Critical care medicine
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Critical care medicine · Dec 1998
Editorial Comment ReviewReduced mortality from septic shock--lessons for the future.
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Critical care medicine · Dec 1998
Effects of the prone position on gas exchange and hemodynamics in severe acute respiratory distress syndrome.
To address the following issues regarding the use of prone position ventilation in patients with severe acute respiratory distress syndrome (ARDS): a) response rate; b) magnitude and duration of improved oxygenation in responders during a 12-hr trial and the consequences of returning to the supine position; c) effects of the prone position on gas exchange and hemodynamics; d) consequences of oxygenation in nonresponders; and e) effects of repeated prone position trials. ⋯ Based on the data from this study, the prone position can improve oxygenation in severely hypoxemic ARDS patients without deleterious effects on hemodynamics. This beneficial effect does not immediately disappear on return to the supine position. In our patients, an absence of response to this technique was not accompanied by worsening hypoxemia or hemodynamic instability. Repeated daily trials in the prone position should be considered in the management of ARDS patients with severe hypoxemia.
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Critical care medicine · Dec 1998
Comparative StudyContinuous venovenous rewarming: results from a juvenile animal model.
To compare a standard and an experimental method of rewarming in 5-wk-old goats with induced moderate hypothermia. ⋯ The use of a modified continuous venovenous hemofiltration circuit for rewarming in a juvenile goat model after induction of moderate hypothermia is more effective than are standard methods.
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Critical care medicine · Dec 1998
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialGastric versus duodenal feeding and gastric tonometric measurements.
To compare the influence of gastric and postpyloric enteral feeding on the gastric tonometric PCO2 gap (tonometric PCO2 - PaCO2). ⋯ The results indicate that gastric enteral feeding increased the PCO2 gap. However, postpyloric enteral feeding does not interact with gastric tonometric measurements and should be used when using gastric tonometry in enterally fed patients.
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To determine whether a systematic review of the literature could identify changes in the mortality of septic shock over time. ⋯ The present review showed a slight reduction in mortality from septic shock over the years, although this result should be approached with caution. The heterogeneity of the articles and absence of a severity score for most of the studies limited our analysis. Furthermore, there was an increasing prevalence of Gram-positive causative organisms, and a change of the predominant origin of sepsis from the abdomen to the chest.