Critical care medicine
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Critical care medicine · Jan 1999
Randomized Controlled Trial Clinical TrialDistribution of normal saline and 5% albumin infusions in septic patients.
To determine the relative distribution of fluid within the extracellular fluid volume (ECFV) after infusing either normal saline or 5% albumin in septic, critically ill patients. ⋯ Expansion of the ECFV in excess of the volume of 5% albumin infused suggests that fluid may move from the intracellular fluid volume to the ECFV in septic patients who receive this fluid.
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To determine the rationale for using stress ulcer prophylaxis (SUP) among clinicians; to assess criteria used to define failure of SUP; and to evaluate the decision-making process in the selection of a prophylactic agent. ⋯ This survey highlighted the lack of consensus in the use of SUP. Many patients receive SUP for an extended period, without clear-cut indications or documented benefit. The cost of unwarranted SUP in patients with low risk of stress ulcer gastrointestinal bleeding is prohibitive. Treatment algorithms or protocols for SUP based on prescribing patterns, hospital formulary restrictions, and cost-analysis should be considered for each institution to guide critical care physicians on the proper use of SUP therapies.
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Critical care medicine · Jan 1999
Aspiration and transtracheal jet ventilation with different pressures and depths of chest compression.
To evaluate aspiration prophylaxis during cardiopulmonary resuscitation (CPR) using transtracheal jet ventilation (TJV) with different pressure-depths of chest compression and chest compression alone without mechanical ventilation. ⋯ Application of TJV during chest compression with different pressures and depths caused no pulmonary aspiration in dogs at frequencies between 600 and 10 cycles/min. The protection against aspiration disappeared if the dogs received only chest compression without TJV. The mechanism of preventing pulmonary aspiration in TJV is thought to be due to forceful unidirectional gas outflow through the larynx and higher airway pressure in the carina than in the upper airway. The airway pressures were not affected by different chest compression pressures and depths because the larynx stayed open during TJV and the air outflow could freely move out without increasing the pressure in the airway.