Journal of critical care
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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 · Sep 1995
Randomized Controlled Trial Clinical TrialContinuous oscillation: outcome in critically ill patients.
To compare turning by an oscillating bed to standard 2-hour turning. Outcomes were survival, length of stay (LOS), duration of mechanical ventilation, and incidence of pneumonia. ⋯ In selected critically ill patients oscillating therapy may improve survival and improve airway clearance. The frequency and degree of turning needed to prevent complications and improve outcome remains unclear. These newer beds should be used with discrimination so as to not increase hospital costs unnecessarily.
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Journal of critical care · Sep 1994
Randomized Controlled Trial Clinical TrialEffects of human growth hormone on fuel utilization and mineral balance in critically ill patients on full intravenous nutritional support.
The effects of recombinant human growth hormone (GH) on fuel utilization, mineral and fluid balance in critically ill patients were studied. ⋯ GH administration in critically ill patients reduces nitrogen loss and improves phosphate retention but does not have an important effect on fuel utilization.
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Journal of critical care · Jun 1994
Review Randomized Controlled Trial Comparative Study Clinical TrialHepatotoxicity related to total parenteral nutrition: comparison of low-lipid and lipid-supplemented solutions.
Because it is unclear whether or not the lipid or carbohydrate component of total parenteral nutrition solutions determines the development of cholestasis during total parenteral nutrition, a prospective randomized clinical trial of a predominantly carbohydrate solution (group I) versus one with isocaloric substitution of 30% nonprotein calories with lipid (group II) was performed. ⋯ With these statistical considerations, we conclude that there was probably no statistically significant difference between the groups for an increase in AST or AP levels during total parenteral nutrition.
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Journal of critical care · Dec 1993
Randomized Controlled Trial Clinical TrialSafety and efficacy of intravenous immunoglobulin prophylaxis in pediatric head trauma patients: a double-blind controlled trial.
Infection is one of the major complications of severe head trauma in children. To assess whether intravenous immunoglobulin (IVIg) decreases the incidence of secondary infection after head injury in children, a randomized, double-blind trial was performed. Thirty-three children (mean age, 6.67 years; mean injury severity score, 32.8; mean Glasgow coma score, 6.1) with severe head injuries were enrolled; 1 child was excluded, 18 received IVIg, and 14 received the placebo preparation. ⋯ There was no difference in the number of days on mechanical ventilation or in number of hospital days. There were no side effects. It is concluded that prophylactic administration of commercial IVIg at a dose of 400 mg/kg, although safe, had no effect on the incidence of secondary infections in children with severe head injuries.