Critical care medicine
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Critical care medicine · Jan 2005
Meta Analysis Comparative StudyA metaanalysis of treatment outcomes of early enteral versus early parenteral nutrition in hospitalized patients.
Nutritional support as enteral or parenteral nutrition (PN) is used in hospitalized patients to reduce catabolism. This study compares outcomes of early enteral nutrition (EN) with early PN in hospitalized patients. ⋯ There was no mortality effect with the type of nutritional supplementation. Although early EN significantly reduced complication rates, this needs to be interpreted in the light of missing data and heterogeneity. The enthusiasm that early EN, as compared with early PN, would reduce mortality appears misplaced.
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Critical care medicine · Jan 2005
Randomized Controlled Trial Comparative Study Clinical TrialRandomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% saline/6% dextran solution on increased intracranial pressure after brain injury.
The aim of this pilot study was to compare the effects of equimolar doses of hypertonic saline and dextran solution (HSD, Rescueflow) with 20% mannitol solution for reduction of increased intracranial pressure. ⋯ When given in an equimolar, rapid, intravenous infusion, HSD reduces intracranial pressure more effectively than mannitol.
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Critical care medicine · Jan 2005
Randomized Controlled Trial Comparative Study Clinical TrialVentilator-associated pneumonia using a closed versus an open tracheal suction system.
The aim of this study was to analyze the prevalence of ventilator-associated pneumonia (VAP) using a closed-tracheal suction system vs. an open system. ⋯ We conclude that in our study, the closed-tracheal suction system did not reduce VAP incidence, even for exogenous pneumonia.
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Critical care medicine · Jan 2005
Effects of the August 2003 blackout on the New York City healthcare delivery system: a lesson for disaster preparedness.
On August 14, 2003, the United States and Canada suffered the largest power failure in history. We report the effects of this blackout on New York City's healthcare system by examining the following: 1) citywide 911 emergency medical service (EMS) calls and ambulance responses; and 2) emergency department (ED) visits and hospital admissions to one of New York City's largest hospitals. ⋯ The blackout dramatically increased EMS and hospital activity, with unexpected increases resulting from respiratory device failures in community-based patients. Our findings suggest that current capacity to respond to public health emergencies could be easily overwhelmed by widespread/prolonged power failure(s). Disaster preparedness planning would be greatly enhanced if fully operational, backup power systems were mandated, not only for acute care facilities, but also for community-based patients dependent on electrically powered lifesaving devices.