Journal of critical care
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The fate of inhaled nitric oxide (NO) has not been precisely defined in critically ill patients. This study aimed at defining the effects of long-term NO inhalation on circulating NO byproduct levels. ⋯ Long-term NO inhalation was associated with a consistent increase in the NO3- plasma concentration. NO byproducts may be implicated in the systemic effects associated with this treatment.
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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 · Sep 1998
Clinical Trial Controlled Clinical TrialEffect of continuous lateral rotational therapy on lung mucus transport in mechanically ventilated patients.
Continuous lateral rotational therapy (CLRT) <40 degrees is a method of altering the position of the ventilated patient to help clear secretions from the lung. CLRT has not been shown to reduce the incidence of atelectasis or pneumonia but potentially offers a way to maximize positional drainage in these patients without producing adverse effects. Treatment intervention, bracketed by two (nonrotational) control periods. The purpose of this study was to determine if CLRT alters mucus transport in critically ill, intubated patients in the intensive care unit of a teaching hospital. ⋯ Positional drainage effected by short duration CLRT did not appear to stimulate significant mucous removal from the lung in critically ill patients but also did not cause any adverse effects.
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Journal of critical care · Sep 1998
Comparative StudyVolume recruitment and oxygenation in pulmonary edema: a comparison between HFOV and CMV.
In acute lung injury, edema floods alveoli decreasing mean lung volume (MLV) and increasing pulmonary venous admixture (Ova/Qt). We reasoned that a ventilatory strategy that uses large tidal volumes (VT) might recruit volume differently than a strategy that uses very small VT (high-frequency oscillatory ventilation, HFOV) which may require an inflation maneuver to total lung capacity (TLC) for full recruitment. ⋯ We conclude that after oleic acid injury in dogs pressure-volume hysteresis has two components: a recruitable portion associated with gas exchange improvement and a nonrecruitable portion. At the level of PEEP used in this study (8.5 cm H2O), full lung recruitment during HFOV required inflation to TLC, whereas during CMV it was accomplished by the relatively large VT.
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Journal of critical care · Sep 1998
Comparative StudyThoracocardiography: noninvasive monitoring of left ventricular stroke volume.
Thoracocardiography noninvasively monitors global stroke volume by inductive plethysmographic recording of ventricular volume curves as previously validated by thermodilution. Our purpose was to investigate the potential of thoracocardiography to individually assess stroke volume of the left ventricle. We hypothesized that curves predominantly reflecting left ventricular volume could be obtained by recording waveforms from thoracocardiographic transducers placed at various levels around the chest, and by identifying their origin as the left ventricle if mean expiratory exceeded mean inspiratory stroke volumes during spontaneous breathing. ⋯ The results suggest that thoracocardiography noninvasively tracks changes in left ventricular stroke volumes. Their absolute value may also be monitored if an initial calibration by an independent technique, such as echocardiography, is performed.