A comprehensive clinical approach for patients requiring a temporary open abdomen treatment (OA) in the ICU

Objective We report an intensive-clinical approach in OA-treatments. Patients-and-methods 28 ICU-admissions (1996-2010): Clean-OA(3), contaminated OA(25). Blunt/penetrating trauma(1), aortic surgery(1), acute pancreatitis(15), primary or secondary peritonitis(11). Age 61\ub113; SAPS-II median-(IQR) 41(33-49); SOFA median-(IQR) 8(7-9)

Phrase Frequency Effects in Language Production

A classic debate in the psychology of language concerns the question of the grain-size of the linguistic information that is stored in memory. One view is that only morphologically simple forms are stored (e.g., ‘car’, ‘red’), and that more complex forms of language such as multi-word phrases (e.g., ‘red car’) are generated on-line from the simple forms. In two experiments we tested this view. In Experiment 1, participants produced noun+adjective and noun+noun phrases that were elicited by experimental displays consisting of colored line drawings and two superimposed line drawings. In Experiment 2, participants produced noun+adjective and determiner+noun+adjective utterances elicited by colored line drawings. In both experiments, naming latencies decreased with increasing frequency of the multi-word phrase, and were unaffected by the frequency of the object name in the utterance. These results suggest that the language system is sensitive to the distribution of linguistic information at grain-sizes beyond individual words

Conscious sedation in the critically ill ventilated patient

Purpose: The aim of sedation is to provide comfort and minimize anxiety. However, adverse effects are noteworthy, and the optimal end point of sedation in intensive care unit patients is still debated. We analyzed if a level 2 on the Ramsay Scale (ie, awake, cooperative, oriented, tranquil patient) is suitable for an invasive therapeutic approach. Materials and Methods: Forty-two patients requiring respiratory support and sedation for at least 4 days were enrolled in a prospective interventional cohort study aiming at maintaining patients awake and collaborative. The Ramsay score was recorded 3 times a day. Once a day, the nurse in charge evaluated adequacy of sedation according to the compliance with nursing care and therapeutic maneuvers in the previous 24 hours. Data were collected until patients were ventilated. Results: Overall, 264 of 582 days were classified as conscious. Sedation was adequate in 93.9% of them. In conscious days, a higher Simplified Acute Physiology Score II score and male sex significantly correlated with inadequate sedation. Conclusions: In a population of severe intensive care unit patients, conscious sedation was achieved in almost half of the days spent on ventilation. The positive implications (eg, on length of weaning and cost of sedation) of a conservative sedation strategy may be highly relevant

Vardenafil and weaning from inhaled nitric oxide: effect on pulmonary hypertension in ARDS

We report a 66-year-old patient with refractory pulmonary hypertension secondary to ARDS who was being treated with inhaled nitric oxide. Enteral vardenafil (phosphodiesterase-5 inhibitor) was tried at two different doses (10 mg and 5 mg), in order to wean the patient from nitric oxide. The higher dose decreased pulmonary pressure but caused systemic hypotension and the drug was discontinued. Subsequently, a 5 mg dose of vardenafil decreased pulmonary pressure without hypotension. Pulmonary hypertension was controlled using vardenafil 10-15 mg divided in 2-3 daily doses. This therapy allowed nitric oxide withdrawal, weaning from mechanical ventilation and discharge from ICU. Vardenafil acted in synergy with inhaled nitric oxide, permitted nitric oxide reduction and discontinuation and proved to be effective as a single, long-term treatment for pulmonary hypertension