Critical care medicine
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Critical care medicine · Oct 1994
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialSafety and efficacy of intravenous Carbicarb in patients undergoing surgery: comparison with sodium bicarbonate in the treatment of mild metabolic acidosis. SPI Research Group. Study of Perioperative Ischemia.
To compare the safety and efficacy of intravenous Carbicarb with intravenous sodium bicarbonate in well-oxygenated patients who developed metabolic acidosis while undergoing major surgery. Carbicarb is an equimolar solution of sodium bicarbonate and sodium carbonate (Na2CO3). It does not undergo significant breakdown to CO2 and H2O, nor does it increase CO2 concentrations to the same extent as does pure sodium bicarbonate. Because of these characteristics, Carbicarb may be a more suitable agent than bicarbonate in the treatment of metabolic acidosis. ⋯ Carbicarb corrects metabolic acidosis as well as sodium bicarbonate. However, the potential therapeutic advantage of Carbicarb remains to be determined, especially in patients with more severe metabolic acidosis.
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Critical care medicine · Oct 1994
Randomized Controlled Trial Comparative Study Clinical TrialRacemic versus l-epinephrine aerosol in the treatment of postextubation laryngeal edema: results from a prospective, randomized, double-blind study.
To determine whether any advantage exists using racemic epinephrine instead of the more potent and less expensive levo(1)-epinephrine in the treatment of postextubation laryngeal edema. ⋯ These data suggest that aerosolized l-epinephrine is as effective as aerosolized racemic epinephrine in the treatment of postextubation laryngeal edema without additional adverse side effects. When dosed appropriately, l-epinephrine is a less expensive and more widely available alternative to racemic epinephrine for the treatment of postextubation laryngeal edema.
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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.