Critical care medicine
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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 Clinical TrialDispatcher-assisted "phone" cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation.
Based on both animal studies and field studies of the process and intermediate outcomes related to cardiopulmonary resuscitation (CPR), we initiated a randomized trial of dispatcher-assisted CPR, with the intervention arm receiving instructions for chest compression only and the control arm receiving standard instructions for airway maintenance ventilation, and chest compression. Of 241 patents randomized to chest compression instructions only, 35 survived (14.6%) compared with 29 of 279 (10.4%) patients in the control arm (p = .09). These results may have implications for future guidelines and teaching CPR.
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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 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.