Showing papers in "Critical Care Medicine in 1995"
TL;DR: This multiple organ dysfunction score, constructed using simple physiologic measures of dysfunction in six organ systems, mirrors organ dysfunction as the intensivist sees it and correlates strongly with the ultimate risk of ICU mortality and hospital mortality.
Abstract: ObjectiveTo develop an objective scale to measure the severity of the multiple organ dysfunction syndrome as an outcome in critical illness.DesignSystematic literature review; prospective cohort study.SettingSurgical intensive care unit (ICU) of a tertiary-level teaching hospital.PatientsAll patient
2,443 citations
TL;DR: A significant number of dangerous human errors occur in the ICU, and applying human factor engineering concepts to the study of the weak points of a specific ICU may help to reduce the number of errors.
Abstract: Objectives The purpose of this study was to investigate the nature and causes of human errors in the intensive care unit (ICU), adopting approaches proposed by human factors engineering. The basic assumption was that errors occur and follow a pattern that can be uncovered.Design Concurrent incident
894 citations
TL;DR: Current evidence provides no support for the use of corticosteroids in patients with sepsis or septic shock, and suggests that their use may be harmful, underscore the need for future methodologically rigorous trials evaluating new immune-modulating therapies in well-defined critically ill patients with overwhelming infection.
Abstract: ObjectiveTo determine the effect of corticosteroid therapy on morbidity and mortality in patients with sepsis.Data SourcesWe searched for published and unpublished research using MEDLINE, EMBASE, and the Science Citation Index, manual searching of Index Medicus, citation review of relevant primary a
610 citations
TL;DR: Potentially preventable medical complications after ruptured cerebral aneurysm add to the total mortality rate of patients, and may increase length of hospital stay in the critical care setting, according to a large, prospective study.
Abstract: ObjectivesThis report examines the frequency, type, and prognostic factors of medical (nonneurologic) complications after subarachnoid hemorrhage in a large, prospective study. The influences of contemporary neurosurgical, neurological, and critical care practice on mortality and morbidity rates aft
605 citations
TL;DR: Early enteral feeding of the experimental formula was safe and well tolerated in ICU patients and a substantial reduction in hospital length of stay was observed, along with a significant reduction in the frequency of acquired infections.
Abstract: OBJECTIVE To determine if early enteral feeding, in an intensive care unit (ICU) patient population, using a formula supplemented with arginine, dietary nucleotides, and fish oil (Impact), results in a shorter hospital stay and a reduced frequency of infectious complications, when compared with feeding a common use enteral formula (Osmolite.HN). DESIGN A prospective, randomized, double-blind, multicenter trial. SETTING ICUs in eight different hospitals. PATIENTS Of 326 patients enrolled in the study, 296 patients were eligible for analysis. They were admitted to the ICU after an event such as trauma, surgery, or sepsis, and met a risk assessment screen (Acute Physiology and Chronic Health Evaluation II [APACHE II] score of > or = 10, or a Therapeutic Intervention Scoring System score of > or = 20) and study eligibility requirements. Patients were stratified by age ( or = 60 yrs of age) and disease (septic or systemic inflammatory response syndrome). INTERVENTIONS Patients were enrolled and full-strength tube feedings were initiated within 48 hrs of the study entry event. Enteral feedings were advanced to a target volume of 60 mL/hr by 96 hrs of the event. One hundred sixty-eight patients were randomized to receive the experimental formula, and 158 patients were randomized to receive the common use control formula. MEASUREMENTS AND MAIN RESULTS Both groups tolerated early enteral feeding well, and the frequency of tube feeding-related complications was low. There were no significant differences in nitrogen balance between groups on study days 4 and 7. Patients receiving the experimental formula had a significant (p = .0001) increase in plasma arginine and ornithine concentrations by study day 7. Plasma fatty acid profiles demonstrated higher concentrations of linoleic acid (p < .01) in the patients receiving the common use formula and higher concentrations of eicosapentaenoic and docosahexaenoic acid (p < .01) in the patients receiving the experimental formula. The mortality rate was not different between the groups and was significantly (p < .001) lower than predicted by the admission severity scores in both feeding groups. In patients who received at least 821 mL/day of the experimental formula, the hospital median length of stay was reduced by 8 days (p < .05). In patients stratified as septic, the median length of hospital stay was reduced by 10 days (p < .05), along with a major reduction in the frequency of acquired infections (p < .01) in the patients who received the experimental formula. In the septic subgroup fed at least 821 mL/day, the median length of stay was reduced by 11.5 days, along with a major reduction in acquired infections (both p < .05) in the patients who received the experimental formula. CONCLUSIONS Early enteral feeding of the experimental formula was safe and well tolerated in ICU patients. In patients who received the experimental formula, particularly if they were septic on admission to the study, a substantial reduction in hospital length of stay was observed, along with a significant reduction in the frequency of acquired infections.
