cells in an injured state has myriad consequences to distant o...

    journal_title:Critical care (London, England)

    pub_type: 信件,评审


    authors: Virzì G,Day S,de Cal M,Vescovo G,Ronco C

    更新日期:2014-01-06 00:00:00

  • Noninvasive ventilation and the upper airway: should we pay more attention?

    abstract::In an effort to reduce the complications related to invasive ventilation, the use of noninvasive ventilation (NIV) has increased over the last years in patients with acute respiratory failure. However, failure rates for NIV remain high in specific patient categories. Several studies have identified factors that contri...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Oppersma E,Doorduin J,van der Heijden EH,van der Hoeven JG,Heunks LM

    更新日期:2013-12-05 00:00:00

  • Beyond volutrauma in ARDS: the critical role of lung tissue deformation.

    abstract::Ventilator-induced lung injury (VILI) consists of tissue damage and a biological response resulting from the application of inappropriate mechanical forces to the lung parenchyma. The current paradigm attributes VILI to overstretching due to very high-volume ventilation (volutrauma) and cyclic changes in aeration due ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Albaiceta GM,Blanch L

    更新日期:2011-04-07 00:00:00

  • B-type natriuretic peptide release and left ventricular filling pressure assessed by echocardiographic study after subarachnoid hemorrhage: a prospective study in non-cardiac patients.

    abstract:INTRODUCTION:Serum B-type natriuretic peptide (BNP) is frequently elevated after subarachnoid hemorrhage (SAH), but whether this high BNP level is related to transient elevation of left ventricular filling pressure (LVFP) is unknown. However, in patients with preexistent cardiac pathologies, it is impossible to differe...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Meaudre E,Jego C,Kenane N,Montcriol A,Boret H,Goutorbe P,Habib G,Palmier B

    更新日期:2009-01-01 00:00:00

  • Choice of hospital after out-of-hospital cardiac arrest--a decision with far-reaching consequences: a study in a large German city.

    abstract:INTRODUCTION:Between 1 and 31% of patients suffering out-of-hospital cardiac arrest (OHCA) survive to discharge from hospital. International studies have shown that the level of care provided by the admitting hospital determines survival for patients suffering from OHCA. These data may only be partially transferable to...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Wnent J,Seewald S,Heringlake M,Lemke H,Brauer K,Lefering R,Fischer M,Jantzen T,Bein B,Messelken M,Gräsner JT

    更新日期:2012-09-12 00:00:00

  • Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19.

    abstract::An outbreak of pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that started in Wuhan, China, at the end of 2019 has become a global pandemic. Both SARS-CoV-2 and SARS-CoV enter host cells via the angiotensin-converting enzyme 2 (ACE2) receptor, which is expressed in various human organ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Ni W,Yang X,Yang D,Bao J,Li R,Xiao Y,Hou C,Wang H,Liu J,Yang D,Xu Y,Cao Z,Gao Z

    更新日期:2020-07-13 00:00:00

  • High-altitude physiology and pathophysiology: implications and relevance for intensive care medicine.

    abstract::Cellular hypoxia is a fundamental mechanism of injury in the critically ill. The study of human responses to hypoxia occurring as a consequence of hypobaria defines the fields of high-altitude medicine and physiology. A new paradigm suggests that the physiological and pathophysiological responses to extreme environmen...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审


    authors: Grocott M,Montgomery H,Vercueil A

    更新日期:2007-01-01 00:00:00

  • Alternative protocol to initiate high-frequency oscillatory ventilation: an experimental study.

    abstract:INTRODUCTION:The objective was to study the effects of a novel lung volume optimization procedure (LVOP) using high-frequency oscillatory ventilation (HFOV) upon gas exchange, the transpulmonary pressure (TPP), and hemodynamics in a porcine model of surfactant depletion. METHODS:With institutional review board approva...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Karmrodt J,David M,Yuan S,Markstaller K

    更新日期:2006-01-01 00:00:00

  • First evidence of a pro-inflammatory response to severe infection with influenza virus H1N1.

    abstract::The great majority of infections caused by the pandemic variant of the influenza virus (nvH1N1) are self-limited, but a small percentage of patients develop severe symptoms requiring hospitalization. Bermejo-Martin and colleagues have presented a pilot study describing the differences in the early immune response for ...

    journal_title:Critical care (London, England)

    pub_type: 评论,信件


    authors: de Castro IF,Guzmán-Fulgencio M,García-Alvarez M,Resino S

    更新日期:2010-01-01 00:00:00

  • A3 adenosine receptors and mitogen-activated protein kinases in lung injury following in vivo reperfusion.

    abstract:INTRODUCTION:Although activation of A3 adenosine receptors attenuates reperfusion lung injury and associated apoptosis, the signaling pathway that mediates this protection remains unclear. Adenosine agonists activate mitogen-activated protein kinases, and these kinases have been implicated in ischemia/reperfusion injur...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Matot I,Weiniger CF,Zeira E,Galun E,Joshi BV,Jacobson KA

    更新日期:2006-01-01 00:00:00

  • Case mix, outcome, and activity for admissions to UK critical care units with severe acute pancreatitis: a secondary analysis of the ICNARC Case Mix Programme Database.

    abstract:INTRODUCTION:Severe acute pancreatitis (SAP) requiring admission to a critical care unit is associated with high mortality and long lengths of stay. We describe the case mix, outcome, and activity of admissions with SAP who were identified from a high-quality clinical database. METHODS:We conducted a secondary analysi...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章


    authors: Harrison DA,D'Amico G,Singer M

    更新日期:2007-01-01 00:00:00