NEJM â Collection Updates for Critical Care

ORIGINAL ARTICLE: Pediatric Hospitalizations Associated with 2009 Pandemic Influenza A (H1N1) in Argentina

Thu, 07Â JanÂ 2010 00:00:00 -05:00

Background: While the Northern Hemisphere experiences the effects of the 2009 pandemic influenza A (H1N1) virus, data from the recent influenza season in the Southern Hemisphere can provide important information...

ORIGINAL ARTICLE: Severe 2009 H1N1 Influenza in Pregnant and Postpartum Women in California

Thu, 07Â JanÂ 2010 00:00:00 -05:00

Background: Like previous epidemic and pandemic diseases, 2009 pandemic influenza A (H1N1) may pose an increased risk of severe illness in pregnant women.

Methods: Statewide surveillance for patients who were hospitalized...

CLINICAL THERAPEUTICS: Activated Protein C for Sepsis

Susanne Toussaint, M.D., M.A., and Herwig Gerlach, M.D., Ph.D. — Thu, 31Â DecÂ 2009 00:00:00 -05:00

A 55-year-old man is brought to the emergency department with abdominal pain, fever (temperature, 102.9Â°F), and dyspnea. His medical history includes an appendectomy 8 years earlier. Abdominal radiography shows free...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 40-2009 â A 29-Year-Old Man with Fever and Respiratory Failure

Thu, 24Â DecÂ 2009 00:00:00 -05:00

Dr. Wilson Tak-Yu Kwong (Medicine): A 29-year-old man was admitted in July 2009 to the critical care unit of this hospital because of fever and respiratory failure.

The patient had been...

OTHER POINTS OF VIEW: Diagnostic Testing for 2009 Pandemic Influenza A (H1N1) Virus Infection in Hospitalized Patients

Thu, 17Â DecÂ 2009 00:00:00 -05:00

Establishing a diagnosis of 2009 pandemic influenza A (H1N1) virus infection in hospitalized patients can be challenging, especially in patients presenting late in their clinical course. Although real-time reverse-transcriptase polymerase...

CORRESPONDENCE: Rapid-Test Sensitivity for Novel Swine-Origin Influenza A (H1N1) Virus in Humans

Thu, 17Â DecÂ 2009 00:00:00 -05:00

To the Editor: Faix et al. (Aug. 13 issue)1 highlight the moderate sensitivity of rapid antigen tests as compared with reverse-transcriptaseâpolymerase-chain-reaction (RT-PCR) assays in detecting the 2009 pandemic influenza A...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 39-2009 â A 28-Year-Old Pregnant Woman with Acute Cardiac Failure

Thu, 17Â DecÂ 2009 00:00:00 -05:00

Dr. Brad W. Butcher (Medicine): A 28-year-old woman was admitted to this hospital 2 days post partum because of cardiac failure.

The patient had been well, except for gestational diabetes mellitus,...

IMAGES IN CLINICAL MEDICINE: Frostbite

Habib Rehman, M.B., B.S. and Aimee Seguin, M.D. — Thu, 17Â DecÂ 2009 00:00:00 -05:00

A 39-year-old man was found in a snowbank, with the ambient temperature â35Â°C. He had been reported missing the previous evening, after an argument with his girlfriend. The emergency services...

OTHER POINTS OF VIEW: When to Consider the Use of Antibiotics in the Treatment of 2009 H1N1 InfluenzaâAssociated Pneumonia

Thu, 10Â DecÂ 2009 00:00:00 -05:00

We are now facing a pandemic caused by an epidemiologically distinct, novel virus, the 2009 pandemic influenza A (H1N1) virus (swine flu), against which few persons born since 1970 have...

OTHER POINTS OF VIEW: Antiviral Treatment for Patients Hospitalized with 2009 Pandemic Influenza A (H1N1)

Thu, 03Â DecÂ 2009 00:00:00 -05:00

With the 2009 H1N1 pandemic well under way, many clinicians are providing care to patients with influenza. Previously, although antiviral treatment was recommended,12 clinicians may not always have prescribed it...

PERSPECTIVE: The Emergency Use Authorization of Peramivir for Treatment of 2009 H1N1 Influenza

Thu, 03Â DecÂ 2009 00:00:00 -05:00

On October 23, 2009, Food and Drug Administration (FDA) Commissioner Margaret Hamburg issued an Emergency Use Authorization (EUA) for peramivir for intravenous injection (BioCryst Pharmaceuticals). Peramivir is an unapproved investigational...

IMAGES IN CLINICAL MEDICINE: Air in the Portal and Mesenteric Veins

Diego de Mendoza-Asensi, M.D. and Kenneth Planas, M.D. — Thu, 19Â NovÂ 2009 00:00:00 -05:00

A 73-year-old man with history of smoking, hypertension, chronic obstructive pulmonary disease, and type 2 diabetes mellitus presented with respiratory distress. The trachea was intubated, and the patient was admitted...

EDITORIAL: Preparing for 2009 H1N1 Influenza

Richard P. Wenzel, M.D., and Michael B. Edmond, M.D., M.P.H. — Thu, 12Â NovÂ 2009 00:00:00 -05:00

In 1743, when disease was presumed to be astral in origin, European newspapers reported on a contagious influence (influenza in Italian) that was being visited on the citizens of Rome....

ORIGINAL ARTICLE: Critical Care Services and 2009 H1N1 Influenza in Australia and New Zealand

The ANZIC Influenza Investigators — Thu, 12Â NovÂ 2009 00:00:00 -05:00

Background: Planning for the treatment of infection with the 2009 pandemic influenza A (H1N1) virus through health care systems in developed countries during winter in the Northern Hemisphere is hampered...

EDITORIAL: Renal Support in Acute Kidney Injury â How Much Is Enough?

Paul M. Palevsky, M.D. — Thu, 22Â OctÂ 2009 00:00:00 -05:00

Decrements in kidney function occur in more than two thirds of hospitalized patients with critical illness,1 and severe acute kidney injury complicates the care of more than 5% of patients...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 33-2009 â A 35-Year-Old Woman with Fever, Abdominal Pain, and Hypotension after Cesarean Section

Thu, 22Â OctÂ 2009 00:00:00 -05:00

Dr. Claudius H.O. Conrad (Surgery): A 35-year-old woman was transferred to this hospital because of abdominal pain, fever, and hypotension.

Three days earlier, an elective cesarean section was performed at another...

ORIGINAL ARTICLE: Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients

The RENAL Replacement Therapy Study Investigators — Thu, 22Â OctÂ 2009 00:00:00 -05:00

Background: The optimal intensity of continuous renal-replacement therapy remains unclear. We conducted a multicenter, randomized trial to compare the effect of this therapy, delivered at two different levels of intensity,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 32-2009 â A 27-Year-Old Man with Progressive Dyspnea

Andrew M. Tager, M.D., Amita Sharma, M.D., and Eugene J. Mark, M.D. — Thu, 15Â OctÂ 2009 00:00:00 -05:00

A 27-year-old man was seen in the outpatient pulmonary division of this hospital because of progressive dyspnea and decreased exercise tolerance.

Approximately 2 years earlier, the patient noted a slight decrease...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2009 â A 26-Year-Old Man with Abdominal Distention and Shock

Thu, 08Â OctÂ 2009 00:00:00 -05:00

Dr. Jeffrey S. Ustin (Trauma, Emergency Surgery, and Surgical Critical Care): A 26-year-old man was admitted to this hospital because of abdominal distention and shock.

The patient had been well until...

ORIGINAL ARTICLE: Moderate Hypothermia to Treat Perinatal Asphyxial Encephalopathy

Thu, 01Â OctÂ 2009 00:00:00 -05:00

Background: Whether hypothermic therapy improves neurodevelopmental outcomes in newborn infants with asphyxial encephalopathy is uncertain.

Methods: We performed a randomized trial of infants who were less than 6 hours of age...

CLINICAL THERAPEUTICS: Parenteral Nutrition in the Critically Ill Patient

Thomas R. Ziegler, M.D. — Thu, 10Â SepÂ 2009 00:00:00 -05:00

A 67-year-old woman with type 2 diabetes mellitus undergoes extensive resection of the small bowel and right colon with a jejunostomy and colostomy because of mesenteric ischemia. In the surgical...

CLINICAL PRACTICE: Neurologic Prognosis after Cardiac Arrest

G. Bryan Young, M.D. — Thu, 06Â AugÂ 2009 00:00:00 -05:00

A 55-year-old man collapses while jogging through the park. A bystander finds him unconscious and without a pulse and initiates cardiopulmonary resuscitation (CPR) while an ambulance is summoned. On arrival...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 23-2009 â A 13-Year-Old Boy with Headache, Nausea, Seizures, and Hypertension

Thu, 23Â JulÂ 2009 00:00:00 -05:00

A 13-year-old boy was admitted to the hospital because of headache, nausea, seizures, renal failure, and hypertension.

The patient had been well until approximately 3 weeks earlier, when intermittent left-sided headaches...

ORIGINAL ARTICLE: Epidemiologic Study of In-Hospital Cardiopulmonary Resuscitation in the Elderly

Thu, 02Â JulÂ 2009 00:00:00 -05:00

Background: It is unknown whether the rate of survival after in-hospital cardiopulmonary resuscitation (CPR) is improving and which characteristics of patients and hospitals predict survival.

Methods: We examined fee-for-service Medicare data...

BOOK REVIEW:

Thu, 28Â MayÂ 2009 00:00:00 -05:00

A search in PubMed for publications that address pediatric nephrology, pediatric critical care, acute kidney injury, and acute dialysis yields more than 1000 publications in the past 15 years, with...

CLINICAL THERAPEUTICS: Fomepizole for Ethylene Glycol and Methanol Poisoning

Jeffrey Brent, M.D., Ph.D. — Thu, 21Â MayÂ 2009 00:00:00 -05:00

A 35-year-old man is brought to the emergency department by his wife after ingesting automobile antifreeze in an attempt at self-harm. On presentation, the patient is somnolent. He is afebrile...

ORIGINAL ARTICLE: Antivenom for Critically Ill Children with Neurotoxicity from Scorpion Stings

Thu, 14Â MayÂ 2009 00:00:00 -05:00

Background: Clinically significant scorpion envenomation by Centruroides sculpturatus produces a dramatic neuromotor syndrome and respiratory insufficiency that often necessitate intensive supportive care. We hypothesized that a scorpion-specific F(abâ²)2 antivenom would...