585 citations
TL;DR: These data indicate decreased antioxidant status in the face of enhanced free radical activity, and suggest potential therapeutic strategies involving antioxidant repletion.
Abstract: Objective: To determine antioxidant vitamin concentrations, lipid peroxidation, and an index of nitric oxide production in patients in the intensive care unit (ICU) with septic shock and relate the findings to the presence of secondary organ failure. Design: A prospective, observational study. Setting: A nine-bed ICU in a University teaching hospital. Patients: Sixteen consecutive patients with septic shock, defined as: a) clinical evidence of acute infection; b) hypo- or hyperthermia ( 38.3 o C); c) tachypnea (>20 breaths/min or being mechanically ventilated); d) tachycardia (>90 beats/min); e) shock (systolic pressure <90 mm Hg) or receiving inotropes. Fourteen patients also had secondary organ dysfunction. Interventions: None. Measurements and Main Results: Antioxidant vitamin concentrations were significantly lower in the patients than the reference range obtained from a comparable group of healthy controls. The mean plasma retinol (vitamin A) concentration was 26.5±19.3 μg/dL compared with 73.5±18.3 μg/dL in healthy subjects (p<.01). Additionally, 13 (81%) patients had retinol values below the lower limit of our reference range (<37.0 μg/dL). Tocopherol (vitamin E) plasma concentrations were below the reference range in all patients (<9.0 mg/L), with a mean value of 3.6±2.0 mg/L compared with 11.5±1.3 mg/L in healthy subjects (p<.001). Plasma β carotene and lycopene concentrations were undetectable (<15 μg/L) in eight (50%) patients, and below our reference range (<101 μg/L and <154 μg/L, respectively) in the remaining patients. In the five patients with three or more dysfunctional secondary organs, plasma thiobarbituric acid-reactive substances were significantly increased (p<.05), suggesting increased lipid peroxidation. Concentrations of thiobarbituric acid-reactive substances correlated negatively with both plasma retinol and plasma tocopherol (r 2 =.42, p<.01 AND R 2 =.48, p<.005, respectively). In the five patients from whom we were able to collect urine, nitrite excretion was increased ∼400-fold (p<.001). Conclusions: These data indicate decreased antioxidant status in the face of enhanced free radical activity, and suggest potential therapeutic strategies involving antioxidant repletion
476 citations
TL;DR: No overall beneficial effect of corticosteroids in patients with sepsis or septic shock was observed; however, there is some evidence for a positive effect in Patients with Gram-negative septicemia.
Abstract: Objective The use of corticosteroids in patients with sepsis or septic shock has been controversial for many decades. Clinical studies have reported beneficial, as well as negative results. We conducted a meta-analysis to assess the clinical evidence and to evaluate treatment effects in specific sub
471 citations
TL;DR: In this paper, a task force of more than 40 experts in disciplines related to the use of analgesic and sedation for adult patients in the intensive care unit (ICU) setting for the purpose of guiding clinical practice.
Abstract: Objective The development of practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit (ICU) setting for the purpose of guiding clinical practice.Participants A task force of more than 40 experts in disciplines related to the use of analgesic and sedati
359 citations
TL;DR: Hemicraniotomy may improve survival in massive hemispheric stroke victims, decreasing mortality rates to < 35%, although some patients seem to benefit significantly.
Abstract: Objective Space-occupying hemispheric infarctions, requiring neurocritical care treatment, demonstrate high mortality and morbidity rates. This study was performed to determine the beneficial effects of decompressive craniotomy on mortality and morbidity rates.Design Open, nonrandomized, control tri
347 citations
TL;DR: In this study, E5 did not reduce mortality in nonshock patients with Gram-negative sepsis whether or not those patients also had organ failure, but E5did result in greater resolution of organ failure in patients with gram-negative Sepsis and E5 resulted in the prevention of adult respiratory distress syndrome and central nervous system organ failure.
