Intensive care medicine
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Intensive care medicine · Jan 1990
Randomized Controlled Trial Comparative Study Clinical TrialThe use of midazolam versus propofol for short-term sedation following coronary artery bypass grafting.
Midazolam and propofol were compared in an open randomized study for postoperative sedation during 12 h of mechanical ventilation in 40 patients following coronary artery bypass grafting. After an intravenous loading dose of midazolam (50 micrograms.kg-1) or propofol (500 micrograms.kg-1), a titrated continuous infusion was administered of midazolam (mean dose 38.1 micrograms.kg-1.h-1 (SEM 2.6)) or propofol (mean dose 909 micrograms.kg-1.h-1 (SEM 100)) together with a narcotic analgesic infusion. During mechanical ventilation midazolam and propofol produced a similar quality of sedation, but recovery (midazolam 66 min (SEM 16); propofol 24 min (SEM 7)) and weaning from the ventilator (midazolam 243 min (SEM 44); propofol 154 min (SEM 33)) where faster with propofol. In the 2 groups administration of an intravenous loading dose caused a significant decrease in mean arterial pressure but hemodynamic tolerance during maintenance infusion was good.
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Intensive care medicine · Jan 1990
Comparative Study Clinical TrialOptimal oxygen delivery in critically ill patients.
Standard hemodynamic support in septic shock is to increase pulmonary capillary wedge pressure to above 15 mmHg by volume replacement and to give inotropic support if the mean arterial pressure (MAP) is not adequate. In an attempt to decrease mortality in critically ill patients, oxygen delivery (DO2) was increased by switching inotropic support from dobutamine alone or in combination with norepinephrine to dopamine alone, or by adding dopexamine, prostacyclin, or hypertonic saline to the treatment. ⋯ The results indicate that if adequate volume and inotropic support is provided for critically ill patients, the detectable oxygen debt is small and has little effect on patient outcome. When DO2 is adequate, factors other than a tissue oxygen deficit seem to determine patient outcome.
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Intensive care medicine · Jan 1990
Randomized Controlled Trial Comparative Study Clinical TrialNosocomial maxillary sinusitis during mechanical ventilation: a prospective comparison of orotracheal versus the nasotracheal route for intubation.
Nosocomial maxillary sinusitis during mechanical ventilation may cause life-threatening complications in ICU patients. The aim of this prospective study was to compare the incidence of maxillary sinusitis according to the route of intubation. 111 consecutive adult patients (mean age: 53, mean SAPS: 12) were randomly assigned to receive either orotracheal (n = 53) or nasotracheal (n = 58) intubation. All had a nasogastric feeding tube. ⋯ This procedure proved successful in 12 out of 17 cases but secondary drainage was performed in 5 cases (1 failure). Incidents related to the route for long-term intubation were significantly (p less than 0.001) more frequent in the orotracheal group (8/53 vs 2/58), however no patient died because of them. In this study, long-term orotracheal intubation reduced significantly the incidence of maxillary sinusitis in comparison with nasotracheal intubation.
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Intensive care medicine · Jan 1990
Randomized Controlled Trial Clinical TrialPlasma catecholamine concentration during sedation in ventilated patients requiring intensive therapy.
The effects of isoflurane and midazolam sedation on the catecholamine responses of ventilated patients were studied over a 24-h period. Sixty ventilated patients admitted to our intensive therapy unit were allocated randomly to receive either isoflurane or midazolam sedation. ⋯ Patients sedated with midazolam showed no significant changes of adrenaline or noradrenaline concentrations. Overall, a more satisfactory degree of sedation was achieved with isoflurane.
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Two patients with multiple organ failure, septicaemia and a deteriorating clinical course were treated by plasma exchange in addition to standard supportive measures. Dramatic improvements were seen in cardio-respiratory (patient 1), neurological and renal parameters (patient 2) which were attributable to the exchanges. Plasma exchange might be of value as adjunctive therapy where overwhelming septicaemia occurs with multiple organ failure.