CORRESPONDENCE: Vitamin D Deficiency in Critically Ill Patients

Thu, 30Â AprÂ 2009 00:00:00 -05:00

To the Editor: Vitamin D deficiency is rarely considered or treated in critically ill patients. However, we recently reported three cases of life-threatening hypocalcemia secondary to vitamin D deficiency,12 highlighting...

EDITORIAL: Glucose Control in the ICU â How Tight Is Too Tight?

Silvio E. Inzucchi, M.D., and Mark D. Siegel, M.D. — Thu, 26Â MarÂ 2009 00:00:00 -05:00

For the past decade, hospitals have focused on the inpatient management of hyperglycemia, particularly in the intensive care unit (ICU). Extensive observational data have shown a consistent, almost linear relationship...

ORIGINAL ARTICLE: Intensive versus Conventional Glucose Control in Critically Ill Patients

The NICE-SUGAR Study Investigators — Thu, 26Â MarÂ 2009 00:00:00 -05:00

Background: The optimal target range for blood glucose in critically ill patients remains unclear.

Methods: Within 24 hours after admission to an intensive care unit (ICU), adults who were expected to...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 9-2009 â An 81-Year-Old Man with Massive Rectal Bleeding

Thu, 19Â MarÂ 2009 00:00:00 -05:00

Dr. John C. Lamattina (Surgery): An 81-year-old man was admitted to this hospital because of massive rectal bleeding.

He had been in his usual state of health until 4 a.m. on...

CLINICAL DECISIONS: Care of an Unresponsive Patient with a Poor Prognosis â Polling Results

Thu, 05Â MarÂ 2009 00:00:00 -05:00

In late January, we presented the case of an unresponsive, 56-year-old homeless patient who had a ruptured aneurysm, a high probability of cancer, and a best prognosis of severe disability...

CLINICAL THERAPEUTICS: Excision and Skin Grafting of Thermal Burns

Dennis P. Orgill, M.D., Ph.D. — Thu, 26Â FebÂ 2009 00:00:00 -05:00

A 45-year-old man was rescued from his burning house. Firefighters removed his smoldering clothes and initiated intravenous access, pulse oximetry, and electrocardiographic monitoring. An endotracheal tube was inserted, and ventilation...

CLINICAL DECISIONS: Care of an Unresponsive Patient with a Poor Prognosis

Thu, 29Â JanÂ 2009 00:00:00 -05:00

A 56-year-old homeless man was found having a seizure and was transported to the hospital. He was found to have a subarachnoid hemorrhage and acute hydrocephalus. He underwent intubation, and...

PERSPECTIVE: Fighting On

Thu, 29Â JanÂ 2009 00:00:00 -05:00

She had been living with multiple myeloma for more than 7 years before she showed up in our intensive care unit (ICU). It had not been easy, but she had...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 2-2009 â A 25-Year-Old Man with Pain and Swelling of the Right Hand and Hypotension

Thu, 15Â JanÂ 2009 00:00:00 -05:00

Dr. William D. Binder (Emergency Services): A 25-year-old man was transferred to the emergency department of this hospital because of pain and swelling of the right hand and hypotension.

The patient...

ORIGINAL ARTICLE: Decontamination of the Digestive Tract and Oropharynx in ICU Patients

Thu, 01Â JanÂ 2009 00:00:00 -05:00

Background: Selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) are infection-prevention measures used in the treatment of some patients in intensive care, but reported effects on patient outcome...

ORIGINAL ARTICLE: Thrombolysis during Resuscitation for Out-of-Hospital Cardiac Arrest

Thu, 18Â DecÂ 2008 00:00:00 -05:00

Background: Approximately 70% of persons who have an out-of-hospital cardiac arrest have underlying acute myocardial infarction or pulmonary embolism. Therefore, thrombolysis during cardiopulmonary resuscitation may improve survival.

Methods: In a double-blind,...

VIDEOS IN CLINICAL MEDICINE: Peripheral Intravenous Cannulation

Thu, 20Â NovÂ 2008 00:00:00 -05:00

...

EDITORIAL: PEEP Guided by Esophageal Pressure â Any Added Value?

Gordon R. Bernard, M.D. — Thu, 13Â NovÂ 2008 00:00:00 -05:00

Treatment of the acute respiratory distress syndrome (ARDS) with positive end-expiratory pressure (PEEP) was introduced more than 40 years ago.12 Few practitioners question the effects of PEEP on hemoglobin saturation,...

ORIGINAL ARTICLE: Mechanical Ventilation Guided by Esophageal Pressure in Acute Lung Injury

Thu, 13Â NovÂ 2008 00:00:00 -05:00

Background: Survival of patients with acute lung injury or the acute respiratory distress syndrome (ARDS) has been improved by ventilation with small tidal volumes and the use of positive end-expiratory...

REVIEW ARTICLE: Venous Thromboembolic Disease and Pregnancy

Paul E. Marik, M.D., and Lauren A. Plante, M.D., M.P.H. — Thu, 06Â NovÂ 2008 00:00:00 -05:00

Pulmonary embolism and deep-vein thrombosis are the two components of a single disease called venous thromboembolism. Approximately 30% of apparently isolated episodes of pulmonary embolism are associated with silent deep-vein...

EDITORIAL: Insulin Infusions in Very-Low-Birth-Weight Infants

Sudha Kashyap, M.D., and Richard A. Polin, M.D. — Thu, 30Â OctÂ 2008 00:00:00 -05:00

Advancements in the care of very-low-birth-weight (<1500 g) infants have resulted in increased survival. The provision of adequate nutrition to meet the growth needs of these infants is one of...

ORIGINAL ARTICLE: Early Insulin Therapy in Very-Low-Birth-Weight Infants

Thu, 30Â OctÂ 2008 00:00:00 -05:00

Background: Studies involving adults and children being treated in intensive care units indicate that insulin therapy and glucose control may influence survival. Hyperglycemia in very-low-birth-weight infants is also associated with...

BOOK REVIEW:

Thu, 16Â OctÂ 2008 00:00:00 -05:00

Lawrence Henderson's simple equation, H+=KÃHA/Aâ, which describes the dynamic equilibrium that occurs when weak acids are in solution, was a revolutionary breakthrough that changed forever the way clinicians evaluate and...

REVIEW ARTICLE: Blunt Aortic Injury

Thu, 16Â OctÂ 2008 00:00:00 -05:00

Blunt aortic injury occurs in less than 1% of motor vehicle crashes but is responsible for 16% of the deaths.1 This injury is second only to head injury as the...

VIDEOS IN CLINICAL MEDICINE: Umbilical Vascular Catheterization

Thu, 09Â OctÂ 2008 00:00:00 -05:00

...

BOOK REVIEW:

Thu, 04Â SepÂ 2008 00:00:00 -05:00

The statistics alone are daunting. In the United States, traumatic injury is the leading cause of death in the first four decades of life. On average, approximately 2 people are...

REVIEW ARTICLE: Current Management of Acute Cutaneous Wounds

Adam J. Singer, M.D., and Alexander B. Dagum, M.D. — Thu, 04Â SepÂ 2008 00:00:00 -05:00

In 2005, 11.8 million wounds were treated in emergency departments in the United States.1 More than half a million burns and 7.3 million lacerations are treated annually,2 and wounds caused...

ORIGINAL ARTICLE: Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema

Thu, 10Â JulÂ 2008 00:00:00 -05:00

Background: Noninvasive ventilation (continuous positive airway pressure [CPAP] or noninvasive intermittent positive-pressure ventilation [NIPPV]) appears to be of benefit in the immediate treatment of patients with acute cardiogenic pulmonary edema...

EDITORIAL: Dialysis in Acute Kidney Injury â More Is Not Better

Joseph V. Bonventre, M.D., Ph.D. — Thu, 03Â JulÂ 2008 00:00:00 -05:00

Acute kidney injury is associated with morbidity and mortality rates of more than 50% in critically ill patients, despite the potential for recovery of renal function and many advances in...

ORIGINAL ARTICLE: Intensity of Renal Support in Critically Ill Patients with Acute Kidney Injury

The VA/NIH Acute Renal Failure Trial Network — Thu, 03Â JulÂ 2008 00:00:00 -05:00

Background: The optimal intensity of renal-replacement therapy in critically ill patients with acute kidney injury is controversial.

Methods: We randomly assigned critically ill patients with acute kidney injury and failure of...

ORIGINAL ARTICLE: Vasopressin and Epinephrine vs. Epinephrine Alone in Cardiopulmonary Resuscitation

Thu, 03Â JulÂ 2008 00:00:00 -05:00

Background: During the administration of advanced cardiac life support for resuscitation from cardiac arrest, a combination of vasopressin and epinephrine may be more effective than epinephrine or vasopressin alone, but...

ORIGINAL ARTICLE: Hypothermia Therapy after Traumatic Brain Injury in Children

Thu, 05Â JunÂ 2008 00:00:00 -05:00

Background: Hypothermia therapy improves survival and the neurologic outcome in animal models of traumatic brain injury. However, the effect of hypothermia therapy on the neurologic outcome and mortality among children...

IMAGES IN CLINICAL MEDICINE: Severe Constipation

Gustavo Cumbo-Nacheli, M.D. — Thu, 29Â MayÂ 2008 00:00:00 -05:00

A 46-year-old man with a history of cerebral palsy presented with difficulty in breathing, which had gradually increased during the previous 2 weeks. He was admitted to the intensive care...

VIDEOS IN CLINICAL MEDICINE: Cricothyroidotomy

James Hsiao, M.D., and Victor Pacheco-Fowler, M.D. — Thu, 29Â MayÂ 2008 00:00:00 -05:00

...

EDITORIAL: Effect of Mechanical Ventilation on the Diaphragm

Gary C. Sieck, Ph.D., and Carlos B. Mantilla, M.D., Ph.D. — Thu, 27Â MarÂ 2008 00:00:00 -05:00

It is widely assumed that respiratory-muscle weakness, either intrinsic or due to fatigue, leads to respiratory failure.1 For the past 30 years, attention has been focused on whether the diaphragm...

