Critical care medicine
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Critical care medicine · Aug 1998
Comparative StudyCardiorespiratory effects of manually compressing the rib cage during tidal expiration in mechanically ventilated patients recovering from acute severe asthma.
To determine the cardiorespiratory effects of manual expiratory rib cage compression in mechanically ventilated patients recovering from acute severe asthma; and to extrapolate these findings to emergency asthma management where ventilation cannot be achieved by positive-pressure ventilation. ⋯ The results suggest that manual compression of the rib cage during consecutive tidal expirations would be ineffective in reducing pulmonary hyperinflation during the emergency management of asthma when air flow obstruction is so severe that ventilation cannot be achieved by positive-pressure ventilation.
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Critical care medicine · Aug 1998
Gastric pH control in critically ill children receiving intravenous ranitidine.
To determine whether the dose of ranitidine recommended in commonly used pediatric drug dosage handbooks (2 to 4 mg/kg/day i.v.) results in successful gastric pH control (pH of >4) in critically ill children. ⋯ The minimum ranitidine dose recommended in commonly used pediatric drug references resulted in unsuccessful gastric pH control in a high percentage of pediatric intensive care unit patients. Critically ill children with normal renal and hepatic function should be treated with a minimum 3 mg/kg/day of intravenous ranitidine and the dose should be titrated to a gastric pH of > or =4.
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Critical care medicine · Aug 1998
Comparative StudyExogenous surfactant and positive end-expiratory pressure in the treatment of endotoxin-induced lung injury.
To evaluate the efficacy of treating endotoxin-induced lung injury with single dose exogenous surfactant and positive end-expiratory pressure (PEEP). ⋯ We conclude that PEEP plus surfactant treatment of endotoxin-induced lung injury transiently improves oxygenation, but is unable to maintain this salutary effect indefinitely. Thus, repeat bolus dosing of surfactant or bolus treatment followed by continuous aerosol delivery may be necessary for a continuous beneficial effect.
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Critical care medicine · Aug 1998
Case Reports Comparative StudyDo autopsies of critically ill patients reveal important findings that were clinically undetected?
To determine if autopsies performed on patients who die in the medical intensive care unit (ICU) provide clinically important new information. ⋯ Although the primary clinical diagnosis was accurate in most cases before death, the cause of death was frequently unknown. Almost all autopsies demonstrated new diagnoses, and knowledge of these new findings would have changed medical ICU therapy in many cases. In the critical care setting, autopsies continue to provide information that could be important for education and quality patient care.