Critical care medicine
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Critical care medicine · Jun 1995
Comparative StudyNoninvasive monitoring of end-tidal carbon dioxide tension via nasal cannulas in spontaneously breathing children with profound hypocarbia.
To determine the correlation between end-tidal CO2 and PaCO2 measured via nasal cannulas in spontaneously breathing children with profound hypocarbia (PaCO2 < 30 torr [< 4.0 kPa]). ⋯ End-tidal CO2 measurement by infrared spectroscopy provides an accurate estimation of PaCO2, even during episodes of severe hypocarbia. Its use may limit the need for invasive monitoring and/or repeated arterial blood gas analyses.
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Critical care medicine · Jun 1995
Triage considerations for patients with acute gastrointestinal hemorrhage admitted to a medical intensive care unit.
To determine whether previously identified clinical criteria, available at the time of triage, can predict clinical outcomes for patients with acute gastrointestinal (GI) hemorrhage. ⋯ These data suggest that objective clinical criteria, available at the time of triage determination, can be utilized to identify a low-risk group of patients with acute GI hemorrhage, having favorable outcomes and potentially no need for intensive care unit services.
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Critical care medicine · Jun 1995
Randomized Controlled Trial Multicenter Study Clinical TrialMedical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Participants of the Multicenter Cooperative Aneurysm Study.
This report examines the frequency, type, and prognostic factors of medical (nonneurologic) complications after subarachnoid hemorrhage in a large, prospective study. The influences of contemporary neurosurgical, neurological, and critical care practice on mortality and morbidity rates after aneurysmal subarachnoid hemorrhage are evaluated. ⋯ Potentially preventable medical complications after ruptured cerebral aneurysm add to the total mortality rate of patients, and may increase length of hospital stay in the critical care setting. The proportion of deaths after subarachnoid hemorrhage from medical complications equals those deaths from either direct effects, rebleeding, or vasospasm individually. Pulmonary complications are the most common nonneurologic cause of death. Cardiac arrhythmia, although frequent, was not associated with significant mortality. The frequency of cardiac arrhythmia and pulmonary edema increased on the day of, or day after, aneurysm surgery. Renal and hepatic dysfunction, and blood dyscrasias, were also observed, underscoring the need for meticulous monitoring for metabolic and hematologic derangements.
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Critical care medicine · Jun 1995
Randomized Controlled Trial Multicenter Study Clinical TrialA second large controlled clinical study of E5, a monoclonal antibody to endotoxin: results of a prospective, multicenter, randomized, controlled trial. The E5 Sepsis Study Group.
To evaluate the safety and efficacy of E5, a murine, monoclonal antibody directed against endotoxin, in the treatment of patients with Gram-negative sepsis. ⋯ In this study, E5 did not reduce mortality in nonshock patients with Gram-negative sepsis whether or not those patients also had organ failure. However, E5 did result in greater resolution of organ failure in patients with Gram-negative sepsis. This benefit extended to those patients with suspected Gram-negative etiology. This finding is important because patients with suspected Gram-negative sepsis and organ failure can be identified without waiting for culture results. In addition, E5 resulted in the prevention of adult respiratory distress syndrome and central nervous system organ failure. However, more studies are needed to determine if this result can be extended to organ failure in general. E5 is safe as a treatment for patients with Gram-negative sepsis.
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Critical care medicine · Jun 1995
Randomized Controlled Trial Clinical TrialEffect of the antiendotoxic agent, taurolidine, in the treatment of sepsis syndrome: a placebo-controlled, double-blind trial.
To assess the benefit gained from administration of the antiendotoxic drug, taurolidine, on outcome in critically ill patients with sepsis syndrome. ⋯ Taurolidine had no beneficial therapeutic effect on the outcome of patients admitted to the intensive therapy unit with sepsis syndrome, using clinical, bacteriologic outcomes, progression of endotoxemia, resolution of organ failure, and 28-day mortality rate as end points.