Critical care medicine
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Critical care medicine · Jun 1996
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialComparative study of propofol versus midazolam in the sedation of critically ill patients: results of a prospective, randomized, multicenter trial.
To compare the effectiveness, characteristics, duration of action, hemodynamic and biochemical effects, and side effects of propofol and midazolam used for continuous intravenous sedation of ventilated critically ill patients. ⋯ In this population of critically ill patients, propofol is an effective and safe alternative for sedation, with some advantages, such as short duration of action and high effectiveness over the conventional regimen with benzodiazepines and opiates.
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Critical care medicine · Jun 1996
Comparative StudyEvaluation of gas exchange, pulmonary compliance, and lung injury during total and partial liquid ventilation in the acute respiratory distress syndrome.
To investigate whether pulmonary compliance and gas exchange will be sustained during "total" perfluorocarbon liquid ventilation followed by "partial" perfluorocarbon liquid ventilation when compared with gas ventilation in the setting of the acute respiratory distress syndrome (ARDS). ⋯ In a model of severe ARDS, pulmonary gas exchange is improved during total followed by partial liquid ventilation. Pulmonary compliance is improved during total, but not during partial liquid ventilation. Total followed by partial liquid ventilation was associated with a reduction in alveolar hemorrhage, pulmonary edema, and lung inflammatory infiltration.
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Critical care medicine · Jun 1996
Selective brain cooling in infant piglets after cardiac arrest and resuscitation.
To test the hypothesis that selective brain cooling could be performed in an infant model of cardiac arrest and resuscitation without changing core temperature and to study its acute effects on regional organ blood flow, cerebral metabolism, and systemic hemodynamics. ⋯ Selective brain cooling by surface cooling can be achieved rapidly in an infant animal model of cardiac arrest and resuscitation without changing core temperature. Brain temperatures known to improve neurologic outcome can be achieved by this technique with minimal adverse effects. Because of its ease of application, selective brain cooling may prove to be an effective, inexpensive method of cerebral resuscitation during pediatric CPR.
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Critical care medicine · Jun 1996
Breathing measurement reduces false-negative classification of tachypneic preextubation trial failures.
There is increased awareness of imposed work of breathing contributing to apparent ventilatory dependency. This study evaluates the impact of tachypnea as an indicator of ventilatory failure during a room air-5 cm H2O continuous positive airway pressure, spontaneous breathing, preextubation trial when associated with increased imposed work of breathing. ⋯ Tachypnea as a marker of respiratory distress is sensitive, but is not sufficiently specific to be used as a criterion in preextubation trials. Reliance on tachypnea as a preextubation trial failure criterion is likely to prolong intubation and ventilatory support for a large number of patients. Patient risks, determined by the extubation failures and reintubation rate, are the same.
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To determine curriculum requirements and educational methods used by Critical Care fellowship training programs in fulfilling Residency Review Committee requirements for a research experience during Critical Care subspecialty training. ⋯ Compliance with current Residency Review Committee requirements for active participation in research is poor for 1-yr fellowship curricula. Reasons for this failure are discussed and a modified requirement is proposed.