Journal of critical care
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Journal of critical care · Jun 2005
Case ReportsTreatment of severe coagulopathy after gunshot injury to the head using recombinant activated factor VII.
Patients with severe penetrating head injury often have a coagulopathy that is difficult to correct. In this report, we describe 3 such patients who were treated with activated factor VII (FVIIa) to stop ongoing hemorrhage that was refractory to conventional treatment. ⋯ In patients with a severe head injury and coagulopathy, use of FVIIa may help in correction of coagulopathy and decrease transfusion requirements. In patients where ongoing bleeding precludes the declaration of brain death, the use of this agent might help in achieving hemodynamic stability and preserve the possibility of organ donation. The ethical implications of using FVIIa in this situation are discussed.
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Journal of critical care · Jun 2005
Randomization and allocation concealment: a practical guide for researchers.
Although the randomized controlled trial is the most important tool currently available to objectively assess the impact of new treatments, the act of randomization itself is often poorly conducted and incompletely reported. The primary purpose of randomizing patients into treatment arms is to prevent researchers, clinicians, and patients from predicting, and thus influencing, which patients will receive which treatments. ⋯ The purpose of this tutorial is to describe a step-by-step process for the preparation of SNOSE. We will outline how to prepare SNOSE to preserve allocation concealment in a trial that (a) uses unrestricted (simple) randomization, (b) stratifies randomization on one factor, (c) uses permuted blocks and, and (d) is conducted at more than 1 study site.
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Journal of critical care · Jun 2005
Comparative StudyA comparison of the rate of bacterial contamination for prefilled disposable and reusable oxygen humidifiers.
Prefilled disposable oxygen humidifiers are considered to prevent nosocomial pneumonia in hospital wards. However, their usefulness in intensive care units (ICUs) has not yet been established. In this study, we evaluated and compared contamination in prefilled disposable oxygen humidifiers and that in reusable oxygen humidifiers. ⋯ In the ICU, bacterial contamination does not occur in oxygen humidifiers even after 56 days of continuous use. However, dust does accumulate in the reusable oxygen humidifier after 35 days of continuous use.
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Journal of critical care · Jun 2005
Simple vs complex radionuclide methods of assessing capillary protein permeability for diagnosing acute respiratory distress syndrome.
Using injection of gallium Ga 67 transferrin, technetium Tc 99m red cells, probes over the lungs, and blood samples, a pulmonary leak index (PLI) and pulmonary transcapillary escape rate (PTCER) for transferrin can be measured. This may help differentiating between cardiogenic pulmonary edema (CPE) and permeability (noncardiogenic) pulmonary edema of the acute respiratory distress syndrome (ARDS). The purpose of the study was to evaluate the relative importance of red cell labeling, blood sampling, and probe measurements in this assessment. ⋯ The diagnostic value of the simple blood TER of (67)Ga-transferrin is similar to that of complex methods, using (99m)Tc-red cells and probe measurements over the lungs, because the complex methods largely depend on the blood TER. Simplification of the method without red cell labeling and probes may facilitate bedside use to diagnose permeability edema of ARDS, particularly in the absence of a pulmonary artery catheter.