Critical care medicine
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Critical care medicine · Jan 1997
Randomized Controlled Trial Clinical TrialRandomized, controlled trial of selective digestive decontamination in 600 mechanically ventilated patients in a multidisciplinary intensive care unit.
To evaluate the efficacy of two regimens of selective decontamination of the digestive tract in mechanically ventilated patients. ⋯ In cases of high colonization and infection rates at the time of ICU admission, the preventive benefit of selective decontamination is highly debatable. Emergence of multiple antibiotic-resistant microorganisms creates a clinical problem and a definite change in the ecology of environmental, colonizing, and infecting bacteria. The selection of multiple antibiotic-resistant Gram-positive cocci is particularly hazardous. No beneficial effect on survival is observed. Moreover, selective decontamination adds substantially to the cost of ICU care.
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Critical care medicine · Jan 1997
Influence of airway pressure on minimum occlusive endotracheal tube cuff pressure.
To examine the in vivo relationship between peak inflation pressure and the minimum occlusive pressure of a "high-volume, low-pressure" endotracheal tube cuff that may in some circumstances promote tracheal ischemic complications. ⋯ Knowledge of the linear relationship between peak inflation pressure and minimum occlusive pressure can help the clinician identify patients who may be at risk for cuff-induced tracheal ischemic complications, such as tracheoesophageal fistula and tracheal stenosis. In our series, a cuff pressure of 25 mm Hg corresponded to a peak inflation pressure of 35.3 mm Hg (48 cm H2O). Patients with higher peak inflation pressures may be at risk for ischemic tracheal injury, despite proper cuff inflation techniques.
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Critical care medicine · Jan 1997
Comparative StudyInfluence of prone position on the extent and distribution of lung injury in a high tidal volume oleic acid model of acute respiratory distress syndrome.
To evaluate the influence of body position on the extent and distribution of experimental lung damage in an oleic acid canine model of acute respiratory distress syndrome, using mechanical ventilation with high tidal volumes and positive end-expiratory pressure (PEEP). ⋯ After oleic acid-induced lung injury, animals ventilated with high tidal volume and PEEP undergo less extensive histologic change in the prone position than in the supine position. The prone position alters the distribution of histologic abnormalities.
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Critical care medicine · Jan 1997
Quality of life after cardiac surgery complicated by multiple organ failure.
To evaluate quality of life after prolonged multiple system intensive care treatment in cardiac surgical patients. ⋯ Patients treated with prolonged multiple system intensive care after heart surgery have a poor outcome with respect to quality of life measured at least 1 yr after discharge from the ICU.
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Critical care medicine · Jan 1997
Tracheal gas insufflation during pressure-control ventilation: effect of using a pressure relief valve.
Pressure-control ventilation minimizes alveolar overdistention by limiting peak airway pressure, but a consequence of this pressure limitation may be a reduction in tidal volume with subsequent hypercarbia. Tracheal gas insufflation (TGI) can be used in combination with pressure-control ventilation to augment CO2 elimination. During pressure-control ventilation with continuous TGI, we observed that peak airway pressure increased above the set inspiratory pressure. Based on this observation, we investigated the ability of the pressure-control ventilator circuit to compensate for continuous TGI and the effect of insertion of a pressure relief valve to eliminate over-pressurization. ⋯ A pressure relief valve is a necessary adjunct to maintain peak airway pressure at set inspiratory pressure and keep total inspiratory tidal volume constant when continuous TGI is administered in conjunction with pressure-control ventilation.