Arch Intern Med
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison between a conventional and a fiberoptic flow-directed thermal dilution pulmonary artery catheter in critically ill patients.
Invasive hemodynamic monitoring is frequently required in the management of patients in intensive care units. A fiberoptic flow-directed thermal dilution pulmonary artery catheter capable of continuously monitoring the mixed venous saturation, while more expensive than a conventional pulmonary artery catheter, theoretically could result in better patient care, and might be cost-effective if it resulted either in fewer blood tests being ordered or in less time in the intensive care unit. To test this hypothesis, we designed a randomized trial in our Medical Intensive Care Unit to compare a standard pulmonary artery catheter with a fiberoptic catheter. ⋯ There were no statistical differences between the groups in age, time in the intensive care unit, number of tests ordered, hours of mechanical ventilator therapy, hours of vasoactive drug therapy, or mortality rate. The only statistically significant differences between the groups were that (1) the fiberoptic catheter required a longer insertion time and (2) there were more technical problems in consistently obtaining the wedge pressure in the patients with the fiberoptic catheters. We conclude that routine substitution of a fiberoptic catheter for the standard pulmonary artery catheter is not indicated.
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The immediate delivery of bystander-administered cardiopulmonary resuscitation (CPR), coupled with the rapid delivery of advanced cardiac life support, can significantly reduce mortality from out-of-hospital cardiac arrest. Because the majority of sudden cardiac deaths occur in the victim's home with family members present, family members of cardiac patients at high risk for sudden death are the logical focus of CPR training. However, previous research has shown that only a small minority of family members of cardiac patients actually learn CPR and that health care professionals have failed to recommend CPR training in this population, in part due to concerns about their ability to learn CPR. ⋯ The elderly, the depressed, and males were more likely to be unsuccessful in demonstrating adequate CPR skills. Our results suggest that the majority of family members of cardiac patients can learn CPR successfully. Specific training strategies may need to be developed and tested to enhance CPR training in those family members of cardiac patients predicted to have difficulty learning CPR.
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Plasma lipids and hemoglobin A1 were measured in 544 type I diabetic patients. Hemoglobin A1 was positively correlated with the levels of total plasma cholesterol, total triglycerides, and low-density lipoprotein cholesterol and negatively correlated with the level of high-density lipoprotein cholesterol in the entire biracial group. ⋯ In the white diabetic population a reduction in hemoglobin A1 of one percentage point was statistically associated with a decrease of 0.16 to 0.17 mmol/L in total plasma cholesterol, a decrease of 0.10 to 0.13 mmol/L in low-density lipoprotein cholesterol, and a reduction of 0.12 to 0.14 mmol/L in triglycerides. These findings suggest that race and gender are important determinants of the response of plasma lipids to glucose control in type I diabetes mellitus.