Critical care medicine
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Critical care medicine · May 1998
ReviewPortable devices used to detect endotracheal intubation during emergency situations: a review.
To review the operational characteristics of commercial devices used to detect endotracheal intubation; and to identify an ideal device for detecting endotracheal intubation in emergency situations, especially in the prehospital setting during cardiac arrest. ⋯ Although no clinical comparative study of commercial devices to detect endotracheal intubation exists, the syringe device (TubeChek) has most of the characteristics necessary for a device to be considered ideal in emergency situations in the prehospital setting. It is simple, inexpensive, easy to handle and operate, disposable, does not require maintenance, gives reliable results for patients with and without cardiac arrest, and can be used for almost all age groups. The device may yield false-negative results, most commonly in the presence of copious secretions and in cases of accidental endobronchial intubation. Regardless of the device used, clinical judgment and direct visualization of the endotracheal tube in the trachea are required to unequivocally confirm proper endotracheal tube placement.
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Critical care medicine · May 1998
Comparative StudyIncreased circulating thrombomodulin in children with septic shock.
To test the hypothesis that children diagnosed with septic shock have increased plasma thrombomodulin values as a manifestation of microcirculatory dysfunction and endothelial injury; to determine whether plasma thrombomodulin concentrations are associated with the extent of multiple organ system failure and mortality. ⋯ Pediatric survivors and nonsurvivors of septic shock have circulating thrombomodulin concentrations 1.5 and 3 times greater than healthy control patients. These findings likely represent sepsis-induced endothelial injury. Patients with multiple organ system failure have circulating thrombomodulin concentrations which are associated with the extent of organ dysfunction. We speculate that measurement of plasma thrombomodulin concentrations in septic shock may be a useful indicator of the severity of endothelial damage and the development of multiple organ system failure.
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Critical care medicine · May 1998
Randomized Controlled Trial Comparative Study Clinical TrialSynergistic sedation with propofol and midazolam in intensive care patients after coronary artery bypass grafting.
To evaluate and compare the clinical efficacy, impact on hemodynamics, safety profiles, and cost of combined administration of propofol and midazolam (synergistic sedation) vs. midazolam and propofol administered as sole agents, for sedation of mechanically ventilated patients after coronary artery bypass grafting. ⋯ In the study conditions, the new synergistic treatment with propofol and midazolam administered together is an effective and safe alternative for sedation, with some advantages over the conventional regimen with propofol or midazolam administered as sole agents, such as absence of hemodynamic impairment, >68% reduction in maintenance dose, and lower pharmaceutical cost.
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Critical care medicine · May 1998
Review Comparative StudyComplications of sedation with midazolam in the intensive care unit and a comparison with other sedative regimens.
To describe the various complications that have been reported with use of midazolam for sedation in the intensive care unit (ICU). ⋯ Continuous infusion midazolam provides effective sedation in the ICU with few complications overall, especially when the dose is titrated.
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Critical care medicine · May 1998
Comparative Study Clinical TrialGastric intramucosal acidosis in mechanically ventilated patients: role of mucosal blood flow.
To investigate whether gastric intramucosal acidosis is associated with a decreased gastric mucosal blood flow in mechanically ventilated patients. ⋯ Our results support the hypothesis that gastric mucosal hypoperfusion underlies the development of intramucosal acidosis in mechanically ventilated patients.