Critical care medicine
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Critical care medicine · Dec 1998
ReviewHas high-frequency ventilation been inappropriately discarded in adult acute respiratory distress syndrome?
To review the basic physiologic principles that support the role for high-frequency ventilation (HFV) in acutely lung-injured patients, to critically assess clinical trial data in this area, and discuss why a metasummary is not feasible and a large-scale clinical trial is needed. ⋯ Current clinical studies are statistically under-powered and a metasummary is not feasible because of study quality, as well as lack of similar clinical end points and measures of magnitude of benefit. A large, multicenter trial should be initiated to define the role of HFV in the treatment of adult ARDS.
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Critical care medicine · Dec 1998
Comparative StudyActivation of the extrinsic coagulation pathway in patients with severe sepsis and septic shock.
To obtain systematic information on the extrinsic coagulation pathway, as well as to investigate the time course of the coagulation abnormalities in sepsis. ⋯ We systematically elucidated coagulation disorders in newly defined sepsis. The extrinsic coagulation pathway is activated in patients with severe sepsis and septic shock. In these patients, enhanced thrombin generation and activation, and fibrin formation were demonstrated when compared with the control subjects. Furthermore, the thrombin generated appears not to be fully neutralized by antithrombin III.
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Critical care medicine · Dec 1998
Editorial Comment ReviewIn search of the Holy Grail: noninvasive or "low-invasive" cardiac output monitoring.
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Critical care medicine · Dec 1998
Noninvasive cardiac output monitoring by aortic blood flow determination: evaluation of the Sometec Dynemo-3000 system.
The Sometec Dynemo-3000 system allows the permanent measurement of descending aorta diameter by an echographic (A-scan) device and the blood flow velocity by a pulse Doppler velocimeter. The Dynemo-3000 then furnishes a new hemodynamic parameter, i.e., descending aortic blood flow (ABF), which is a fraction of the cardiac output (CO). We evaluate the ability of this system to measure the aortic diameter and to accurately detect ABF changes. ⋯ The Dynemo-3000 system is able to display the real aortic diameter, which is one of the most important components of this noninvasive ultrasonic technique. When compared with TD-CO, the ABF determination provided by this ultrasonic device constitutes a reliable noninvasive tool for estimating CO and tracking its changes.
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Critical care medicine · Dec 1998
Comparative StudyNoninvasive management of pediatric neuromuscular ventilatory failure.
To evaluate the use of mouth piece/nasal intermittent positive-pressure ventilation (IPPV) as an alternative to intubation or to permit extubation for patients with primarily neuromuscular ventilatory impairment and no ventilator-free breathing ability. ⋯ The use of inspiratory and expiratory aids can decrease the need for intubation for patients with neuromuscular ventilatory failure in the absence of significant lung disease. It can also permit extubation, despite the need for continuous ventilatory support and, thereby, decrease the need to resort to tracheostomy.