Critical care medicine
-
Critical care medicine · Mar 2006
Randomized Controlled Trial Comparative StudyA prospective, randomized trial of rifampicin-minocycline-coated and silver-platinum-carbon-impregnated central venous catheters.
Central venous catheters are the predominant cause of nosocomial bacteremia; however, the effectiveness of different antimicrobial central venous catheters remains uncertain. We compared the infection rate of silver-platinum-carbon (SPC)-impregnated catheters with rifampicin-minocycline (RM)-coated catheters. ⋯ The SPC catheter is a clinically effective antimicrobial catheter; however, the RM catheter had a lower colonization rate. Both catheter types had low rates of catheter-related bloodstream infection. These results indicate that future studies will require similar rigorous methodology and thousands of central venous catheters to demonstrate differences in catheter-related bloodstream infection rates.
-
Critical care medicine · Mar 2006
Randomized Controlled Trial Comparative StudyEfficiency of oxygen administration: sequential gas delivery versus "flow into a cone" methods.
Fio2 values of a new oxygen mask that exploits efficiencies afforded by sequential gas delivery (SGD) were compared to those of a nonrebreathing mask (NRM) and a Venturi oxygen mask. ⋯ We conclude that SGD can be exploited to provide FIO2>0.95 with oxygen flows as low as 8 L/min, as well as accurate and efficient dosing of oxygen even in the presence of hyperpnea.
-
Critical care medicine · Mar 2006
ReviewDecision tools for life support: a review and policy analysis.
To identify, describe, and compare published documents intended to guide decisions about the administration, withholding, or withdrawal of life support in critical care. ⋯ Published tools for guiding life-support decisions vary widely in their genesis, authorship, format, focus, and practicality. They also differ in their attention to, and positions on, key life-support dilemmas. Future research on decision tools should focus on how users interpret and apply the messages in these tools and their impacts on practice, quality of care, participant experiences, and outcomes.
-
Critical care medicine · Mar 2006
Comparative StudyIntensive insulin therapy reduces microdialysis glucose values without altering glucose utilization or improving the lactate/pyruvate ratio after traumatic brain injury.
To determine that intensive glycemic control does not reduce microdialysis glucose concentration brain metabolism of glucose. ⋯ Intensive insulin therapy results in a net reduction in microdialysis glucose and an increase in microdialysis glutamate and lactate/pyruvate without conveying a functional outcome advantage.
-
Critical care medicine · Mar 2006
Randomized Controlled Trial Comparative StudyVasopressors and intestinal mucosal perfusion after cardiac surgery: Norepinephrine vs. phenylephrine.
To evaluate the potential differential effects of norepinephrine, an alpha1-, beta1-, and beta2-receptor agonist, to the alpha1-agonist phenylephrine on jejunal mucosal perfusion, gastric-arterial PCO2 gradient, and the global splanchnic oxygen demand-supply relationship after cardiac surgery. ⋯ Phenylephrine induced a more pronounced global alpha1-mediated splanchnic vasoconstriction compared with norepinephrine. Neither of the vasoconstrictors impaired perfusion of the gastrointestinal mucosa in postcardiac surgery patients. The lack of norepinephrine-induced, alpha1-mediated impairment of gastrointestinal perfusion is not explained by a beta2-mediated counteractive vasodilation but instead by possible mucosal autoregulatory escape.