ORIGINAL ARTICLE: Rapid Disuse Atrophy of Diaphragm Fibers in Mechanically Ventilated Humans

Thu, 27Â MarÂ 2008 00:00:00 -05:00

Background: The combination of complete diaphragm inactivity and mechanical ventilation (for more than 18 hours) elicits disuse atrophy of myofibers in animals. We hypothesized that the same may also occur...

REVIEW ARTICLE: Acute Pulmonary Embolism

Victor F. Tapson, M.D. — Thu, 06Â MarÂ 2008 00:00:00 -05:00

Pulmonary embolism, most commonly originating from deep venous thrombosis of the legs, ranges from asymptomatic, incidentally discovered emboli to massive embolism causing immediate death. Chronic sequelae of venous thromboembolism (deep...

EDITORIAL: Septic Shock â Vasopressin, Norepinephrine, and Urgency

Joseph E. Parrillo, M.D. — Thu, 28Â FebÂ 2008 00:00:00 -05:00

Septic shock is one of the most challenging problems in critical care medicine. Shock due to sepsis accounts for many of the deaths in medical and surgical intensive care units.1234...

ORIGINAL ARTICLE: Vasopressin versus Norepinephrine Infusion in Patients with Septic Shock

Thu, 28Â FebÂ 2008 00:00:00 -05:00

Background: Vasopressin is commonly used as an adjunct to catecholamines to support blood pressure in refractory septic shock, but its effect on mortality is unknown. We hypothesized that low-dose vasopressin...

PERSPECTIVE: Harming through Protection?

Thu, 21Â FebÂ 2008 00:00:00 -05:00

About 80,000 catheter-related bloodstream infections occur in U.S. intensive care units (ICUs) each year, causing as many as 28,000 deaths and costing the health care system as much as $2.3...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 5-2008 â An 18-Month-Old Girl with an Advanced Neck Contracture after a Burn

Thu, 14Â FebÂ 2008 00:00:00 -05:00

An 18-month-old girl was transferred from a hospital in China to the Shriners Hospital for Children in Boston for management of a life-threatening neck contracture.

The child had been well until...

EDITORIAL: Corticosteroids in Septic Shock

Simon Finfer, F.R.C.P., F.J.F.I.C.M. — Thu, 10Â JanÂ 2008 00:00:00 -05:00

As the balance of evidence regarding corticosteroid treatment for septic shock shifts once again toward the negative, the study by Sprung et al.1 in this issue of the Journal elicits...

ORIGINAL ARTICLE: Intensive Insulin Therapy and Pentastarch Resuscitation in Severe Sepsis

Thu, 10Â JanÂ 2008 00:00:00 -05:00

Background: The role of intensive insulin therapy in patients with severe sepsis is uncertain. Fluid resuscitation improves survival among patients with septic shock, but evidence is lacking to support the...

ORIGINAL ARTICLE: Hydrocortisone Therapy for Patients with Septic Shock

Thu, 10Â JanÂ 2008 00:00:00 -05:00

Background: Hydrocortisone is widely used in patients with septic shock even though a survival benefit has been reported only in patients who remained hypotensive after fluid and vasopressor resuscitation and...

VIDEOS IN CLINICAL MEDICINE: Central Venous Catheterization â Subclavian Vein

Thu, 13Â DecÂ 2007 00:00:00 -05:00

...

IMAGES IN CLINICAL MEDICINE: Herpes Labialis

Julian W. Tang, M.D. and Paul K.S. Chan, M.D. — Thu, 01Â NovÂ 2007 00:00:00 -05:00

A 68-year-old man with a history of asthma and chronic obstructive pulmonary disease was admitted to our hospital with a 1-day history of dyspnea, fever, and epigastric and chest pain....

VIDEOS IN CLINICAL MEDICINE: Chest-Tube Insertion

Thu, 11Â OctÂ 2007 00:00:00 -05:00

...

PERSPECTIVE: The Code

Thu, 27Â SepÂ 2007 00:00:00 -05:00

How do you deal with the emotionally challenging aspects of clinical care?...

CLINICAL THERAPEUTICS: Low-Tidal-Volume Ventilation in the Acute Respiratory Distress Syndrome

Atul Malhotra, M.D. — Thu, 13Â SepÂ 2007 00:00:00 -05:00

A 55-year-old man who is 178 cm tall and weighs 95 kg is hospitalized with community-acquired pneumonia and progressively severe dyspnea. His arterial oxygen saturation while breathing 100% oxygen through...

ORIGINAL ARTICLE: Efficacy and Safety of Epoetin Alfa in Critically Ill Patients

Thu, 06Â SepÂ 2007 00:00:00 -05:00

Background: Anemia, which is common in the critically ill, is often treated with red-cell transfusions, which are associated with poor clinical outcomes. We hypothesized that therapy with recombinant human erythropoietin...

EDITORIAL: Targeting Anemia with Erythropoietin during Critical Illness

Deborah Cook, M.D., and Mark Crowther, M.D. — Thu, 06Â SepÂ 2007 00:00:00 -05:00

The overall goals of clinical research in the intensive care unit (ICU) are to improve clinical outcomes through enhanced understanding of how critical illness develops and how such illness is...

ORIGINAL ARTICLE: Use of a Continuous-Flow Device in Patients Awaiting Heart Transplantation

Thu, 30Â AugÂ 2007 00:00:00 -05:00

Background: The use of left ventricular assist devices is an accepted therapy for patients with refractory heart failure, but current pulsatile volume-displacement devices have limitations (including large pump size and...

ORIGINAL ARTICLE: Saline or Albumin for Fluid Resuscitation in Patients with Traumatic Brain Injury

The SAFE Study Investigators — Thu, 30Â AugÂ 2007 00:00:00 -05:00

Background: The Saline versus Albumin Fluid Evaluation study suggested that patients with traumatic brain injury resuscitated with albumin had a higher mortality rate than those resuscitated with saline. We conducted...

PERSPECTIVE: Bridge to Life â Cardiac Mechanical Support

Thu, 30Â AugÂ 2007 00:00:00 -05:00

Even with well-managed care, many patients with severe heart failure reach a stage at which medical therapy is insufficient to sustain an acceptable level of cardiac function. It is estimated...

VIDEOS IN CLINICAL MEDICINE: Positive-Pressure Ventilation with a Face Mask and a Bag-Valve Device

Thu, 26Â JulÂ 2007 00:00:00 -05:00

...

PERSPECTIVE: Organ Donation after Cardiac Death

Thu, 19Â JulÂ 2007 00:00:00 -05:00

Although the numbers of organ donors and transplantations in the United States have more than doubled over the past 20 years (see line graph), the demand for organs continues to...

IMAGES IN CLINICAL MEDICINE: Severe Digital Ischemia

Rafael S. Cires, M.D. and Susana V. Maya, M.D. — Thu, 05Â JulÂ 2007 00:00:00 -05:00

A 56-year-old woman with diabetes mellitus complicated by retinopathy and mild nephropathy and managed with glyburide (glibenclamide) and metformin reported having abdominal pain and fever for the past 48 hours....

IMAGES IN CLINICAL MEDICINE: A Complication of Central Venous Catheterization

Sudip Nanda, M.D. and Laurie Strockoz-Scaff, P.A.C. — Thu, 24Â MayÂ 2007 00:00:00 -05:00

A 65-year-old man with a history of hypertension, diabetes mellitus, coronary artery disease with angioplasty and bypass grafting, and deep-vein thrombosis (with placement of an inferior vena cava filter several...

VIDEOS IN CLINICAL MEDICINE: Central Venous Catheterization

Thu, 24Â MayÂ 2007 00:00:00 -05:00

...

SPECIAL ARTICLE: Level and Volume of Neonatal Intensive Care and Mortality in Very-Low-Birth-Weight Infants

Thu, 24Â MayÂ 2007 00:00:00 -05:00

Background: There has been a large increase in both the number of neonatal intensive care units (NICUs) in community hospitals and the complexity of the cases treated in these units....

ORIGINAL ARTICLE: Advanced Life Support for Out-of-Hospital Respiratory Distress

Thu, 24Â MayÂ 2007 00:00:00 -05:00

Background: Respiratory distress is a common symptom of patients transported to hospitals by emergency medical services (EMS) personnel. The benefit of advanced life support for such patients has not been...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 15-2007 â A 20-Year-Old Woman with Asthma and Cardiorespiratory Arrest

Thu, 17Â MayÂ 2007 00:00:00 -05:00

A 20-year-old woman with asthma was taken to the emergency room of another hospital because of cardiorespiratory arrest. The patient had had severe asthma since childhood. She was born after...

EDITORIAL: Blood Transfusion â When Is More Really Less?

Howard L. Corwin, M.D., and Jeffrey L. Carson, M.D. — Thu, 19Â AprÂ 2007 00:00:00 -05:00

Blood transfusion has for years been considered to have obvious clinical benefits and to be a relatively low-risk procedure. Not until the early 1980s did transfusion practices begin to come...

ORIGINAL ARTICLE: Transfusion Strategies for Patients in Pediatric Intensive Care Units

Thu, 19Â AprÂ 2007 00:00:00 -05:00

Background: The optimal hemoglobin threshold for erythrocyte transfusions in critically ill children is unknown. We hypothesized that a restrictive transfusion strategy of using packed red cells that were leukocyte-reduced before...

EDITORIAL: The Healing Power of Listening in the ICU

Craig M. Lilly, M.D., and Barbara J. Daly, Ph.D, R.N. — Thu, 01Â FebÂ 2007 00:00:00 -05:00

Critical care services are highly valued because they can often restore function in patients with acute life-threatening illnesses. In this context, advances in medical science have led to increased expectations...

ORIGINAL ARTICLE: A Communication Strategy and Brochure for Relatives of Patients Dying in the ICU

Thu, 01Â FebÂ 2007 00:00:00 -05:00

Background: There is a need for close communication with relatives of patients dying in the intensive care unit (ICU). We evaluated a format that included a proactive end-of-life conference and...

EDITORIAL: Team-Based Prevention of Catheter-Related Infections

Richard P. Wenzel, M.D., and Michael B. Edmond, M.D. — Thu, 28Â DecÂ 2006 00:00:00 -05:00

Each year, 36 million patients are admitted to acute care hospitals in the United States, staying for 164 million days.1 Eleven percent (18 million days) of these hospitalizations are spent...

