Abstract:
OBJECTIVE:To investigate the impact of prophylactic continuous lateral rotation therapy on the prevalence of ventilator-associated pneumonia, duration of mechanical ventilation, length of stay, and mortality in critically ill medical patients. DESIGN:Prospective, randomized, clinical study. SETTING:Three medical intensive care units of an university tertiary care hospital. PATIENTS:Patients were randomized to continuous lateral rotation therapy or standard care if they were mechanically ventilated for <48 hrs and free from pneumonia. Primary study end point was development of ventilator-associated pneumonia. Ventilator-associated pneumonia was defined as infiltrate on the chest radiograph plus newly developed purulent tracheal secretion plus increasing signs of inflammation. The diagnosis had to be confirmed microbiologically and required the growth of a pathogen >10(4) colony-forming units/mL in bronchoalveolar lavage. Radiologists were blinded to randomization whereas clinical outcome assessors were not. INTERVENTIONS:Rotation therapy was performed continuously in a specially designed bed over an arc of 90 degrees. Additional measures to prevent ventilator-associated pneumonia were equally standardized in both groups including semirecumbent position. MEASUREMENTS AND MAIN RESULTS:Ventilator-associated pneumonia frequency during the intensive care unit stay was 11% in the rotation group and 23% in the control group (p = .048), respectively. Duration of ventilation (8 +/- 5 vs. 14 +/- 23 days, p = .02) and length of stay (25 +/- 22 days vs. 39 +/- 45 days, p = .01) were significantly shorter in the rotation group. In a forward stepwise logistic regression model including the continuous lateral rotation therapy, gender, Lung Injury Score, and Simplified Acute Physiology Score II, continuous lateral rotation therapy just failed to reach statistical significance with respect to development of ventilator-associated pneumonia (p = .08). Intolerance to continuous lateral rotation therapy during the weaning phase was observed in 29 patients (39%). Mortality was comparable in both groups. CONCLUSIONS:Ventilator-associated pneumonia prevalence was significantly reduced by continuous lateral rotation therapy. Continuous lateral rotation therapy led to shorter ventilation time and length of stay. Continuous lateral rotation therapy should be considered in ventilated patients at risk for ventilator-associated pneumonia as a feasible method exerting additive effects to other preventive measures.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Staudinger T,Bojic A,Holzinger U,Meyer B,Rohwer M,Mallner F,Schellongowski P,Robak O,Laczika K,Frass M,Locker GJdoi
10.1097/CCM.0b013e3181bc8218subject
Has Abstractpub_date
2010-02-01 00:00:00pages
486-90issue
2eissn
0090-3493issn
1530-0293journal_volume
38pub_type
杂志文章,随机对照试验abstract:OBJECTIVE:Artery puncture and hematoma formation are the most common immediate complications during internal jugular vein catheterization. This study was performed to assess whether the bevel-down approach of the puncture needle decreases the incidence of posterior venous wall damage and hematoma formation during inter...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0b013e318232da48
更新日期:2012-02-01 00:00:00
abstract:OBJECTIVE:The effect of levosimendan, a novel inotropic vasodilator (inodilator), on the microvascular gastric mucosal hemoglobin oxygenation (muHbo(2)) is unknown. A possible effect could thereby be selective for the splanchnic region or could primarily reflect changes in systemic oxygen transport (Do(2)) and/or oxyge...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000150653.89451.6f
更新日期:2005-01-01 00:00:00
abstract:INTRODUCTION:Ventilator settings for patients with severe acute respiratory distress syndrome supported by venovenous extracorporeal membrane oxygenation are currently set arbitrarily. The impact on serum and pulmonary biotrauma markers of the transition to ultra-protective ventilation settings following extracorporeal...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0000000000003894
更新日期:2019-11-01 00:00:00
abstract:OBJECTIVES:A recent post hoc analysis suggested that driving pressure may be more important than traditional ventilatory variables in determining outcome in mechanically ventilated patients with acute respiratory distress syndrome. We conducted a systematic review and meta-analysis to summarize the risk of mortality fo...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析
doi:10.1097/CCM.0000000000002838
更新日期:2018-02-01 00:00:00
abstract::Recorded values (SpO2) of oxygen saturation from six noninvasive pulse oximeters were compared to each other and to the value from a cooximeter. Simultaneous measurements were obtained from each instrument in eight healthy nonsmoking volunteers rendered hypoxic greater than 70% SpO2. Functional arterial oxygen saturat...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198907000-00016
更新日期:1989-07-01 00:00:00
