Journal of critical care
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Journal of critical care · Mar 1998
Randomized Controlled Trial Clinical TrialDecelerating flow ventilation effects in acute respiratory failure.
The purpose of this article is to analyze the effect of a pressure-regulated volume-controlled ventilation mode on lung mechanics and gas exchange in patients with acute respiratory failure. ⋯ Pressure-limited ventilation allows mechanical ventilation for the same tidal volume as VC but results in a lower peak inspiratory pressure and a slightly lower PaCO2. The mechanism responsible for this gas exchange effect is unknown but is probably related to a better air distribution of the decelerated flow. The clinical relevance of this phenomenon remains to be established.
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Journal of critical care · Mar 1998
The use of neuromuscular blocking agents in the emergency department to facilitate tracheal intubation in the trauma patient: help or hindrance?
The purpose of this study is to examine the relationship between the occurrence of a difficult intubation and (1) the use of neuromuscular blocking agents (NMB) and (2) the presence of airway injuries. It is a retrospective analysis of data from a trauma registry. ⋯ The use of succinylcholine may result in fewer difficult intubations in the trauma patient than when a nondepolarizing NMB is used. The presence of airway injuries did not appear to predispose to difficult intubations.
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Journal of critical care · Mar 1998
An approach to the treatment of severe adult respiratory failure.
The purpose of this article is to evaluate outcome in adult patients with severe respiratory failure managed with an approach using (1) limitation of end inspiratory pressure, (2) inverse ratio ventilation, (3) titration of PEEP by SvO2, (4) intermittent prone positioning, (5) limitation of FiO2, (6) diuresis, (7) transfusion, and (8) extracorporeal life support (ECLS) if patients failed to respond. ⋯ An approach that emphasizes lung protection and early implementation of extracorporeal life support is associated with high rates of survival in patients with severe respiratory failure.