Critical care medicine
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Critical care medicine · Jun 1996
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialComparative study of propofol versus midazolam in the sedation of critically ill patients: results of a prospective, randomized, multicenter trial.
To compare the effectiveness, characteristics, duration of action, hemodynamic and biochemical effects, and side effects of propofol and midazolam used for continuous intravenous sedation of ventilated critically ill patients. ⋯ In this population of critically ill patients, propofol is an effective and safe alternative for sedation, with some advantages, such as short duration of action and high effectiveness over the conventional regimen with benzodiazepines and opiates.
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Critical care medicine · Jun 1996
Comparative StudyEvaluation of gas exchange, pulmonary compliance, and lung injury during total and partial liquid ventilation in the acute respiratory distress syndrome.
To investigate whether pulmonary compliance and gas exchange will be sustained during "total" perfluorocarbon liquid ventilation followed by "partial" perfluorocarbon liquid ventilation when compared with gas ventilation in the setting of the acute respiratory distress syndrome (ARDS). ⋯ In a model of severe ARDS, pulmonary gas exchange is improved during total followed by partial liquid ventilation. Pulmonary compliance is improved during total, but not during partial liquid ventilation. Total followed by partial liquid ventilation was associated with a reduction in alveolar hemorrhage, pulmonary edema, and lung inflammatory infiltration.
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Critical care medicine · Jun 1996
Comparative StudyProspective, controlled study of the outcome of human immunodeficiency virus-1 antibody-positive children admitted to an intensive care unit.
Intensive care resources are both scarce and costly in South Africa. We set out to ascertain whether human immunodeficiency virus (HIV) status affects the spectrum of disease and the prognosis in children treated in pediatric intensive care units (ICUs). ⋯ Outcome in children with AIDS admitted to the pediatric ICU was significantly worse than the outcome in HIV-uninfected children. However, the number of AIDS patients studied was small. HIV antibody-positive children without AIDS do as well as uninfected controls. Ethics committees in resource-constrained countries may be assisted by such data when making difficult decisions on the admissions of HIV-infected patients to pediatric ICU facilities.
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Critical care medicine · Jun 1996
Comparative StudyPrivate attending physician status and the withdrawal of life-sustaining interventions in a medical intensive care unit population.
To assess the influence of private attending physician status on the withdrawal of life-sustaining interventions among patients dying within a medical intensive care unit (ICU). ⋯ Among patients dying within a medical ICU, those patients without a private attending physician are more likely to undergo the active withdrawal of life-sustaining interventions.
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Critical care medicine · Jun 1996
Breathing measurement reduces false-negative classification of tachypneic preextubation trial failures.
There is increased awareness of imposed work of breathing contributing to apparent ventilatory dependency. This study evaluates the impact of tachypnea as an indicator of ventilatory failure during a room air-5 cm H2O continuous positive airway pressure, spontaneous breathing, preextubation trial when associated with increased imposed work of breathing. ⋯ Tachypnea as a marker of respiratory distress is sensitive, but is not sufficiently specific to be used as a criterion in preextubation trials. Reliance on tachypnea as a preextubation trial failure criterion is likely to prolong intubation and ventilatory support for a large number of patients. Patient risks, determined by the extubation failures and reintubation rate, are the same.