Intensive care medicine
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Intensive care medicine · May 1999
Randomized Controlled Trial Clinical TrialAdditional inspiratory work of breathing imposed by tracheostomy tubes and non-ideal ventilator properties in critically ill patients.
To determine the tracheostomy tube-related additional work of breathing (WOBadd) in critically ill patients and to show its reduction by different ventilatory modes. ⋯ The results indicate that, depending on respiratory flow rate, (1) tracheostomy tubes can cause a considerable amount of WOBadd, and (2) ATC, in contrast to IPS, is a suitable mode to compensate for WOBadd at any ventilatory effort of the patient.
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Intensive care medicine · May 1999
Clinical Trial Controlled Clinical TrialEvaluation of a new, rapid lactate analyzer in critical care.
To determine the reliability, precision and clinical usefulness of a newly developed substrate-specific lactate/blood gas analyzer (Chiron M865). ⋯ The new Chiron lactate analyzer is reliable for serial whole blood lactate measurements in an intensive care stat laboratory. Samples should be kept on ice immediately after sampling to minimize in vitro erythrocyte production of lactate.
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Intensive care medicine · May 1999
Randomized Controlled Trial Multicenter Study Clinical TrialTrial of dexamethasone treatment for severe bacterial meningitis in adults. Adult Meningitis Steroid Group.
To evaluate the clinical benefit of early adjunctive dexamethasone therapy for severe bacterial meningitis in adults. ⋯ Bacterial meningitis is still a severe disease in adults, since the overall observed rate of death or severe neurologic sequelae was 26.7%. The reported data are inconclusive regarding a systematic use of dexamethasone as an adjunctive therapy for bacterial meningitis in adults. Moreover this treatment impairs antibiotic penetration into the cerebrospinal fluid (CSF) that can lead to therapeutic failure, particularly in areas with high or increasing rates of penicillin-resistant S. pneumoniae.
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Intensive care medicine · May 1999
Clinical Trial Controlled Clinical TrialTime course of activated coagulation time at various sites during continuous haemodiafiltration using nafamostat mesilate.
To determine the adequate site of activated coagulation time (ACT) measurement during continuous haemodiafiltration (CHDF) using nafamostat mesilate. ⋯ The ACT value at the inlet of the circuit may be adequate to monitor anticoagulation during CHDF using nafamostat.
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Intensive care medicine · May 1999
Noninvasive ventilation: experience at a community teaching hospital.
To describe our hospital's experience with noninvasive positive pressure ventilation (bilevel positive airway pressure; BiPAP) for patients with respiratory failure (RF). ⋯ BiPAP is highly effective in selected patients with RF during routine use in a community teaching hospital. The success rate is higher amongst patients presenting with hypercapnic than amongst those with hypoxemic RF and BiPAP failure is associated with an increased likelihood of in-hospital mortality. BiPAP may also be used successfully to temporize patients who develop RF in the period following endotracheal extubation. The duration of BiPAP dependency (35 h in this study) was shorter than in previous trials, and, though this is speculative, may have been minimized by our performing a trial of unassisted breathing each day.