Critical care medicine
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Critical care medicine · Sep 1995
Survival in patients with severe adult respiratory distress syndrome treated with high-level positive end-expiratory pressure.
To assess the mortality rate and complications in a population of surgical patients with severe adult respiratory distress syndrome (ARDS) treated with positive end-expiratory pressure (PEEP) of > 15 cm H2O in an attempt to reduce intrapulmonary shunt to approximately 0.20 and reduce FIO2 to < 0.50. ⋯ This subset of patients with severe ARDS treated with high-level PEEP had a mortality rate lower than those rates previously reported by other researchers using more conventional ventilatory support and resuscitation techniques. FIO2 may be significantly reduced and PaO2 may be maintained at acceptable values by decreasing intrapulmonary shunt fraction using high-level PEEP.
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Critical care medicine · Sep 1995
Practice Guideline GuidelinePractice parameters for sustained neuromuscular blockade in the adult critically ill patient: an executive summary. Society of Critical Care Medicine.
The development of practice parameters for achieving sustained neuromuscular blockade in the adult critically ill patient for the purpose of guiding clinical practice. ⋯ A consensus of experts provided three recommendations with supporting data for achieving sustained neuromuscular blockade in critically ill patients: a) pancuronium is the preferred neuromuscular blocking agent for most critically ill patients; b) vecuronium is the preferred neuromuscular blocking agent for those patients with cardiac disease or hemodynamic instability in whom tachycardia may be deleterious; c) patients receiving neuromuscular blocking agents should be appropriately assessed for the degree of blockade that is being sustained. This executive summary selectively presents supporting information and is not intended as a substitute for the complete document.
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Critical care medicine · Sep 1995
Practice Guideline GuidelinePractice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit: an executive summary. Society of Critical Care Medicine.
The development of practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit (ICU) setting for the purpose of guiding clinical practice. ⋯ A consensus of experts provided six recommendations with supporting data for intravenous analgesia and sedation in the ICU setting: a) morphine sulfate is the preferred analgesic agent for critically ill patients; b) fentanyl is the preferred analgesic agent for critically ill patients with hemodynamic instability, for patients manifesting symptoms of histamine release with morphine, or morphine allergy; c) hydromorphone can serve as an acceptable alternative to morphine; d) midazolam or propofol are the preferred agents only for the short-term (< 24 hrs) treatment of anxiety in the critically ill adult; e) lorazepam is the preferred agent for the prolonged treatment of anxiety in the critically ill adult; f) haloperidol is the preferred agent for the treatment of delirium in the critically ill adult. This executive summary selectively presents supporting information and is not intended as a substitute for the complete document.
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Critical care medicine · Sep 1995
Comparative StudyIntraoperative end-tidal carbon dioxide values and derived calculations correlated with outcome: prognosis and capnography.
To determine how much information concerning resuscitation and outcome is provided by the end-tidal CO2 and derived variables obtained during surgery. ⋯ End-tidal CO2 and derived values should be monitored closely in critically ill or injured patients. Efforts should be made--by increasing cardiac output and core temperature and by adjusting ventilation as needed--to maintain the end-tidal CO2 at > or = 29 torr (> or = 3.9 kPa) and the arterial to end-tidal CO2 difference at < or = 7 torr (< or = 1.0 kPa).
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Critical care medicine · Sep 1995
Comparative StudyOxygen transport and cardiovascular effects of resuscitation from severe hemorrhagic shock using hemoglobin solutions.
To test the short-term efficacy of three hemoglobin solutions in restoring cardiac output, intravascular pressures, oxygen transport (DO2), and oxygen consumption (VO2) after resuscitation from severe hemorrhagic shock. ⋯ Resuscitation from severe hemorrhagic shock with 8% stroma-free hemoglobin, PHP44, or PHP88 is equally effective in restoring cardiac index and vascular pressures as using whole blood. However, resuscitation with the three hemoglobin solutions only transiently restored DO2 after hemorrhagic shock. The subsequent reduction of DO2 compared with the DO2 value using whole blood was due mostly to hemodilution. With the two PHP solutions, formation of red blood cell aggregates probably resulted in sequestration of red cell mass and additional loss of oxygen carrying capacity.