Abstract: ObjectiveTo evaluate the safety and efficacy of E5, a murine, monoclonal antibody directed against endotoxin, in the treatment of patients with Gram-negative sepsis.DesignA multicenter, randomized, double-blind, placebo-controlled trial.SettingFifty-three hospitals across the United States, includin
339 citations
TL;DR: Enteral nutrition is not started in all eligible ICU patients, and approximately half of those patients receiving enteral nutrition achieved tolerance of the regimen, and use of paralytic agents and the presence of high gastric residuals were associated with intolerance.
Abstract: ObjectivesTo describe current enteral nutrition-prescribing practices for critically ill patients, and to identify factors associated with initiation of, and tolerance to, enteral nutrition.DesignA prospective, cohort study.SettingTwo tertiary care medical-surgical intensive care units (ICU) in Onta
TL;DR: High-frequency oscillator ventilator ventilation is both safe and effective in adult patients with severe ARDS failing conventional ventilation and support the need for a prospective, randomized trial of algorithm-controlled conventional ventilation vs. high- frequency oscillatory ventilation for adults withsevere ARDS.
Abstract: Objective To evaluate the safety and effectiveness of high-frequency oscillatory ventilation using a protocol designed to recruit and maintain optimal lung volume in patients with severe adult respiratory distress syndrome (ARDS).Setting Surgical and medical intensive care units in a tertiary care,
TL;DR: The prognostic value of blood lactate concentrations, gastric intramucosal pH, and their combination in patients with severe sepsis were compared and it was found that intramural PCO2 was a more specific predictor of mortality than intramukosal pH.
Abstract: Objective To compare the prognostic value of blood lactate concentrations, gastric intramucosal pH, and their combination in patients with severe sepsis.Design Prospective, noninterventional study.Setting Medical/surgical intensive care unit of a university hospital.Patients The study included 35 co
TL;DR: The survey data indicate that there is a considerable variation in the management of patients with severe head injury in the United States and the establishment of guidelines for themanagement of head injury based on available scientific data and moderated by practical and financial considerations may lead to improvement in the standard of care.
Abstract: ObjectiveThis survey was designed to study current practices in the monitoring and treatment of patients with severe head injury in the United States.Data SourcesThe collected data represent answers to telephone interviews of nurse managers, clinical specialists, and staff nurses specializing in neu
TL;DR: Ultrasound guidance improves the success rate of subclavian venous catheterization performed by less experienced operators as well as conventional landmark techniques when landmark techniques fail.
Abstract: Objective: To determine if ultrasound guidance can be safely performed and improve success rates for subclavian venous catheterization performed by less experienced operators. Design: Prospective, randomized study. Setting: Twenty-bed trauma-surgical-medical intensive care unit in a C24-bed, community, tertiary care, teaching hospital. Patients: After the decision for central venous cannulation was made, informed consent was obtained, and less experienced operators then attempted to insert subclavian catheters in 33 critical care patients. Interventions: Catheter placements were attempted, either by landmark technique, ultrasound technique, or by landmark attempts with ultrasound salvage. Catheterization techniques to be used were randomized using a random number table. Measurements and Main Results: Fifty-three placement procedures were attempted in 33 patients. One procedure was excluded from data analysis. Successful catheterizations, occurrence rates of complications, number of attempts, and number of catheter kits used were recorded. In the analysis, 52 catheterization procedures were studied. Twelve (44%) catheters were successfully placed from 27 attempts using the landmark technique vs. 23 (92%) successful catheterizations during 25 ultrasound procedures (p=.0003). Fifteen failed landmark technique attempts had ultrasound salvage attempted, with 12 (80%) catheters successfully inserted. Eleven complications (minor) occurred in 27 attempts of subclavian venous catheterization using conventional landmark technique vs. one complication (minor) in 25 attempts of subclavian venous catheterization with ultrasound guidance (p=.002). There were no major complications in either group. The landmark group required an average of 2.5 venipunctures and 1.4 catheter kits per attempted catheterization. The ultrasound group required an average of 1.4 venipuncture attempts and 1.0 insertion kit. The statistical significance in differences in groups for the average number of venipunctures was p=.0007 and average number of kits used was p=.0003. Conclusions: Ultrasound guidance improves the success rate of subclavian venous catheterization performed by less experienced operators. There were no major complications in either group. Ultrasound guidance is usually successful in allowing performance of subclavian venous catheterizations when landmark techniques fail
TL;DR: Administration of milrinone in neonates with low cardiac output after cardiac surgery lowers filling pressures, systemic and pulmonary arterial pressures, and systemic andmonary vascular resistances, while improving cardiac index.
