Critical care medicine
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A telephone survey of 602 randomly selected hospitals was conducted to identify existing ethics committees, i.e., those with the potential to become involved in the decision-making process in specific cases. Using the number of acute care beds as the criterion, hospitals were divided into 2 groups: (1) over 200 beds; n = 400; (2) 200 or fewer beds; n = 202. Chairpersons of identified committees completed detailed questionnaires. ⋯ Almost all committees were advisory, not decision-making bodies, and considered very effective by their chairpersons. Ethics committees have not, however, solved current medical ethical problems; nor have they allayed the concerns of patients' rights advocates about patient representation and control. Further study is warranted.
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Critical care medicine · Nov 1983
Randomized Controlled Trial Comparative Study Clinical TrialFluid resuscitation in circulatory shock: a comparison of the cardiorespiratory effects of albumin, hetastarch, and saline solutions in patients with hypovolemic and septic shock.
Twenty-six consecutive patients in hypovolemic shock were randomized to fluid challenge with 5% albumin (A), 6% hetastarch (H), or 0.9% saline (S) solutions. Fluid challenge consisted of 250 ml of test fluid every 15 min until the pulmonary artery wedge pressure (WP) reached 15 mm Hg. Thereafter, WP was maintained at 15 mm Hg for an additional 24 h with infusions of the same test fluid. ⋯ Resuscitation with S resulted in a significantly higher incidence of pulmonary edema (87.5%) than did resuscitation with A (22%) or H (22%). Urine output was not different among the groups at any time during the study. We conclude that 6% H performs as well as 5% A as a resuscitative fluid and that resuscitation with either of these colloids is associated with a lower incidence of pulmonary edema than is resuscitation with 0.9% S.
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Critical care medicine · Nov 1983
Spontaneous ischemic ventricular fibrillation in dogs: a new model for the study of cardiopulmonary resuscitation.
Most sudden cardiac deaths in man are associated with events causing myocardial ischemia and only 40-60% of these patients are successfully resuscitated. Further progress in reducing the mortality from such events will depend on a better understanding of the interventions used during CPR. ⋯ Initial controlled, randomized studies of the model demonstrate that it responds to resuscitation in a manner similar to human resuscitation. Further study of this model during CPR may lead to changes in patient care which will improve survival from episodes of sudden cardiac death.
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Critical care medicine · Nov 1983
Left ventricular regional myocardial blood flows during controlled positive pressure ventilation and positive end-expiratory pressure in dogs.
A decrease in myocardial blood flow (MBF) has been suggested as a possible cause for the depression of left ventricular function during mechanical ventilation. In 8 dogs, hemodynamic effects of controlled mechanical ventilation with 15 cm H2O of PEEP or (CPPV15) were compared to controlled mechanical ventilation without PEEP (IPPV). Addition of PEEP caused a significant decrease in left ventricular epicardial, midwall (p less than .01) endocardial and septal (p less than .05) blood flows. ⋯ Left ventricular myocardial oxygen consumption (LVMVO2) and coronary sinus oxygen content (Ccso2) also did not show any significant change. Pulmonary vascular resistance (PVR) increased significantly (p less than .01). The observed decrease in MBF during PEEP therapy may be due to shift of the interventricular septum, reflexly mediated coronary vasoconstriction, or decreased net coronary filling pressure.
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Critical care medicine · Nov 1983
Clinical TrialPatient-controlled inhalational analgesia in prehospital care: a study of side-effects and feasibility.
A clinical trial of a 50:50 mixture of nitrous oxide and oxygen for pain relief was carried out to determine the feasibility of its use in a field setting and the side-effects produced by this sedative/analgesic. The gas mixture was delivered from a single-tank system using a demand-valve apparatus which was triggered by the patient's inspiratory effort. This "patient-controlled" sedation/analgesia was provided to 1243 patients over a period of 18 months. ⋯ No consistent or clinically adverse changes were found in BP or pulse rates. The trial supports the concept that this agent is a promising sedative/analgesic for the relief of mild to moderate pain and anxiety. Because of its safety, it is particularly suited to use in prehospital emergency care.