Critical care medicine
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Critical care medicine · Oct 1997
Randomized Controlled Trial Comparative Study Clinical TrialClinical utility of hygroscopic heat and moisture exchangers in intensive care patients.
To compare the degree of bacterial circuit colonization, frequency of ventilator-associated pneumonia (VAP), character of respiratory secretions, rewarming of hypothermic patients, disposable costs, and air flow resistance in intensive care patients ventilated using either a heat and moisture exchanger (HME) or hot water (HW) humidifier circuit. ⋯ Circuits with a bacterial-viral filtering HME are less readily colonized by bacteria. Contamination is a random event. Humidification technique has no influence on the frequency rate of VAP, the effectiveness of rewarming, nor the character of the respiratory secretions. Breathing resistance is generally low and disposable costs are reduced when an HME is used.
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Critical care medicine · Oct 1997
Comparative StudyCerebral oxygenation during warming after cardiopulmonary bypass.
To evaluate jugular venous oxygen saturation (SjVO2), measured with a fiberoptic oximetry catheter, and brain tissue oxygen saturation, measured by near-infrared spectroscopy (NIRSO2), as monitors of cerebral oxygenation during cardiopulmonary bypass surgery. ⋯ The study confirms other studies showing that jugular venous desaturation can occur during rewarming after cardiopulmonary bypass surgery. Presently, SjvO2 appears to be a better monitor of cerebral oxygenation than NIRSO2. However, NIRSO2 has promise as a noninvasive monitor of cerebral oxygenation if future developments allow more quantitative measurements of oxygen saturation.
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Critical care medicine · Oct 1997
Meta AnalysisEffect of noninvasive positive pressure ventilation on mortality in patients admitted with acute respiratory failure: a meta-analysis.
To critically appraise and summarize the trials examining the addition of noninvasive positive pressure ventilation to standard therapy on hospital mortality and need for endotracheal intubation in patients admitted with acute respiratory failure. ⋯ The addition of noninvasive positive pressure ventilation to standard therapy in patients with acute respiratory failure improves survival and decreases the need for endotracheal intubation. However, this effect is restricted to patients whose cause of acute respiratory failure is an exacerbation of COPD. Further research is warranted to determine whether noninvasive positive pressure ventilation confers benefit in patients without COPD who have acute respiratory failure.
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Critical care medicine · Oct 1997
Multicenter Study Comparative StudyLimitation of therapeutic activity in elderly critically ill patients. Project for the Epidemiological Analysis of Critical Care Patients.
To establish whether the age of patients admitted into the intensive care unit (ICU) influences the amount of therapy received. ⋯ Patients > 75 yrs of age represent a large proportion of patients in Spanish ICUs. Although their mortality rate and severity scores were higher than those values in younger patients, patients > 75 yrs of age received less therapy.
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Critical care medicine · Oct 1997
Randomized Controlled Trial Comparative Study Clinical TrialEpinephrine-induced lactic acidosis following cardiopulmonary bypass.
To determine if lactic acidosis occurring after cardiopulmonary bypass could be attributed to the metabolic or other effects of epinephrine administration. ⋯ The use of epinephrine after cardiopulmonary bypass precipitates the development of lactic acidosis in some patients. This phenomenon is presumably a beta-mediated effect, and is associated with an increase in whole-body and lower limb blood flow and a decrease in whole-body and transfemoral oxygen extraction. The phenomenon does not appear to be related to reduced tissue perfusion and does not have the poor outlook of lactic acidosis associated with shock.