Abstract: Objective To evaluate the hemodynamic effects of intravenous milrinone in neonates with low cardiac output after cardiac surgery.Design Prospective cohort study.Setting Pediatric cardiac intensive care unit.Patients Ten neonates with low cardiac output (cardiac index of less than equals 3.0 L/min/m2
TL;DR: Mucosal hypoxia is not responsible for lipopolysaccharide-induced mucosal acidosis in this normodynamic pig model of septic shock and a rightward shift of the oxyhemoglobin dissociation curve (the Bohr effect) can explain the increase in mucosal oxygenation observed in endotoxemic pigs.
Abstract: Objective To evaluate the hypothesis that splanchnic ischemia and mucosal hypoxia are responsible for lipopolysaccharide-induced intramucosal acidosis in pigs.Design Prospective, randomized, unblinded study.Setting Surgical research laboratory at a large, university-affiliated medical center.Subject
TL;DR: The calibration of risk prediction methods comparing predicted with actual mortality across the breadth of risk for a population of patients is excellent, but overall accuracy in individual patient predictions is such that clinical judgment must remain a major part of decision-making.
Abstract: Objective To review the evolution and development of mortality risk prediction methods as they have been applied to the management of septic patients. Data Sources Selected relevant articles from the pertinent literature. Study Selection Theoretical and clinical data on the mortality risk identification, severity of illness scoring systems, and cytokine levels as they relate to mortality in patients with sepsis. Data Extraction All concepts relating to mortality risk prediction, cytokines, severity of illness, and intensive care unit (ICU) mortality were explored and interrelated accordingly. Data Synthesis In order to improve the precision of the evaluation of new therapies for the treatment of sepsis, to monitor their utilization and to refine their indications, it has been recommended that mortality risk stratification or severity of illness scoring systems be utilized in clinical trials and in practice. With the increasing influence of managed care on healthcare delivery, there will be an increased demand for techniques to stratify patients for cost-effective allocation of care. Severity of illness scoring systems are widely utilized for patient stratification in the management of cancer and heart disease. However, the use of such systems in patients with sepsis has been limited to applications in clinical trial design for assurance of balance among treatment groups. Mortality risk prediction in sepsis has evolved from identification of risk factors, and simple counts of failing organs, to sophisticated techniques that mathematically transform a raw score, comprised of physiologic and/or clinical data, into a predicted risk of death. Most of the developed systems are based on global ICU populations rather than upon sepsis patient databases. A few, newer systems are derived from such data-bases. However, the overall discriminating ability of the various methods is similar. Mortality prediction has also been carried out from assessments of endotoxin or cytokine (interleukin-1, interleukin-6, tumor necrosis factor) plasma concentrations. While increased levels of these substances have been correlated with increased mortality, difficulties with bioassay and their sporadic appearance in the bloodstream prevent these measurements from being practically applied. The calibration of risk prediction methods comparing predicted with actual mortality across the breadth of risk for a population of patients is excellent, but overall accuracy in individual patient predictions is such that clinical judgment must remain a major part of decision-making. However, as databases of appropriate patient information increase in size and complexity, it may be possible in the future to devise a scoring system that can be relied on to assist in clinical decision-making. Conclusions Severity of illness scoring systems are widely used in critically ill patients. However, their use in patients with sepsis has largely been limited to a means of stratification in clinical trials. As newer sepsis therapies become available, it may be possible to use such systems for refining their indications, and monitoring their utilization. Finally, as the data-bases supporting the systems increase in size and complexity, it may be possible to utilize them in clinical decision-making.
TL;DR: In septic shock patients, the administration of methylene blue results in a transient and reproducible increase in arterial pressure, associated with an improvement in cardiac function, but does not increase cellular oxygen availability.
Abstract: Objective A release of nitric oxide has been incriminated in the cardiovascular alterations of septic shock. Since guanylate cyclase is the target enzyme in the endothelium-dependent relaxation mediated by nitric oxide, we studied the acute effects of methylene blue, a potent inhibitor of guanylate
TL;DR: In multiple trauma patients, excessive triggering of the inflammatory cascade-as expressed by complement activation and stimulation of neutrophils producing elastase--plays an important and early role in the development of multiple organ failure.
