Critical care medicine
-
Critical care medicine · May 1996
Randomized Controlled Trial Multicenter Study Clinical TrialAssessment of the safety and efficacy of the monoclonal anti-tumor necrosis factor antibody-fragment, MAK 195F, in patients with sepsis and septic shock: a multicenter, randomized, placebo-controlled, dose-ranging study.
To investigate the safety, biological effects, and efficacy of the anti-tumor necrosis factor (TNF) antibody fragment, MAK 195F, in a phase II trial in patient with severe sepsis. ⋯ There was no increase in survival from sepsis for the patients receiving anti-TNF treatment in the overall study population. Retrospective stratification of patients by IL-6 concentrations suggests beneficial effects of the drug for patients with baseline circulating IL-6 concentrations of > 1000 pg/mL. This hypothesis requires validation in a larger, blinded, prospective study.
-
Critical care medicine · May 1996
Albuterol delivery by metered-dose inhaler in a mechanically ventilated pediatric lung model.
To assess albuterol delivery by metered-dose inhaler in a mechanically ventilated pediatric lung model and to determine the influence of the following variables on albuterol delivery: endotracheal tube diameter; type of spacer; humidification; and pulmonary mechanics. ⋯ These in vitro results suggest that pulmonary disease mechanics and a 6.0-mm endotracheal tube improve albuterol delivery. Future clinical investigations in intubated pediatric patients with pulmonary disease are needed to address the clinical significance of these results.
-
Critical care medicine · May 1996
Accuracy and reliability of disposable pressure transducers coupled with modern pressure monitors.
To determine the bedside accuracy of direct patient pressure monitoring when used with new and clinically used disposable blood pressure (BP) transducers. ⋯ All disposable BP transducers tested were much more accurate than the American National Standards Institute standard for accuracy. Even the worst case transducers were twice as accurate as required by the American National Standards Institute standard. Only one bedside monitor was outside the +/- 2% accuracy range (103 mm Hg). Based on these findings, this author recommends that fixed calibration disposable transducers and fixed calibration bedside pressure monitoring systems be used. The clinical risks of air embolism and infection from the calibrating mercury manometer and the complexity of the calibration task are the overriding factors for making these recommendations.
-
Critical care medicine · May 1996
Meta AnalysisDoes selective decontamination of the digestive tract reduce mortality for severely ill patients?
To investigate the relationship between baseline risk of death and reduced mortality after selective decontamination of the digestive tract in intensive care unit patients. ⋯ Mortality reduction from selective decontamination of the digestive tract appears related to the mortality risk of patients at the time of study entry. Future trials should consider using baseline risk assessment as part of trial design and outcome analysis.
-
Critical care medicine · May 1996
Comparative Study Clinical Trial Controlled Clinical TrialVolume-controlled versus biphasic positive airway pressure ventilation in leukopenic patients with severe respiratory failure.
To study comparatively the effects of volume-controlled vs. biphasic positive airway pressure mechanical ventilation on respiratory mechanics and oxygenation in leukopenic patients with severe respiratory failure. ⋯ Biphasic positive airway pressure ventilation offers the advantage of significantly reduced peak inspiratory and positive end-expiratory pressures at a lower FIO2 and with at least similar oxygenation and CO2 removal as achieved by volume-controlled mechanical ventilation. Our results are in line with previous reports on nonleukopenic patients and suggest that the positive effects of pressure-limited mechanical ventilation are independent of circulating white blood cells. Further studies are mandatory to demonstrate clinical benefit in this critically ill patient population.