AIM To determine morbidity and mortality in hip fracture patients and also to assess for any independent associations between Do-Not-Resuscitate (DNR) status and increased post-operative morbidity and mortality in patients undergoing surgical repair of hip fractures. METHODS We conducted a propensity score matched retrospective analysis using de-identified data from the American College of Su...

OBJECTIVE To determine whether a collaborative learning strategy-derived clinical practice guideline can reduce the duration of endotracheal intubation following infant heart surgery. DESIGN Prospective and retrospective data collected from the Pediatric Heart Network in the 12 months pre- and post-clinical practice guideline implementation at the four sites participating in the collaborative...

OBJECTIVE To determine whether the predictive accuracy of clinical judgment alone can be improved by supplementing it with an objective weaning protocol as a decision support tool. METHODS This was a multicenter prospective cohort study carried out at three medical/surgical ICUs. The study involved all consecutive difficult-to-wean ICU patients (failure in the first spontaneous breathing tria...

RATIONALE AND OBJECTIVES Duration of weaning from mechanical ventilation may be reduced by the use of a systematic approach. We assessed whether a closed-loop knowledge-based algorithm introduced in a ventilator to act as a computer-driven weaning protocol can improve patient outcomes as compared with usual care. METHODS AND MEASUREMENTS We conducted a multicenter randomized controlled study ...

STUDY PROTOCOL Conditioned high-flow nasal cannula oxygen therapy for preventing reintubation in mechanically ventilated patients at low risk for extubation failure PRIMARY INVESTIGATOR Dr. Gonzalo Hernandez, MD PhD Critical Care Department of Hospital Virgen de la Salud Toledo, Spain CO-INVESTIGATORS Dr. Concepción Vaquero, MD. Hospital Universitario Ramón y Cajal, Madrid, Spain Dr. Paloma Gon...

OBJECTIVES The many advantages of early tracheal extubation following congenital cardiac surgery in young infants and children are now widely recognized. Benefits include avoiding the morbidity associated with prolonged intubation and the consequences of sedation and positive pressure ventilation in the setting of altered cardiopulmonary physiology. Our practice of tracheal extubation of young ...

BACKGROUND Identifying risk factors for unplanned extubation in patients receiving mechanical ventilation can help guide prevention strategies. OBJECTIVE To assess the risk of unplanned extubation with different sedation strategies. METHODS A 36-month quality improvement study in a 33-bed intensive care unit at a tertiary-care center. RESULTS A total of 92 unplanned extubations occurred (...

BACKGROUND The efficacy of corticosteroids in reducing the incidence of postextubation laryngeal oedema is controversial. We aimed to test our hypothesis that methylprednisolone started 12 h before a planned extubation could prevent postextubation laryngeal oedema. METHODS We did a placebo-controlled, double-blind multicentre trial in 761 adults in intensive-care units. Patients who were vent...

We read with interest the recent Critical Care review of post-extubation laryngeal edema and stridor resulting in respiratory failure [1]. We mostly agree with the authors’ opinion in that article except that the cuff leak test (CLT) was proposed as a standard extubation algorithm. We have two reasons to disagree. First, although the CLT has been widely used for the prediction of post-extubatio...