Intermittent subglottic secretion drainage and ventilator-associated pneumonia: a multicenter trial.

Rationale: Ventilator-associated pneumonia (VAP) causes substantial morbidity and mortality. The influence of subglottic secretion drainage (SSD) in preventing VAP remains controversial.

Objectives: To determine whether SSD reduces the overall incidence of microbiologically confirmed VAP.

Frequency and clinical impact of preserved bispectral index activity during deep sedation in mechanically ventilated ICU patients.

Objective: Despite an overall correlation between the bispectral index of the EEG (BIS) and clinical sedation assessment, unexpectedly high BIS values can be observed at deep sedation levels. We assessed the frequency, interindividual variability and clinical impact of high BIS values during clinically deep sedation.

Design And Setting: Prospective observational study in two university-affiliated intensive care units.

Failure to achieve glycemic control despite intensive insulin therapy in a medical ICU: incidence and influence on ICU mortality.

Objective: Intensive insulin therapy reduces mortality in subgroups of intensive care unit (ICU) patients, and awareness of the importance of blood glucose level (BGL) control has increased among ICU physicians and nurses. The impact of insulin treatment strategies on mortality may be influenced by their efficacy in achieving the target BGL range. We assessed the efficacy of an insulin treatment strategy in maintaining BGL within the target range, and we compared ICU mortality in patients who did and did not reach the BGL target.

[Arousal disorders].

Altered states of consciousness are a common reason for visits to the emergency room and admission to intensive care unit. Management of unconscious patient can be difficult because the potential causes of an altered mental status are considerable and the time for diagnosis and effective intervention is short. First, the patient must airway, breathing, and circulation protected.

Early embolization and vasopressor administration for management of life-threatening hemorrhage from pelvic fracture.

Background: In this retrospective study, we reviewed our protocol for management of hemodynamically unstable patients with pelvic injury.

Methods: We managed the patients with the same predetermined plan including controlled hemodynamic resuscitation with early use of vasopressors and pelvic angiography as a first-line treatment.

Results: Of 311 patients with pelvic fracture, 32 hemodynamically unstable patients (10.

Sedation algorithm in critically ill patients without acute brain injury.

Objective: To determine whether use of a sedation algorithm to promote a high level of tolerance to the intensive care environment and preserve consciousness affected time to arousal and duration of mechanical ventilation in patients without acute brain injury.

Design: Two-phase, prospective, controlled study.

Setting: University-affiliated medical intensive care unit.