ORIGINAL ARTICLE: An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU

Thu, 28Â DecÂ 2006 00:00:00 -05:00

Background: Catheter-related bloodstream infections occurring in the intensive care unit (ICU) are common, costly, and potentially lethal.

Methods: We conducted a collaborative cohort study predominantly in ICUs in Michigan. An evidence-based...

EDITORIAL: Diagnosis of Ventilator-Associated Pneumonia

Marin H. Kollef, M.D. — Thu, 21Â DecÂ 2006 00:00:00 -05:00

In this issue of the Journal, Heyland et al., writing for the Canadian Critical Care Trials Group, report the results of a multicenter, randomized trial comparing the use of bronchoalveolar...

ORIGINAL ARTICLE: A Randomized Trial of Diagnostic Techniques for Ventilator-Associated Pneumonia

The Canadian Critical Care Trials Group — Thu, 21Â DecÂ 2006 00:00:00 -05:00

Background: Critically ill patients who require mechanical ventilation are at risk for ventilator-associated pneumonia. Current data are conflicting as to the optimal diagnostic approach in patients who have suspected ventilator-associated...

CLINICAL PROBLEM-SOLVING: Sum of the Parts

Thu, 07Â DecÂ 2006 00:00:00 -05:00

A 36-year-old Pakistani woman presented to the emergency room with a 10-day history of a nonproductive cough, dyspnea, and fever. She reported having no night sweats and no contact with...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 35-2006 â A Newborn Boy with Hypotonia

Thu, 16Â NovÂ 2006 00:00:00 -05:00

A 2-day-old boy was admitted to the special care nursery of this hospital because of hypotonia.

He was delivered at another hospital to a 40-year-old mother (gravida 2, para 2) at...

CLINICAL PRACTICE: Management of Hyperglycemia in the Hospital Setting

Silvio E. Inzucchi, M.D. — Thu, 02Â NovÂ 2006 00:00:00 -05:00

A 53-year-old woman with asthma and multilobar pneumonia is admitted with respiratory failure. She is intubated and treated with antibiotics, albuterol, and methylprednisolone. A random blood glucose measurement obtained on...

REVIEW ARTICLE: Management of Sepsis

James A. Russell, M.D. — Thu, 19Â OctÂ 2006 00:00:00 -05:00

A better understanding of the inflammatory, procoagulant, and immunosuppressive aspects of sepsis has contributed to rational therapeutic plans from which several important themes emerge.1 First, rapid diagnosis (within the first...

PERSPECTIVE: Surviving Sepsis â Practice Guidelines, Marketing Campaigns, and Eli Lilly

Thu, 19Â OctÂ 2006 00:00:00 -05:00

Practice guidelines approved by expert panels are intended to standardize care in such a way as to improve health outcomes. In recent years, the developers of such standards have started...

IMAGES IN CLINICAL MEDICINE: Elevated Jugular Venous Pressure

SÃ¡ndor GyÃ¶rik, M.D. and Andrea Menafoglio, M.D. — Thu, 14Â SepÂ 2006 00:00:00 -05:00

A 43-year-old man presented to the emergency room in respiratory distress after a 3-week illness. He had a history of alcoholism but no other serious illness. He had a respiratory...

EDITORIAL: Volunteers at Risk

Jeffrey M. Drazen, M.D. — Thu, 07Â SepÂ 2006 00:00:00 -05:00

Clinical research can be a risky endeavor. In this issue of the Journal, Suntharalingam et al.1 describe the events that occurred when six healthy volunteers received a dose (0.1 mg...

CLINICAL PROBLEM-SOLVING: More Than Meets the Eye

Thu, 07Â SepÂ 2006 00:00:00 -05:00

A 61-year-old woman was hospitalized with a two-day history of palpitations and dyspnea. She was found to be in atrial fibrillation with a rapid ventricular response, and intravenous diltiazem and...

ORIGINAL ARTICLE: Cytokine Storm in a Phase 1 Trial of the Anti-CD28 Monoclonal Antibody TGN1412

Thu, 07Â SepÂ 2006 00:00:00 -05:00

Six healthy young male volunteers at a contract research organization were enrolled in the first phase 1 clinical trial of TGN1412, a novel superagonist anti-CD28 monoclonal antibody that directly stimulates...

EDITORIAL: Cardiac Resuscitation â When Is Enough Enough?

Gordon A. Ewy, M.D. — Thu, 03Â AugÂ 2006 00:00:00 -05:00

Cardiac arrest is a leading cause of death in the United States.1 In spite of periodic updates of the Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care of the American...

ORIGINAL ARTICLE: Validation of a Rule for Termination of Resuscitation in Out-of-Hospital Cardiac Arrest

Thu, 03Â AugÂ 2006 00:00:00 -05:00

Background: We prospectively evaluated a clinical prediction rule to be used by emergency medical technicians (EMTs) trained in the use of an automated external defibrillator for the termination of basic...

EDITORIAL: Inhaled NO for Preterm Infants â Getting to Yes?

Ann R. Stark, M.D. — Thu, 27Â JulÂ 2006 00:00:00 -05:00

Preterm birth, especially at an extremely low gestational age, is often perilous. Despite improved survival associated with contemporary neonatal intensive care, more than one third of survivors with a birth...

ORIGINAL ARTICLE: Early Inhaled Nitric Oxide Therapy in Premature Newborns with Respiratory Failure

Thu, 27Â JulÂ 2006 00:00:00 -05:00

Background: The safety and efficacy of early, low-dose, prolonged therapy with inhaled nitric oxide in premature newborns with respiratory failure are uncertain.

Methods: We performed a multicenter, randomized trial involving 793...

ORIGINAL ARTICLE: Inhaled Nitric Oxide in Preterm Infants Undergoing Mechanical Ventilation

Thu, 27Â JulÂ 2006 00:00:00 -05:00

Background: Bronchopulmonary dysplasia in premature infants is associated with prolonged hospitalization, as well as abnormal pulmonary and neurodevelopmental outcome. In animal models, inhaled nitric oxide improves both gas exchange and...

SPECIAL ARTICLE: Hospital Volume and the Outcomes of Mechanical Ventilation

Thu, 06Â JulÂ 2006 00:00:00 -05:00

Background: An increased volume of patients is associated with improved survival in numerous high-risk medical and surgical conditions. The relationship between the number of patients admitted (hospital volume) and outcome...

IMAGES IN CLINICAL MEDICINE: Tooth Aspiration

Yevgeniy Ostrinsky, M.D. and Zaza Cohen, M.D. — Thu, 15Â JunÂ 2006 00:00:00 -05:00

A 77-year-old man with a history of hypertension was found on the sidewalk, face down and unresponsive. He had tonicâclonic movements and was brought to the hospital. The initial chest...

EDITORIAL: Fluid-Management Strategies in Acute Lung Injury â Liberal, Conservative, or Both?

Emanuel P. Rivers, M.D., M.P.H. — Thu, 15Â JunÂ 2006 00:00:00 -05:00

One of the factorial assessments carried out in the Fluids and Catheters Treatment Trial (FACTT) conducted by the National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical...

ORIGINAL ARTICLE: Comparison of Two Fluid-Management Strategies in Acute Lung Injury

Thu, 15Â JunÂ 2006 00:00:00 -05:00

Background: Optimal fluid management in patients with acute lung injury is unknown. Diuresis or fluid restriction may improve lung function but could jeopardize extrapulmonary-organ perfusion.

Methods: In a randomized study, we...

EDITORIAL: Pulmonary-Artery Catheters â Peace at Last?

Deborah Shure, M.D. — Thu, 25Â MayÂ 2006 00:00:00 -05:00

The history of the use of the pulmonary-artery catheter (PAC) illustrates a great deal about physicians' often uncritical acceptance of technology in clinical applications. In 1956, Forssmann, Cournand, and Richards...

ORIGINAL ARTICLE: Pulmonary-Artery versus Central Venous Catheter to Guide Treatment of Acute Lung Injury

Thu, 25Â MayÂ 2006 00:00:00 -05:00

Background: The balance between the benefits and the risks of pulmonary-artery catheters (PACs) has not been established.

Methods: We evaluated the relationship of benefits and risks of PACs in 1000 patients...

IMAGES IN CLINICAL MEDICINE: Spurious Platelet Count

Michele Siegenthaler, M.D. and Olivier Spertini, M.D. — Thu, 04Â MayÂ 2006 00:00:00 -05:00

A previously healthy 48-year-old man was admitted for severe burns involving his face, thorax, and upper and lower limbs (45 percent of body-surface area) associated with an inhalation injury. The...

EDITORIAL: PEEP or No PEEP â Lung Recruitment May Be the Solution

Arthur S. Slutsky, M.D., and Leonard D. Hudson, M.D. — Thu, 27Â AprÂ 2006 00:00:00 -05:00

The acute respiratory distress syndrome (ARDS) is characterized by inflammatory lung injury with alveolar flooding and abnormalities in surfactant function. ARDS (a subcategory of acute lung injury) is associated with...

ORIGINAL ARTICLE: Lung Recruitment in Patients with the Acute Respiratory Distress Syndrome

Thu, 27Â AprÂ 2006 00:00:00 -05:00

Background: In the acute respiratory distress syndrome (ARDS), positive end-expiratory pressure (PEEP) may decrease ventilator-induced lung injury by keeping lung regions open that otherwise would be collapsed. Since the effects...

ORIGINAL ARTICLE: Efficacy and Safety of Corticosteroids for Persistent Acute Respiratory Distress Syndrome

Thu, 20Â AprÂ 2006 00:00:00 -05:00

Background: Persistent acute respiratory distress syndrome (ARDS) is characterized by excessive fibroproliferation, ongoing inflammation, prolonged mechanical ventilation, and a substantial risk of death. Because previous reports suggested that corticosteroids may...

VIDEOS IN CLINICAL MEDICINE: Placement of an Arterial Line

Thu, 13Â AprÂ 2006 00:00:00 -05:00

...

IMAGES IN CLINICAL MEDICINE: Nebulizer-Associated Anisocoria

Neil Iosson, M.R.C.P., M.B., B.Chir. — Thu, 02Â MarÂ 2006 00:00:00 -05:00

A 42-year-old intravenous drug user was transferred to the ward for noninvasive respiratory support after discharge from the intensive care unit, where she had been treated for fungal pneumonia and...

