Critical care medicine
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Critical care medicine · Nov 2000
Efficacy of interposed abdominal compression-cardiopulmonary resuscitation (CPR), active compression and decompression-CPR and Lifestick CPR: basic physiology in a spreadsheet model.
This study was undertaken to understand and predict results of experimental cardiopulmonary resuscitation (CPR) techniques involving compression and decompression of either the chest or the abdomen. Simple mathematical models of the adult human circulation were used. ⋯ Interposed abdominal compression-CPR, active compression and decompression of the chest, and Lifestick CPR, which combines interposed abdominal compression and active compression and decompression, produce, respectively, 1.9-, 1.2-, and 2.4-fold greater blood flow than standard CPR and systemic perfusion pressures of 45, 30, and 58 mm Hg, respectively. These positive effects are explained by improved pump priming and are consequences of fundamental principles of cardiovascular physiology.
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Critical care medicine · Nov 2000
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialTotal parenteral nutrition enriched with arginine and glutamate generates glutamine and limits protein catabolism in surgical patients hospitalized in intensive care units.
To study the effect of a parenteral nutrition solution enriched with potential precursors of glutamine, i.e., arginine and glutamate, on plasma glutamine concentrations and protein metabolism. ⋯ Total parenteral nutrition enriched with arginine and glutamate promotes a better nitrogen balance, limits protein myofibrillar catabolism, and generates glutamine, with arginine (not glutamate) probably being the main contributor to the glutamine-generating effect of the solution through the formation of ornithine.
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Critical care medicine · Nov 2000
Randomized Controlled Trial Clinical TrialInhaled nitric oxide reduces the need for extracorporeal membrane oxygenation in infants with persistent pulmonary hypertension of the newborn.
We previously reported improved oxygenation, but no change, in rates of extracorporeal membrane oxygenation (ECMO) use or death among infants with persistent pulmonary hypertension of the newborn who received inhaled nitric oxide (NO) with conventional ventilation, irrespective of lung disease. The goal of our study was to determine whether treatment with inhaled NO improves oxygenation and clinical outcomes in infants with persistent pulmonary hypertension of the newborn and associated lung disease who are ventilated with high-frequency oscillatory ventilation (HFOV). ⋯ Among infants ventilated by HFOV, those receiving inhaled NO had a reduced need for ECMO. We speculate that HFOV enhances the effectiveness of inhaled NO treatment in infants with persistent pulmonary hypertension of the newborn and associated lung disease.
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Critical care medicine · Nov 2000
Randomized Controlled Trial Clinical TrialThe carotid pulse check revisited: what if there is no pulse?
This study was undertaken to evaluate the diagnostic accuracy and time required by first responders to assess the carotid pulse in potentially pulseless patients. We conducted a prospective, randomized study of first responders (n = 206; four different training levels) and were blinded as to the patients' conditions in the cardiac operating rooms of a university hospital. Sixteen patients underwent coronary artery bypass surgery on nonpulsatile cardiopulmonary bypasses. ⋯ However, merely 2% of the participants (1 of 59) correctly recognized a truly pulseless patient within 10 secs. Recognition of pulselessness of the carotid artery by rescuers with basic cardiopulmonary resuscitation training is time-consuming and highly inaccurate. Although the carotid pulse check needs to be taught, its importance in the context of layperson basic life support should be de-emphasized.
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Critical care medicine · Nov 2000
Randomized Controlled Trial Comparative Study Clinical TrialPercutaneous tracheostomy in critically ill patients: a prospective, randomized comparison of two techniques.
To prospectively compare two commonly used methods for percutaneous dilational tracheostomy (PDT) in critically ill patients. ⋯ Patients experiencing PDT with the Ciaglia PDT kit had a lower surgical complication rate (2% vs. 25%), less operative and postoperative bleeding, and less overall technical difficulties than did patients undergoing PDT with the Griggs PDT kit. Ciaglia PDT is, therefore, the preferred technique for percutaneous tracheostomy in critically ill patients.