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This web-based survey assessed 1976 critical care practitioners' perceptions of the risks for unplanned extubation. Members of the American Association for Respiratory Care, the American Association of Critical Care Nurses, and the Society of Critical Care Medicine reported a number of factors associated with unplanned extubation, including outward migration of the endotracheal tube (ETT; reported by 73% of respondents), the patient tugging on the ETT (87%), removing a nasogastric tube (71%), absence of physical restraints (72%), a nurse/patient ratio of 1:3 (60%), trips out of the ICU for tests (59%), and light sedation (42%).
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Project IMPACT, a proprietary database originally created by the Society for Critical Care Medicine and now maintained by Cerner Corp., collects data from a voluntary consortium of ICUs across America.
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Paralytic agents such as vecuronium and cis-atracurium have been used as "rescue therapies" in patients with ARDS for many years, but, as with other rescue strategies including prone mechanical ventilation or inhaled vasodilators, evidence of a mortality benefit from this intervention has been lacking.
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Although corticosteroids are beneficial in treating severe exacerbations of chronic obstructive pulmonary disease (COPD), studies to date have not shown high-doses (such as methylprednisolone, 2 mg/kg or more per 24 h) administered intravenously (IV) to be superior to lower doses (e.g., prednisone, 40 mg/day) given orally, with respect to clinically important outcomes.
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In this issue: FDA Advisory Committee recommends approval of dabigatran, safety of proton pump inhibitors, effectiveness of glucosamine and chondroitin, FDA Actions.
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The authors set out to compare arterial and central venous blood gases (ABG and VBG, respectively), to evaluate the utility and accuracy of a predefined algorithm for adjusting VBG pH and pCO2 to approximate that of ABG, and to define clinical scenarios where a VBG may not be a useful substitute for an ABG.
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In this secondary analysis of data from a study on the pre-extubation prediction of post-extubation work of breathing in patients recovering from acute respiratory failure, Mehta and colleagues sought to determine whether the size of a patient's endotracheal tube (ETT) affected respiratory rate, tidal volume, and other "weaning parameters" commonly measured during spontaneous breathing and used to predict successful extubation.
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Management of patients with accidental or intentional poisoning in drug overdose is a common problem for the intensivist. The actual incidence of poisoning in the United States is unknown because of lack of adequate reporting, but a minimum of several million cases occur annually. The vast majority of these cases do not require ICU admission.
