Intensive care medicine
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Intensive care medicine · Jun 2012
Randomized Controlled TrialRemifentanil/midazolam versus fentanyl/midazolam for analgesia and sedation of mechanically ventilated neonates and young infants: a randomized controlled trial.
Common opioids for analgesia and sedation of mechanically ventilated infants may tend to accumulate and cause prolonged sedation with an unpredictable extubation time. Remifentanil is a promising option due to its unique pharmacokinetic properties, which seem to be valid in adults as well as in infants. ⋯ As neonates and young infants have a decreased metabolism of common opioids like fentanyl and are more prone to respiratory depression, remifentanil could be the ideal opioid for analgesia and sedation of mechanically ventilated infants.
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Intensive care medicine · Jun 2012
Randomized Controlled TrialPropofol and remifentanil versus midazolam and fentanyl for sedation during therapeutic hypothermia after cardiac arrest: a randomised trial.
To compare two protocols for sedation and analgesia during therapeutic hypothermia: midazolam and fentanyl versus propofol and remifentanil. The primary outcome was the time from discontinuation of infusions to extubation or decision not to extubate (offset time). Secondary outcomes were blood pressure, heart rate, use of vasopressors and inotropic drugs, pneumonia and neurological outcome. ⋯ Time to offset was significantly shorter in patients treated with propofol and remifentanil. However, the clinical course in 40 % of patients prevented discontinuation of sedation and potential benefits from a faster recovery. The propofol and remifentanil group required norepinephrine twice as often, but both protocols were tolerated in most patients.
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Intensive care medicine · Jun 2012
Electrical velocimetry as a tool for measuring cardiac output in small infants after heart surgery.
Cardiac output (CO), the product of stroke volume (SV) and heart rate, is essential to guarantee organ perfusion, especially in the intensive care setting. As invasive measurement of CO bears the risk of complications there is a need for non-invasive alternatives. We investigated if electrical velocimetry (EV) and transthoracic Doppler (Doppler-TTE) are interchangeable for the non-invasive measurement of SV and able to reflect the post-surgical SV/CO trend. ⋯ EV and Doppler-TTE are interchangeable for estimating SV. EV has the advantages of easy handling and allows continuous measurement.