Articles: critical-illness.
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Critical care medicine · Aug 1995
Randomized Controlled Trial Clinical TrialEffect of erythromycin on gastric motility in mechanically ventilated critically ill patients: a double-blind, randomized, placebo-controlled study.
To document the action of erythromycin on gastric emptying and motility in mechanically ventilated patients. ⋯ In mechanically ventilated patients, intravenous erythromycin (200 mg over 30 mins) increases indices of antral motility and accelerates gastric emptying as assessed by the kinetics of acetaminophen absorption.
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This study was undertaken to assess any salivary aspiration in seriously ill patients with tracheostomies in an Intensive Care Unit setting. The alpha-amylase activity in the tracheostomies in an Intensive Care Unit setting. The alpha-amylase activity in the tracheobronchial secretions of 15 such patients were analysed to evaluate the incidence of salivary aspiration. ⋯ The other nine patients showed a low level of amylase activity in their secretions. Two patients in the latter group developed severe pulmonary disease. This study demonstrates that a high level of alpha-amylase activity in the tracheobronchial secretions of tracheotomized, ventilated patients indicates that salivary aspiration may be taking place, and further suggests that progressively increasing levels may indicate the likelihood of a major pulmonary complication developing.
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J Intensive Care Med · Jul 1995
Clinical Trial Controlled Clinical TrialA prospective study of continuous venovenous hemodiafiltration in critically ill patients with acute renal failure.
We studied the biochemical and the clinical consequences of the application of continuous venovenous hemodiafiltration to the management of acute renal failure in critically ill patients. One hundred consecutive surgical and medical ICU patients with acute renal failure were entered into a prospective clinical study at an intensive care unit of tertiary institution. ⋯ included the following: mean patient age was 60.9 years (range 21-81 yr); mean APACHE II score, 28.6 (95% confidence interval; 27.4-29.8); and number of failing organs, mean, 4.1 (95% confidence interval; 3.8-4.4). At commencement of continuous venovenous hemofiltration with dialysis, 79% of patients were receiving inotropic drugs and 72% were septic, and, in 35%, bacteremia or fungemia was demonstrated. Renal replacement therapy was applied for a mean duration of 186.2 hours (95% confidence interval; 149.2-223.7), with a mean hourly net ultrafiltrate production of 621 mL (95% confidence interval; 594-648) and a mean urea clearance of 28.1 mL/min (95% confidence interval; 26.7-29.5). Azotemia was controlled in all patients (plasma urea < 30 mmol/L). During the more than 18,000 hours of treatment, there was no therapy-associated hemodynamic instability. Complications were rare. They included two cases of hemofilter rupture with minor blood loss and a single case of bleeding at the site of the vascular-access catheter. Forty-three patients survived to ICU discharge, and 40 survived to hospital discharge. Continuous venovenous hemodiafiltration is a safe and an effective form of renal replacement therapy in critically ill patients. In such patients, who have a high predicted mortality rate, it was associated with a 40% survival rate. These findings suggests that continuous venovenous hemodiafiltration may be ideally suited to patients with multisystem organ failure with acute renal failure.
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Much of today's medical care relies on experience unsupported by investigation, and emergency medical care is no exception; research is necessary to improve this care. Critically ill and injured patients are the patients who will benefit the most from improvements in emergency medical diagnostic and treatment methods. Yet, the federal bureaucracy has effectively banned research on these patients, since they cannot generally give "informed consent." We argue that, with the proper safeguards, research on critically ill and injured patients should be performed in the emergency medicine (EDs and EMS) settings without informed consent. To require such consent when not obtainable compromises both the researchers who must get such consent and the patients who must continue to endure old, and often untested therapies.