Can lung ultrasonography predict prone positioning response in acute respiratory distress syndrome patients?

Purpose: The purpose was to assess whether lung ultrasonography (L-US) is a useful tool in prediction of prone positioning (PP) oxygenation response in patients with acute respiratory distress syndrome (ARDS).

Methods: In a prospective study, 19 ARDS patients were included for assessment of PP oxygenation response. The latter was assessed for at least 12 hours 6 different ultrasonography windows were performed on each hemithorax before prone (H0, H2, H12 before return to supine and at H14 (2 hours after return to supine).

Determination of the learning curve for ultrasound-guided jugular central venous catheter placement.

Purpose: Use of ultrasound (US) when introducing central venous catheters (CVC) may improve success rates, reduce the number of needle punctures, and decrease complication rates, but has been hampered by supposed difficulty in learning how to perform the technique. This study describes the learning curve for US-guided jugular CVC placement after a training program.

Methods: After an initial slide presentation and a video, intensivists who had not previously used US for CVC placement were evaluated qualitatively for US set up (score S1) and technical skills (score S2).

Number of supervised studies required to reach competence in advanced critical care transesophageal echocardiography.

Purpose: To determine the minimum number of supervised transesophageal echocardiography (TEE) that intensivists should perform to reach competence in performing and interpreting a comprehensive hemodynamic assessment in ventilated intensive care unit patients.

Methods: Prospective and multicentric study. Skills of 41 intensivists (trainees) with no (level 0) or little (level 1) experience in echocardiography was evaluated over a 6-month period, using a previously validated skills assessment score (/40 points).

Clinical relevance of classification according to weaning difficulty.

Objective: To evaluate the clinical relevance of the weaning from mechanical ventilation classification system derived from the 2005 international consensus conference, in patients who receive mechanical ventilation for more than 48 hours, and evaluate its correlation with prognosis.

Methods: We conducted a retrospective cohort study in a 12-bed intensive care unit (ICU) in a teaching hospital. We included patients who required > 48 hours of mechanical ventilation and who passed a spontaneous breathing trial (SBT).

Impact of clinical guidelines to improve appropriateness of laboratory tests and chest radiographs.

Objective: To assess the impact of clinical guidelines to improve appropriate use of routine laboratory tests and bedside chest radiographs in a medical intensive care.

Design: A two-year (Period-1: 2005, Period-2: 2006), retrospective, comparative study, before and after policy implementation.

Patients: All consecutive patients admitted during the study periods.

Feasibility and potential cost/benefit of routine isoflurane sedation using an anesthetic-conserving device: a prospective observational study.

Background: Inhaled sedation is efficient and easily controllable; in low concentrations it causes minimal changes in the patient and very little interference with hemodynamics. Awakening after inhaled sedation is quick and predictable. The major reason inhaled sedation has not become widely used in intensive care is that no commercially available administration device has been available.

Validation of a skills assessment scoring system for transesophageal echocardiographic monitoring of hemodynamics.

Objective: Transesophageal echocardiography (TEE) is increasingly used in hemodynamic monitoring in the intensive care unit. This paper describes and validates a scoring system for assessing competence in TEE performed by intensivists for this indication.

Design: Prospective study over an 18-month period.

Gut dysfunction and endoscopic lesions after out-of-hospital cardiac arrest.

Background: Cardiac arrest induces severe mesenteric ischaemia. The objective of this study was to assess the frequency of gut dysfunction and endoscopic lesions following resuscitation after cardiac arrest, and to evaluate the potential value of gut endoscopy performance in these circumstances.

Methods: This is a retrospective data files survey of 3617 patients from the database in a medical intensive care unit.

Impact of a nurses' protocol-directed weaning procedure on outcomes in patients undergoing mechanical ventilation for longer than 48 hours: a prospective cohort study with a matched historical control group.

Introduction: The aim of the study was to determine whether the use of a nurses' protocol-directed weaning procedure, based on the French intensive care society (SRLF) consensus recommendations, was associated with reductions in the duration of mechanical ventilation and intensive care unit (ICU) length of stay in patients requiring more than 48 hours of mechanical ventilation.

Methods: This prospective study was conducted in a university hospital ICU from January 2002 through to February 2003. A total of 104 patients who had been ventilated for more than 48 hours and were weaned from mechanical ventilation using a nurses' protocol-directed procedure (cases) were compared with a 1:1 matched historical control group who underwent conventional physician-directed weaning (between 1999 and 2001).

Noninvasive continuous positive airway pressure in elderly cardiogenic pulmonary edema patients.

Objective: To compare the physiological effects and the clinical efficacy of continuous positive airway pressure (CPAP) vs standard medical treatment in elderly patients (> or =75 years) with acute hypoxemic respiratory failure related to cardiogenic pulmonary edema.

Design: A prospective, randomized, concealed, and unblinded study of 89 consecutive patients who were admitted to the emergency departments of one general, and three teaching, hospitals.

Intervention: Patients were randomly assigned to receive standard medical treatment alone ( n=46) or standard medical treatment plus CPAP ( n=43).

Noninvasive continuous positive airway pressure ventilation using a new helmet interface: a case-control prospective pilot study.

Objective: To evaluate the clinical efficacy of noninvasive continuous positive airway pressure ventilation (CPAP) using a new interface, constituted by a cephalic plastic helmet, in comparison with a standard facial mask.

Design And Setting: A prospective pilot study with matched-control group, in the emergency department of a teaching hospital.

Patients And Methods: Eleven consecutive adult patients with acute hypoxemic respiratory failure related to cardiogenic pulmonary edema (whether hypercapnic or not) were enrolled in the study, after failure of the initial medical treatment.

Influence of the humidification device during acute respiratory distress syndrome.

Objective: To evaluate the effects of the humidification device on respiratory, hemodynamic and gas exchange parameters in acute respiratory distress syndrome (ARDS) patients.

Design: A prospective open study.

Setting: A medical intensive care unit of a university hospital.

A prospective survey of early 12-h prone positioning effects in patients with the acute respiratory distress syndrome.

Objectives: To evaluate of the oxygenation effects of 12-h prone positioning (PP) in ARDS patients and to assess the safety of such a procedure.

Design And Setting: Prospective observational study in a medical intensive care unit (12 beds) of a university hospital.

Patients: 51 consecutive ARDS patients.