Critical care medicine
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Critical care medicine · Jul 2002
Randomized Controlled Trial Comparative Study Clinical TrialGastric versus small-bowel tube feeding in the intensive care unit: a prospective comparison of efficacy.
To compare the outcomes of intensive care unit patients fed through a nasogastric vs. a nasal-small-bowel tube including the time from tube placement to feeding, time to reach goal rate, and adverse events. ⋯ Gastric feeding demonstrates no increase in aspiration or other adverse outcomes compared with small-bowel feeding in the intensive care unit. Gastric feeding can be started and advanced to goal sooner with fewer placement attempts than small-bowel feeding.
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Critical care medicine · Jul 2002
ReviewGastrointestinal promotility drugs in the critical care setting: a systematic review of the evidence.
Gastrointestinal promotility agents may improve tolerance to enteral nutrition, reduce gastroesophageal reflux and pulmonary aspiration, and therefore have the potential to improve outcomes of critically ill patients. ⋯ As a class of drugs, promotility agents appear to have a beneficial effect on gastrointestinal motility in critically ill patients. A one-time dose of erythromycin may facilitate small-bowel feeding tube insertion. Administration of metoclopramide appears to increase physiologic indexes of gastrointestinal transit and feeding tolerance. Concerns about safety and lack of effect on clinically important outcomes preclude strong treatment recommendations.
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Critical care medicine · Jul 2002
Survival and functional outcome in pediatric traumatic brain injury: a retrospective review and analysis of predictive factors.
The aim of this study was to evaluate the relationship of patient care variables to survival and functional outcome in the pediatric population with traumatic brain injury. ⋯ The ability to maintain a cerebral perfusion pressure of > or =50 mm Hg was the single most important predictor of traumatic brain injury survival in this study. This suggests that monitoring and optimizing cerebral perfusion pressure is critical to the management of these patients. The relationship between cognitive outcome and therapeutic interventions used to optimize cerebral perfusion pressure is unclear and requires further evaluation in a large prospective study.
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Critical care medicine · Jul 2002
Immunoparalysis in patients with severe trauma and the effect of inhaled interferon-gamma.
To evaluate the local immune status in patients with severe trauma and the influence of interferon-gamma on patients with immunoparalysis. ⋯ A significant proportion of multiply injured patients developed immunoparalysis. The administration of interferon-gamma resulted in the recovery of levels of human leukocyte antigen-DR expression in alveolar macrophages, influenced the inflammatory reaction, and decreased the incidence ventilator-associated pneumonia, without affecting the patients' outcome.
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We explored the possibility that the administration of intravenous dopamine increases the risk for delirium as manifested by need for haloperidol. ⋯ The retrospective nature of this study, the inexact method to assess acuity, and, most of all, the use of haloperidol as an indicator of the presence of delirium preclude concluding that dopamine is directly a risk factor for delirium, much less a causal risk factor. However, the association is potent enough to suggest this possibility strongly and thus supports the need for prospective studies to examine the relationship between dopamine and delirium and to consider possible prophylactic treatment against delirium in those given dopamine.