Abstract:
OBJECTIVE:To assess the mortality rate and complications in a population of surgical patients with severe adult respiratory distress syndrome (ARDS) treated with positive end-expiratory pressure (PEEP) of > 15 cm H2O in an attempt to reduce intrapulmonary shunt to approximately 0.20 and reduce FIO2 to < 0.50. DESIGN:Retrospective review of patients treated by a standardized ventilatory support protocol at the time of their illness. SETTING:A 24-bed surgical intensive care unit in a university medical center. PATIENTS:All patients admitted to the surgical intensive care unit during a 34-month period who met the criteria for severe ARDS (Pao2 of < or = 70 torr [< or = 9.3 kPa] on an FIO2 of > or = 0.50, diffuse interstitial and/or alveolar infiltrates on chest radiograph, decreased lung compliance, no evidence of congestive heart failure, and a likely predisposing etiology) were evaluated. Patients treated with PEEP of > 15 cm H2O were selected for this review. INTERVENTIONS:Patients were treated by a protocol to achieve oxygenation end points, which consisted of maintaining arterial oxyhemoglobin saturation (as determined by pulse oximetry of > or = 0.92), while reducing FIO2 to < 0.50 and decreasing intrapulmonary shunt fraction to < or = 0.20 by adding PEEP. With the exception of patients with suspected intracranial hypertension related to closed-head injury, low-rate intermittent mandatory ventilation was the primary mode of ventilation. Pressure-support ventilation was added, when needed, to improve patient comfort, enhance spontaneous tidal volume, or improve CO2 excretion. MEASUREMENTS AND MAIN RESULTS:Eighty-six patients with severe ARDS were treated with a PEEP of > 15 cm H2O. Nineteen of these patients died early of severe closed-head injury or massive uncontrollable hemorrhage and were excluded from the evaluation. The remaining 67 patients had a mean Lung Injury Score of 3.3 during their treatment with high PEEP. Twenty (30%) of 67 patients died. Eight of the deaths occurred after decrease of ventilatory support and with acceptable blood gases. The other 12 patients who died had continued oxygenation deficits and received increased levels of ventilatory support at the time of death. Twenty-six (39%) of 67 patients had radiographic manifestations of barotrauma (pneumothorax, subcutaneous emphysema, etc.) related to their primary injuries or to complications related to central venous catheter placement. Seven (17%) of 41 patients developed clinical or radiographic signs of barotrauma while receiving high-level PEEP. The hemodynamic effects of increased airway pressure were managed with fluids and inotropic agents, when necessary, and did not limit the application of PEEP to reach the defined end point of treatment. CONCLUSIONS:This subset of patients with severe ARDS treated with high-level PEEP had a mortality rate lower than those rates previously reported by other researchers using more conventional ventilatory support and resuscitation techniques. FIO2 may be significantly reduced and PaO2 may be maintained at acceptable values by decreasing intrapulmonary shunt fraction using high-level PEEP.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
DiRusso SM,Nelson LD,Safcsak K,Miller RSdoi
10.1097/00003246-199509000-00008subject
Has Abstractpub_date
1995-09-01 00:00:00pages
1485-96issue
9eissn
0090-3493issn
1530-0293journal_volume
23pub_type
杂志文章abstract:OBJECTIVE:To compare the scales and predictive power for hospital mortality of three recent multiple organ dysfunction scores. DESIGN:Prospective, observational, validation cohort study. SETTING:A ten-bed medical-surgical intensive care unit in a Finnish tertiary care hospital. PATIENTS:Among the 591 consecutive pat...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200208000-00005
更新日期:2002-08-01 00:00:00
abstract:OBJECTIVES:Corticosteroid therapy is frequently used in septic patients given the rationale that there is an increased demand for corticosteroid in sepsis, and up to 60% of severe septic patients experience adrenal insufficiency. However, the efficacy of corticosteroid therapy and whether the therapy should be based on...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001264
更新日期:2015-11-01 00:00:00
abstract:BACKGROUND AND METHODS:Twelve adult male albino rabbits were assigned alternately to normotensive and hypotensive groups to assess the effect of hypovolemic shock on spontaneous correction of dilutional coagulopathy. All animals underwent dilutional exchange transfusion with 200 mL of rabbit RBCs and 5% human albumin. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199102000-00022
更新日期:1991-02-01 00:00:00
abstract:OBJECTIVE:To identify factors associated with granting or refusing intensive care unit (ICU) admission, to analyze ICU characteristics and triage decisions, and to describe mortality in admitted and refused patients. DESIGN:Observational, prospective, multiple-center study. SETTING:Four university hospitals and seven...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.ccm.0000157752.26180.f1
更新日期:2005-04-01 00:00:00
abstract:OBJECTIVE:To determine whether any advantage exists using racemic epinephrine instead of the more potent and less expensive levo(1)-epinephrine in the treatment of postextubation laryngeal edema. DESIGN:Prospective, double-blind, randomized study. SETTING:Pediatric intensive care unit in a university teaching hospita...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1994-10-01 00:00:00
abstract::Critical care clinicians no longer consider family members as visitors in the intensive care unit. Family-centered care has emerged from the results of qualitative and quantitative studies evaluating the specific needs of families of patients dying in the intensive care unit. In addition, interventional studies have e...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000237049.44246.8C
更新日期:2006-11-01 00:00:00
abstract:OBJECTIVE:Heatstroke requires active body cooling and organ failure supportive care. Although heat waves are expected to recur over the next decades, little is known about the risk factors for mortality in heatstroke patients. We examined the prognosis and risk factors for hospital mortality in patients with heatstroke...
