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Objective: To evaluate respiratory variations in carotid and brachial peak velocity and other hemodynamic parameters to predict responsiveness to fluid challenge.Methods: A prospective observational study was performed on mechanically ventilated patients with septic shock. Outcomes included the measurements of central venous pressure, intrathoracic blood volume index, stroke volume variation (SVV), pleth variability index(PVI), and ultrasound assessments of respiratory variations in inferior vena cava diameter (ΔIVC), carotid Doppler peak velocity (ΔCDPV), and brachial artery peak velocity (ΔVpeak brach).Results: All patients received 200 mL normal saline challenge. There were 27 responders and 22 non-responders. Responders had higher SVV, PVI, ΔIVC, ΔCDPV, and ΔVpeak brach measurements. In addition, all these measurements had statistically significant linear correlations with changes in cardiac index (CI).When responders were defined by ΔCI≥10%, receiver operating characteristics (ROC) curve analysis showed that fluid responsiveness could be predicted:11.5% optimal cut-off 1evels of SVV with sensitivity of 75% and specificity of 85%, 15.5% optimal cut-off 1evels of PVI with sensitivity of 65% and specificity of 80%, 20.5% optimal cut-off 1evels of ΔIVC with sensitivity of 67% and specificity of 77%, 13% optimal cut-off 1evels of ΔCDPV with sensitivity of 78%% and specificity of 90%, 11.7% optimal cut-off 1evels of ΔVpeak brach with sensitivity of 70% and specificity of 80%.Conclusion: Ultrasound assessment of ΔIVC and ΔVpeak brach, especially ΔCDPV, could predict fluid responsiveness and might be recommended as a continuous and noninvasive method to monitor functional hemodynamic parameter in mechanically ventilated patients with septic shock. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate the effectiveness and safety of active mobilization on improving physical function and hospital outcomes in patients undergoing mechanical ventilation for more than 24 hours. Data Sources: PubMed, Embase, CINAHL, CENTRAL, Physiotherapy Evidence Database, SinoMed, and ISI Web of Knowledge were searched for randomized controlled trials (RCTs), quasi-RCTs, other comparative studies, and case series with 10 or more consecutive cases. Additional studies were identified through references, citation tracking, and by contacting the authors of eligible studies. Study Selection: Two reviewers independently selected potential studies according to the inclusion criteria. Data Extraction: Two reviewers independently extracted data and assessed the methodologic quality. Data Synthesis: A narrative form was used to summarize study characteristics and outcomes, because the substantial heterogeneity between the individual studies precluded formal meta-analyses. Among the 17 eligible studies, 7 RCTs, 1 quasi-RCT, 1 prospective cohort study, and 1 history controlled study were used to examine the effectiveness; and 2 RCTs, 1 prospective cohort study, and 7 case series were used to examine the safety of active mobilization in patients receiving mechanical ventilation for more than 24 hours. We found that active mobilization may improve muscle strength, functional independence, and the ability to wean from ventilation and may decrease the length of stay in the intensive care unit (ICU) and hospital. However, only 1 study reported that active mobilization reduced the 1-year mortality rate. No serious adverse events were reported among included studies. Conclusions: Active mobilization appears to have a positive effect on physical function and hospital outcomes in mechanical ventilation patients. Early active mobilization protocols may be initiated safely in the ICU setting and continued in post-ICU settings. However, the current available ... [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate the effectiveness and safety of active mobilization on improving physical function and hospital outcomes in patients undergoing mechanical ventilation for more than 24 hours. Data Sources: PubMed, Embase, CINAHL, CENTRAL, Physiotherapy Evidence Database, SinoMed, and ISI Web of Knowledge were searched for randomized controlled trials (RCTs), quasi-RCTs, other comparative studies, and case series with 10 or more consecutive cases. Additional studies were identified through references, citation tracking, and by contacting the authors of eligible studies. Study Selection: Two reviewers independently selected potential studies according to the inclusion criteria. Data Extraction: Two reviewers independently extracted data and assessed the methodologic quality. Data Synthesis: A narrative form was used to summarize study characteristics and outcomes, because the substantial heterogeneity between the individual studies precluded formal meta-analyses. Among the 17 eligible studies, 7 RCTs, 1 quasi-RCT, 1 prospective cohort study, and 1 history controlled study were used to examine the effectiveness; and 2 RCTs, 1 prospective cohort study, and 7 case series were used to examine the safety of active mobilization in patients receiving mechanical ventilation for more than 24 hours. We found that active mobilization may improve muscle strength, functional independence, and the ability to wean from ventilation and may decrease the length of stay in the intensive care unit (ICU) and hospital. However, only 1 study reported that active mobilization reduced the 1-year mortality rate. No serious adverse events were reported among included studies. Conclusions: Active mobilization appears to have a positive effect on physical function and hospital outcomes in mechanical ventilation patients. Early active mobilization protocols may be initiated safely in the ICU setting and continued in post-ICU settings. However, the current available studies have great heterogeneity and limited methodologic quality. Further research is needed to provide more robust evidence to support the effectiveness and safety of active mobilization. [Copyright &y& Elsevier]

Purpose: The purpose of this study was to investigate sedation practices and the perception of discomfort during mechanical ventilation in Chinese intensive care units (ICUs). Material and Method: A prospective, observational, cohort study was conducted in 31 Chinese ICUs in academic hospitals from June 15 to August 15, 2006. Conscious patients who were discharged from the ICU after mechanical ventilation were consecutively included. Using a standardized questionnaire, a personal interview was conducted with each patient within 2 days after discharge from the ICU. Patients were asked about recollections of emotional and physical discomfort. Sedation and analgesia administration data were collected from patient records. Results: As prospectively defined, 83 (50.9%) of 163 patients met criteria for complex-mixed discomfort (ie, at least 1 emotional and 2 physical disturbances). Similarly, 79.1% of patients remembered seriously uncomfortable experiences associated with 1 of the 3 predefined sources. Both protocolized sedation and continuous sedation without a defined protocol, but not intermittent sedation, significantly reduced the relative risk of complex-mixed discomfort occurrences (P < .001). Notably, only 14.7% of patients received protocolized sedation, and 61 (37.4%) of 163 were not given any sedatives. Conclusion: Mechanically ventilated ICU patients in Chinese academic hospitals were inadequately treated for discomfort. Protocolized sedation can effectively improve patient comfort. [Copyright &y& Elsevier]