Journal of critical care
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Journal of critical care · Mar 2000
Randomized Controlled Trial Clinical TrialThe anticatabolic and wound healing effects of the testosterone analog oxandrolone after severe burn injury.
Severe burn injury leads to marked catabolism and decreased lean mass, which can impair healing. Anabolic agents can attenuate net catabolism. Our purpose was to determine whether the testosterone analog, oxandrolone, given during the acute post burn period decreased the degree of nitrogen loss and loss of body weight while also increasing the healing rate of a skin donor site. ⋯ We found the anabolic agent, oxandrolone, significantly decreased weight loss and net nitrogen loss and increased donor site wound healing compared with placebo controls. We noted no complications with the use of oxandrolone.
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Journal of critical care · Dec 1999
Randomized Controlled Trial Clinical TrialEffectiveness of albumin versus normal saline as a test of volume responsiveness in post-cardiac surgery patients.
A volume challenge is useful for determining whether cardiac output will respond to further volume loading by the Frank-Starling mechanism. To properly test this mechanism, there must be an increase in right atrial pressure (Pra) but this requires variable amounts of normal saline. The purpose of this study was to determine if 100 mL of 25% albumin would reliably provide a predictable increase in Pra and to compare this with a volume challenge with normal saline. As in a previous study, we also examined the potential for the pattern of respiratory variation of Pra to predict the response to a fluid challenge. ⋯ A hyperoncotic albumin solution appears to have an inotropic effect in patients following cardiopulmonary bypass procedures. We also again show that the pattern of respiratory variation in right atrial pressure is a useful guide to predict response to volume loading.
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Journal of critical care · Jun 1999
Randomized Controlled Trial Multicenter Study Clinical TrialIL-1ra administration does not improve cardiac function in patients with severe sepsis.
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Journal of critical care · Sep 1998
Randomized Controlled Trial Multicenter Study Clinical TrialSurrogates' agreement with patients' resuscitation preferences: effect of age, relationship, and SUPPORT intervention. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment.
The purpose of this study was to evaluate an intervention to improve patient-surrogate agreement on end-of-life resuscitation preferences. ⋯ The SUPPORT intervention was not successful in increasing agreement between patients and surrogates. Because of the complex issues involved in end-of-life decision-making, a more aggressive intervention may be needed. Other findings suggest that improvements in communication are particularly needed when patients are older and when the surrogate is not a patient's immediate relative.
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Journal of critical care · Mar 1998
Randomized Controlled Trial Clinical TrialDecelerating flow ventilation effects in acute respiratory failure.
The purpose of this article is to analyze the effect of a pressure-regulated volume-controlled ventilation mode on lung mechanics and gas exchange in patients with acute respiratory failure. ⋯ Pressure-limited ventilation allows mechanical ventilation for the same tidal volume as VC but results in a lower peak inspiratory pressure and a slightly lower PaCO2. The mechanism responsible for this gas exchange effect is unknown but is probably related to a better air distribution of the decelerated flow. The clinical relevance of this phenomenon remains to be established.