journal_title:Critical care medicine
pub_type: 评论,杂志文章,多中心研究
doi:10.1097/01.CCM.0000206469.33615.02
更新日期:2006-04-01 00:00:00
abstract:OBJECTIVES:To assess the variability in short-term sepsis mortality by hospital among Centers for Medicare and Medicaid Services beneficiaries in the United States during 2013-2014. DESIGN:A retrospective cohort design. SETTING:Hospitalizations from 3,068 acute care hospitals that participated in the Centers for Medi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003324
更新日期:2018-11-01 00:00:00
abstract:OBJECTIVE:To determine whether low-dose dopamine administration reduces the incidence or severity of acute renal failure, need for dialysis, or mortality in patients with critical illness. DATA SOURCES AND STUDY SELECTION:We performed a MEDLINE search of literature published from 1966 to 2000 for studies addressing th...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析
doi:10.1097/00003246-200108000-00005
更新日期:2001-08-01 00:00:00
abstract:OBJECTIVE:To determine alterations in intestinal epithelial permeability to solutes in burn injured rats with and without Enterococcus faecalis infection and the role of neutrophils in the intestinal permeability changes. DESIGN:Prospective sham-controlled animal study. SETTING:University research laboratory. SUBJEC...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000145579.66001.05
更新日期:2004-11-01 00:00:00
abstract::Seven dogs with electromagnetic flow probes implanted on their main (QT) and left (QL) pulmonary arteries, had catheters placed in their left atria and pulmonary artery, and were ventilated via Carlen's double-lumen endotracheal tubes. The effect of high-frequency oscillation (HFO) on the redistribution of pulmonary b...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198405000-00008
更新日期:1984-05-01 00:00:00
abstract::A simple, safe, and effective system for umbilical artery monitoring controls continuous fluid infusion to prevent fluid overinfusion and keep the catheter from clotting. Accurate and continuous pressure measurements can be recorded simultaneously with fluid infusion. A convenient method for checking dynamic response ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198207000-00009
更新日期:1982-07-01 00:00:00
abstract:OBJECTIVES:To compare the effects of two lung-protective ventilation strategies on pulmonary vascular mechanics in early acute respiratory distress syndrome. DESIGN:Experimental study. SETTING:University animal research laboratory. SUBJECTS:Twelve pigs (30.8 ± 2.5 kg). INTERVENTIONS:Acute respiratory distress syndr...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002701
更新日期:2017-11-01 00:00:00
abstract:OBJECTIVE:Intrahospital transport of critically ill patients is often necessary for optimal patient care. However, transport of intensive care unit (ICU) patients within the hospital has been associated with a high rate of potentially detrimental complications. This study was designed to determine the occurrence rate o...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199510000-00009
更新日期:1995-10-01 00:00:00
abstract:OBJECTIVES:To evaluate the preload dependence of femoral maximal change in pressure over time (dP/dtmax) during volume expansion in preload dependent and independent critically ill patients. DESIGN:Retrospective database analysis. SETTING:Two adult polyvalent ICUs. PATIENTS:Twenty-five critically ill patients with a...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004515
更新日期:2020-10-01 00:00:00
abstract:OBJECTIVE:To evaluate the effects of sympathetic and parasympathetic nervous system activity on the heart rate and other hemodynamic variables in acute emergency patients with mild to moderately severe trauma. DESIGN:Clinical study. SETTING:Level 1 university-run trauma service. PATIENTS:Fourteen trauma patients stu...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000127776.78490.e4
更新日期:2004-06-01 00:00:00
abstract::Percutaneous cholecystostomy was employed successfully as an alternative to cholecystectomy for the treatment of acute cholecystitis with perforation in an elderly woman. The procedure, performed portably in the cardiac care unit, was selected because progressive cardiac and renal decompensation made the patient an ex...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198508000-00017
更新日期:1985-08-01 00:00:00
abstract:OBJECTIVE:To explore the hypothesis that beta-1 adrenoreceptor blockade may be protective through the attenuation of sympathetic hyperactivity and catecholaminergic inflammatory effects on cardiac and hepatic function. DESIGN:Prospective, randomized, controlled study. SETTING:Animal laboratory in a university medical...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181c03dfa
更新日期:2010-02-01 00:00:00