EDITORIAL: Intensive Insulin in Intensive Care

Atul Malhotra, M.D. — Thu, 02Â FebÂ 2006 00:00:00 -05:00

Among the critically ill, elevations in blood glucose, a marker previously ignored or described as adaptive, became a major therapeutic target after a 2001 study indicated a mortality benefit of...

ORIGINAL ARTICLE: Intensive Insulin Therapy in the Medical ICU

Thu, 02Â FebÂ 2006 00:00:00 -05:00

Background: Intensive insulin therapy reduces morbidity and mortality in patients in surgical intensive care units (ICUs), but its role in patients in medical ICUs is unknown.

Methods: In a prospective, randomized,...

CLINICAL PRACTICE: Preventing Nephropathy Induced by Contrast Medium

Brendan J. Barrett, M.B., and Patrick S. Parfrey, M.D. — Thu, 26Â JanÂ 2006 00:00:00 -05:00

A 71-year-old man with type 2 diabetes and hypertension is referred for coronary angiography. His medications include metformin and a thiazide. Before the angiogram, his serum creatinine level is 1.8...

SPECIAL ARTICLE: A National Evaluation of the Effect of Trauma-Center Care on Mortality

Thu, 26Â JanÂ 2006 00:00:00 -05:00

Background: Hospitals have difficulty justifying the expense of maintaining trauma centers without strong evidence of their effectiveness. To address this gap, we examined differences in mortality between level 1 trauma...

IMAGES IN CLINICAL MEDICINE: Urinary Calcium Oxalate Crystals in Ethylene Glycol Intoxication

Jose Morfin, M.D. and Andrew Chin, M.D. — Thu, 15Â DecÂ 2005 00:00:00 -05:00

A 73-year-old man presented with a self-inflicted stab wound to the abdomen. A plasma ethanol level of 27 mg per deciliter was found on preliminary toxicologic screening; the results of...

EDITORIAL: Severe Sepsis and Therapy with Activated Protein C

Joseph E. Parrillo, M.D. — Thu, 29Â SepÂ 2005 00:00:00 -05:00

Sepsis, severe sepsis, and septic shock represent a spectrum of increasingly severe diseases that result from serious infection and the body's response to microbiologic invasion. Population data suggest that 750,000...

ORIGINAL ARTICLE: Drotrecogin Alfa (Activated) for Adults with Severe Sepsis and a Low Risk of Death

Thu, 29Â SepÂ 2005 00:00:00 -05:00

Background: In November 2001, the Food and Drug Administration (FDA) approved drotrecogin alfa (activated) (DrotAA) for adults who had severe sepsis and a high risk of death. The FDA required...

IMAGES IN CLINICAL MEDICINE: Ebstein's Anomaly

Aiden J. O'Loughlin, M.B., B.S. and Chris Hayward, F.R.A.C.P. — Thu, 22Â SepÂ 2005 00:00:00 -05:00

A 44-year-old woman presented with increasing dyspnea. The patient had Ebstein's anomaly, which had first been diagnosed when she was in her early 20s. She had declined heart transplantation three...

IMAGES IN CLINICAL MEDICINE: Uremic Frost

Stephen R. Walsh, M.D.C.M. and Nereida A. Parada, M.D. — Thu, 31Â MarÂ 2005 00:00:00 -05:00

A 57-year-old woman with hypertension and chronic renal insufficiency who had refused dialysis for two years was found in respiratory distress after one week of upper respiratory symptoms due to...

IMAGES IN CLINICAL MEDICINE: Severe Fecal Impaction

Yann LoubiÃ¨res, M.D. and Olivier Chereau, M.D. — Thu, 24Â MarÂ 2005 00:00:00 -05:00

A 49-year-old man with a history of paraplegia due to poliomyelitis, surgical treatment of a lumbar ependymoma, and chronic renal insufficiency due to a neuropathic bladder was admitted to the...

REVIEW ARTICLE: Care of the Potential Organ Donor

Thu, 23Â DecÂ 2004 00:00:00 -05:00

Even in the face of the urgent need for transplantable organs, there continues to be a disparity between the number of potential organ donors and that of actual donors.1 Reducing...

ORIGINAL ARTICLE: Effect of Recombinant Surfactant Protein CâBased Surfactant on the Acute Respiratory Distress Syndrome

Thu, 26Â AugÂ 2004 00:00:00 -05:00

Background: Preclinical studies suggest that exogenous surfactant may be of value in the treatment of the acute respiratory distress syndrome (ARDS), and two phase 2 clinical trials have shown a...

PERSPECTIVE: Exogenous Surfactant Replacement in ARDS â One Day, Someday, or Never?

Simon V. Baudouin, M.D. — Thu, 26Â AugÂ 2004 00:00:00 -05:00

Most therapies that fail to show benefit in well-conducted, randomized, controlled trials are abandoned by both clinical investigators and pharmaceutical companies. Treatment with exogenous surfactant for the acute respiratory distress...

EDITORIAL: PEEP in ARDS â How Much Is Enough?

Mitchell M. Levy, M.D. — Thu, 22Â JulÂ 2004 00:00:00 -05:00

In 1967, Ashbaugh et al.1 introduced the use of positive end-expiratory pressure (PEEP) during mechanical ventilation to treat refractory hypoxemia in patients with the acute respiratory distress syndrome (ARDS). Almost...

ORIGINAL ARTICLE: Higher versus Lower Positive End-Expiratory Pressures in Patients with the Acute Respiratory Distress Syndrome

The National Heart, Lung, and Blood Institute ARDS Clinical Trials Network — Thu, 22Â JulÂ 2004 00:00:00 -05:00

Background: Most patients requiring mechanical ventilation for acute lung injury and the acute respiratory distress syndrome (ARDS) receive positive end-expiratory pressure (PEEP) of 5 to 12 cm of water. Higher...

IMAGES IN CLINICAL MEDICINE: Massive Subcutaneous Emphysema after Tracheal Perforation

Kenzo Hirose, M.D. and Brendan C. Visser, M.D. — Thu, 15Â JulÂ 2004 00:00:00 -05:00

A 77-year-old woman underwent laminectomy and posterior spinal fusion from T12 to S1, an operation that was performed while she was in the prone position. At the conclusion of the...

REVIEW ARTICLE: Acute Renal Failure and Sepsis

Robert W. Schrier, M.D., and Wei Wang, M.D. — Thu, 08Â JulÂ 2004 00:00:00 -05:00

Acute renal failure occurs in approximately 19 percent of patients with moderate sepsis, 23 percent with severe sepsis, and 51 percent with septic shock when blood cultures are positive (Table...

EDITORIAL: Noninvasive Ventilation â Don't Push Too Hard

Jonathon Dean Truwit, M.D., and Gordon R. Bernard, M.D. — Thu, 10Â JunÂ 2004 00:00:00 -05:00

Noninvasive mechanical ventilation has been used increasingly over the past decade in an effort to avoid endotracheal intubation and to accelerate the discontinuation of mechanical ventilation. Noninvasive ventilation as adjunctive...

ORIGINAL ARTICLE: Noninvasive Positive-Pressure Ventilation for Respiratory Failure after Extubation

Thu, 10Â JunÂ 2004 00:00:00 -05:00

Background: The need for reintubation after extubation and discontinuation of mechanical ventilation is not uncommon and is associated with increased mortality. Noninvasive positive-pressure ventilation has been suggested as a promising...

EDITORIAL: Is Albumin Safe?

Deborah Cook, M.D. — Thu, 27Â MayÂ 2004 00:00:00 -05:00

The Saline versus Albumin Fluid Evaluation (SAFE) Study, reported in this issue of the Journal,1 heralds a new era in critical care marked by the large, simple, randomized trial popularized...

ORIGINAL ARTICLE: A Comparison of Albumin and Saline for Fluid Resuscitation in the Intensive Care Unit

The SAFE Study Investigators — Thu, 27Â MayÂ 2004 00:00:00 -05:00

Background: It remains uncertain whether the choice of resuscitation fluid for patients in intensive care units (ICUs) affects survival. We conducted a multicenter, randomized, double-blind trial to compare the effect...

IMAGES IN CLINICAL MEDICINE: Air Embolism after the Insertion of a Central Venous Catheter

Ulf K.M. TeichgrÃ¤ber, M.D. and Thomas Benter, M.D. — Thu, 06Â MayÂ 2004 00:00:00 -05:00

A 17-year-old girl was involved in a car accident as a passenger. Before she was transported by helicopter to a hospital, a central venous catheter was inserted. She was admitted...

IMAGES IN CLINICAL MEDICINE: Pneumoperitoneum

Jolanda H.M. van Steijn, M.D. and Peter H.J. van der Voort, M.D., Ph.D. — Thu, 29Â AprÂ 2004 00:00:00 -05:00

A 47-year-old man was admitted to the intensive care unit with respiratory failure complicating pneumonia due to legionella infection. Mechanical ventilation with positive end-expiratory pressure was initiated. Radiographs of the...

ORIGINAL ARTICLE: Measurements of Serum Free Cortisol in Critically Ill Patients

Amir H. Hamrahian, M.D., Tawakalitu S. Oseni, M.D., and Baha M. Arafah, M.D. — Thu, 15Â AprÂ 2004 00:00:00 -05:00

Background: Because more than 90 percent of circulating cortisol in human serum is protein-bound, changes in the binding proteins can alter measured serum total cortisol concentrations without influencing free concentrations...

PERSPECTIVE: Glucocorticoid Therapy in the Intensive Care Unit

Lynn Loriaux, M.D. — Thu, 15Â AprÂ 2004 00:00:00 -05:00

Acute adrenal insufficiency, a rare cause of shock, is manifested as shock that is poorly responsive to fluid resuscitation and pressors, not unlike cardiogenic or septic shock. It is almost...

ORIGINAL ARTICLE: Avian Influenza A (H5N1) in 10 Patients in Vietnam

Thu, 18Â MarÂ 2004 00:00:00 -05:00

Background: Recent outbreaks of avian influenza A (H5N1) in poultry throughout Asia have had major economic and health repercussions. Human infections with this virus were identified in Vietnam in January...

