Critical care medicine
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Critical care medicine · Jun 2000
Randomized Controlled Trial Comparative Study Clinical TrialOrnithine alpha-ketoglutarate improves wound healing in severe burn patients: a prospective randomized double-blind trial versus isonitrogenous controls.
To compare the effectiveness on wound healing time in severe burn patients of ornithine alpha-ketoglutarate supplementation of enteral feeding vs. an isonitrogenous control. Previous clinical and experimental studies suggest a beneficial effect of enterally administered ornithine alpha-ketoglutarate supplementation on protein metabolism in burn patients, but few data deal with clinical outcome. ⋯ Ornithine alpha-ketoglutarate supplementation of enteral feeding significantly shortens wound healing time in severe burn patients. In addition, ornithine alpha-ketoglutarate administration was safe and well tolerated and decreased protein hypercatabolism in the less severe burn patients.
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Critical care medicine · Jun 2000
Randomized Controlled Trial Comparative Study Clinical TrialThe incidence of ventilator-associated pneumonia and success in nutrient delivery with gastric versus small intestinal feeding: a randomized clinical trial.
Enteral feeding provides nutrients for patients who require endotracheal tubes and mechanical ventilation. There is a presumed increase in the risk of ventilator-associated pneumonia (VAP) with tube feeding. This has stimulated the development of procedures for duodenal intubation and small intestinal (SI) feeding as primary prophylaxes to prevent VAP. ⋯ There is no clear difference in the incidence of VAP in SI compared with G enteral nutrition. Patients given feeding into the SI do receive higher calorie and protein intakes.
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Critical care medicine · Jun 2000
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialPostnatal changes of extracellular volume, atrial natriuretic factor, and diuresis in a randomized controlled trial of high-frequency oscillatory ventilation versus intermittent positive-pressure ventilation in premature infants <30 weeks gestation.
High-frequency oscillatory ventilation (HFOV) with a high lung volume strategy is an experimental mode of ventilating preterm infants aimed at achieving maximal alveolar recruitment Higher mean airway pressures are used during HFOV than during intermittent positive-pressure ventilation (IPPV), and the intrathoracic volume increase is relatively constant. Both factors increase the risk to depress organ blood flow and diuresis. Our objective was to test the hypothesis that high lung volume HFOV attenuates the postnatal reduction of extracellular volume in preterm infants by reducing plasma atrial natriuretic factor and diuresis. ⋯ High lung volume HFOV as primary mode of ventilation in preterm infants <30 wks gestation did not result in unwanted fluid retention and a decrease in diuresis in the first days of life.
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Critical care medicine · Jun 2000
Randomized Controlled Trial Comparative Study Clinical TrialPhysiologic evaluation of noninvasive mechanical ventilation delivered with three types of masks in patients with chronic hypercapnic respiratory failure.
The efficacy of noninvasive mechanical ventilation (NIMV) in improving breathing pattern and arterial blood gases (ABG) in hypercapnic patients has been well documented; however, little attention has been given to the choice of the interface and the ventilatory mode. We evaluated the effects of three types of masks and two modes of ventilation on patients' ABG, breathing pattern, and tolerance to ventilation. ⋯ In this physiologic study, we have shown that in patients with hypercapnic respiratory failure, irrespective of the underlying pathology, the type of interface affects the NIMV outcome more than the ventilatory mode.
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Critical care medicine · Jun 2000
Clinical Trial Controlled Clinical TrialRespiratory comfort and breathing pattern during volume proportional assist ventilation and pressure support ventilation: a study on volunteers with artificially reduced compliance.
To assess respiratory comfort and associated breathing pattern during volume assist (VA) as a component of proportional assist ventilation and during pressure support ventilation (PSV). ⋯ For volunteers breathing with artificially reduced respiratory system compliance, respiratory comfort is higher with VA than with PSV. This is probably caused by a better adaptation of the ventilatory support to the volunteer's need with VA.