Critical care medicine
-
Critical care medicine · Jun 1998
Randomized Controlled Trial Comparative Study Clinical TrialDelivery of high concentrations of inspired oxygen via Tusk mask.
Nonrebreather face masks (NRM) are frequently used in patients with respiratory distress and profound hypoxemia. A simpler modification to the partial rebreather face mask, using only two pieces of respiratory tubing or "tusks," has also been shown to increase FiO2 compared with the NRM in five normal subjects. Clinically, we have observed this modification to further increase PaO2 in critically ill patients already using the NRM in the intensive care unit. This study was designed to compare the Tusk mask with the NRM in both a larger group of normal subjects and in patients with underlying lung disease. ⋯ Both normal subjects and patients with compromised pulmonary function achieved a higher PaO2 using a Tusk mask than when using the conventional NRM, at the same oxygen flow rate. Patients with hypoxemia may obtain lifesaving benefit from the additional concentration of oxygen delivered via the Tusk mask.
-
Critical care medicine · Jun 1998
Clinical TrialA rapid assay for the detection of circulating D-dimer is associated with clinical outcomes among critically ill patients.
To determine whether the results of a rapid, semiquantitative assay for the detection of circulating D-dimer in whole blood (SRDD assay) are associated with the occurrence of clinical outcomes among critically ill patients. ⋯ Our preliminary investigation suggests that the results from a rapid whole blood assay for the semiquantitative detection of circulating D-dimer are associated with clinical outcomes among patients admitted to a medical ICU. In addition, the use of D-dimer to identify the presence of active intravascular thrombosis may identify patients likely to benefit from antithrombotic therapies in the ICU setting.
-
Critical care medicine · Jun 1998
Comparative StudyTreatment of refractory intracranial hypertension with 23.4% saline.
To evaluate the effect of intravenous bolus administration of 23.4% saline (8008 mOsm/L) on refractory intracranial hypertension (RIH) in patients with diverse intracranial diseases. ⋯ This preliminary case series suggests that the intravenous bolus administration of 23.4% saline reduces ICP and augments CPP in patients with resistant increased ICP. This reduction can be maintained for several hours while other therapeutic measures are being considered. The patient population most likely to respond to this therapy needs to be further defined. Although more research is needed, this treatment is promising as a new modality for RIH because of its ICP-lowering effect without intravascular volume depletion.
-
Critical care medicine · Jun 1998
Comparative StudyUnplanned extubation: risk factors of development and predictive criteria for reintubation.
To define patients at risk for unplanned extubation; to assess the influence of nursing workload on the incidence of unplanned extubation; and to determine predictive criteria for patients requiring reintubation. ⋯ Patients at risk for unplanned extubation are characterized by oral intubation and insufficient sedation. In the department studied, and with the specific score used, we did not observe a relationship between the nursing workload and the incidence of unplanned extubation. A Glasgow Coma Score of <11, the accidental nature of unplanned extubation, and a PaO2/FiO2 ratio <200 torr (<26.7 kPa) are factors associated with a risk of reintubation.
-
Critical care medicine · Jun 1998
Comparative StudyEffects of continuous negative extrathoracic pressure versus positive end-expiratory pressure in acute lung injury patients.
To compare the effects of continuous negative extrathoracic pressure (CNEP) and positive end-expiratory pressure (PEEP) at the same level of transpulmonary pressure. ⋯ In acute lung injury patients, a CNEP of -20 cm H2O has the capability to obtain transpulmonary pressure and lung function improvement similar to a PEEP of 15 cm H2O. CNEP differs from the positive pressure by increasing the venous return and the preload of the heart, and has no negative effects on cardiac performance.