CiteULike: jyuh Kress

DNA barcodes: Genes, genomics, and bioinformatics

John Kress — 2008-02-26T20:40:18-00:00

Proceedings of the National Academy of Sciences, Vol. 105, No. 8. (26 February 2008), pp. 2761-2762.

10.1073/pnas.0800476105

Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial

Timothy Girard — 2008-02-18T04:30:18-00:00

The Lancet, Vol. 371, No. 9607., pp. 126-134.

SummaryBackground Approaches to removal of sedation and mechanical ventilation for critically ill patients vary widely. Our aim was to assess a protocol that paired spontaneous awakening trials (SATs)--ie, daily interruption of sedatives--with spontaneous breathing trials (SBTs).Methods In four tertiary-care hospitals, we randomly assigned 336 mechanically ventilated patients in intensive care to management with a daily SAT followed by an SBT (intervention group; n=168) or with sedation per usual care plus a daily SBT (control group; n=168). The primary endpoint was time breathing without assistance. Data were analysed by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00097630.Findings One patient in the intervention group did not begin their assigned treatment protocol because of withdrawal of consent and thus was excluded from analyses and lost to follow-up. Seven patients in the control group discontinued their assigned protocol, and two of these patients were lost to follow-up. Patients in the intervention group spent more days breathing without assistance during the 28-day study period than did those in the control group (14[middle dot]7 days vs 11[middle dot]6 days; mean difference 3[middle dot]1 days, 95% CI 0[middle dot]7 to 5[middle dot]6; p=0[middle dot]02) and were discharged from intensive care (median time in intensive care 9[middle dot]1 days vs 12[middle dot]9 days; p=0[middle dot]01) and the hospital earlier (median time in the hospital 14[middle dot]9 days vs 19[middle dot]2 days; p=0[middle dot]04). More patients in the intervention group self-extubated than in the control group (16 patients vs six patients; 6[middle dot]0% difference, 95% CI 0[middle dot]6% to 11[middle dot]8%; p=0[middle dot]03), but the number of patients who required reintubation after self-extubation was similar (five patients vs three patients; 1[middle dot]2% difference, 95% CI -5[middle dot]2% to 2[middle dot]5%; p=0[middle dot]47), as were total reintubation rates (13[middle dot]8% vs 12[middle dot]5%; 1[middle dot]3% difference, 95% CI -8[middle dot]6% to 6[middle dot]1%; p=0[middle dot]73). At any instant during the year after enrolment, patients in the intervention group were less likely to die than were patients in the control group (HR 0[middle dot]68, 95% CI 0[middle dot]50 to 0[middle dot]92; p=0[middle dot]01). For every seven patients treated with the intervention, one life was saved (number needed to treat was 7[middle dot]4, 95% CI 4[middle dot]2 to 35[middle dot]5).Interpretation Our results suggest that a wake up and breathe protocol that pairs daily spontaneous awakening trials (ie, interruption of sedatives) with daily spontaneous breathing trials results in better outcomes for mechanically ventilated patients in intensive care than current standard approaches and should become routine practice.

Usefulness of the external jugular vein examination in detecting abnormal central venous pressure in critically ill patients.

AG Vinayak — 2007-07-18T06:16:59-00:00

Arch Intern Med, Vol. 166, No. 19. (23 October 2006), pp. 2132-2137.

BACKGROUND: Central venous pressure (CVP) provides important information for the management of critically ill patients. The external jugular vein (EJV) is easier to visualize than the internal jugular vein and may give a reliable estimate of CVP. METHODS: To determine the usefulness of the EJV examination in detecting abnormal CVP values, we performed a prospective blinded evaluation comparing it with CVP measured using an indwelling catheter in critically ill patients with central venous catheters. Blinded EJV examinations were performed by clinicians with 3 experience levels (attending physicians, residents and fellows, and interns and fourth-year medical students) to estimate CVP (categorized as low [</=5 cm of water] or high [>/=10 cm of water]). The usefulness of the EJV examination in discriminating low vs high CVP was measured using receiver operating characteristic curve analysis. RESULTS: One hundred eighteen observations were recorded among 35 patients. The range of CVP values was 2 to 20 cm of water. The EJV was easier to visualize than the internal jugular vein (mean visual analog scale score, 8 vs 5; P<.001). The reliability for determining low and high CVP was excellent, with areas under the curve of 0.95 (95% confidence interval [CI], 0.88-1.00) and 0.97 (95% CI, 0.92-1.00), respectively, for attending physicians and 0.86 (95% CI, 0.78-0.95) and 0.90 (95% CI, 0.84-0.96), respectively, for all examiners. CONCLUSION: The EJV examination correlates well with catheter-measured CVP and is a reliable means of identifying low and high CVP values.