John Muscedere

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Intermittent positive pressure ventilation with large tidal volumes and high peak airway pressures can result in pulmonary barotrauma. In the present study, we examined the hypothesis that ventilation at very low lung volumes can also worsen lung injury by repeated opening and closing of airway and alveolar duct units as ventilation occurs from below to(More)
BACKGROUND Critically ill patients have considerable oxidative stress. Glutamine and antioxidant supplementation may offer therapeutic benefit, although current data are conflicting. METHODS In this blinded 2-by-2 factorial trial, we randomly assigned 1223 critically ill adults in 40 intensive care units (ICUs) in Canada, the United States, and Europe who(More)
BACKGROUND Ventilator-associated pneumonia (VAP) is an important patient safety issue in critically ill patients. PURPOSE To develop an evidence-based guideline for the prevention of VAP. DATA SOURCES MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews. STUDY SELECTION The authors systematically searched for relevant randomized,(More)
vasive positive-pressure ventilation and noninvasive continuous positive airway pressure by mask has increased substantially for acutely ill patients. Initial case series and uncontrolled cohort studies that suggested benefit in selected patients led to many randomized controlled trials (RCTs). Both methods of ventilation have been used in the setting of(More)
BACKGROUND AND PURPOSE Aspiration of secretions containing bacterial pathogens into the lower respiratory tract is the main cause of ventilator-associated pneumonia. Endotracheal tubes with subglottic secretion drainage can potentially reduce this and, therefore, the incidence of ventilator-associated pneumonia. New evidence on subglottic secretion drainage(More)
OBJECTIVE Procalcitonin may be associated with reduced antibiotic usage compared to usual care. However, individual randomized controlled trials testing this hypothesis were too small to rule out harm, and the full cost-benefit of this strategy has not been evaluated. The purpose of this analysis was to evaluate the effect of a procalcitonin-guided(More)
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made(More)
Increasingly, very old patients are admitted to Intensive Care Units (ICUs). The objective of this study was to describe 12-month outcomes of these patients and determine which characteristics are associated with a return to baseline physical function 1 year later. In this prospective cohort study in 22 Canadian hospitals, we recruited 610 patients aged 80(More)
OBJECTIVE Very elderly persons admitted to ICUs are at high risk of death. To document life-sustaining interventions (mechanical ventilation, vasopressors, renal replacement therapy) provided in the ICU and outcomes of care. DESIGN Multicenter, prospective cohort study. SETTING ICUs of 24 Canadian hospitals. PARTICIPANTS/SETTING Patients 80 years old(More)