Critical care medicine
-
Critical care medicine · Oct 2002
Randomized Controlled Trial Multicenter Study Clinical TrialCost-effectiveness of inhaled nitric oxide in near-term and term infants with respiratory failure: eighteen- to 24-month follow-up for Canadian patients.
The objective of this article is to conduct a cost-effectiveness analysis, based on data up to 18-24 months of follow-up, of the use of inhaled nitrogen oxide vs. oxygen, administered to near-term and term infants with severe respiratory failure who were referred for consideration for extracorporeal membrane oxygenation. ⋯ Timelines of analysis were from randomization until the follow-up, which occurred between 18 and 24 months after randomization. Costs included those for initial hospitalization (neonatal intensive care, medications, extracorporeal membrane oxygenation, transport) and standard medical services above routine care and developmental services received until follow-up. Outcomes included mortality rate, clinical outcomes, and a variety of neurodevelopmental indicators. Costs were not significantly different between interventions. While infants who received inhaled nitrogen oxide generally did better than those who received oxygen, the only variable that was significant was the number of seizure disorders. On economic grounds, inhaled nitrogen oxide was the preferred intervention.
-
Critical care medicine · Oct 2002
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialEffects of early high-volume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: a prospective, randomized trial.
To study the effects of the initiation time of continuous venovenous hemofiltration and of the ultrafiltrate rate in patients with circulatory and respiratory insufficiency developing early oliguric acute renal failure. The primary end points were mortality at 28 days and recovery of renal function. ⋯ In the present study of critically ill patients with oliguric acute renal failure, survival at 28 days and recovery of renal function were not improved using high ultrafiltrate volumes or early initiation of hemofiltration.
-
Critical care medicine · Oct 2002
Randomized Controlled Trial Clinical TrialAlbumin and furosemide therapy in hypoproteinemic patients with acute lung injury.
Hypoproteinemia, fluid retention, and weight gain are associated with development of acute lung injury and mortality in critically ill patients, without proof of cause and effect. We designed a clinical trial to determine whether diuresis and colloid replacement in hypoproteinemic patients with acute lung injury would improve pulmonary physiology. ⋯ Albumin and furosemide therapy improves fluid balance, oxygenation, and hemodynamics in hypoproteinemic patients with acute lung injury. Determining the effect of this simple therapy on cost, outcomes, and other patient populations requires further study.
-
Critical care medicine · Oct 2002
ReviewA review of nerve agent exposure for the critical care physician.
Nerve agents are discussed. The article discusses their properties, routes of exposure, toxicodynamics, targets of toxicity, and treatment. It is concluded that a focused organized approach to the treatment of nerve agents is key to its successful management.
-
Critical care medicine · Oct 2002
ReviewMinimally invasive hemodynamic monitoring for the intensivist: current and emerging technology.
To review minimally invasive cardiac output monitoring devices currently available for use in the intensive care unit. ⋯ Emerging noninvasive or minimally invasive means of cardiac output monitoring are based on varied physiologic principles and can be used for following hemodynamic trends. Each of these methods has advantages and disadvantages; it is important for the clinician to understand the strengths and limitations of each device to effectively use the information derived.