Critical care medicine
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Critical care medicine · Feb 2003
Randomized Controlled Trial Comparative Study Clinical TrialControlled trial of oronasal versus nasal mask ventilation in the treatment of acute respiratory failure.
Noninvasive positive pressure techniques such as continuous and bilevel positive airway pressure avoid intubation and its attendant complications in selected patients with acute respiratory failure. However, mask intolerance remains a common cause for failure of noninvasive ventilatory techniques. The aim of our study was to assess patient tolerance of oronasal vs. nasal mask ventilation in acute respiratory failure. ⋯ Although both masks performed similarly with regard to improving vital signs and gas exchange and avoiding intubation, the nasal mask was less well tolerated than the oronasal mask in patients with acute respiratory failure.
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Critical care medicine · Feb 2003
Randomized Controlled Trial Clinical TrialUse of ultrasound guidance in the insertion of radial artery catheters.
To assess the role of a portable ultrasound device in the insertion of radial artery catheters. ⋯ Ultrasound is a useful adjunct to arterial catheter insertion and increases the rate of success at first attempt. The technique is easy to learn and may reduce the time taken to insert the catheter.
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Critical care medicine · Feb 2003
Comparative StudyBacteremic sepsis in intensive care: temporal trends in incidence, organ dysfunction, and prognosis.
To determine whether changes have occurred at our center in the incidence, patterns of organ dysfunctions, prognostic factors, and case-fatality rate of bacteremic sepsis. ⋯ The fatality rate of bacteremic sepsis remained constant over the study period, despite an increased incidence of bacteremia and associated organ dysfunction. Continued efforts need to be directed toward the prevention of bacteremic sepsis, given the magnitude and poor prognosis of this syndrome.
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Critical care medicine · Feb 2003
Time course of hemoglobin concentrations in nonbleeding intensive care unit patients.
To evaluate the time course of hemoglobin concentrations in nonbleeding intensive care unit patients. ⋯ Hemoglobin concentrations typically decline by >0.5 g/dL/day during the first days of intensive care unit stay in nonbleeding patients. Beyond the third day, hemoglobin concentrations can remain relatively constant in nonseptic patients but continue to decrease in septic patients, as well as patients with high sepsis-related organ failure assessment or Acute Physiology and Chronic Health Evaluation II scores. These observations may help in the interpretation of hemoglobin concentrations in critically ill patients.
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Critical care medicine · Feb 2003
Comparative StudyPerformance of the partial CO2 rebreathing technique under different hemodynamic and ventilation/perfusion matching conditions.
The partial CO2 rebreathing technique has been demonstrated to accurately measure the effective pulmonary capillary blood flow (PCBF) in different clinical situations. Usually, PCBF is calculated from changes in CO2 elimination (VCO2) and end-tidal partial pressure of CO2 (PetCO2 ), which can be obtained noninvasively. In this study, we investigated the performance of the partial CO2 rebreathing technique under different conditions of ventilation/perfusion matching and hemodynamic states. In addition, we investigated whether the determination of arterial blood gases combined with mathematical modeling of gas exchange can improve the performance of this method. ⋯ Although PCBF is systematically underestimated during hyperdynamic cardiac output states and high alveolar deadspaces, the performance of the partial CO2 rebreathing technique can be improved by means of arterial blood gas sampling and an algorithm that takes in account the effects of nonequilibration of PetCO2 during rebreathing and the variation of Pc'CO2 to PetCO2 differences from the nonrebreathing to the rebreathing period. Such an algorithm may prove useful under moderately increased alveolar deadspace and normal to hypodynamic cardiac output states.