Critical care medicine
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The role of tracheostomy in burn patients is controversial. Previous studies, primarily in adults, suggested that severely burned patients with tracheostomies have a higher incidence of tracheostomy site infections, mortality, and pneumonia. The purpose of this study is to determine the safety and efficacy of early tracheostomy in severely burned children. ⋯ Early tracheostomy in severely burned children is safe and effective. It provides a secure airway and may result in improvement in ventilator management for these children.
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Critical care medicine · Apr 2002
Frequency and determinants of drug administration errors in the intensive care unit.
The study aimed to identify both the frequency and the determinants of drug administration errors in the intensive care unit. ⋯ Efforts to reduce drug administration errors in the intensive care unit should be aimed at the risk factors we identified in this study. Especially, focusing on system differences between the two intensive care units (e.g., presence or absence of full-time specialized intensive care physicians, presence or absence of protocols for the preparation of all parenteral drugs) may help reduce suboptimal drug administration.
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Very early extubation of children after cardiac surgery has been suggested as a safe alternative to prolonged postoperative intubation but is still not common practice. Studies of early extubation in children may not have described reasons for failure to extubate, or have included nonbypass or only low-risk repairs. We present our experience with very early extubation in an inclusive group of children after cardiac surgery. ⋯ Successful early extubation of even young children is possible and easily accomplished in most children undergoing cardiopulmonary bypass, even with complex procedures, but advantages of extubation in the operating room vs. immediate ICU extubation remain unclear. Transient mild-to-moderate mixed acidosis is common and requires no treatment. Full implementation requires acceptance by surgical and ICU staffs.
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Critical care medicine · Apr 2002
Comparative StudyDopexamine but not dopamine increases gastric mucosal oxygenation during mechanical ventilation in dogs.
To compare the effects of dopamine and dopexamine on gastric mucosal oxygenation during mechanical ventilation without and with positive end-expiratory airway pressure (PEEP) and after compensation of the PEEP-induced hemodynamic suppression. ⋯ Dopexamine but not dopamine improved gastric mucosal oxygenation in dogs. This effect was independent of the dosage and the ventilation mode. Thus, dopexamine may reverse a decrease in splanchnic oxygenation induced by ventilation with PEEP. The dopexamine-induced increase in gastric mucosal oxygenation was mediated by beta2-adrenoceptors, which explains the superior effects of dopexamine to dopamine on mu-Hbo2. The regional effects of both catecholamines were not mirrored by systemic hemodynamics.
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Critical care medicine · Apr 2002
Randomized Controlled Trial Multicenter Study Clinical TrialFluid thresholds and outcome from severe brain injury.
To determine, by retrospective analysis, critical thresholds for intracranial pressure, mean arterial pressure, cerebral perfusion pressure, and fluid balance associated with poor outcome in patients with severe brain injury. ⋯ Exceeding thresholds of intracranial pressure, mean arterial pressure, cerebral perfusion pressure, and fluid volume may be detrimental to severe brain injury outcome. Fluid balance lower than -594 mL was associated with an adverse effect on outcome, independent of its relationship to intracranial pressure, mean arterial pressure, or cerebral perfusion pressure.