Critical care medicine
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Critical care medicine · Mar 2005
Multicenter Study Clinical TrialCombining high-frequency oscillatory ventilation and recruitment maneuvers in adults with early acute respiratory distress syndrome: the Treatment with Oscillation and an Open Lung Strategy (TOOLS) Trial pilot study.
To determine the safety, feasibility, and lung-recruitment efficacy of an explicit ventilation protocol combining high-frequency oscillatory ventilation and recruitment maneuvers. ⋯ The combination of high-frequency oscillatory ventilation and recruitment maneuvers resulted in rapid and sustained improvement in oxygenation, likely through lung recruitment. This explicit high-frequency oscillatory ventilation protocol appears well tolerated, feasible, and physiologically sound.
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Critical care medicine · Mar 2005
Randomized Controlled Trial Clinical TrialA controlled trial of smart infusion pumps to improve medication safety in critically ill patients.
Intravenous medications are vital during inpatient management. Errors associated with the administration of medications through intravenous infusion pumps to critically ill patients can result in adverse drug events. We sought to assess the impact of smart pumps with integrated decision support software on the incidence and nature of medication errors and adverse drug events. ⋯ Intravenous medication errors and adverse drug events were frequent and could be detected using smart pumps. We found no measurable impact on the serious medication error rate, likely in part due to poor compliance. Although smart pumps have great promise, technological and nursing behavioral factors must be addressed if these pumps are to achieve their potential for improving medication safety.
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Critical care medicine · Mar 2005
Comparative Study Clinical TrialComparison of two bispectral index algorithms in monitoring sedation in postoperative intensive care patients.
Comparison of two versions of bispectral index (BIS) derived from the electroencephalogram in mechanically ventilated and continuously sedated patients after major abdominal surgery. ⋯ The newer algorithm BIS XP did not perform better than the previous version BIS in patients after major surgery who were mechanically ventilated and sedated on an intensive care unit. This precludes the use of BIS or BIS XP for distinguishing, among deeply sedated ICU patients, those with and without preserved cerebral electrical activity.
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Critical care medicine · Mar 2005
ReviewPrognostic determinants of acute respiratory distress syndrome in adults: impact on clinical trial design.
The objective of this study was to review known clinical predictors and biologic markers of adverse clinical outcomes in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) that might be used as selection criteria in clinical trials of novel therapies for ALI/ARDS. ⋯ The design of clinical trials for new therapies for ALI and ARDS is a complex problem that ultimately will have a major impact on both trial outcome and generalizability. A number of clinical factors and biologic markers can be used to differentiate groups of patients at highest risk for adverse clinical outcomes. Whether enriching study populations with these sicker patients will increase or decrease the likelihood of a treatment effect for a given therapy is unknown.
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Critical care medicine · Mar 2005
Randomized Controlled Trial Clinical TrialEffect of hypertonic saline dextran on acid-base balance in patients undergoing surgery of abdominal aortic aneurysm.
To evaluate the magnitude and cause of metabolic acidosis after infusion of 7.5% sodium chloride 6% dextran 70. ⋯ Both the intravenous administration of 7.5% sodium chloride and the conventional fluid regimen with saline-based 6% hydroxyethyl starch solution resulted in a metabolic acidosis of equal extent. This suggests dilution of plasma buffers or a decrease in strong ion difference to be the primary cause of metabolic acidosis.