Critical care medicine
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Critical care medicine · Aug 1996
Multicenter Study Comparative StudyComparative assessment of pediatric intensive care in Moscow, the Russian Federation: a prospective, multicenter study.
Comparative assessment of pediatric intensive care. ⋯ We provided a quantitative description and assessment of pediatric intensive care in Moscow. Moderate efficiency may reflect a low threshold for ICU admission due to poor nurse/patient ratios on the wards. Effectiveness in the low- and medium-risk strata is below standard, as compared with a Western reference population. Excess mortality was concentrated in the low- and medium-risk strata, and can only partially be explained by the inclusion of co-morbidity. Future analysis should focus on specific treatment protocols, protocol adherence, and the determination of infectious and therapeutic complications.
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Critical care medicine · Aug 1996
Multicenter Study Clinical TrialCalf's lung surfactant extract in acute hypoxemic respiratory failure in children.
Open-label trial of the safety and short-term efficacy of calf's lung surfactant in pediatric respiratory failure. ⋯ Administration of calf's lung surfactant appears to be safe and is associated with rapid improvement in oxygenation and moderation of ventilator support in children with acute hypoxemic respiratory failure. These results set the stage for a randomized, controlled study.
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Critical care medicine · Aug 1996
Comparative StudyCerebral oxygenation monitoring by near-infrared spectroscopy is not clinically useful in patients with severe closed-head injury: a comparison with jugular venous bulb oximetry.
To compare continuous jugular venous bulb oximetry and cerebral near-infrared spectroscopy in patients with severe closed head injury. ⋯ Tissue oxygen saturation determined by near-infrared spectroscopy does not reflect significant changes in cerebral oxygenation detected by the global measurement of jugular venous bulb oximetry. This finding may be explained by inadequate signal detection and inaccuracies in the algorithm used to filter out extracranial components. Until these technical difficulties are addressed, near-infrared spectroscopy, as measured by the machine assessed in this study, cannot be routinely recommended for assessment of cerebral oxygenation in patients with acute head injury.
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Critical care medicine · Aug 1996
Hormonal and hemodynamic changes in a validated animal model of brain death.
To examine the hormonal and hemodynamic changes in a validated animal model of brain death. ⋯ In a validated animal model of brain death, significant decreases in the circulating concentrations of stress hormones, as well as hemodynamic instability, occurred after brain death. Measurements of plasma adrenocorticotrophic hormone and vasopressin values may be useful as diagnostic predictors of brain death. Furthermore, the observed changes may contribute to organ dysfunction after brain death and may necessitate hormonal as well as inotropic and vasoactive support to maintain donor organ function in the clinical setting.
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Critical care medicine · Aug 1996
Randomized Controlled Trial Clinical TrialN-acetyl-L-cysteine depresses cardiac performance in patients with septic shock.
To investigate the effects of adjunctive therapy with parenteral N-acetyl-L-cysteine in patients with newly diagnosed septic shock. ⋯ Adjunctive therapy with N-acetyl-L-cysteine in newly diagnosed septic shock was associated with a depression in cardiovascular performance, as indicated by progressive reductions in cardiac index, left ventricular stroke work index, and MAP.