Critical care medicine
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Critical care medicine · Apr 1994
Comparative StudyAlveolar-arterial oxygen gradients before extracorporeal life support for severe pediatric respiratory failure: improved outcome for extracorporeal life support-managed patients?
Recent reports have described the usefulness of the alveolar-arterial oxygen tension difference (P[A-a]O2) in predicting mortality in children with acute respiratory failure managed with mechanical ventilation. We reviewed our experience with extracorporeal life support for acute pediatric respiratory failure and specifically examined P(A-a)O2 measurements during the 24 hrs before extracorporeal life support to determine if defined cutoffs established with conventional mechanical ventilation were applicable to extracorporeal life-support survival. ⋯ Based on previous reports of the utility of P(A-a)O2 measurements to predict mortality, our preliminary evidence suggests that extracorporeal life support results in 62% survival for pediatric respiratory failure patients predicted to have no chance of survival using conventional mechanical ventilation. Prospective, randomized trials of children with severe acute respiratory failure managed with mechanical ventilation vs. extracorporeal life support may be indicated.
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Critical care medicine · Apr 1994
Editorial CommentMonitoring and therapy for young trauma patients.
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Critical care medicine · Apr 1994
Randomized Controlled Trial Comparative Study Clinical TrialEffect of hydroxyethyl starch on the activity of blood coagulation and fibrinolysis in healthy volunteers: comparison with albumin.
The aim of this study was to investigate whether hydroxyethyl starch of medium molecular weight (200 daltons), compared with albumin, has specific effects on blood coagulation and fibrinolysis. ⋯ a) Medium molecular weight hydroxyethyl starch has a specific lowering effect on factor VIII:C concentrations; this phenomenon may be hazardous to patients who need full hemostatic competence and who receive medium molecular weight hydroxyethyl starch (e.g., as a plasma expander). b) Medium molecular weight hydroxyethyl starch does not specifically influence the activity of the fibrinolytic system.
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Critical care medicine · Apr 1994
Randomized Controlled Trial Clinical TrialAerosolized ribavirin in mechanically ventilated children with respiratory syncytial virus lower respiratory tract disease: a prospective, double-blind, randomized trial.
To study the effect of ribavirin aerosol therapy on the immediate clinical course of mechanically ventilated children with respiratory syncytial virus lower respiratory tract disease. ⋯ Ribavirin aerosol therapy can be safely administered to mechanically ventilated children with severe respiratory syncytial virus lower respiratory tract disease. However, this therapy does not appear to affect immediate clinical outcome in such patients.
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Critical care medicine · Apr 1994
Randomized Controlled Trial Comparative Study Clinical TrialClosed versus open endotracheal suctioning: costs and physiologic consequences.
To examine the physiologic consequences and costs associated with two methods of endotracheal suctioning: closed vs. open. ⋯ The closed suction method resulted in significantly fewer physiologic disturbances. Closed suctioning appears to be an effective and cost-efficient method of endotracheal suctioning that is associated with fewer suction-induced complications.