IMAGES IN CLINICAL MEDICINE: Anterior Cervical Osteophytes Causing Airway Compromise

Paul Aronowitz, M.D. and Fabiola Cobarrubias, M.D. — Thu, 25Â DecÂ 2003 00:00:00 -05:00

An 81-year-old man had had mild dysphagia for several years. During the six months before admission, the dysphagia worsened, and he had occasional hemoptysis. For several days before admission he...

PERSPECTIVE: Tools of the Trade

Danielle Ofri, M.D., Ph.D. — Thu, 30Â OctÂ 2003 00:00:00 -05:00

I grasped the list of patients, fingering the crispness of the sheet that represented my first day of service on the medical wards. I knew that the sheet would soon...

ORIGINAL ARTICLE: The Prevention of Radiocontrast-AgentâInduced Nephropathy by Hemofiltration

Thu, 02Â OctÂ 2003 00:00:00 -05:00

Background: Nephropathy induced by exposure to radiocontrast agents, a possible complication of percutaneous coronary interventions, is associated with significant in-hospital and long-term morbidity and mortality. Patients with preexisting renal failure...

PERSPECTIVE: Invasive Cardiovascular Procedures â Optimizing Patient Safety

John W. Hirshfeld, Jr., M.D. — Thu, 02Â OctÂ 2003 00:00:00 -05:00

Invasive cardiovascular procedures offer many patients substantial diagnostic and therapeutic benefits. Vascular angioplasty, electrophysiological ablation procedures, and transjugular intrahepatic portosystemic shunt procedures are among the important therapeutic procedures that provide...

ORIGINAL ARTICLE: Withdrawal of Mechanical Ventilation in Anticipation of Death in the Intensive Care Unit

Thu, 18Â SepÂ 2003 00:00:00 -05:00

Background: In critically ill patients who are receiving mechanical ventilation, the factors associated with physicians' decisions to withdraw ventilation in anticipation of death are unclear. The objective of this study...

PERSPECTIVE: Decisions at the End of Life

Jeffrey M. Drazen, M.D. — Thu, 18Â SepÂ 2003 00:00:00 -05:00

In the more than 30 years that I have been practicing medicine, the most difficult task for me has been speaking to the family members of patients whose health is...

PERSPECTIVE: Responding to Organ Failure in HIV-Infected Patients

Michelle E. Roland, M.D., and Diane V. Havlir, M.D. — Thu, 05Â JunÂ 2003 00:00:00 -05:00

Until recently, patients infected with the human immunodeficiency virus (HIV) who had organ failure were not routinely evaluated for transplantation. The poor prognosis for persons with the acquired immunodeficiency syndrome...

ORIGINAL ARTICLE: Nitroprusside in Critically Ill Patients with Left Ventricular Dysfunction and Aortic Stenosis

Thu, 01Â MayÂ 2003 00:00:00 -05:00

Background: Vasodilators are considered to be contraindicated in patients with severe aortic stenosis because of concern that they may precipitate life-threatening hypotension. However, vasodilators such as nitroprusside may improve myocardial...

ORIGINAL ARTICLE: The Epidemiology of Sepsis in the United States from 1979 through 2000

Thu, 17Â AprÂ 2003 00:00:00 -05:00

Background: Sepsis represents a substantial health care burden, and there is limited epidemiologic information about the demography of sepsis or about the temporal changes in its incidence and outcome. We...

HEALTH POLICY REPORT: How Best to Ventilate? Trial Design and Patient Safety in Studies of the Acute Respiratory Distress Syndrome

Robert Steinbrook, M.D. — Thu, 03Â AprÂ 2003 00:00:00 -05:00

Each year, about 150,000 people in the United States have acute lung injury or its most severe form, the acute respiratory distress syndrome â devastating lung diseases associated with a...

EDITORIAL: Controlling Research Trials

Jeffrey M. Drazen, M.D. — Thu, 03Â AprÂ 2003 00:00:00 -05:00

Clinical research, especially in the form of large multicenter trials, promotes changes in practice; without the accrual of new knowledge, clinical care will not advance. A deadlock between the National...

REVIEW ARTICLE: Preventing Complications of Central Venous Catheterization

David C. McGee, M.D., and Michael K. Gould, M.D. — Thu, 20Â MarÂ 2003 00:00:00 -05:00

In the United States, physicians insert more than 5 million central venous catheters every year.1 Central venous catheters allow measurement of hemodynamic variables that cannot be measured accurately by noninvasive...

EDITORIAL: Neuromuscular Sequelae of Critical Illness

Leonard D. Hudson, M.D., and Catherine M. Lee, M.D. — Thu, 20Â FebÂ 2003 00:00:00 -05:00

Until recently, survival to hospital discharge was the primary outcome considered in reports concerning populations of critically ill patients. But a body of knowledge is now being developed about longer-term...

REVIEW ARTICLE: Corticosteroid Insufficiency in Acutely Ill Patients

Mark S. Cooper, M.D., and Paul M. Stewart, M.D. — Thu, 20Â FebÂ 2003 00:00:00 -05:00

An increase in tissue corticosteroid levels during acute illness is an important protective response. Many diseases and their treatments interfere with the normal corticosteroid response to illness and thus induce...

ORIGINAL ARTICLE: One-Year Outcomes in Survivors of the Acute Respiratory Distress Syndrome

Thu, 20Â FebÂ 2003 00:00:00 -05:00

Background: As more patients survive the acute respiratory distress syndrome, an understanding of the long-term outcomes of this condition is needed.

Methods: We evaluated 109 survivors of the acute respiratory distress...

REVIEW ARTICLE: The Pathophysiology and Treatment of Sepsis

Richard S. Hotchkiss, M.D., and Irene E. Karl, Ph.D. — Thu, 09Â JanÂ 2003 00:00:00 -05:00

Sepsis is the leading cause of death in critically ill patients in the United States. Sepsis develops in 750,000 people annually, and more than 210,000 of them die.12 After numerous...

EDITORIAL: Progress in Research on Pulmonary-Artery Catheters

Polly E. Parsons, M.D. — Thu, 02Â JanÂ 2003 00:00:00 -05:00

Pulmonary-artery catheters are widely used in critically ill patients both for diagnosis and to guide therapy. According to current estimates, there are more than 1.2 million pulmonary-artery catheters placed annually...

ORIGINAL ARTICLE: A Randomized, Controlled Trial of the Use of Pulmonary-Artery Catheters in High-Risk Surgical Patients

Thu, 02Â JanÂ 2003 00:00:00 -05:00

Background: Some observational studies suggest that the use of pulmonary-artery catheters to guide therapy is associated with increased mortality.

Methods: We performed a randomized trial comparing goal-directed therapy guided by a...

ORIGINAL ARTICLE: Salmonella Sepsis Caused by a Platelet Transfusion from a Donor with a Pet Snake

Thu, 03Â OctÂ 2002 00:00:00 -05:00

Platelet transfusions carry a serious risk of bacterial sepsis. Platelets are stored at room temperature for no longer than 120 hours (five days), and a single bacterium of the type...

SPECIAL ARTICLE: An Economic Evaluation of Activated Protein C Treatment for Severe Sepsis

Thu, 26Â SepÂ 2002 00:00:00 -05:00

Background: Recombinant human activated protein C was shown in the Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study to reduce mortality among patients with severe sepsis....

PERSPECTIVE: Treating Sepsis

Thu, 26Â SepÂ 2002 00:00:00 -05:00

Sepsis, a leading cause of death in the United States, is now viewed physiologically as a proinflammatory and procoagulant response to invading pathogens. There are three recognized stages in the...

SOUNDING BOARD: Assessing the Use of Activated Protein C in the Treatment of Severe Sepsis

Thu, 26Â SepÂ 2002 00:00:00 -05:00

In 2001, the Food and Drug Administration (FDA) evaluated an application for the use of drotrecogin alfa (activated), or recombinant human activated protein C (Xigris, Eli Lilly), in patients with...

SOUNDING BOARD: Risks and Benefits of Activated Protein C Treatment for Severe Sepsis

Thu, 26Â SepÂ 2002 00:00:00 -05:00

A new hypothesis with implications for the treatment of sepsis has recently been tested â the hypothesis that part of the pathophysiology of sepsis is caused by unrestricted or inappropriate...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 28-2002 â A 35-Year-Old Long-Term Traveler with a Rapidly Progressive Soft-Tissue Infection

Deborah J. Hoadley and Eugene J. Mark — Thu, 12Â SepÂ 2002 00:00:00 -05:00

A 35-year-old woman was admitted to the hospital because of pain and swelling of the right thigh.

The patient had been in excellent health until the morning before admission, when she...

ORIGINAL ARTICLE: Voriconazole versus Amphotericin B for Primary Therapy of Invasive Aspergillosis

Thu, 08Â AugÂ 2002 00:00:00 -05:00

Background: Voriconazole is a broad-spectrum triazole that is active against aspergillus species. 02080826.xml We conducted a randomized trial to compare voriconazole with amphotericin B for primary therapy of invasive aspergillosis.

Methods:...

ORIGINAL ARTICLE: Changes in Pathogens Causing Early-Onset Sepsis in Very-Low-Birth-Weight Infants

Thu, 25Â JulÂ 2002 00:00:00 -05:00

Background: It is uncertain whether the rates and causes of early-onset sepsis (that occurring within 72 hours after birth) among very-low-birth-weight infants have changed in recent years, since antibiotics have...

ORIGINAL ARTICLE: Bacteremia Traced to an Infused Narcotic

Thu, 16Â MayÂ 2002 00:00:00 -05:00

Background: From June 30, 1998, through March 21, 1999, several patients in the surgical intensive care unit of a hospital acquired Serratia marcescens bacteremia. We investigated this outbreak.

Methods: A case...

ORIGINAL ARTICLE: Pulmonary Dead-Space Fraction as a Risk Factor for Death in the Acute Respiratory Distress Syndrome

Thu, 25Â AprÂ 2002 00:00:00 -05:00

Background: No single pulmonary-specific variable, including the severity of hypoxemia, has been found to predict the risk of death independently when measured early in the course of the acute respiratory...

