Intensive care medicine
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Intensive care medicine · May 2002
Randomized Controlled Trial Clinical TrialShort-term effects of expiration under positive pressure in patients with acute exacerbation of chronic obstructive pulmonary disease and mild acidosis requiring non-invasive positive pressure ventilation.
To investigate the feasibility and the efficacy of expiration under positive pressure (PEP mask) as a chest physiotherapy in patients with exacerbation of chronic obstructive pulmonary disease (COPD) and acute hypercapnic respiratory failure (AHRF) requiring non-invasive positive pressure ventilation (NIPPV). ⋯ Expiration under positive pressure was effective in acutely removing secretions in patients with exacerbation of COPD and mild acidosis requiring NIPPV. In conclusion, we suggest that this chest physiotherapy technique represents a useful therapeutic option for such patients and it should often be performed in addition to NIPPV.
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Intensive care medicine · May 2002
Randomized Controlled Trial Clinical TrialProne position as prevention of lung injury in comatose patients: a prospective, randomized, controlled study.
Comatose patients frequently exhibit pulmonary function worsening, especially in cases of pulmonary infection. It appears to have a deleterious effect on neurologic outcome. We therefore conducted a randomized trial to determine whether daily prone positioning would prevent lung worsening in these patients. ⋯ In a selected population of comatose ventilated patients, daily prone positioning reduced the incidence of lung worsening.
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Intensive care medicine · May 2002
Randomized Controlled Trial Comparative Study Clinical TrialPre-operative optimisation employing dopexamine or adrenaline for patients undergoing major elective surgery: a cost-effectiveness analysis.
To compare the cost and cost-effectiveness of a policy of pre-operative optimisation of oxygen delivery (using either adrenaline or dopexamine) to reduce the risk associated with major elective surgery, in high-risk patients. ⋯ Based on resource use and effectiveness data collected in the trial, pre-operative optimisation of high-risk surgical patients undergoing major elective surgery is cost-effective compared with standard treatment.
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The need for reintubation within 24-72 h of planned extubation is a common event, occurring in 2-25% of extubated patients. Risk factors for extubation failure include being a medical, multidisciplinary or paediatric patient; age >70 years; a longer duration of mechanical ventilation; use of continuous intravenous sedation; and anaemia (haemoglobin <10 g/dl or haematocrit <30%) at the time of extubation. The pathophysiology of extubation failure can be distinct from that seen with weaning failure and includes upper airway obstruction, inadequate cough, excess respiratory secretions, encephalopathy, and cardiac dysfunction. ⋯ Tests designed to assess for upper airway obstruction, secretion volume, and the effectiveness of cough seem most promising for improving the decision to extubate. Mortality increases with delays in reintubation for patients failing extubation. Timely identification of patients at elevated risk of extubation failure followed by rapid re-establishment of ventilatory support can improve outcome.