Chest
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Randomized Controlled Trial Clinical Trial
Double-blind, placebo-controlled trial of antithrombin III concentrates in septic shock with disseminated intravascular coagulation.
Septic shock is frequently complicated by a syndrome of disseminated intravascular coagulation (DIC). Numerous uncontrolled clinical studies have reported that antithrombin III (ATIII) substitution might prevent DIC and death in septic shock. ⋯ Mortality was reduced by 44 percent in this trial, but the difference did not reach the statistical significance. Circulating protein C and protein S levels were not modified by ATIII supplementation. High doses of ATIII concentrates significantly improved sepsis-induced DIC during septic shock. The trend toward improved survival suggests further randomized studies.
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Randomized Controlled Trial Clinical Trial
Magnesium bolus or infusion fails to improve expiratory flow in acute asthma exacerbations.
Intravenous magnesium sulfate improves objective measures of expiratory flow in patients with acute severe exacerbations of asthma. ⋯ Use of IV magnesium sulfate in addition to standard therapy does not provide clinically meaningful improvement of objective measures of expiratory flow in patients with moderate to severe asthma exacerbations.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of albuterol administered by metered dose inhaler (and holding chamber) or wet nebulizer in acute asthma.
Comparative studies of albuterol by wet nebulizer or metered dose inhaler have tested fixed doses of medications. We compared the dose-response relationship to albuterol by wet nebulization or metered dose inhaler in acute asthma. ⋯ Albuterol by metered dose inhaler provided similar bronchodilation to that achieved by wet nebulization in patients with acute asthma. The cumulative dose-response technique is applicable in the emergency department setting and is helpful in comparing the relative utility of various bronchodilator regimens.
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Randomized Controlled Trial Clinical Trial
The impact of intraoperative autotransfusion on cardiac surgery. A prospective randomized double-blind study.
The effect of intraoperative autotransfusion during coronary artery bypass grafting was studied in a randomized double-blind trial involving 38 patients. Nineteen patients had the collected RBCs washed and autotransfused (autotransfusion group), while the remaining patients had their washed cells discarded (control group). Postoperative hemoglobin and hematocrit values were similar. ⋯ Platelet utilization also was markedly decreased in the autotransfusion group. Cryoprecipitate and fresh frozen plasma utilization also was less in the autotransfusion group than in the control group, but this did not reach statistical significance. We conclude that the intraoperative use of autotransfusion decreases the volume of homologous blood products transfused, which results in reduced exposure of the patients to banked blood products.
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Mortality of the adult respiratory distress syndrome (ARDS) remains high and could be increased by pulmonary barotrauma induced by positive-pressure mechanical ventilation. Extracorporeal CO2 removal combined with low-frequency positive-pressure ventilation (ECCO2R-LFPPV) has been proposed to reduce lung injury while supporting respiratory failure. ⋯ Bleeding was the only complication related to the technique and was the cause of death in four patients. This method allowed improvement in gas exchange along with reduction of the risk of barotrauma caused by the ventilator.