EDITORIAL: Hemodynamic and Metabolic Therapy in Critically Ill Patients

Thu, 08Â NovÂ 2001 00:00:00 -05:00

The poliomyelitis epidemic of 1952 in Denmark was a key impetus for the development of modern critical care medicine. Mortality among patients with respiratory failure was dramatically reduced by applying...

ORIGINAL ARTICLE: Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock

Thu, 08Â NovÂ 2001 00:00:00 -05:00

Background: Goal-directed therapy has been used for severe sepsis and septic shock in the intensive care unit. This approach involves adjustments of cardiac preload, afterload, and contractility to balance oxygen...

ORIGINAL ARTICLE: Intensive Insulin Therapy in Critically Ill Patients

Thu, 08Â NovÂ 2001 00:00:00 -05:00

Background: Hyperglycemia and insulin resistance are common in critically ill patients, even if they have not previously had diabetes. Whether the normalization of blood glucose levels with insulin therapy improves...

EDITORIAL: A Great Constitutional Disturbance

Thu, 25Â OctÂ 2001 00:00:00 -05:00

Serious injury causes âa great constitutional disturbance,â as Daniel Drake, a surgeon, said in describing his own burn injury in 1830.1 The disturbance includes an initial âebb phaseâ of immediate...

ORIGINAL ARTICLE: Reversal of Catabolism by Beta-Blockade after Severe Burns

Thu, 25Â OctÂ 2001 00:00:00 -05:00

Background: The catecholamine-mediated hypermetabolic response to severe burns causes increased energy expenditure and muscle-protein catabolism. We hypothesized that blockade of Î²-adrenergic stimulation with propranolol would decrease resting energy expenditure and...

REVIEW ARTICLE: Advances in Mechanical Ventilation

Martin J. Tobin, M.D. — Thu, 28Â JunÂ 2001 00:00:00 -05:00

The chief reason that patients are admitted to an intensive care unit is to receive ventilatory support. In this article, I update the basic principles of mechanical ventilation, which I...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 15-2001 â A 72-Year-Old Man with Persistent Fever and Hypotension

Ursula B. Kaiser, E. Tessa Hedley-Whyte — Thu, 17Â MayÂ 2001 00:00:00 -05:00

A 72-year-old man was admitted to the hospital because of persistent fever and hypotension.

The patient had been well until eight days earlier, when nausea and vomiting developed, with lower abdominal...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 11-2001 â Rapidly Progressive Renal Failure in a 35-Year-Old Woman with Systemic Lupus Erythematosus

Cecil H.Coggins, Robert T. McCluskey — Thu, 12Â AprÂ 2001 00:00:00 -05:00

A 35-year-old woman was admitted to the hospital because of rapidly worsening renal failure.

Twelve years before admission, she had received a diagnosis of systemic lupus erythematosus, manifested by Raynaud's syndrome,...

EDITORIAL: Severe Sepsis â A New Treatment with Both Anticoagulant and Antiinflammatory Properties

Thu, 08Â MarÂ 2001 00:00:00 -05:00

In the last half of the 20th century, the use of antibiotics for the treatment of bacterial infections transformed the practice of medicine, resulting in sharp reductions in morbidity and...

ORIGINAL ARTICLE: Efficacy and Safety of Recombinant Human Activated Protein C for Severe Sepsis

Thu, 08Â MarÂ 2001 00:00:00 -05:00

Background: Drotrecogin alfa (activated), or recombinant human activated protein C, has antithrombotic, antiinflammatory, and profibrinolytic properties. In a previous study, drotrecogin alfa activated produced dose-dependent reductions in the levels of...

EDITORIAL: Hypothermia for Traumatic Brain Injury â A Good Idea Proved Ineffective

Thu, 22Â FebÂ 2001 00:00:00 -05:00

Traumatic brain injury is an important cause of death and disability in both civilians and military personnel.1 In areas with organized trauma care systems and adequate critical care, the mortality...

ORIGINAL ARTICLE: Lack of Effect of Induction of Hypothermia after Acute Brain Injury

Thu, 22Â FebÂ 2001 00:00:00 -05:00

Background: Induction of hypothermia in patients with brain injury was shown to improve outcomes in small clinical studies, but the results were not definitive. To study this issue, we conducted...

ORIGINAL ARTICLE: Adverse Events, Including Death, Associated with the Use of 1,4-Butanediol

Thu, 11Â JanÂ 2001 00:00:00 -05:00

Background: 1,4-Butanediol is an industrial solvent that, when ingested, is converted to Î³-hydroxybutyrate, a drug of abuse with depressant effects, primarily on the central nervous system. After reports of toxic...

EDITORIAL: Ibuprofen and Patent Ductus Arteriosus

Thu, 07Â SepÂ 2000 00:00:00 -05:00

The ductus arteriosus connects the pulmonary artery to the descending aorta. During fetal life it diverts most of the combined ventricular output away from the lungs toward the placenta. In...

ORIGINAL ARTICLE: Endemic Infection in a Neonatal Intensive Care Unit

Thu, 07Â SepÂ 2000 00:00:00 -05:00

Background: Nosocomial infections due to Pseudomonas aeruginosa have been well described, but the environmental reservoir of the organism varies. We conducted an epidemiologic and molecular investigation of endemic P. aeruginosa...

ORIGINAL ARTICLE: A Comparison of Ibuprofen and Indomethacin for Closure of Patent Ductus Arteriosus

Thu, 07Â SepÂ 2000 00:00:00 -05:00

Background: Indomethacin is the conventional treatment for patent ductus arteriosus in preterm infants. However, its use is associated with various side effects. In a prospective study, we compared ibuprofen and...

EDITORIAL: Cardiopulmonary Resuscitation â Strengthening the Links in the Chain of Survival

Thu, 25Â MayÂ 2000 00:00:00 -05:00

The major determinants of survival after witnessed out-of-hospital cardiac arrest due to ventricular fibrillation include whether a bystander initiates cardiopulmonary resuscitation (CPR) and how quickly defibrillation is accomplished.

The now-classic observations...

ORIGINAL ARTICLE: Cardiopulmonary Resuscitation by Chest Compression Alone or with Mouth-to-Mouth Ventilation

Thu, 25Â MayÂ 2000 00:00:00 -05:00

Background: Despite extensive training of citizens of Seattle in cardiopulmonary resuscitation (CPR), bystanders do not perform CPR in almost half of witnessed cardiac arrests. Instructions in chest compression plus mouth-to-mouth...

EDITORIAL: A Wake-Up Call in the Intensive Care Unit

Thu, 18Â MayÂ 2000 00:00:00 -05:00

In few other areas of medicine is the saying âyou can't get something for nothingâ more true than in the intensive care unit. Modern advances in critical care have offered...

ORIGINAL ARTICLE: Daily Interruption of Sedative Infusions in Critically Ill Patients Undergoing Mechanical Ventilation

Thu, 18Â MayÂ 2000 00:00:00 -05:00

Background: Continuous infusions of sedative drugs in the intensive care unit may prolong the duration of mechanical ventilation, prolong the length of stay in the intensive care unit and the...

EDITORIAL: Culmination of an Era in Research on the Acute Respiratory Distress Syndrome

Thu, 04Â MayÂ 2000 00:00:00 -05:00

The acute respiratory distress syndrome is a form of noncardiogenic pulmonary edema that results from acute damage to the alveoli. Most patients with this syndrome will die if they do...

REVIEW ARTICLE: The Acute Respiratory Distress Syndrome

Lorraine B. Ware, M.D., and Michael A. Matthay, M.D. — Thu, 04Â MayÂ 2000 00:00:00 -05:00

The acute respiratory distress syndrome is a common, devastating clinical syndrome of acute lung injury that affects both medical and surgical patients. Since the last review of this syndrome appeared...

IMAGES IN CLINICAL MEDICINE: Pneumomediastinum and Severe Subcutaneous Emphysema

Frank G.H. van der Kleij, M.D. and Jan G. Zijlstra, M.D., Ph.D. — Thu, 04Â MayÂ 2000 00:00:00 -05:00

Figure 1. A 76-year-old man with chronic obstructive pulmonary disease was admitted after a car accident. The initial clinical and radiographic evaluation showed no evidence of rib fractures or other...

ORIGINAL ARTICLE: Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome

The Acute Respiratory Distress Syndrome Network — Thu, 04Â MayÂ 2000 00:00:00 -05:00

Background: Traditional approaches to mechanical ventilation use tidal volumes of 10 to 15 ml per kilogram of body weight and may cause stretch-induced lung injury in patients with acute lung...

ORIGINAL ARTICLE: Long-Term Outcome of Fulminant Myocarditis as Compared with Acute (Nonfulminant) Myocarditis

Thu, 09Â MarÂ 2000 00:00:00 -05:00

Background: Lymphocytic myocarditis causes left ventricular dysfunction that may be persistent or reversible. There are no clinical criteria that predict which patients will recover ventricular function and which cases will...

SOUNDING BOARD: Pharmacologic Paralysis and Withdrawal of Mechanical Ventilation at the End of Life

Thu, 17Â FebÂ 2000 00:00:00 -05:00

The right of a patient or surrogate to refuse life-sustaining treatment, including mechanical ventilation, is firmly established in American law and bioethics.1 Moreover, practice standards now encourage clinicians to administer...

REVIEW ARTICLE: Gas Embolism

Claus M. Muth, M.D., and Erik S. Shank, M.D. — Thu, 17Â FebÂ 2000 00:00:00 -05:00

Gas embolism, the entry of gas into vascular structures, is a largely iatrogenic clinical problem that can result in serious morbidity and even death.1 Since gas embolism can result from...

ORIGINAL ARTICLE: Low-Dose Nitric Oxide Therapy for Persistent Pulmonary Hypertension of the Newborn

Thu, 17Â FebÂ 2000 00:00:00 -05:00

Background: Inhaled nitric oxide improves gas exchange in neonates, but the efficacy of low-dose inhaled nitric oxide in reducing the need for extracorporeal membrane oxygenation has not been established.

Methods: We...

ORIGINAL ARTICLE: Amiodarone for Resuscitation after Out-of-Hospital Cardiac Arrest Due to Ventricular Fibrillation

Thu, 16Â SepÂ 1999 00:00:00 -05:00

Background: Whether antiarrhythmic drugs improve the rate of successful resuscitation after out-of-hospital cardiac arrest has not been determined in randomized clinical trials.