abstract:OBJECTIVE:To examine the pulmonary and cardiac function of children who survived an episode of acute hypoxemic respiratory failure. DESIGN:Descriptive cohort analysis. SETTING:Pediatric clinical research center of a university hospital. PATIENTS:Utilizing the criteria of PaO2 < 75 torr (< 10 kPa) with an FIO2 of > 0...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199601000-00024
更新日期:1996-01-01 00:00:00
abstract:OBJECTIVE:Inotropic and vasopressor drugs are routinely used in critically ill patients to maintain adequate blood pressure and cardiac output in patients with cardiogenic shock although potentially at the expense of increasing myocardial oxygen demand. Pacing optimization has been demonstrated as effective in reducing...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001655
更新日期:2016-08-01 00:00:00
abstract:BACKGROUND:Although survival is traditionally modeled using Cox proportional hazards modeling, this approach may be inappropriate in sepsis, in which the proportional hazards assumption does not hold. Newer, more flexible models, such as Gray's model, may be more appropriate. OBJECTIVES:To construct and compare Gray's...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.ccm.0000114819.37569.4b
更新日期:2004-03-01 00:00:00
abstract:OBJECTIVE:To evaluate partial occlusion in patients with pulmonary hypertension with regard to a) the degree to which it leads to overestimation of pulmonary artery occlusion pressure (Ppao) and b) identification of factors that could enhance its recognition. DESIGN:Observational descriptive study. SETTING:Medical in...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200301000-00015
更新日期:2003-01-01 00:00:00
abstract:OBJECTIVES:This study was designed to assess the effects on macrocirculation and microcirculation of adding an intra-aortic balloon pump to peripheral venoarterial extracorporeal membrane oxygenation in patients with severe cardiogenic shock and little/no residual left ventricular ejection. DESIGN:A prospective, singl...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000410
更新日期:2014-09-01 00:00:00
abstract:OBJECTIVES:To determine whether relative hyperglycemia was associated with in-hospital mortality in critically ill patients independent of other prognostic variables and whether this association is affected by background glycemia. DESIGN:Prospective observational study. SETTING:Mixed medical-surgical ICU in a metropo...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004133
更新日期:2020-02-01 00:00:00
abstract:OBJECTIVE:The administration of vasopressin during cardiopulmonary resuscitation (CPR) provides significantly more vital organ blood flow when compared with epinephrine during cardiac arrest in pigs. The effects of this potent vasoconstrictor on postresuscitation cardiovascular function remain unknown. The purpose of t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199612000-00014
更新日期:1996-12-01 00:00:00
abstract:OBJECTIVE:The benefit of continuous on-site presence by a staff academic critical care specialist in the intensive care unit of a teaching hospital is not known. We compared the quality of care and patient/family and provider satisfaction before and after changing the staffing model from on-demand to continuous 24-hr c...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/01.CCM.0000297887.84347.85
更新日期:2008-01-01 00:00:00
abstract::A system of instrumentation for continuous measurement of oxygen consumption (VO2), carbon dioxide production (VCO2) and minute ventilation (V1) in human newborns on assisted ventilation is described. VO2 and VCO2 are measured by open-circuit indirect calorimetry utilizing a Servomex OA 184 differential paramagnetic o...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198311000-00011
更新日期:1983-11-01 00:00:00
abstract:OBJECTIVE:To determine the relationships between plasma L-arginine concentrations and the severity of respiratory distress syndrome (RDS) or systemic blood pressure in premature infants. DESIGN:Prospective, observational study. SETTING:Neonatal intensive care, tertiary referral hospital. SUBJECTS:Fifty-three prematu...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199807000-00033
更新日期:1998-07-01 00:00:00
abstract:OBJECTIVE:To directly compare the cerebrovascular effects of norepinephrine and dopamine in patients with acute traumatic brain injury. DESIGN:Prospective randomized crossover trial. SETTING:Neurosciences critical care unit of a university hospital. PATIENTS:Ten acutely head-injured patients requiring vasoactive dru...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/01.ccm.0000120054.32845.a6
更新日期:2004-04-01 00:00:00
abstract:OBJECTIVE:To determine the accuracy of a technique using capnography to prevent inadvertent placement of small-bore feeding tubes and Salem sump tubes into the lungs. SETTING:Twelve-bed medical intensive care unit (MICU) in a 557-bed teaching hospital. PATIENTS:A total of 25 ventilated adult MICU patients were studie...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-200105000-00004
更新日期:2001-05-01 00:00:00
abstract:OBJECTIVES:In acute respiratory distress syndrome, conservative fluid management increases ventilator-free days without affecting mortality. Response to fluid management may differ based on patients' initial central venous pressure. We hypothesized that initial central venous pressure would modify the effect of fluid m...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001555
