Critical care medicine
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Critical care medicine · Jan 1998
Removal of piperacillin in critically ill patients undergoing continuous venovenous hemofiltration.
Continuous hemofiltration is now widely used in the intensive care unit. Our study aimed to assess the removal of piperacillin under continuous hemofiltration and to define a suitable dosage regimen of administration. ⋯ Piperacillin was not removed to a significant extent during continuous hemofiltration. Further, in the intensive care unit, patients in shock with multiple organ failure such as liver failure might behave differently from patients with stable end-stage renal disease. A 4-g dose of piperacillin twice a day is recommended in such patients.
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Critical care medicine · Jan 1998
Noninvasive ventilation via bilevel positive airway pressure support in pediatric practice.
To evaluate the efficacy of bilevel positive airway pressure support in critically ill children with underlying medical conditions. ⋯ A decrease in respiratory rate, heart rate, and dyspnea score and an improvement in oxygenation were noted in >90% of patients studied, resulting in only an 8% frequency of intubation. The efficacy of bilevel positive airway pressure support ventilation in selected groups of patients indicates the need to include this form of noninvasive pressure support ventilation in the care offered by pediatric ICUs.
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Critical care medicine · Jan 1998
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialEffects of inhaled nitric oxide in patients with acute respiratory distress syndrome: results of a randomized phase II trial. Inhaled Nitric Oxide in ARDS Study Group.
To evaluate the safety and physiologic response of inhaled nitric oxide (NO) in patients with acute respiratory distress syndrome (ARDS). In addition, the effect of various doses of inhaled NO on clinical outcome parameters was assessed. ⋯ From this placebo-controlled study, inhaled NO appears to be well tolerated in the population of ARDS patients studied. With mechanical ventilation held constant, inhaled NO is associated with a significant improvement in oxygenation compared with placebo over the first 4 hrs of treatment. An improvement in oxygenation index was observed over the first 4 days. Larger phase III studies are needed to ascertain if these acute physiologic improvements can lead to altered clinical outcome.
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Critical care medicine · Jan 1998
Multicenter StudyEvaluation of two outcome prediction models on an independent database.
To evaluate the performance of the New Simplified Acute Physiology Score (SAPS II) and the admission Mortality Probability Model (MPM0) in a large independent database, using formal statistical assessment. ⋯ The original SAPS II and MPM0 models did not accurately predict mortality on an independent large international multicenter ICU patient database. Results of studies utilizing general outcome prediction models without previous validation in the target population should be interpreted with prudence.
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Critical care medicine · Jan 1998
Comparative Study Clinical Trial Controlled Clinical TrialProcoagulant activity in patients with isolated severe head trauma.
To determine the degree of regional and systemic coagulation activation soon after isolated severe head injury. ⋯ Within 6 hrs after severe isolated head trauma, systemic procoagulant overflow from the traumatized cerebral microvasculature proceeds to the thrombin level and is then inhibited by antithrombin III. Regional and systemic hypercoagulability and increased D-dimer concentrations appear to be common among head trauma patients. Increased procoagulant and consecutive fibrinolytic turnover may, therefore, spark disseminated intravascular coagulation in this patient group.