Methods: We conducted a randomized, double-blind, placebo-controlled study of...

EDITORIAL: Growth Hormone Therapy in Critically Ill Patients

Thu, 09Â SepÂ 1999 00:00:00 -05:00

In this issue of the Journal, Takala et al.1 report an increase in mortality among critically ill patients treated with growth hormone. This finding is of major importance and will...

ORIGINAL ARTICLE: A Comparison of Enoxaparin with Placebo for the Prevention of Venous Thromboembolism in Acutely Ill Medical Patients

Thu, 09Â SepÂ 1999 00:00:00 -05:00

Background: The efficacy and safety of thromboprophylaxis in patients with acute medical illnesses who may be at risk for venous thromboembolism have not been determined in adequately designed trials.

Methods: In...

ORIGINAL ARTICLE: Increased Mortality Associated with Growth Hormone Treatment in Critically Ill Adults

Thu, 09Â SepÂ 1999 00:00:00 -05:00

Background: The administration of growth hormone can attenuate the catabolic response to injury, surgery, and sepsis. However, the effect of high doses of growth hormone on the length of stay...

IMAGES IN CLINICAL MEDICINE: Emphysematous Pyelonephritis

Mohamad Ali S. Eloubeidi, M.D., M.H.S. — Thu, 02Â SepÂ 1999 00:00:00 -05:00

Figure 1. A 47-year-old woman with obesity and poorly controlled diabetes mellitus presented with a five-day history of fever, dysuria, and left-flank pain refractory to intravenous antibiotics and intravenous fluids....

EDITORIAL: Early Revascularization in Cardiogenic Shock â A Positive View of a Negative Trial

Thu, 26Â AugÂ 1999 00:00:00 -05:00

During the past two decades, revolutionary changes in our understanding of both the pathogenesis and the treatment of acute myocardial infarction have resulted in impressive gains in survival among patients...

ORIGINAL ARTICLE: Early Revascularization in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Thu, 26Â AugÂ 1999 00:00:00 -05:00

Background: The leading cause of death in patients hospitalized for acute myocardial infarction is cardiogenic shock. We conducted a randomized trial to evaluate early revascularization in patients with cardiogenic shock.

Methods:...

ORIGINAL ARTICLE: A Comparison of Standard Cardiopulmonary Resuscitation and Active CompressionâDecompression Resuscitation for Out-of-Hospital Cardiac Arrest

Thu, 19Â AugÂ 1999 00:00:00 -05:00

Background: We previously observed that short-term survival after out-of-hospital cardiac arrest was greater with active compressionâdecompression cardiopulmonary resuscitation (CPR) than with standard CPR. In the current study, we assessed the...

ORIGINAL ARTICLE: Phenobarbital Compared with Phenytoin for the Treatment of Neonatal Seizures

Thu, 12Â AugÂ 1999 00:00:00 -05:00

Background: Seizures occur in 1 to 2 percent of neonates admitted to an intensive care unit. The treatment is usually with either phenobarbital or phenytoin, but the efficacy of the...

REVIEW ARTICLE: Acute Necrotizing Pancreatitis

Todd H. Baron, M.D., and Desiree E. Morgan, M.D. — Thu, 06Â MayÂ 1999 00:00:00 -05:00

Acute pancreatitis may be clinically mild or severe. Severe acute pancreatitis is usually a result of pancreatic glandular necrosis. The morbidity and mortality associated with acute pancreatitis are substantially higher...

ORIGINAL ARTICLE: Temporal Trends in Cardiogenic Shock Complicating Acute Myocardial Infarction

Thu, 15Â AprÂ 1999 00:00:00 -05:00

Background: Limited information is available on trends in the incidence of and mortality due to cardiogenic shock complicating acute myocardial infarction. We studied the incidence of cardiogenic shock complicating acute...

REVIEW ARTICLE: Lung Transplantation

Selim M. Arcasoy, M.D., and Robert M. Kotloff, M.D. — Thu, 08Â AprÂ 1999 00:00:00 -05:00

Since the performance of the first successful lung transplantation nearly two decades ago, the procedure has gained widespread acceptance as a therapeutic option for a diverse array of lung diseases....

EDITORIAL: Bronchopulmonary Dysplasia â No Simple Solution

Thu, 01Â AprÂ 1999 00:00:00 -05:00

Progress in the treatment of neonates with the respiratory distress syndrome has been one of the medical success stories of the past 15 years. During this time, the widespread use...

ORIGINAL ARTICLE: Early Inhaled Glucocorticoid Therapy to Prevent Bronchopulmonary Dysplasia

Thu, 01Â AprÂ 1999 00:00:00 -05:00

Background: The safety and efficacy of inhaled glucocorticoid therapy for asthma stimulated its use in infants to prevent bronchopulmonary dysplasia. We tested the hypothesis that early therapy with inhaled glucocorticoids...

REVIEW ARTICLE: The Prevention of Ventilator-Associated Pneumonia

Marin H. Kollef, M.D. — Thu, 25Â FebÂ 1999 00:00:00 -05:00

Nosocomial pneumonia is a leading cause of death from hospital-acquired infections, with an associated crude mortality rate of approximately 30 percent.1 Ventilator-associated pneumonia refers specifically to nosocomial bacterial pneumonia that...

EDITORIAL: Transfusions in Critically Ill Patients

Thu, 11Â FebÂ 1999 00:00:00 -05:00

The art of fluid administration and hemodynamic support is one of the most challenging aspects of treating critically ill patients. Considering that every year in the United States over 11...

ORIGINAL ARTICLE: A Multicenter, Randomized, Controlled Clinical Trial of Transfusion Requirements in Critical Care

Thu, 11Â FebÂ 1999 00:00:00 -05:00

Background: To determine whether a restrictive strategy of red-cell transfusion and a liberal strategy produced equivalent results in critically ill patients, we compared the rates of death from all causes...

REVIEW ARTICLE: Treating Patients with Severe Sepsis

Arthur P. Wheeler, M.D., and Gordon R. Bernard, M.D. — Thu, 21Â JanÂ 1999 00:00:00 -05:00

Sepsis is an infection-induced syndrome defined as the presence of two or more of the following features of systemic inflammation: fever or hypothermia, leukocytosis or leukopenia, tachycardia, and tachypnea or...

EDITORIAL: The American Health Care System Revisited â A New Series

Thu, 07Â JanÂ 1999 00:00:00 -05:00

The American health care system is at once the most expensive and the most inadequate system in the developed world, and it is uniquely complicated. In 1997 we spent about...

ORIGINAL ARTICLE: A Comparison of Two Antimicrobial-Impregnated Central Venous Catheters

Thu, 07Â JanÂ 1999 00:00:00 -05:00

Background: The use of central venous catheters impregnated with either minocycline and rifampin or chlorhexidine and silver sulfadiazine reduces the rates of catheter colonization and catheter-related bloodstream infection as compared...

REVIEW ARTICLE: Carbon Monoxide Poisoning

Armin Ernst, M.D., and Joseph D. Zibrak, M.D. — Thu, 26Â NovÂ 1998 00:00:00 -05:00

Carbon monoxide intoxication continues to be one of the most common causes of morbidity due to poisoning in the United States.12 It may be intentional or accidental, and exposure may...

ORIGINAL ARTICLE: A Comparison of Noninvasive Positive-Pressure Ventilation and Conventional Mechanical Ventilation in Patients with Acute Respiratory Failure

Thu, 13Â AugÂ 1998 00:00:00 -05:00

Background: and Methods: The role of noninvasive positive-pressure ventilation delivered through a face mask in patients with acute respiratory failure is uncertain. We conducted a prospective, randomized trial of noninvasive...

EDITORIAL: Preventing Blindness in Premature Infants

Thu, 28Â MayÂ 1998 00:00:00 -05:00

In 1942 Terry reported a retinal vasculopathy causing blindness in premature infants.1 The condition was called retrolental fibroplasia, because a fibrovascular mass could be seen behind the crystalline lens. Hundreds...

ORIGINAL ARTICLE: A Multicenter Trial of Two Dexamethasone Regimens in Ventilator-Dependent Premature Infants

Thu, 16Â AprÂ 1998 00:00:00 -05:00

Background: Ventilator-dependent premature infants are often treated with dexamethasone. However, the optimal timing of therapy is unknown.

Methods: We compared the benefits and hazards of initiating dexamethasone therapy at two weeks...

REVIEW ARTICLE: Status Epilepticus

Daniel H. Lowenstein, M.D., and Brian K. Alldredge, Pharm.D. — Thu, 02Â AprÂ 1998 00:00:00 -05:00

A patient in status epilepticus has continuous or rapidly repeating seizures. Although the danger of this pattern of seizure activity has been recognized since antiquity, our understanding of the pathophysiology...

ORIGINAL ARTICLE: A Comparison of Sucralfate and Ranitidine for the Prevention of Upper Gastrointestinal Bleeding in Patients Requiring Mechanical Ventilation

Thu, 19Â MarÂ 1998 00:00:00 -05:00

Background: Critically ill patients who require mechanical ventilation are at increased risk for gastrointestinal bleeding from stress ulcers. There are conflicting data on the effect of histamine H2-receptor antagonists and...

ORIGINAL ARTICLE: An Epidemic of in an Intensive Care Nursery Associated with Colonization of Health Care Workers' Pet Dogs

Thu, 12Â MarÂ 1998 00:00:00 -05:00

Background: Malassezia species are lipophilic yeasts that are emerging as nosocomial pathogens, particularly in low-birth-weight neonates who receive lipid emulsions. When a cluster of patients with Malassezia pachydermatis infection was...

REVIEW ARTICLE: Acute Oliguria

Saulo Klahr, M.D., and Steven B. Miller, M.D. — Thu, 05Â MarÂ 1998 00:00:00 -05:00

Acute oliguria (excretion of less than 400 ml of urine per day) is often the earliest sign of impaired renal function and poses a diagnostic and management challenge to the...

SOUNDING BOARD: The Slow Code â Should Anyone Rush to Its Defense?

Thu, 12Â FebÂ 1998 00:00:00 -05:00

The past two decades have witnessed dramatic changes in professional values and social expectations regarding medical care and decision making at the end of life. Increased emphasis on patients' autonomy...

EDITORIAL: Predicting Outcomes of Burns