Critical care medicine
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Critical care medicine · Apr 2002
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialMulticenter, prospective, randomized, single-blind study comparing the efficacy and gastrointestinal complications of early jejunal feeding with early gastric feeding in critically ill patients.
To compare the incidence of enteral nutrition-related gastrointestinal complications, the efficacy of diet administration, and the incidence of nosocomial pneumonia in patients fed in the stomach or in the jejunum. ⋯ Gastrointestinal complications are less frequent in ICU patients fed in the jejunum. Nevertheless, it seems to be a necessary learning curve to achieve better results with a postpyloric access. Early enteral nutrition using a nasojejunal route seems not to be an efficacious measure to decrease nosocomial pneumonia in critically ill patients.
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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.
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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
Multicenter StudyTime course of platelet counts in critically ill patients.
Although thrombocytopenia in the intensive care unit (ICU) is associated with a poorer outcome, the precise relationship between the time course of platelet counts and the mortality rate has not been well defined. ⋯ Platelet count changes in the critically ill have a biphasic pattern that is different in survivors and nonsurvivors. Late thrombocytopenia is more predictive of death than early thrombocytopenia. A relative increase in platelet count after thrombocytopenia was present in survivors but not in nonsurvivors. Although a single measured platelet count is of little value for predicting outcome, changes in platelet count over time are related to patient outcome.