Journal of critical care
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Journal of critical care · Dec 1997
Randomized Controlled Trial Clinical TrialTreatment with N-acetylcysteine during acute respiratory distress syndrome: a randomized, double-blind, placebo-controlled clinical study.
Intravenous N-acetylcysteine (NAC) has been reported to improve systemic oxygenation and reduce the need for ventilatory support in patients with an acute lung injury. In the more serious form, namely established adult respiratory distress syndrome (ARDS) (PaO2/FIO2 < or = 200 mm Hg), we tested the hypothesis that treatment with intravenous NAC may be beneficial. ⋯ In this relatively small group of patients presenting with an established ARDS subsequent to a variety of underlying diseases, intravenous NAC treatment during 72 hours neither improved systemic oxygenation nor reduced the need for ventilatory support.
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Journal of critical care · Dec 1997
Randomized Controlled Trial Clinical TrialFewer interventions in the immediate post-extubation management of pediatric intensive care unit patients: safety and cost containment.
The purpose of this article was to compare the safety and patient charges of two postextubation treatment regimens. ⋯ A modified postextubation management protocol, consisting of fewer interventions, resulted in significant patient charge savings with no increased risk to the patient.
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Journal of critical care · Dec 1997
Randomized Controlled Trial Clinical TrialStudy of some phagocyte membrane receptors in patients receiving intravenous polyvalent immunoglobulins as adjunct treatment for nosocomial pneumonia.
Phagocytosis is a major mechanism of defense against bacterial infections. The ingestion of bacteria by phagocytes involves a variety of cell membrane recognition structures and, among them, immunoglobulin receptors. The aim of this study was to test the phagocytic activity of granulocytes and monocytes of intensive care unit (ICU) patients, and to evaluate the effects of intravenous polyvalent immunoglobulins (IVIG) used as adjunct treatment of nosocomial pneumonia on some phagocyte membrane receptors of these patients. ⋯ Infected ICU patients display a deficiency of phagocytosis membrane receptors of blood granulocytes and monocytes. The addition of IVIG to standard therapy does not improve the phagocytic activity of ICU patients with nosocomial pneumonia.
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Journal of critical care · Jun 1997
Randomized Controlled Trial Comparative Study Clinical TrialPositive pressure inspiration differentially affects right and left ventricular outputs in postoperative cardiac surgery patients.
The purpose of this study was to determine the dynamic changes in right ventricular (RV) and left ventricular (LV) output during positive airway pressure inspiratory hold maneuvers so as to characterize the interaction of processes in creating steady-state cardiac output during positive pressure ventilation. ⋯ Positive pressure inspiration induces time-dependent changes in central hemodynamics, which are dissimilar between RV and LV function. Initially, inspiration increases RV output but decreases LV output, such that intrathoracic blood volume increases. However, sustained inspiratory pressures induce proportionally similar decreases in both RV and LV outputs. Thus, the hemodynamic effects of positive pressure ventilation will depend on the degree of lung inflation, the inspiratory time, and when measurements are made within the ventilatory cycle. These data also suggest that positive pressure ventilation with up to 20 cm H2) P(aw) does not significantly impair ventricular performance in humans.
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Journal of critical care · Jun 1997
Randomized Controlled Trial Comparative Study Clinical TrialGastric intramucosal pH changes after volume replacement with hydroxyethyl starch or crystalloid in patients undergoing elective abdominal aortic aneurysm repair.
Gastric intramucosal pH (pHi), a surrogate marker of tissue oxygenation, falls following abdominal aorta aneurysm (AAA) repair. We tested the hypothesis that volume replacement with a hydroxyethyl starch solution would result in better preserved splanchnic oxygenation than would volume replacement with crystalloid solutions. ⋯ In patients undergoing major surgery, volume resuscitation with hydroxyethyl starch solutions may improve microvascular blood flow and tissue oxygenation.