Critical care medicine
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Critical care medicine · Oct 1993
Randomized Controlled Trial Comparative Study Clinical TrialTitration of intravenous anesthetics for cardioversion: a comparison of propofol, methohexital, and midazolam.
To compare propofol, methohexital, and midazolam administered as titrated infusions for sedation during electrical cardioversion. ⋯ All three drugs are acceptable choices for use during elective direct-current cardioversion. Titration of the agent results in a total drug dose which is usually less than the typical induction dose. There were no significant differences in the hemodynamic actions of these drugs at any time interval. Both propofol and methohexital proved superior in their ability to provide a more rapid anesthetic onset and recovery as compared with midazolam. Propofol offers the advantage of requiring no premixing or dilution, and it is not a controlled substance, although it does result in more pain on injection.
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Critical care medicine · Oct 1993
Multicenter Study Comparative StudyValue and cost of teaching hospitals: a prospective, multicenter, inception cohort study.
To examine variations in case-mix, structure, resource use, and outcome performance among teaching and nonteaching intensive care units (ICU). ⋯ Teaching ICUs care for more complex patients in a substantially more complicated organizational setting. The best risk-adjusted survival rates occur at teaching ICUs, but production cost is higher in teaching units, secondary to increased testing and therapy. Teaching ICUs are also successfully transferring knowledge to trainees who, after their training, are achieving equivalent results at slightly lower cost in nonteaching ICUs.
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Critical care medicine · Oct 1993
Multicenter StudyImproving intensive care: observations based on organizational case studies in nine intensive care units: a prospective, multicenter study.
To examine organizational practices associated with higher and lower intensive care unit (ICU) outcome performance. ⋯ The best and worst organizational practices found in this study can be used by ICU leaders as a checklist for improving ICU management.
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Critical care medicine · Oct 1993
Randomized Controlled Trial Clinical TrialSelective decontamination of the digestive tract in neurosurgical intensive care unit patients: a double-blind, randomized, placebo-controlled study.
The aim of this study was to assess, in a selected population, the effects of selective decontamination of the digestive tract on colonization of the oropharynx, trachea, stomach and rectum, and on the infection rate. An economical assessment was also performed. ⋯ Selective decontamination of the digestive tract is an effective technique in reducing infectious morbidity in comatose neurosurgical patients. Because of its cost, this technique should be used only in selected populations.
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Critical care medicine · Oct 1993
Randomized Controlled Trial Comparative Study Clinical TrialEffects of norepinephrine, epinephrine, and dopamine infusions on oxygen consumption in volunteers.
To determine the relationships between plasma concentrations of norepinephrine, epinephrine, and dopamine and oxygen consumption (VO2) during infusion of these catecholamines. ⋯ Administration of norepinephrine, epinephrine, or dopamine results in marked increases in VO2 in volunteers. In patients, the administration of catecholamines or sympathomimetics to attain optimal values of cardiac index, oxygen delivery (DO2), and VO2 may increase the oxygen demand and thus obscure the DO2-VO2 relationship.