Critical care medicine
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Critical care medicine · Jan 1997
Randomized Controlled Trial Clinical TrialOxygen delivery, oxygen consumption, and gastric intramucosal pH are not improved by a computer-controlled, closed-loop, vecuronium infusion in severe sepsis and septic shock.
To investigate the influence of the neuromuscular blocking agent vecuronium on oxygen delivery (DO2), oxygen consumption (VO2), oxygen extraction ratio, and gastric intramucosal pH in heavily sedated patients with severe sepsis or septic shock. ⋯ In these patients, vecuronium infusion achieved the targeted level of paralysis and improved respiratory compliance but did not alter intramucosal pH, VO2, DO2, or oxygen extraction ratios. With deep sedation, neuromuscular blockade in severe sepsis/septic shock does not significantly influence oxygen flux and should be abandoned as a routine method of improving tissue oxygenation in these patients.
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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
Comparative StudyPrediction of outcome from intensive care: a prospective cohort study comparing Acute Physiology and Chronic Health Evaluation II and III prognostic systems in a United Kingdom intensive care unit.
To evaluate the ability of two prognostic systems to predict hospital mortality in adult intensive care patients. ⋯ Both predictive models demonstrated a similar degree of overall goodness-of-fit. APACHE II showed better calibration, but discrimination was better with APACHE III. Hospital mortality was higher than predicted by both models, but was underestimated to a greater degree by APACHE III. Risk estimates by both models showed considerable variation across the disease spectrum of ICU patients. Risk predictions for surgical patients and patients with gastrointestinal disease were better with APACHE II. Factors reflecting the clinical practice of an individual ICU are not accounted for by APACHE II and III. Overall, the performance of APACHE III was not superior to that of its predecessor for a cohort of United Kingdom ICU patients; for certain diagnostic categories, APACHE III performed worse than APACHE II despite an improved system of disease classification.
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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.