Intensive care medicine
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Intensive care medicine · Nov 2009
Randomized Controlled Trial Multicenter StudyThe effects of etomidate on adrenal responsiveness and mortality in patients with septic shock.
Use of etomidate in the critically ill is controversial due to its links with an inadequate response to corticotropin and potential for excess mortality. In a septic shock population, we tested the hypotheses that etomidate administration induces more non-responders to corticotropin and increases mortality and that hydrocortisone treatment decreases mortality in patients receiving etomidate. ⋯ The use of bolus dose etomidate in the 72 h before study inclusion is associated with an increased incidence of inadequate response to corticotropin, but is also likely to be associated with an increase in mortality. We recommend clinicians demonstrate extreme caution in the use of etomidate in critically ill patients with septic shock.
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Intensive care medicine · Nov 2009
Randomized Controlled TrialIs volume and leak monitoring feasible during nasopharyngeal continuous positive airway pressure in neonates?
To investigate tidal volume (VT) and leak measurements during continuous positive airway pressure (CPAP) in neonates using a commercial ventilatory device equipped with a flow sensor at the Y-piece. ⋯ Leak and corrected VT could be determined in the presence of leaks of up to 69%, but leaks during CPAP often exceeded the measuring range. Reliable volume and leak monitoring was not possible with the tested equipment during nasopharyngeal CPAP. Advanced equipment is necessary to further investigate the effects of leaks on neonatal CPAP therapy.