Intensive care medicine
-
Intensive care medicine · Mar 2003
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialTreatment with bovine surfactant in severe acute respiratory distress syndrome in children: a randomized multicenter study.
To determine whether bovine surfactant given in cases of severe pediatric acute respiratory distress syndrome (ARDS) improves oxygenation. ⋯ In the pilot study the PaO(2)/FIO(2) increased by a mean of 100 at 48 h (n=19). A higher PaO(2)/FIO(2) ratio was observed in the surfactant group 2 h after the first dose (58 from baseline vs. 9), at 48 h there was a trend towards a higher ratio (38 from baseline vs. 22). The rate of rescue therapy was significantly lower in the surfactant group. Outcome criteria were not affected by a second surfactant dose (n=11). A significant difference in PaO(2)/FIO(2) in favor of surfactant at 48 h was found in the subgroup with an initial PaO(2)/FIO(2) ratio higher than 65 and in patients without pneumonia. CONCLUSIONS. Surfactant therapy in severe ARDS improves oxygenation immediately after administration. This improvement is sustained only in the subgroup of patients without pneumonia and that with an initial PaO(2)/FIO(2) ratio higher than 65
-
Intensive care medicine · Mar 2003
Randomized Controlled Trial Comparative Study Clinical TrialEndotracheal suctioning versus minimally invasive airway suctioning in intubated patients: a prospective randomised controlled trial.
Endotracheal suctioning in intubated patients is routinely applied in most ICUs but may have negative side effects. We hypothesised that on-demand minimally invasive suctioning would have fewer side effects than routine deep endotracheal suctioning, and would be comparable in duration of intubation, length of stay in the ICU, and ICU mortality. ⋯ This study demonstrated that minimally invasive airway suctioning in intubated ICU-patients had fewer side effects than routine deep endotracheal suctioning, without being inferior in terms of duration on intubation, length of stay, and mortality.
-
Intensive care medicine · Mar 2003
Comment Randomized Controlled Trial Multicenter Study Clinical TrialDCL-Hb for trauma patients with severe hemorrhagic shock: the European "On-Scene" multicenter study.
A major cause of death in patients with severe hemorrhagic shock following trauma is the subsequent occurrence of multiple organ failure due to tissue hypoxia. Early administration of an oxygen carrier may reduce the occurrence of organ failures and improve survival. It may also reduce the need of blood products. ⋯ The early application of an oxygen carrier (DCLHb) to patients with severe hemorrhagic shock following trauma had no significant effect on the occurrence of organ failure or on 5- and 28-day survival in this abbreviated trial. However, early infusion of up to 1000 ml DCLHb reduces the need for blood products without changing morbidity or survival.
-
During home mechanical ventilation the prescribed settings are applied without permanent supervision of health professionals. After a long-time period of unattended operation at home the ventilator may not apply the ventilation parameters prescribed. This quality control study of home mechanical ventilation assessed whether tidal volume (V(T)), frequency (f), and minute ventilation (V'(E)) actually applied by the ventilator coincide with the values set on the ventilator control panel and with those prescribed. ⋯ Regularly assessing the actual performance of ventilators at the patient's home is a quality control procedure useful for detecting malfunctions which could improve compliance and outcome of home mechanical ventilation.
-
Intensive care medicine · Mar 2003
Microalbuminuria does not reflect increased systemic capillary permeability in septic shock.
To investigate the correlation between microalbuminuria and extravascular lung water in patients in septic shock who require mechanical ventilation for severe respiratory failure. ⋯ In this study patients in septic shock with significantly elevated EVLW had normal urinary M:Cr, and there was no correlation between M:Cr and EWLV, and PaO(2)/FIO(2). Therefore based on the current results routine measurements of microalbuminuria to determine endothelial permeability cannot be recommended in critically ill patients.