Critical care medicine
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Critical care medicine · Apr 2000
Review Case ReportsUse of recruitment maneuvers and high-positive end-expiratory pressure in a patient with acute respiratory distress syndrome.
To present the use of a novel high-pressure recruitment maneuver followed by high levels of positive end-expiratory pressure in a patient with the acute respiratory distress syndrome (ARDS). ⋯ Accumulating data suggest that the maximization and maintenance of lung recruitment may reduce lung parenchymal injury from positive pressure ventilation in ARDS. We demonstrate that in this case PEEP alone was not adequate to recruit the injured lung and that a high-pressure recruitment maneuver was required. After recruitment, high-level PEEP was needed to prevent derecruitment and this level of PEEP was not adequately predicted by the P(Flex) of the PV curve.
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Critical care medicine · Apr 2000
Comparative Study Clinical TrialClinical evaluation of a new, point-of-care hemocytometer.
This study was designed to compare results obtained with a new point-of-care hemocytometer with those of two established (point-of-care and laboratory-based) instruments. ⋯ The Ichor hemocytometer provides accurate hematologic results that can facilitate rapid quantitative assessment of CBC variables and thus may be clinically useful, especially in critically ill patients.
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Critical care medicine · Apr 2000
Comparative StudyCerebral perfusion, cardiac output, and arterial pressure in patients with fulminant hepatic failure.
To evaluate whether changes in cardiac output influence cerebral perfusion directly. In fulminant hepatic failure, the circulation is characterized by wide variations in cardiac output and cerebral blood flow (CBF). ⋯ This study shows that CBF correlates to arterial pressure rather than to cardiac output in patients with fulminant hepatic failure. The presence of pressure-passive cerebral circulation stresses the importance of strict cardiovascular control in securing continuous and sufficient cerebral oxygenation and in avoiding the development of cerebral hyperemia and cerebral edema.
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Critical care medicine · Apr 2000
Editorial Comment ReviewAre randomized controlled trials ethical in critically ill children?
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Critical care medicine · Apr 2000
Comparative StudyUse of intensive care-specific interventions in major teaching and other hospitals: a regional comparison.
To compare the use of 40 specific medical interventions in intensive care units (ICUs) of major teaching and other hospitals ⋯ Patients in ICUs at major teaching hospitals were, in aggregate, more likely to receive diagnostic and therapeutic interventions than patients at other hospitals. Variation among major teaching hospitals suggests that factors other than teaching status also affect the use of these interventions.