Abstract: Objective: To evaluate the posttraum atic course of several inflam m atory mediators or markers (complement com ponents C3, C3a, ter minal complement com plex, thromboxane B2, C-reactive protein, elastase, and neopterin) in relation to the developm ent of m ultiple organ failure and m ortality. Design: Prospective study of a selected pa tient group. Setting: Surgical intensive care units in three European trauma hospitals. Patients: Patients (n = 56) with severe blunt trauma (Injury Severity Score of i>33). Interventions: Arterial blood samples were sequentially obtained. M easurem ents a n d M ain Results: N on survivors (n = 8) had significantly higher circu lating C3a and elastase concentrations on the first postinjury day, compared w ith survivors (n = 48), No differences betw een these groups were found for term inal complement complex, thromboxane B„, C-reactive protein, and the neopterin/creatinine ratio. Five patients died before day 5. Eighteen pa tients developed m ultiple organ failure, which was diagnosed from day 5 onward, leaving 33 patients w ithout m ultiple organ failure. The patients with subsequent m ultiple organ fail ure showed significantly higher mean circulat ing concentrations of C3a (914 ± 190 [ s e m ] ng/
TL;DR: The new versions of the severity systems analyzed perform better than their older counterparts (APACHE III, SAPS II, MPM II) and show good discrimination and calibration in this international database.
Abstract: Objective : To compare the performance of three severity of illness scoring systems used commonly for intensive care unit (ICU) patients in a large international data set. The systems analyzed were versions II and III of the Acute Physiology and Chronic Health Evaluation (APACHE) system, versions I and II of the Simplified Acute Physiology Score (SAPS), and versions I and II of the Mortality Probability Model (MPM), computed at admission and after 24 hrs in the ICU. Design : A multicenter, multinational cohort study. Setting : One hundred thirty-seven ICUs in 12 European and North American countries. Patients : During a 3-month period, 14,745 patients were consecutively admitted to 137 ICUs enrolled in the study. Interventions : Collection of information necessary to compute the APACHE II and APACHE III scores, SAPS I and SAPS II, and MPM I and MPM II scores. Patients were followed until hospital discharge. Statistical comparison, including indices of calibration (goodness-of-fit) and discrimination (area under the receiver operating characteristic curve). Measurements and Main Results : Despite having acceptable receiver operating characteristic areas, the older versions of the systems analyzed (APACHE II, SAPS, and MPM I computed at admission-MPM I computed after 24 hrs in the ICU) demonstrated poor calibration for the whole database. The new versions of the systems (SAPS II and MPM II) were superior to their older counterparts. This superiority is reflected by larger receiver operating characteristic areas and better fit. The APACHE III system improved its receiver operating characteristic area compared with the APACHE II system, which showed the best fit of the old systems analyzed. Conclusions : The new versions of the severity systems analyzed (APACHE III, SAPS II, MPM II) perform better than their older counterparts (APACHE II, SAPS I, and MPM I). APACHE II, SAPS II, and MPM II show good discrimination and calibration in this international database. (Crit Care Med 1995 ; 23 :1327-1335)
TL;DR: An endocrine prognostic index based on ICU admission measurements of thyroxine, thyrotropin, and cortisol concentrations is a superior discriminator of patient outcome than the APACHE II score.
Abstract: ObjectiveTo determine the ability of various endocrine parameters, measured at the time of intensive care unit (ICU) admission, to predict patient outcome.DesignProspective, cohort study of patients requiring intensive care.SettingThe medical/surgical ICU at South Cleveland Hospital, UK and a medica
TL;DR: This study demonstrated the activation of the L-arginine:nitric oxide pathway in human endotoxemic septic shock, suggesting that nitric oxide may be an important mediator of the hemodynamic disturbances in this pathophysiologic situation.
Abstract: Objective To investigate the relationship between nitric oxide production, endotoxemia, and hemodynamic alterations in human septic shock.Design Prospective study.Setting A 32-bed intensive care unit in a university referral hospital.Patients Two groups of septic patients with shock (n=13) or withou
TL;DR: It is concluded that femoral vein catheterization is associated with a 25% frequency of lower extremity deep vein thrombosis compared with similar patients receiving subclavian or internal jugular vein catheters.
