Critical care medicine
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Critical care medicine · Aug 1993
Randomized Controlled Trial Comparative Study Clinical TrialIntraoperative and postoperative effects of vancomycin administration in cardiac surgery patients: a prospective, double-blind, randomized trial.
In response to an increased frequency of Staphylococcus epidermidis infections in postoperative cardiac surgery patients, antibiotic prophylaxis was changed to include both vancomycin and cefazolin pre- and intraoperatively. Subsequent to the addition of vancomycin prophylaxis, clinical impression and retrospective analysis supported a correlation between vancomycin administration and post-cardiopulmonary bypass norepinephrine use. ⋯ The results show that a significantly greater number of patients who received vancomycin required a norepinephrine infusion and that, despite norepinephrine infusion therapy, systemic vascular resistance was not normalized in this group of patients. The study supports the conclusion that perioperative administration of vancomycin in cardiac surgery patients may result in hypotension requiring the use of a vasopressor in an attempt to normalize hemodynamic indices.
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Critical care medicine · Aug 1993
Randomized Controlled Trial Comparative Study Clinical TrialInfluence of long-term oro- or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia: results of a prospective, randomized, clinical trial.
To compare the occurrence rate of nosocomial maxillary sinusitis and pneumonia in patients who have undergone nasotracheal vs. orotracheal intubation. ⋯ In patients undergoing prolonged mechanical ventilation, there was no statistically significant difference in the occurrence rate of nosocomial sinusitis or pneumonia between patients undergoing tracheal intubation via the nasal vs. oral route. A trend (p = 0.008) suggests less sinusitis in the orotracheal group.
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Critical care medicine · Aug 1993
Randomized Controlled Trial Comparative Study Clinical TrialThoracic electrical bioimpedance measurement of cardiac output in postaortocoronary bypass patients.
To assess the degree of correlation and agreement between cardiac output by thermodilution and bioimpedance using the BoMed NCCOM3-R7 monitor in postaortocoronary bypass patients. ⋯ Use of the BoMed NCCOM3-R7 bioimpedance monitor as a replacement for thermodilution-derived cardiac output cannot be recommended in postaortocoronary bypass patients. The distortions of patients' normal anatomy and physiology, coupled with the presence of endotracheal tubes and mechanical ventilation, mediastinal tubes and chest tubes, result in only fair correlation, significant bias, and poor precision between the two measures of cardiac output.
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Critical care medicine · Aug 1993
Comparative StudyPressure-controlled ventilation versus controlled mechanical ventilation with decelerating inspiratory flow.
To ascertain whether pressure-controlled ventilation offers any advantage with respect to conventional controlled mechanical ventilation with decelerating flow. ⋯ Our study failed to demonstrate any important difference between pressure-controlled ventilation and controlled mechanical ventilation with decelerating inspiratory flow waveform. The differences in the airway pressures detected by the ventilator are spurious and are due to the place (inspiratory line) where these pressures were measured. The difference between the peak pressure measured in the orotracheal tube has statistical, but not clinical, value and is lower in controlled mechanical ventilation. Based on the limited number of variables we studied and unless the tendency indicated in the quasi-static compliance is demonstrated in the future, we do not believe that pressure-controlled ventilation contributes any uniqueness to the theory or practice of mechanical ventilation.
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Critical care medicine · Aug 1993
Comparative StudyInfrared tympanic thermometry in the pediatric intensive care unit.
To determine the performance of two different commercially available, noncontact infrared tympanic thermometers in predicting core body temperature as measured by pulmonary artery catheters in pediatric intensive care unit (ICU) patients. The performance of the tympanic thermometers was compared with the performance of an indwelling rectal probe and digital axillary temperature determinations. ⋯ In a pediatric ICU population, rectal probes reflect core temperature better than axillary determinations and both infrared tympanic models estimated core body temperature better than digital axillary temperature. One of the tympanic systems (Thermoscan Pro-1 infrared tympanic thermometer) performed in a similar way to the indwelling rectal probes and may be used to estimate core temperature in situations where a pulmonary artery catheter is not in place. The other test tympanic system (First Temp) had greater variability than the rectal probes.