Critical care medicine
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Critical care medicine · Apr 2002
Comparative Study Clinical Trial Controlled Clinical TrialPatient-ventilator interactions during partial ventilatory support: a preliminary study comparing the effects of adaptive support ventilation with synchronized intermittent mandatory ventilation plus inspiratory pressure support.
To compare the effects of adaptive support ventilation (ASV) and synchronized intermittent mandatory ventilation plus pressure support (SIMV-PS) on patient-ventilator interactions in patients undergoing partial ventilatory support. ⋯ In patients undergoing partial ventilatory support, with clinical and electromyographic signs of increased respiratory muscle loading, ASV provided levels of minute ventilation comparable to those of SIMV-PS. However, with ASV, central respiratory drive and sternocleidomastoid activity were markedly reduced, suggesting decreased inspiratory load and improved patient-ventilator interactions. These preliminary results warrant further testing of ASV for partial ventilatory support.
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Critical care medicine · Apr 2002
Randomized Controlled Trial Comparative Study Clinical TrialPercutaneous tracheostomy: prospective comparison of the translaryngeal technique versus the forceps-dilational technique in 100 critically ill adults.
To compare two different techniques of percutaneous tracheostomy: Griggs' forceps-dilational technique and Fantoni's translaryngeal technique, both performed with the manufacturer's basic kit and with bronchoscopic guidance. ⋯ Serious complications related to percutaneous tracheostomy occurred in 8.5% and 1.8% of the cases in the translaryngeal technique and the forceps-dilational technique group, respectively (p <.001). Technical difficulties were not rare when using the translaryngeal technique (23%). On the basis of our results, we concluded that the forceps-dilation technique is superior to the translaryngeal technique, with fewer technical difficulties and fewer complications for critically ill patients.
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Critical care medicine · Apr 2002
Review Comparative StudyArginine vasopressin during cardiopulmonary resuscitation: laboratory evidence, clinical experience and recommendations, and a view to the future.
When stimulating adult pigs with ventricular fibrillation or postcountershock pulseless electrical activity for cardiopulmonary resuscitation, vasopressin improved vital organ blood flow, cerebral oxygen delivery, ability to be resuscitated, and neurologic recovery better than epinephrine. In pediatric preparations with asphyxia, epinephrine was superior to vasopressin, whereas in both pediatric pigs with ventricular fibrillation and adult porcine models with asphyxia, combinations of vasopressin and epinephrine proved to be highly effective. This may suggest that a different efficiency of vasopressors in pediatric vs. adult preparations and different effects of dysrhythmic vs. asphyxial cardiac arrest on vasopressor efficiency may be of significant importance. ⋯ In patients who experienced out-of-hospital ventricular fibrillation, a larger proportion of patients treated with vasopressin survived 24 hrs compared with patients treated with epinephrine; during in-hospital cardiopulmonary resuscitation, comparable short-term survival was found in groups treated with either vasopressin or epinephrine. Currently, a large trial comprising patients who experience out-of-hospital cardiac arrest and who are treated with vasopressin vs. epinephrine is ongoing in Germany, Austria, and Switzerland. The new cardiopulmonary resuscitation guidelines of both the American Heart Association and the European Resuscitation Council consider 40 units of vasopressin intravenously and 1 mg of epinephrine intravenously equally effective for the treatment of adult patients with ventricular fibrillation; however, because of a lack of clinical data, no recommendation for vasopressin has been made for adult patients with asystole and pulseless electrical activity or for pediatric patients.
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Permanent brain damage after cardiac arrest and resuscitation is determined by many factors, predominantly arrest (no-flow) time, cardiopulmonary resuscitation (low-flow) time, and temperature. Research since around 1970 into cardiopulmonary-cerebral resuscitation has attempted to mitigate the postischemic-anoxic encephalopathy. These efforts' results have recently shown outcome benefits as documented in clinically relevant outcome models in dogs and in clinical trials. ⋯ This "suspended animation for delayed resuscitation" strategy includes use of an aortic flush of cold saline (or preservation solution) within the first 5 mins of no flow. This strategy should also be explored for the larger number of patients with unresuscitable out-of-hospital cardiac arrests. Suspended animation for prolonged preservation of viability could buy time for transport and repair during hypothermic no flow followed by resuscitation, or it could serve as a bridge to prolonged cardiopulmonary bypass.
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Critical care medicine · Apr 2002
Unexpected high risk of contamination with staphylococci species attributable to standard preparation of syringes for continuous intravenous drug administration in a simulation model in intensive care units.
To determine the risk of bacterial contamination of the infusate in a simulation model of syringes prepared for continuous intravenous drug administration by intensive care unit nurses. Widely accepted standard procedures in the intensive care unit were compared with syringes prepared by pharmaceutical technicians working under standard aseptic conditions according to national guidelines. ⋯ In the intensive care unit, standard procedures for preparing syringes for intravenous administration of drugs lack vigorous aseptic precautions, leading to a high contamination rate of the infusate. This risk is increased when ampules instead of 50 mL-vials are used to prepare the syringes.