Critical care medicine
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Critical care medicine · Aug 1994
ReviewEvaluation of new diagnostic technologies: bronchoalveolar lavage and the diagnosis of ventilator-associated pneumonia.
To present criteria to aid intensive care workers in the assessment of diagnostic technologies, using the example of bronchoalveolar lavage for the evaluation of ventilator-associated pneumonia. ⋯ We present guidelines for the assessment of diagnostic technology, and apply them to bronchoalveolar lavage for the evaluation of ventilator-associated pneumonia. Bronchoalveolar lavage has been studied in both the laboratory and clinical setting, and the diagnostic sensitivity and specificity of this technique are high. Further randomized trials evaluating management decisions and patient benefit would facilitate decisions regarding the appropriate dissemination of bronchoalveolar lavage.
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Critical care medicine · Aug 1994
Effects of disposable or interchangeable positive end-expiratory pressure valves on work of breathing during the application of continuous positive airway pressure.
To determine which of a series of disposable or interchangeable positive end-expiratory pressure (PEEP) devices functions with the least imposition of inspiratory and expiratory work during continuous positive airway pressure. ⋯ All of the disposable/interchangeable PEEP valves that were studied imposed a considerable amount of both inspiratory and expiratory work, even when the continuous flow provided exceeded the peak inspiratory flow demands of the lung model. The primary reason for the high imposed work levels is the high gas-flow resistance of all of the valves studied.
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Critical care medicine · Aug 1994
Intravenous lorazepam as an amnestic and anxiolytic agent in the intensive care unit: a prospective study.
To assess the efficacy and hemodynamic safety of intravenous lorazepam as an amnestic and anxiolytic agent in patients undergoing critical care procedures. ⋯ This study confirms the beneficial anxiolytic and amnestic effects of lorazepam in a subgroup of patients undergoing critical care procedures. The study also substantiates the safety of this drug in this patient population.
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Critical care medicine · Aug 1994
Randomized Controlled Trial Comparative Study Clinical TrialContinuous intravenous infusions of lorazepam versus midazolam for sedation during mechanical ventilatory support: a prospective, randomized study.
To evaluate the efficacy of continuous infusions of lorazepam vs. midazolam for sedation in the intensive care unit (ICU). ⋯ While there was a tendency to a longer time required for return to baseline mental status in patients receiving midazolam, this was not statistically significant. Findings of interest concerning both midazolam and lorazepam were: a) time to achieve sedation in medical ICU patients is often prolonged; b) actual dose requirements necessary to maintain sedation in this patient population are larger than the current literature describes; c) time to awaken after discontinuation of the infusion was occasionally delayed for > 24 hrs; d) large volumes of fluid were required to deliver these doses of drug via this route of administration.
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Critical care medicine · Aug 1994
ReviewRegionalization of critical care medicine: task force report of the American College of Critical Care Medicine.
To review the existing literature and task force opinions on regionalization of critical care services, and to synthesize a judgement on possible costs, benefits, disadvantages, and strategies. ⋯ Regionalization of critical care medicine probably is beneficial and the concept should be explored.