Critical care medicine
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Critical care medicine · Aug 1994
ReviewEvaluation of new diagnostic technologies: bronchoalveolar lavage and the diagnosis of ventilator-associated pneumonia.
To present criteria to aid intensive care workers in the assessment of diagnostic technologies, using the example of bronchoalveolar lavage for the evaluation of ventilator-associated pneumonia. ⋯ We present guidelines for the assessment of diagnostic technology, and apply them to bronchoalveolar lavage for the evaluation of ventilator-associated pneumonia. Bronchoalveolar lavage has been studied in both the laboratory and clinical setting, and the diagnostic sensitivity and specificity of this technique are high. Further randomized trials evaluating management decisions and patient benefit would facilitate decisions regarding the appropriate dissemination of bronchoalveolar lavage.
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Critical care medicine · Aug 1994
Comparative StudyTranstracheal Doppler in infants and small children following surgery for congenital heart disease: rational use of an improved technology.
To compare measurements of cardiac output utilizing an improved transtracheal Doppler technology with measurements obtained using two-dimensional echocardiography. ⋯ An improved transtracheal Doppler technology compares favorably with echocardiographic determination of cardiac output in infants and young children. This improved technology may provide a useful means to assess cardiac output and may allow titration of therapy in critically ill infants and children.
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Critical care medicine · Aug 1994
Effects of disposable or interchangeable positive end-expiratory pressure valves on work of breathing during the application of continuous positive airway pressure.
To determine which of a series of disposable or interchangeable positive end-expiratory pressure (PEEP) devices functions with the least imposition of inspiratory and expiratory work during continuous positive airway pressure. ⋯ All of the disposable/interchangeable PEEP valves that were studied imposed a considerable amount of both inspiratory and expiratory work, even when the continuous flow provided exceeded the peak inspiratory flow demands of the lung model. The primary reason for the high imposed work levels is the high gas-flow resistance of all of the valves studied.
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Critical care medicine · Aug 1994
Intravenous lorazepam as an amnestic and anxiolytic agent in the intensive care unit: a prospective study.
To assess the efficacy and hemodynamic safety of intravenous lorazepam as an amnestic and anxiolytic agent in patients undergoing critical care procedures. ⋯ This study confirms the beneficial anxiolytic and amnestic effects of lorazepam in a subgroup of patients undergoing critical care procedures. The study also substantiates the safety of this drug in this patient population.
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Critical care medicine · Aug 1994
Nasal mechanical ventilation for hypercapnic respiratory failure in chronic obstructive pulmonary disease: determinants of success and failure.
To evaluate the efficacy of nasal mechanical ventilation in patients with chronic obstructive pulmonary disease and hypercapnic respiratory failure and to identify predictors of success or failure of nasal mechanical ventilation. ⋯ Patients who failed nasal mechanical ventilation appeared to have a greater severity of illness; they were unable to minimize the amount of mouth leak (because of lack of teeth, secretions, or breathing pattern) and were unable to coordinate with the ventilator. These features may allow identification of poor candidates for nasal mechanical ventilation, avoiding unnecessary delays in endotracheal intubation and mechanical ventilation.