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CONTEXT The need for lung protection is universally accepted, but the optimal level of positive end-expiratory pressure (PEEP) in patients with acute lung injury (ALI) or acute respiratory distress syndrome remains debated. OBJECTIVE To compare the effect on outcome of a strategy for setting PEEP aimed at increasing alveolar recruitment while limiting(More)
BACKGROUND In patients undergoing mechanical ventilation for the acute respiratory distress syndrome (ARDS), neuromuscular blocking agents may improve oxygenation and decrease ventilator-induced lung injury but may also cause muscle weakness. We evaluated clinical outcomes after 2 days of therapy with neuromuscular blocking agents in patients with early,(More)
OBJECTIVES To describe the current practice of physicians, to report complications associated with endotracheal intubation (ETI) performed in THE intensive care unit (ICU), and to isolate predictive factors of immediate life-threatening complications. DESIGN Multiple-center observational study. SETTING Seven intensive care units of two university(More)
OBJECTIVE To measure the impact of implementation of the systematic evaluation of pain and agitation by nurses using the Behavioral Pain Scale (BPS), the Numerical Rating Scale (NRS) for pain, and the Richmond Agitation Sedation Scale (RASS) associated with medical staff education in analgesia and sedation management in intensive care unit (ICU) patients.(More)
BACKGROUND Lung-protective ventilation with the use of low tidal volumes and positive end-expiratory pressure is considered best practice in the care of many critically ill patients. However, its role in anesthetized patients undergoing major surgery is not known. METHODS In this multicenter, double-blind, parallel-group trial, we randomly assigned 400(More)
Abstract Objective. To evaluate the incidence and identify factors associated with the occurrence of post-extubation stridor and to evaluate the performance of the cuff-leak test in detecting this complication. Design. Prospective, clinical investigation. Setting. Intensive care unit of a university hospital. Patients. Hundred twelve extubations were(More)
BACKGROUND The impact of intraoperative ventilation on postoperative pulmonary complications is not defined. The authors aimed at determining the effectiveness of protective mechanical ventilation during open abdominal surgery on a modified Clinical Pulmonary Infection Score as primary outcome and postoperative pulmonary function. METHODS Prospective(More)
OBJECTIVE To determine the prevalence, associated findings, and consequences of cytomegalovirus (CMV) antigenemia in critically ill patients. DESIGN A retrospective, case-control clinical study. SETTING A 12-bed university hospital medical-surgical ICU. PATIENTS Two hundred thirty-seven patients with fever for > 72 h, without proven evidence of(More)
IMPORTANCE Evidence supporting the choice of intravenous colloid vs crystalloid solutions for management of hypovolemic shock remains unclear. OBJECTIVE To test whether use of colloids compared with crystalloids for fluid resuscitation alters mortality in patients admitted to the intensive care unit (ICU) with hypovolemic shock. DESIGN, SETTING, AND(More)
RATIONALE Mechanical ventilation (MV) is associated with adverse effects on the diaphragm, but the cellular basis for this phenomenon, referred to as ventilator-induced diaphragmatic dysfunction (VIDD), is poorly understood. OBJECTIVES To determine whether mitochondrial function and cellular energy status are disrupted in human diaphragms after MV, and(More)