Critical care medicine
-
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.
-
Critical care medicine · Jan 1997
Randomized Controlled Trial Clinical TrialProlonged sedation of critically ill patients with midazolam or propofol: impact on weaning and costs.
To compare the effectiveness of sedation, the time required for weaning, and the costs of prolonged sedation of critically ill mechanically ventilated patients with midazolam and propofol. ⋯ In our population of critically ill patients sedated with midazolam or propofol over prolonged periods, midazolam and propofol were equally effective as sedative agents. However, despite remarkable differences in the cost of sedation with these two agents, the economic profile is more favorable for propofol than for midazolam due to a shorter weaning time associated with propofol administration.
-
Critical care medicine · Jan 1997
Comparative StudyType B lactic acidosis following cardiopulmonary bypass.
To describe, characterize, and identify the associations of postcardiac surgical lactic acidosis occurring in the absence of clinical evidence of tissue hypoperfusion. ⋯ This report documents the occurrence of lactic acidosis in a subgroup of patients undergoing cardiopulmonary bypass. The pathogenesis of this disorder is uncertain, but it appears to not relate to inadequate oxygen delivery. Systemic vasodilation and reduced oxygen extraction appear to be features of this disorder, which has an excellent prognosis.
-
To describe a 10-yr experience with an end-of-life practice in a hospital. ⋯ A hands-on approach to the care of dying patients by this specialty, palliative care service has provided patients, families, and clinicians with the type of support needed for satisfactory end-of-life care. A summary of our experience may be useful to others.