Starting and Sustaining an Extracorporeal Membrane Oxygenation Program.

The use of extracorporeal membrane oxygenation (ECMO) is growing rapidly in all patient populations, especially adults for both acute lung or heart failure. ECMO is a complex, high risk, resource-intense, expensive modality that requires appropriate planning, training, and management for successful outcomes. This article provides an optimal approach and the basic framework for initiating a new ECMO program, which can be tailored to meet local needs.

Interaction between peri-operative blood transfusion, tidal volume, airway pressure and postoperative ARDS: an individual patient data meta-analysis.

Background: Transfusion of blood products and mechanical ventilation with injurious settings are considered risk factors for postoperative lung injury in surgical Patients.

Methods: A systematic review and individual patient data meta-analysis was done to determine the independent effects of peri-operative transfusion of blood products, intra-operative tidal volume and airway pressure in adult patients undergoing mechanical ventilation for general surgery, as well as their interactions on the occurrence of postoperative acute respiratory distress syndrome (ARDS). Observational studies and randomized trials were identified by a systematic search of MEDLINE, CINAHL, Web of Science, and CENTRAL and screened for inclusion into a meta-analysis.

Beta-blockers in intensive care medicine: potential benefit in acute brain injury and acute respiratory distress syndrome.

Sympathetic activation is a well-known phenomenon after acute brain injury and in critical illness. In this review we describe pathophysiological considerations that may help in elucidating the potential role of beta (β)-adrenergic antagonists to block some of the adverse sympathetic effects in acute brain injury (subarachnoid hemorrhage and traumatic brain injury) and the acute respiratory distress syndrome. In acute brain injury cardiac dysfunction has been studied most extensively but its pathophysiology is only partly elucidated in man.

Intra-operative assessment of human pulmonary alveoli in vivo using Sidestream Dark Field imaging: a feasibility study.

Background: In vivo videomicroscopy has been used for years to visualize subpleural alveoli in animal studies. This has led to a better understanding of alveolar physiology. We tested the hypothesis whether a novel handheld videomicroscope could be used for intraoperative detection of alveoli in surgical patients during mechanical ventilation.

The effect of open lung ventilation on right ventricular and left ventricular function in lung-lavaged pigs.

Introduction: Ventilation according to the open lung concept (OLC) consists of recruitment maneuvers, followed by low tidal volume and high positive end-expiratory pressure, aiming at minimizing atelectasis. The minimization of atelectasis reduces the right ventricular (RV) afterload, but the increased intrathoracic pressures used by OLC ventilation could increase the RV afterload. We hypothesize that when atelectasis is minimized by OLC ventilation, cardiac function is not affected despite the higher mean airway pressure.

Scoring system for the selection of high-risk patients in the intensive care unit.

Objective: Patients admitted to the intensive care unit greatly differ in severity and intensity of care. We devised a system for selecting high-risk patients that reduces bias by excluding low-risk patients and patients with an early death irrespective of the treatment.

Design: A posteriori analysis of a multiple-center prospective observational trial.

The effect of a managerial-based intervention on the occurrence of out-of-range-measurements and mortality in intensive care units.

Purpose: To evaluate the effect of an organization-based managerial intervention on performance of intensive care units (ICUs).

Methods And Participants: Prospective multicentre cluster-randomized study with an intervention at the level of ICU staff was carried out. The intervention comprised a set of managerial changes, concerning the nurses' level of skill discretion and participation in decision-making introduced during a period of six months.

Volume of activity and occupancy rate in intensive care units. Association with mortality.

Objective: Mortality after many procedures is lower in centers where more procedures are done. It is controversial whether this is true for intensive care units, too. We examined the relationship between the volume of activity of intensive care units (ICUs) and mortality by a measure of risk-adjusted volume of activity specific for ICUs.

Nursing activities score.

Objectives: The instruments used for measuring nursing workload in the intensive care unit (e.g., Therapeutic Intervention Scoring System-28) are based on therapeutic interventions related to severity of illness.