Articles: critical-care.
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Am. J. Respir. Crit. Care Med. · Jan 1996
Comparative StudyRisk factors for nosocomial pneumonia: comparing adult critical-care populations.
The purpose of the study was to examine risk factors for nosocomial pneumonia in the surgical and medical/respiratory intensive care unit (ICU) populations. In a public teaching hospital, all cases of nosocomial pneumonia in the surgical and medical/respiratory ICUs (n = 20, respectively) were identified by prospective surveillance during a 5-yr period from 1987-1991. Each group of ICU cases was compared with 40 ICU control patients who did not acquire pneumonia, and analyzed for 25 potential risk factors. ⋯ APACHE III score was found to be predictive of nosocomial pneumonia in the surgical ICU population, but not in the medical/respiratory ICU population. We conclude that certain groups deserve special attention for infection control intervention. Surgical ICU patients with high APACHE scores and receiving prolonged mechanical ventilation may be at the greatest risk of acquiring nosocomial pneumonia of all hospitalized patients.
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Nephrol. Dial. Transplant. · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of sodium and ultrafiltration modelling on plasma volume changes and haemodynamic stability in intensive care patients receiving haemodialysis for acute renal failure: a prospective, stratified, randomized, cross-over study.
Haemodynamic stability in intensive care unit (ICU) patient with acute renal failure (ARF) during intermittent dialytic support has been the focus for several variations to dialysis delivery. Indeed this has been noted by many as a possible cause for prolonged renal dysfunction created by repeated hypotensive renal insult, as well as a reason for the lower delivered dialysis dose afforded. End-stage renal failure patients supported by intermittent dialysis have benefitted from variable sodium dialysate and variable ultrafiltration rate protocols. The current study has focused upon the response to these dialysis variations in the ICU ARF patient. ⋯ Haemodynamic stability was greater during Protocol B than during Protocol A in all patients. Significantly less intervention was noted during Protocol B, despite the same dialysis delivery during both Protocols. Relative Blood volume changes were less during Protocol B, despite a greater total ultrafiltration. Variable sodium dialysate coupled with a variable ultrafiltration rate seems to be the preferred dialysis prescription for ICU ARF patients undergoing intermittent haemodialysis.
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Sepsis and septic shock continue to be the most common causes of death and multiple organ failure among patients in intensive care units. The standard therapeutic regimens include surgical removal of the source of sepsis, antimicrobial therapy, optimizing oxygenation, volume resuscitation, and treatment with catecholamines. ⋯ New therapeutic approaches have become available, including the administration of high doses immunoglobulins, monoclonal antibodies against endotoxin, pentoxilfyline and nitrous oxide inhibitors. Based on the encouraging findings, controlled clinical studies are undertaken to assay with precision their clinical efficacy.
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Acta neurochirurgica · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialKetamine for analgosedative therapy in intensive care treatment of head-injured patients.
Ketamine was supposed to be contra-indicated in head injured patients although it possesses numerous advantages over other commonly used analgosedative drugs. Referring to these potential advantages and the lack of definitive data about its effect upon ICP, CPP or neurological development, we conducted a prospective study in which moderate or severely head injured patients (n = 35) were prospectively allocated to receive treatment either with a combination of ketamine or midazolam or fentanyl and midazolam. The initial dose was 6.5 mg/kg/day midazolam, 65 mg/kg/day ketamine or 65 micrograms/kg/day fentanyl and was later adjusted due to clinical requirements for a period of 3 to 14 days. ⋯ A comparison of the remaining patients revealed a lower requirement of catecholamines (significant on first day, p<0.05), an on average 8 mm Hg higher cerebral perfusion pressure and a 2 mm Hg higher intracranial pressure in the study [corrected] group. Enteral food intake was better in the study group. The outcome was comparable in both groups with or without inclusion of withdrawn patients.