Articles: critical-care.
-
Am. J. Respir. Crit. Care Med. · May 1996
Randomized Controlled Trial Comparative Study Clinical TrialHome versus intensive care pressure support devices. Experimental and clinical comparison.
A bench study using an artificial lung model and a clinical study in patients were performed to evaluate six commercially available home pressure support devices. Six devices were tested in the in vitro study, including five designed for home use and one designed for use in intensive care units. Minimal positive end-expiratory pressure (PEEP) varied across home devices, from 0.5 cm H2O to 4.3 cm H2O. ⋯ However, the esophageal pressure-time product was 30% higher with the home device (165 +/- 93 versus 119 +/- 80 cm H2O/min, p < 0.05). In conclusion, differences exist between devices in terms of occurrence of rebreathing, speed of attainment of stable pressure support level, and expiratory resistance. These differences characterizing the delivery of pressure support may have clinical impact on the inspiratory effort of patients.
-
This article, the first in the new DCCN department for acute-care nurse practitioners, clinical nurse specialists, and advanced practice nurses, focuses on the pharmacodynamics of propofol. The advanced practice nurse working in the ICU is likely to institute propofol protocols, teach staff about the drug, and collaborate with the bedside nurse on the patient's outcome to this treatment.
-
Comparative Study Clinical Trial Controlled Clinical Trial
ST segment monitoring with a derived 12-lead electrocardiogram is superior to routine cardiac care unit monitoring.
Prior studies have shown that a derived 12-lead electrocardiogram with a simple electrode configuration is comparable with the standard electrocardiogram for arrhythmia analysis. ⋯ The findings show that derived 12-lead ST monitoring is superior to routine monitoring of leads V1 and II for detecting transient myocardial ischemia. ST monitoring of the derived 12-lead electrocardiogram may identify high-risk patients with unstable angina and provide prognostic information that would not be otherwise available from the usual clinical measures.
-
Intensive care medicine · May 1996
Multicenter StudyModification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit. ICU-Acquired Pneumonia Study Group.
To assess the frequency of and the reasons for changing empiric antibiotics during the treatment of pneumonia acquired in the intensive care unit (ICU). ⋯ A high percentage of patients (43.7%) required modification of empiric antibiotic treatment for pneumonia acquired in the ICU. In 62.1% of cases the main reason for changing antibiotic treatment was inadequate antibiotic coverage of microorganisms. Attributable mortality was significantly higher in patients with inappropriate initial antibiotic therapy. Rapid and accurate diagnostic methods are needed to initiate appropriate antibiotic treatment as soon as pneumonia is suspected.