abstract:OBJECTIVES:Sepsis, a life-threatening organ dysfunction caused by a dysregulated host response to infection, is a leading cause of death and disability among children worldwide. Identifying sepsis in pediatric patients is difficult and can lead to treatment delay. Our objective was to assess the host proteomic response...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004083
更新日期:2020-01-01 00:00:00
abstract::We report a case of an amniotic fluid embolism (AFE) causing a cardiorespiratory arrest associated temporally with ingestion of castor oil in a full-term normal pregnancy. Risk factors usually associated with AFE were not found in this patient. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198806000-00016
更新日期:1988-06-01 00:00:00
abstract:BACKGROUND:Noninvasive positive-pressure ventilation (NPPV) has been shown to be effective in select patients enrolled in clinical trials. However, few data are available on the use of NPPV as routine standard medical care for patients with respiratory failure outside of controlled trials. MEASUREMENTS AND MAIN RESULT...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000300084.67277.90
更新日期:2008-02-01 00:00:00
abstract::The heart rate variability (HRV) of 82 patients exhibiting sinus rhythm and admitted for possible myocardial infarction (MI) was evaluated. Using a simple information entropy measure to quantify the HRV, patients subsequently diagnosed with MI or experiencing significant dysrhythmia (n = 35) exhibited less entropy (0....
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198801000-00014
更新日期:1988-01-01 00:00:00
abstract::A small, double-blind crossover study compared the efficacy of aminophylline and doxapram in ventilator weaning of eight premature infants recovering from respiratory distress syndrome (RDS). Although neither drug was significantly better than the other, four infants were weaned from mechanical ventilation after drug ...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-198502000-00016
更新日期:1985-02-01 00:00:00
abstract:OBJECTIVE:To compare compliance and end-expiratory lung volume during reexpansion of normal and surfactant-deficient ex vivo atelectatic lungs with either gas or total liquid ventilation. DESIGN:Controlled, animal study using an ex vivo lung preparation. SETTING:A research laboratory at a university medical center. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199602000-00015
更新日期:1996-02-01 00:00:00
abstract::Eleven patients in hypertensive crisis were treated with iv sodium nitroprusside (SNP). In all cases, rapid clinical improvement was obtained. Nevertheless, 9 patients developed progressive resistance to the hypotensive effect of the drug. For the first 2 h, the mean infusion rate was 1.68 +/- 0.64 micrograms/kg . min...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198205000-00002
更新日期:1982-05-01 00:00:00
abstract:OBJECTIVES:To evaluate the internal consistency, validity, responsiveness, and minimal important difference of the Functional Status Score for the ICU, a physical function measure designed for the ICU. DESIGN:Clinimetric analysis. SETTINGS:Five international datasets from the United States, Australia, and Brazil. PA...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001949
更新日期:2016-12-01 00:00:00
abstract:OBJECTIVE:To assess survival after cardiac arrest and to determine whether age is an independent determinant of late mortality or poor neurologic outcome. DESIGN:Analyses using results of Brain Resuscitation Clinical Trial I (1979 to 1984) and Brain Resuscitation Clinical Trial II (1984 to 1989), two randomized, doubl...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/00003246-199501000-00007
更新日期:1995-01-01 00:00:00
abstract:BACKGROUND:The randomized two-way factorial Dressing Study (1,636 patients, 28,931 catheter days) showed that a chlorhexidine-impregnated sponge decreased the incidence of major catheter-related infections from 1.4‰ to 0.6‰ catheter days, and that scheduled dressing changes every 7 days was not inferior to scheduled ch...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0b013e31822f0604
更新日期:2012-01-01 00:00:00
abstract:OBJECTIVES:ICU admission delays can negatively affect patient outcomes, but emergency department volume and boarding times may also affect these decisions and associated patient outcomes. We sought to investigate the effect of emergency department and ICU capacity strain on ICU admission decisions and to examine the ef...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002993
更新日期:2018-05-01 00:00:00
abstract:OBJECTIVE:To compare three devices that measure core body temperature at the bedside in ICU patients. DESIGN:Prospective, consecutive sample. SETTING:Voluntary community teaching hospital. PATIENTS:Fifteen patients, 78 +/- 6 (SD) yrs of age, admitted to the medical ICU over a 5-month period who had pulmonary artery ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199106000-00015
更新日期:1991-06-01 00:00:00