Critical care medicine
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Critical care medicine · Feb 1999
Comparative StudyA cost analysis of enterally administered lorazepam in the pediatric intensive care unit.
To determine the cost savings of replacing intravenous midazolam with enterally administered lorazepam in mechanically ventilated children who require long-term continuous sedation. ⋯ Transitioning from intravenous midazolam to enterally administered lorazepam in critically ill children who require long-term sedation results in significant cost savings. The oral formulation of lorazepam was convenient to use, inexpensive, and effective in maintaining a continuous and appropriate level of sedation once midazolam was discontinued.
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Critical care medicine · Feb 1999
Comparative StudyPerioperative predictors of extubation failure and the effect on clinical outcome after cardiac surgery.
To determine perioperative predictors of extubation failure (requirement for reintubation and mechanical ventilation after prior successful weaning from ventilator support and extubation) after cardiac surgery and the effect on clinical outcome. ⋯ Extubation failure after cardiac surgery is uncommon. Although extubation failure increased the utilization of ICU and hospital resources, it did not affect mortality after cardiac surgery. Protocols for early extubation and ICU discharge should be modified in the presence of certain preoperative and operative predictors of extubation failure to avoid unnecessary increase in the cost of care after cardiac surgery.
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Critical care medicine · Feb 1999
Comparative StudyMeconium and amniotic fluid embolism: effects on coagulation in pregnant mini-pigs.
A hallmark of amniotic fluid embolism is the induction of coagulation defects. Little is known about the nature of these defects or the causative agent or agents. The purpose of this study was to assess the effects of meconium containing (native) meconium-amniotic-fluid infusion (MAFI) and meconium-free (centrifuged) amniotic-fluid infusion (AFI) on the coagulation system in the mini-pig model. ⋯ Both MAFI and, to a much lesser extent, AFI cause an activation of coagulation in mini-pigs. The changes induced by meconium-free AFI are probably not sufficient to explain the high mortality of the condition.
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Critical care medicine · Feb 1999
Porcine endotoxemic shock is associated with increased expired nitric oxide.
Nitric oxide (NO) is believed to decrease systemic vascular resistance in sepsis, but the data are mainly from studies on rats and mice. We tested this hypothesis in pigs and also whether there is induction of the inducible form of nitric oxide synthase (iNOS). ⋯ The time course and pattern of changes in expired NO during endotoxemia followed the change in systemic hemodynamics, which supports a causal role for NO in sepsis. However, this is not due to a large production of NO by iNOS induction. The hemodynamic pattern, nitrite in blood, and changes in expired NO also differed markedly from those findings in rodent models and caution should be used in extrapolating from rodents to higher order animals.
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Critical care medicine · Feb 1999
Randomized Controlled Trial Comparative Study Clinical TrialSufentanil, fentanyl, and alfentanil in head trauma patients: a study on cerebral hemodynamics.
To determine the effects of bolus injection and infusion of sufentanil, alfentanil, and fentanyl on cerebral hemodynamics and electroencephalogram activity in patients with increased intracranial pressure (ICP) after severe head trauma. ⋯ The results of the present study show that alfentanil, sufentanil, and fentanyl produce similar transient increases in ICP when administered by bolus injection in patients with increased ICP. No evidence of cerebral ischemia was observed in the study patients.