Abstract
In a randomized trial the effect of a predefined strategy of prone positioning on the duration of mechanical ventilation was evaluated in multiple trauma patients with acute lung injury or acute respiratory distress syndrome. Patients in the prone group (n = 21) were continuously kept prone for at least 8 hours and a maximum of 24 hours per day. Prone positioning was continued until a PaO2:FiO2 ratio of more than 300 was present in the prone as well as the supine position over a period of 48 hours. Patients in the supine group (n = 19) were positioned according to standard care guidelines. The duration of ventilatory support did not differ significantly between the two groups (20 ± 17 days in the prone group and 33 ± 23 days in the supine group). The mean duration of ventilatory support in prone position was 11 ± 5 hours a day. A mean of 7 ± 4 posture changes was applied per patient. One patient in the prone group and three patients in the supine group died due to multiorgan failure (P = 0.33). The PaO2:FiO2 ratio increased significantly more in the prone group than in the supine group in the first 4 days (P = 0.03). Thereafter no significant difference in the PaO2:FiO2 ratio was evident between the two groups. The number of adverse effects was not different between the groups. Therefore, despite an improvement of gas exchange, no clinical outcome benefit was detected.
Highlights
Activation of the HPA axis occurs in order to control potentially deleterious effects of systemic inflammation during sepsis
Arterial blood gases (ABGs) are the immediate, easiest, most reliable and cost effective bedside method of assessing an unstable patient. It portrays an array of functional reserves from the lungs to the kidneys and the blood cells in between
A significant benefit was demonstrated with amikacin/ceftazidime versus pefloxacin/ceftazidime, risk difference (RD) = 20%, in a single low-quality trial
Summary
Activation of the HPA axis occurs in order to control potentially deleterious effects of systemic inflammation during sepsis. The aim of the study was to evaluate the effects of PEEP on intrathoracic blood volumes and cardiac function measured by the COLD system in ARDS patients. The objective was to identify risk factors and outcome of pregnant women who required intensive care This pilot study aims to find stress (S) and other personality traits (physical symptoms [PS], anger [A]) among the ICU staff, and any existing correlation between them and length of working time (LWT) in the ICU and with educational level (EDL). The role of Drotrecogin alfa (activated) (recombinant human activated protein C [rhAPC]) in modulating microvascular coagulation through the inhibition of thrombin generation has been well studied in experimental and clinical settings of severe sepsis, little is known about its direct anti-inflammatory effects on vascular endothelial cells. The aim is to determine whether an effective lifestyle adaptation program post CABG could enhance the quality of life of the CABG patient
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