Abstract: ObjectiveTo determine the frequency of central venous catheter-induced deep vein thrombosis of the femoral vein.DesignProspective, randomized, controlled trial.SettingTertiary care center.PatientsForty-five patients in a medicalsurgical intensive care unit who required central venous catheterization
TL;DR: In this article, the authors evaluated the effect of early postoperative feeding with a nutritionally complete enteral diet supplemented with the nutrients arginine, ribonucleic acid (RNA), and ω-3 fatty acids on the immune function in patients undergoing surgery for upper gastrointestinal (GI) malignancies.
Abstract: Objective: To evaluate the effect of early postoperative feeding with a nutritionally complete enteral diet supplemented with the nutrients arginine, ribonucleic acid (RNA), and ω-3 fatty acids on the immune function in patients undergoing surgery for upper gastrointestinal (GI) malignancies. Design: Prospective, randomized, placebo-controlled, double-blind study. Setting: Surgical intensive care unit (ICU) in a German university hospital. Patients: Forty-two consecutive patients receiving an enteral diet via needle catheter jejunostomy after GI surgery for cancer. Interventions: Patients were randomized to receive either the arginine, RNA, and ω-3 fatty acids supplemented diet or an isocaloric and isonitrogenous placebo diet. Early enteral nutrition was started on postoperative day 1 in the surgical ICU with 20 mL/hr and progressed to the optimal goal of 80 mL/hr by postoperative day 5. Measurements and Main Results: Clinical examination and adverse GI symptoms were recorded on a daily basis. Body weight was determined twice weekly. Immunoglobulin concentrations were determined by laser nephelometry. Interferon-γ concentrations were measured with a modified enzyme-linked immunosorbent assay method. Fluorescence-activated cell scan flow cytometry was performed to analyze B cells, T lymphocytes and their subsets. Clinical patient characteristics and mean caloric intake were similar between the two groups and both formulas were well tolerated. The number of T lymphocytes and their subsets, helper T cells (CD4) and activated T cells (CD3, HLA-DR), were significantly higher in the supplemented diet group on postoperative days 10 and 16 (p<.05). Mean interferon-γ concentration after phytohemagglutinin stimulation was higher in the supplemented diet group on postoperative day 16. In the supplemented diet group, mean immunoglobulin M concentrations were significantly higher on postoperative day 10 and mean immunoglobulin G concentrations were higher on postoperative day 16 (p<.05) compared with the results in the placebo group. B-lymphocyte indices were significantly higher in the supplemented vs. the placebo diet group on postoperative days 7 and 10 (p<.05). Conclusions: Supplementation of enteral diet with arginine, RNA, and ω-3 fatty acids in the early postoperative time period improves postoperative immunologic responses and helps to overcome more rapidly the immunologic depression after surgical trauma
TL;DR: Reactive hyperemia in the forearm is significantly diminished in patients with sepsis, suggesting impaired microvascular blood flow and rheologic changes, including impaired red blood cell deformability, increased leukocyte aggregation, and endothelial adherence may contribute to this abnormality by compromising effective capillary cross-sectional area.
Abstract: Objective To investigate the rheologic changes and circulatory abnormalities at the microvascular level during severe sepsis.Design Prospective, controlled trial.Setting Medical and surgical intensive care units of a university-affiliated hospital.Patients Nine normal controls and eight adult patien
TL;DR: Intrahospital transport of critically ill patients is safe and carries a low risk of detrimental complications, and patients requiring "high-risk" interventions experienced a higher mortality rate than did APACHE-matched controls, but the increase in mortality does not appear to be directly related to the intrahospital Transport.
Abstract: ObjectiveIntrahospital 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 th
TL;DR: It is indicated that prolonged endotracheal intubation impairs the swallowing reflex, with improvement within 1 wk, which could contribute to microinhalations and aspiration pneumonia after extubation.
Abstract: ObjectivesTo assess the swallowing reflex after prolonged endotracheal intubation and to assess the influence of age and duration of intubation on this reflex.DesignProspective, observational, clinical study.SettingThe intensive care unit of a university teaching hospital.PatientsThe swallowing refl
TL;DR: The quality of nursing appears to be a measurable and critical factor in the weaning from mechanical ventilation of patients with chronic obstructive pulmonary disease, below a threshold in the available workforce of ICU nurses.
Abstract: Objective To evaluate the influence of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease.Design Data were collected prospectively over a 1-yr period (study year) and compared with previously collected prospective data recorded in ou