Journal of critical care
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Journal of critical care · Dec 2013
Randomized Controlled Trial Comparative StudyDexmedetomidine preserves attention/calculation when used for cooperative and short-term intensive care unit sedation.
Differential effects on cognition were recently demonstrated between dexmedetomidine (DEX) and propofol (PRO) when used for cooperative sedation. Propofol was found to reduce cognition, whereas DEX improved cognition. To further discriminate these effects, we evaluated the effect of PRO vs DEX in selected areas of cognition. ⋯ Our findings indicate that DEX improved ACE attention/calculation subscale in awake patients receiving cooperative sedation. This is in contrast to the deterioration in all mean ACE subscale scores observed using PRO, suggesting DEX preserved cognitive function with specific preservation of focus and attention and allows for greater cognition compared with PRO across all cognitive domains.
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Journal of critical care · Dec 2013
Randomized Controlled Trial Multicenter StudyImplementation of a protocol for integrated management of pain, agitation, and delirium can improve clinical outcomes in the intensive care unit: A randomized clinical trial.
Inappropriate diagnosis and treatment of pain, agitation, and delirium (PAD) in intensive care settings results in poor patient outcomes. We designed and used a protocol for systematic assessment and management of PAD by the nurses to improve clinical intensive care unit (ICU) outcomes. ⋯ The current randomized trial provided evidence for a substantial reduction in the duration of need to ventilatory support, length of ICU stay, and mortality rates in ICU-admitted patients through protocol-directed management of PAD.
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Journal of critical care · Dec 2013
Randomized Controlled Trial Multicenter StudyThe relationship between positive end-expiratory pressure and cardiac index in patients with acute respiratory distress syndrome.
The purpose of the study is to evaluate the association between positive end-expiratory pressure (PEEP) and cardiac index in patients with acute respiratory distress syndrome (ARDS). ⋯ In patients with ARDS who are managed with liberal or conservative fluid management protocols, PEEP is not associated with lower cardiac index.
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Journal of critical care · Dec 2013
Randomized Controlled TrialFosphenytoin for seizure prevention in childhood coma in Africa: A randomized clinical trial.
We conducted a double-blind trial to determine whether a single intramuscular injection of fosphenytoin prevents seizures and neurologic sequelae in children with acute coma. ⋯ A single intramuscular injection of fosphenytoin (20 phenytoin equivalents/kg) does not prevent seizures or neurologic deficits in childhood acute nontraumatic coma.