Critical care medicine
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Critical care medicine · Nov 2000
Review Comparative Study Clinical Trial Controlled Clinical TrialCardiopulmonary resuscitation with a hydraulic-pneumatic band.
Improved blood flow during cardiopulmonary resuscitation (CPR) has been shown to enhance survival from cardiac arrest. Chest compression with a circumferential pneumatic vest enhances blood flow, but the size, weight, and energy consumption of the inflation system limit its portability and, thereby, have made clinical studies difficult. The purpose of this investigation was to study an improved circumferential chest compression device that uses a constricting band that is pneumatically actuated. ⋯ The system for performing HB-CPR, however, was substantially lighter (10 vs. 50 kg) and consumed less energy (300 vs. 1000 watts) than that for PV-CPR. Thus, HB-CPR appears to produce a similar improvement in hemodynamics over S-CPR as PV-CPR but may be more portable than PV-CPR. Therefore, HB-CPR may allow larger scale testing of circumferential chest compression approaches.
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Critical care medicine · Nov 2000
Randomized Controlled Trial Comparative Study Clinical TrialMidazolam and 2% propofol in long-term sedation of traumatized critically ill patients: efficacy and safety comparison.
We proposed to compare the efficacy and safety of midazolam and propofol in its new preparation (2% propofol) when used for prolonged, deep sedation in traumatized, critically ill patients. We also retrospectively compared 2% propofol with its original preparation, 1% propofol, used in a previous study in a similar and contemporary set of patients. ⋯ Propofol's new preparation is safe when used in severely traumatized patients. Its more concentrated formula improves the lipid overload problem seen with the prolonged use of the previous preparation. Nevertheless, a major number of therapeutic failures were detected with 2% propofol because of the need for dosage increase. This fact could be caused by a different disposition and tissue distribution pattern of both propofol preparations. New studies will be needed to confirm these results.
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Critical care medicine · Nov 2000
Randomized Controlled Trial Comparative Study Clinical TrialThe comfort of breathing: a study with volunteers assessing the influence of various modes of assisted ventilation.
To assess the subjective feeling of comfort of healthy volunteers breathing on various modes of ventilation used in intensive care. ⋯ Assisted spontaneous breathing was the most comfortable mode of ventilation because the pattern was primarily determined by the volunteer. Synchronized intermittent mandatory ventilation was the most uncomfortable because the ventilatory pattern was imposed on the volunteers, leading to ventilator-volunteer dyssynchrony. We also conclude there is wide individual variation in the subjective feeling of comfort. Whereas the mode of ventilation in ICUs is based primarily on the physiologic needs of the patient, the feeling of comfort may be considered when choosing an appropriate mode of ventilation during the weaning phase of critical illness.
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Critical care medicine · Nov 2000
ReviewRole of mouth-to-mouth rescue breathing in bystander cardiopulmonary resuscitation for asphyxial cardiac arrest.
There is increasing evidence that mouth-to-mouth rescue breathing may not be necessary during brief periods of bystander cardiopulmonary resuscitation (CPR) for ventricular fibrillation. In contrast to ventricular fibrillation cardiac arrests, it has been assumed that rescue breathing is essential for treatment of asphyxial cardiac arrests because the cardiac arrests result from inadequate ventilation. ⋯ Two randomized, controlled swine investigations using models of bystander CPR for asphyxial cardiac arrest establish the following: a) that prompt initiation of bystander CPR is a crucially important intervention; and b) that chest compressions plus mouth-to-mouth rescue breathing is markedly superior to either technique alone. One of these studies further demonstrates that early in the asphyxial pulseless arrest process doing something (mouth-to-mouth rescue breathing or chest compressions) is better than doing nothing.
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Critical care medicine · Nov 2000
Effectiveness of end-tidal carbon dioxide tension for monitoring thrombolytic therapy in acute pulmonary embolism.
In acute massive pulmonary embolism with hemodynamic instability, monitoring of pulmonary artery pressure can be used to assess the efficacy of thrombolytic therapy. As a noninvasive alternative to pulmonary artery catheterization, we investigated the efficacy of continuous monitoring of end-tidal CO2 tension. ⋯ Analysis of ETCO2 allows monitoring of the efficacy of thrombolysis and may reflect recurrent embolism. Thus, on the basis of this small study, analysis of ETCO2 appears to be useful for noninvasive monitoring in mechanically ventilated patients with massive pulmonary embolism.