Accuracy of Critical Care Pain Observation Tool and Behavioral Pain Scale to assess pain in critically ill conscious and unconscious patients: prospective, observational study.

Background: Critically ill patients admitted to intensive care unit (ICU) may suffer from different painful stimuli, but the assessment of pain is difficult because most of them are almost sedated and unable to self-report. Thus, it is important to optimize evaluation of pain in these patients. The main aim of this study was to compare two commonly used scales for pain evaluation: Critical Care Pain Observation Tool (CPOT) and Behavioral Pain Scale (BPS), in both conscious and unconscious patients.

Protective mechanical ventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function.

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 randomized, open-label, clinical trial performed in 56 patients scheduled to undergo elective open abdominal surgery lasting more than 2 h.

In vitro evaluation of an active heat-and-moisture exchanger: the Hygrovent Gold.

Background: To improve the heat and humidification that can be achieved with a heat-and-moisture exchanger (HME), a hybrid active (ie, adds heat and water) HME, the Hygrovent Gold, was developed. We evaluated in vitro the performance of the Hygrovent Gold.

Methods: We tested the Hygrovent Gold (with and without its supplemental heat and moisture options activated), the Hygrobac, and the Hygrovent S.

Prognostic role of clinical and laboratory criteria to identify early ventilator-associated pneumonia in brain injury.

Background: We investigated the role of the clinical pulmonary infection score (CPIS), serum levels of procalcitonin (PCT), C-reactive protein (CRP), and serum amyloid A (SAA) in the detection of patients with early ventilator-associated pneumonia (VAP).

Methods: Observational study in a university hospital. In 58 patients with severe brain injury receiving mechanical ventilation, CPIS, PCT, CRP and SAA were evaluated at ICU entry and at days 3 to 4 of hospital stay for VAP diagnosis (confirmed by endotracheal aspirate or BAL cultures).

Performance of heated wire humidifiers: an in vitro study.

Purpose: We assessed the performance of heated wire humidifiers (HWHs), which should avoid water condensation in the circuit.

Methods: We evaluated the efficiency of 3 HWHs, MR850 (Fisher & Paykel, Auckland, New Zealand), CONCHATHERM IV (Hudson RCI, Temecula, Calif), and DAR HC 2000 (Mallinckrodt DAR, Mirandola, Italy), in comparison with that of the MR730 heated humidifier (HH), which has a standard circuit. We measured gas temperature and absolute humidity (AH) at the Y piece of the ventilatory circuit using a test lung ventilated at 2 minute ventilation volumes (5 and 15 L/min).

An integrated approach to prevent and treat respiratory failure in brain-injured patients.

Purpose Of Review: Brain-injured patients are at increased risk of extracerebral organ dysfunction, in particular ventilator-associated pneumonia. The purpose of this review is to discuss functional abnormalities, clinical treatment, and possible prevention of respiratory function abnormalities in brain-injured patients.

Recent Findings: Ventilator-associated pneumonia worsens the neurologic outcome and increases the intensive care unit and hospital stay, costs, and risk of death.

Circulating levels of granulocyte macrophage colony-stimulating factor in patients with the systemic inflammatory response syndrome.

Objectives: Granulocyte-macrophage colony stimulating factor (GM-CSF) is a key regulator cytokine that modulates the proliferation and maturation of polymorphonuclear and mononuclear progenitors. This study was designed to investigate and clarify the role of GM-CSF in 52 critically ill patients with systemic inflammatory response syndrome (SIRS).

Methods: Serum levels of GM-CSF were detected by an immunoenzyme assay.

Noninvasive positive pressure ventilation delivered by helmet vs. standard face mask.

Objective: This bench and human study compared large and small helmets with face mask (FM) for delivery of noninvasive positive pressure ventilation.

Design: A lung simulator was employed, and the human study involved six healthy subjects. We evaluated a continuous high-flow (CPAPHF), low flow (CPAPLF), ventilator (CPAPVENT) CPAP, and pressure support ventilation (PSV 10 and 20 cmH2O).

Non-invasive ventilation delivered by conventional interfaces and helmet in the emergency department.

Non-invasive positive pressure ventilation is increasingly used as a first-line treatment for respiratory failure. Non-invasive positive pressure ventilation can reduce the complications of endotracheal intubation such as barotrauma, nosocomial infections and the need for sedation. Non-invasive positive pressure ventilation has been shown to reduce the rate of endotracheal intubation in acute cardiogenic pulmonary oedema (27%), in chronic obstructive pulmonary disease (21%), and in acute respiratory failure (17%).

New treatment of acute hypoxemic respiratory failure: noninvasive pressure support ventilation delivered by helmet--a pilot controlled trial.

Objective: To assess the efficacy of noninvasive pressure support ventilation (NPSV) using a new special helmet as first-line intervention to treat patients with hypoxemic acute respiratory failure (ARF), in comparison to NPSV using standard facial mask.

Design And Setting: Prospective clinical pilot investigation with matched control group in three intensive care units of university hospitals.

Patients And Methods: Thirty-three consecutive patients without chronic obstructive pulmonary disease and with hypoxemic ARF (defined as severe dyspnea at rest, respiratory rate >30 breaths/min, PaO2:FiO2 < 200, and active contraction of the accessory muscles of respiration) were enrolled.