Critical care medicine
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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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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
Comparative StudyPlasma procalcitonin and C-reactive protein in acute septic shock: clinical and biological correlates.
To determine the relationship between plasma procalcitonin (PCT) levels, C-reactive protein (CRP), white blood cell count (WBC), ionized calcium (Ca2+), and patient outcome; and to compare the diagnostic and prognostic information provided by PCT and by CRP. ⋯ PCT levels were correlated with the severity of disease at onset (APACHE II) and inflammation (CRP) but not with Ca2+ levels. Inaugural PCT or CRP levels per se poorly predicted outcome but decreasing levels were associated with a higher probability of survival. In this respect, PCT was found to be an earlier marker than CRP.