更新日期:2016-04-01 00:00:00
abstract:OBJECTIVES:To assess the specific host responses to systemic endotoxemia and tumor necrosis factor (TNF) activation after abdominal aortic aneurysm surgery by measuring antiendotoxin core antibodies (EndoCab) immunoglobulin (Ig)G and IgM, and soluble p55TNF receptor concentrations. The role of the gut in initiating the...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199709000-00013
更新日期:1997-09-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to evaluate the relationship of patient care variables to survival and functional outcome in the pediatric population with traumatic brain injury. DESIGN:Retrospective chart review. SETTING:A 16-bed pediatric critical care unit in an academic community children's hospital. PATIENT...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200207000-00038
更新日期:2002-07-01 00:00:00
abstract:OBJECTIVES:To explore the relationship between timing of continuous renal replacement therapy commencement and clinical outcomes in critically ill patients with acute kidney injury. The primary outcomes were all-cause mortality at 28 and 90 days. DESIGN:Nested observational cohort study using data from the Randomized ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/CCM.0000000000000343
更新日期:2014-08-01 00:00:00
abstract:OBJECTIVES:To review the difficulties associated with defining sepsis and its complications and to characterize the role of the proinflammatory cytokines in the development of human septic shock, adult respiratory distress syndrome, and the systemic inflammatory response syndrome. DATA SOURCES:Information presented at...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-07-01 00:00:00
abstract:OBJECTIVES:Ethicists advise that life-sustaining treatment decisions should be made in keeping with patient preferences. Until recently, there has been little systematic study of the impact of patient preferences on the use of various life-sustaining treatments or the consequent cost of hospital care. This prospective ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199611000-00009
更新日期:1996-11-01 00:00:00
abstract:OBJECTIVES:To determine if vecuronium doses individualized by peripheral nerve stimulation are lower than those doses chosen by standard clinical techniques; and to determine whether patients monitored by peripheral nerve stimulation exhibit shorter recovery times and less prolonged neuromuscular blockade after discont...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199704000-00005
更新日期:1997-04-01 00:00:00
abstract:OBJECTIVES:Preclinical studies reveal the neuroprotective properties of xenon, especially when combined with hypothermia. The purpose of this study was to investigate the feasibility and cardiac safety of inhaled xenon treatment combined with therapeutic hypothermia in out-of-hospital cardiac arrest patients. DESIGN:A...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0b013e31828a4337
更新日期:2013-09-01 00:00:00
abstract::The effects of hypertonic mannitol on postischemic cerebral circulation were studied in 20 dogs. Mannitol, 2 g/kg iv, was infused into ten dogs during a 2-h period starting 1.5 h after 6 min of complete cerebral ischemia. One hour postischemia, regional cerebral blood flow (rCBF) was 36% in the control group (ten dogs...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198607000-00010
更新日期:1986-07-01 00:00:00
abstract:OBJECTIVE:To assess whether paralysis alters pulmonary deposition of albuterol delivered by metered dose inhaler and spacer to small animals. DESIGN:A parallel group study of intubated and ventilated rabbits. INTERVENTIONS:Animals in group 1 (n = 7) were paralyzed with intravenous pancuronium, and ventilated at a rat...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199701000-00026
更新日期:1997-01-01 00:00:00
abstract:OBJECTIVE:To investigate the interrelationship between cardiac surgery, age, circulating concentrations of the vitamin D hormone 1,25-dihydroxyvitamin D, and clinical outcome. DESIGN:Prospective, monocentric, two-arm parallel study. SETTING:Tertiary Heart and Diabetes Center in the Federal State of North Rhine-Westph...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/CCM.0b013e31824e8c42
更新日期:2012-07-01 00:00:00
abstract:OBJECTIVE:To define the relative needs of the staffs of rural, community hospitals for training in advanced cardiac life support (ACLS), identify weaknesses, and modify a standard ACLS course to meet these needs. DESIGN:Prospective assessment of knowledge and skills relating to the practice of ACLS. SETTING:Rural, co...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199405000-00006
更新日期:1994-05-01 00:00:00
abstract:OBJECTIVE:To determine the effects of accidental injury of varying severity on interleukin (IL)-1 alpha, IL-6, IL-8, tumor necrosis factor-alpha (TNF-alpha), and endotoxin release. DESIGN:Prospective, multi-unit, longitudinal study. SETTING:Emergency Departments and intensive care units of two university hospitals. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199306000-00010
更新日期:1993-06-01 00:00:00