Critical care medicine
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Critical care medicine · Nov 1999
Randomized Controlled Trial Comparative Study Clinical TrialProspective, randomized, controlled trial to determine the effect of early enhanced enteral nutrition on clinical outcome in mechanically ventilated patients suffering head injury.
To determine the effect of early enhanced enteral nutrition (EN) on clinical outcome of head-injured patients. ⋯ Enhanced EN appears to accelerate neurologic recovery and reduces both the incidence of major complications and postinjury inflammatory responses.
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Critical care medicine · Nov 1999
Comparative Study Clinical Trial Controlled Clinical TrialPulmonary lactate release in patients with acute lung injury is not attributable to lung tissue hypoxia.
To determine whether pulmonary lactate production in patients with acute lung injury is attributable to lung tissue hypoxia. ⋯ The lungs of patients with ALI produce lactate that is proportional to the severity of lung injury. This lactate production does not seem to be attributable to lung tissue hypoxia.
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Critical care medicine · Nov 1999
ReviewIs there a preferred technique for weaning the difficult-to-wean patient? A systematic review of the literature.
To answer the following question: In difficult-to-wean patients, which of the three commonly used techniques of weaning (T-piece, synchronized intermittent mandatory ventilation, or pressure support ventilation) leads to the highest proportion of successfully weaned patients and the shortest weaning time? ⋯ There are few trials designed to determine the most effective mode of ventilation for weaning, and more work is required in this area. From the trials reviewed, we could not identify a superior weaning technique among the three most popular modes, T-piece, pressure support ventilation, or synchronized intermittent mandatory ventilation. However, it appears that synchronized intermittent mandatory ventilation may lead to a longer duration of the weaning process than either T-piece or pressure support ventilation. Finally, the manner in which the mode of weaning is applied may have a greater effect on the likelihood of weaning than the mode itself.
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Critical care medicine · Nov 1999
Comparative StudyBlind protected specimen brush and bronchoalveolar lavage in ventilated children.
To determine whether nonbronchoscopic protected specimen brush (PSB) and bronchoalveolar lavage (BAL) are contributive for diagnosing ventilator-associated pneumonia in mechanically ventilated children. ⋯ The results of this study indicate the following: a) nonbronchoscopic PSB and BAL were feasible in a large population of mechanically ventilated children; b) nonbronchoscopic techniques were contributive for diagnosing ventilator-associated pneumonia in children; and c) a combined diagnostic approach, using nonbronchoscopic PSB and BAL, was superior to using either test alone.
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Critical care medicine · Nov 1999
Comparative Study Clinical TrialIntermittent prone positioning in the treatment of severe and moderate posttraumatic lung injury.
Severe posttraumatic lung injury is characterized by impairment of gas exchange and pulmonary densities. The influence of intermittent prone positioning on pulmonary gas exchange and parenchymal densities was investigated prospectively in patients with pulmonary injury after multiple trauma with blunt chest trauma. ⋯ Repeated prone positioning recruits collapsed lung tissue and improves gas exchange in trauma patients with blunt chest trauma and severe ARDS as well as in trauma patients with acute lung injury.