Critical care medicine
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Critical care medicine · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialProspective, randomized trial of two antiseptic solutions for prevention of central venous or arterial catheter colonization and infection in intensive care unit patients.
To compare the efficacy of a newly available antiseptic solution (composed of 0.25% chlorhexidine gluconate, 0.025% benzalkonium chloride, and 4% benzyl alcohol), with 10% povidone iodine, on the prevention of central venous or arterial catheter colonization and infection. ⋯ The 4% alcohol-based solution of 0.25% chlorhexidine gluconate and 0.025% benzalkonium chloride was more effective than 10% povidone iodine for insertion site care of short-term central venous and arterial catheters. This effect appeared related to a more efficacious prevention of infections with Gram-positive bacteria.
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Critical care medicine · Nov 1996
Randomized Controlled Trial Multicenter Study Clinical TrialRanitidine improves lymphocyte function after severe head injury: results of a randomized, double-blind study.
To study the immunomodulatory effect of the histamine receptor antagonist, ranitidine, in patients admitted to the intensive care unit after severe head injury. ⋯ This study demonstrates an immunostimulatory effect of the histamine-2-receptor antagonist, ranitidine, both at the cellular and mediator levels in patients after head injury.
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Critical care medicine · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialTracheal pressure triggering a demand-flow continuous positive airway pressure system decreases patient work of breathing.
Triggering a ventilator "ON" at the carinal end of the endotracheal tube decreases imposed work of breathing by bypassing the resistance imposed by the breathing circuit and the endotracheal tube. We compared work of breathing during spontaneous ventilation between three methods of triggering the ventilator "ON": a) conventional pressure triggering from inside the ventilator; b) flow-by triggering; or c) tracheal pressure triggering at the carinal end of the endotracheal tube. We hypothesized that the work of breathing would be substantially decreased with tracheal pressure triggering compared with conventional pressure and flow-by methods in patients receiving continuous positive airway pressure. ⋯ The tracheal pressure triggering of a demand-flow continuous positive airway pressure system creates an effect similar to pressure-support ventilation that significantly decreases imposed work of breathing and, thus, total work of breathing. We recommend moving the triggering site of the ventilator to the carinal end of the endotracheal tube.
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Critical care medicine · Nov 1996
Plasma proinflammatory cytokine concentrations, Acute Physiology and Chronic Health Evaluation (APACHE) III scores and survival in patients in an intensive care unit.
To more clearly define the relationships between plasma proinflammatory cytokine concentrations, physiologic disturbance, and survival in severely ill patients. ⋯ Plasma cytokine concentrations fluctuate in serious illness and have a poor correlation with derangement of whole body physiology in seriously ill patients. Only the presence of bioactive TNF in plasma was an independent predictor of mortality. Daily measurement of plasma proinflammatory cytokine concentrations is unlikely to have clinical application in the ICU setting, except possibly in specific subgroups of patients.
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Critical care medicine · Nov 1996
Comparative StudyEndothelial cell activity varies in patients at risk for the adult respiratory distress syndrome.
The endothelial cell produces many bioactive compounds that are presumed to play important roles in the pathogenesis of the adult respiratory distress syndrome (ARDS). We postulated that individuals with sepsis and trauma-two at-risk diagnoses for the development of ARDS--might demonstrate differences in the degree of endothelial cell activity. ⋯ These findings suggest that differences in endothelial cell activity exist between sepsis and trauma patients who are at risk for the development of ARDS.