Articles: critical-care.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Heat and moisture exchangers for conditioning of inspired air of intubated patients in intensive care. The humidification properties of passive air exchangers under clinical conditions].
Heat and moisture exchangers (HME) are used as artificial noses for intubated patients to prevent tracheo-bronchial or pulmonary damage resulting from dry and cold inspired gases. HME are mounted directly on the tracheal tube, where they collect a large fraction of the heat and moisture of the expired air, adding this to the subsequent inspired breath. The effective performance depends on the water-retention capacity of the HME: the amount of water added to the inspired gas cannot exceed the stored water uptake of the previous breath. ⋯ These data are simple to obtain without affecting the patient and can easily be interpreted. It was demonstrated that, compared to physiological conditions, the DAR Hygrobac and Gibeck Humid Vent 2P-HME coated with hygroscopic salts-were able to maintain sufficient inspiratory humidity and heat. The Pall-HME, solely a condensation humidifier, did not meet the physiological requirements.
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Infusionsther Transfusionsmed · Apr 1995
Comparative StudyIs the transfusion requirement predictable in critically ill patients after admission to the intensive care unit?
In intensive care medicine the clinical decision to order and transfuse red blood cells (RBC) is usually based on hematocrit or hemoglobin levels. The intention of this study was to investigate whether clinical or laboratory variables, taken after the admission of patients to the intensive care unit (ICU), are able to predict the transfusion requirement of the following 72 h. ⋯ A hematocrit value < or = 20% and a APACHE-II score > or = 20 at the time of admission to the ICU referred to a demand for blood transfusion. We believe that these parameters are useful as predictive instruments. The initially measured systolic blood pressure had no prognostic capacity. In the individual patient a number of factors should be taken into account to decide whether to transfuse or not.
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The movement of nurse education to the tertiary sector is all but complete in Australia. Trends are changing as new partnerships are being forged and the focus of education is now reponsive to economic and political factors. These factors have resulted in the regionalisation of health care facilities and the de-institutionalisation of health services in Queensland. ⋯ Strategies which were developed collaboratively addressed course content including logistics, time management, the critical selective selection of appropriate content, assessment critera, 'registerbility' within Queensland and other states, and clinical competence will be addressed. Moreover, this process of developing the course content utilised Australian National Registering Authority (ANRAC 1990) Competencies and Benners' (1984) use of the Dreyfus model to guide the expected knowledge level of the clinician at course completion. In particular this paper will not only address the blending of theory and practice to consolidate the relationship inherent between the clinician and education, but will establish the fact that no gap exists.
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Anaesth Intensive Care · Apr 1995
Randomized Controlled Trial Clinical TrialIs there a role for selective decontamination of the digestive tract in primarily infected patients in the ICU?
The role of selective decontamination of the digestive tract (SDD) for the prevention of nosocomial infection in critically ill patients remains controversial, and the efficacy of this technique in patients who are already infected on presentation to the intensive care unit has not previously been assessed. We performed a double-blind randomized placebo controlled trial of SDD (parenteral cefotaxime, six-hourly oral and enteral polymyxin E, tobramycin, and amphotericin B vs placebo) for all infected patients presenting to the ICU requiring mechanical ventilation for more than 48 hours and ICU stay of more than 5 days. Daily clinical and microbiological monitoring for secondary infection was undertaken until hospital discharge. ⋯ The number of patients receiving SDD who developed nosocomial infections was significantly reduced (P = 0.048), and there were no infections caused by the enterobacteriaceae or Candida spp in this group. No difference in ICU (17.5 vs 18.8 days) or hospital stay (32.7 vs 34.2 days) or mortality (17% vs 22.3%) was shown. Critically ill, primarily infected patients are protected from nosocomial infection by the use of SDD.