Critical care medicine
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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.
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Critical care medicine · Aug 1994
Review Comparative StudyContinuous infusion of loop diuretics in the critically ill: a review of the literature.
a) To present the pharmacodynamic concepts behind the administration of loop diuretics via continuous infusion; b) to review the clinical trials and reports in critically ill patients that have described this method of drug delivery; and c) to discuss the data. ⋯ Administration of loop diuretics by continuous intravenous infusion may improve diuresis in critically ill patients who require prompt, controllable diuresis, or who demonstrate "diuretic tolerance" to conventional administration regimens. Despite few, well-designed studies using this method of administration in clinical practice, pharmacodynamic concepts support continuous infusion over bolus administration, including decreased dosage requirements, improved diuretic response and few adverse effects.
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Critical care medicine · Aug 1994
Comparative StudySustained inflations improve respiratory compliance during high-frequency oscillatory ventilation but not during large tidal volume positive-pressure ventilation in rabbits.
To determine whether volume recruitment maneuvers that induce significant lung reexpansion during high-frequency oscillatory ventilation are also of value during conventional positive-pressure ventilation. ⋯ Active recruitment of lung volume during high-frequency oscillatory ventilation appears necessary, because small pressure/volume cycles adequate to support high-frequency gas transport are not able to reexpand atelectatic lung units without the aid of a sustained inflation. We conclude that volume recruitment maneuvers improve respiratory system compliance substantially during high-frequency oscillatory ventilation at 15 Hz, but these maneuvers offer potential risk and no benefit during conventional positive-pressure ventilation with large tidal volumes or when using smaller tidal volumes and high levels of positive end-expiratory pressure.
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Critical care medicine · Aug 1994
Impaired cerebral autoregulation in the newborn lamb during recovery from severe, prolonged hypoxia, combined with carotid artery and jugular vein ligation.
To study the effect of severe prolonged hypoxia combined with ligation of the carotid artery and jugular vein (simulating pre-extracorporeal membrane oxygenation [ECMO] events) on cerebral autoregulation in the newborn lamb. ⋯ These findings indicate that cerebral autoregulation is disrupted during the recovery phase from an insult caused by prolonged, severe hypoxia with carotid artery and jugular vein ligation. This insult results in significant differences in right and left hemispheric cerebral blood flow rates when cerebral autoregulation is lost. If these results can be extrapolated to the human state, they may help to explain the role of pre-ECMO hypoxia combined with vessel ligation as a risk factor in cerebral injury in ECMO patients.