Critical care medicine
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Critical care medicine · Oct 1994
Randomized Controlled Trial Comparative Study Clinical TrialProspective, randomized comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure.
To compare the effectiveness of high-frequency oscillatory ventilation with conventional mechanical ventilation in pediatric patients with respiratory failure. ⋯ Our results indicate that high-frequency oscillatory ventilation, utilizing an aggressive volume recruitment strategy, results in significant improvement in oxygenation compared with a conventional ventilatory strategy designed to limit increases in peak airway pressures. Furthermore, despite the use of higher mean airway pressures, the optimal lung volume strategy used in this study was associated with a lower frequency of barotrauma, as indicated by requirement for supplemental oxygen at 30 days, and improved outcome compared with conventional mechanical ventilation.
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Critical care medicine · Oct 1994
Clinical Trial Controlled Clinical TrialGlucose content of tracheal aspirates: implications for the detection of tube feeding aspiration.
To determine, using a sensitive glucose assay, whether monitoring of tracheal aspirate glucose concentration could serve as a marker of aspiration of enteral feedings. ⋯ Tracheal secretions contain high glucose concentrations, both in enterally fed patients without evidence of aspiration pneumonitis and in nonenterally fed patients. The concentration of glucose in tracheal secretions appears to be determined, in part, by ambient extracellular glucose concentrations. We conclude that measurement of glucose in tracheal secretions is unlikely to be useful in monitoring for tube feeding aspiration in tracheally intubated, enterally fed patients.
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Critical care medicine · Oct 1994
Comparative StudySuppression of the thyrotropin response to thyrotropin-releasing hormone and its association with severity of critical illness.
To study whether the suppression of the thyrotropin (thyroid-stimulating hormone, TSH) response to thyrotropin-releasing hormone (TRH) correlates with severity of illness and death in patients with nonthyroidal critical illness. ⋯ In critically ill patients with multiple organ failure, suppression of the TSH response to TRH frequently occurs and correlates with severity of illness and outcome. Our data indicate that measurement of the TSH response is helpful in evaluating the severity of illness and prognosis for critically ill patients.
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Critical care medicine · Oct 1994
Comparative Study Clinical TrialQuantitated left ventricular systolic mechanics in children with septic shock utilizing noninvasive wall-stress analysis.
To quantitate ventricular systolic mechanics in septic children. ⋯ The frequency rate (40%) of reversible impaired ventricular contractility in children with septic shock is significant. Afterload is normal or increased in the majority of septic subjects, possibly due to acute ventricular dilation. Decreased preload contributes to altered ventricular performance in the majority of children with septic shock, persisting days after the initiation of therapy. Wall-stress analysis provided detailed information regarding ventricular mechanics that was not otherwise obtainable by standard ejection phase indices.
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Critical care medicine · Oct 1994
Comparative StudyHemodynamic effects of different modes of mechanical ventilation in acute cardiac and pulmonary failure: an experimental study.
To determine the hemodynamic effects of four different modes of mechanical ventilation in an animal model of acute cardiac and pulmonary failure. ⋯ Synchronized high-frequency ventilation improves cardiac performance in control conditions. No hemodynamic difference is present between the four modes of mechanical ventilation in the cardiac and pulmonary failure periods. External negative pressure oscillation combined with pressure support ventilation has moderate hemodynamic advantages over controlled mechanical ventilation and high-frequency oscillation in different clinical settings, but it also results in a deterioration of pulmonary gas exchange during the pulmonary failure period.