Critical care medicine
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Critical care medicine · Oct 1997
Comparative Study Clinical Trial Controlled Clinical TrialAirway humidification in mechanically ventilated neonates and infants: a comparative study of a heat and moisture exchanger vs. a heated humidifier using a new fast-response capacitive humidity sensor.
To study the efficiency of a heated humidifier and a heat and moisture exchanger in mechanically ventilated neonates and infants. ⋯ Passive airway humidification by a heat and moisture exchanger is effective in mechanically ventilated neonates and infants over a 6-hr period. However, the performance and safety of a heat and moisture exchanger in prolonged mechanical ventilation remain to be proven.
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Critical care medicine · Oct 1997
Multicenter Study Comparative StudyPediatric critical care training programs have a positive effect on pediatric intensive care mortality.
Comparison of severity and diagnosis-adjusted mortality rates from pediatric intensive care units (ICUs) staffed by physicians training in pediatric critical care, as well as pediatric residents, with mortality rates from pediatric ICUs staffed with only pediatric residents. ⋯ Pediatric ICUs with critical care fellowship programs are generally associated with better risk-adjusted mortality rates than pediatric ICUs without such fellowship training programs. The cause for this effect requires a more in-depth study. The presence or absence of such training programs does not guarantee superior or inferior performance.
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Critical care medicine · Oct 1997
Randomized Controlled Trial Comparative Study Clinical TrialPatient-ventilator flow dyssynchrony: flow-limited versus pressure-limited breaths.
Patient-ventilator flow dyssynchrony occurs when ventilator flow delivery is insufficient to meet patient demands. If sufficiently severe, flow dyssynchrony can produce significant imposed loads on ventilatory muscles. Flow dyssynchrony can be improved by increasing ventilator flow delivery. We hypothesized that the variable flow pressure-limited breath would be a better approach for matching patient flow demands than adjusting a set flow on a conventional volume-cycled breath. ⋯ The pressure-limited, variable-flow approach to ventilator gas delivery appears to be more responsive to a vigorous patient effort than a fixed-flow approach.
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Critical care medicine · Oct 1997
Clinical TrialDobutamine improves the adequacy of gastric mucosal perfusion in epinephrine-treated septic shock.
To assess the effects of dobutamine at a rate of 5 micrograms/kg/min on hemodynamics and gastric intramucosal acidosis in patients with hyperdynamic septic shock treated with epinephrine. ⋯ The addition of 5 micrograms/kg/min of dobutamine added to epinephrine in hyperdynamic septic shock selectively improved the adequacy of gastric mucosal perfusion without modification in systemic hemodynamics.
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Critical care medicine · Oct 1997
Comparative StudyEffect of mechanical ventilation strategy on dissemination of intratracheally instilled Escherichia coli in dogs.
To test the effect of different mechanical ventilation strategies on dissemination of intratracheally instilled Escherichia coli in dogs and to determine the extent and distribution of lung damage. ⋯ We conclude that the ventilatory strategy most likely to overdistend the lungs while allowing repetitive opening and closure of alveoli (group 2) facilitated bacterial translocation from the alveoli to the bloodstream and increased lung injury, as determined by histologic and gravimetric analysis. PEEP ameliorated these effects, despite lung overdistention, but increased histologic and gravimetric indices of lung injury in dependent as compared with the nondependent regions.