Critical care : the official journal of the Critical Care Forum
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The most appropriate inotropic agent for use in the newborn is uncertain. Dopamine and epinephrine are commonly used, but have unknown effects during hypoxia and pulmonary hypertension; the effects on the splanchnic circulation, in particular, are unclear. ⋯ Epinephrine is more effective than dopamine at increasing cardiac output during hypoxia in this model. Although epinephrine preserves the SAP/PAP ratio, dopamine shows preferential pulmonary vasoconstriction, which might be detrimental if it also occurs during the management of infants with persistent fetal circulation. Dopamine, but not epinephrine, increases portal flow and total hepatic flow during hypoxia.
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Randomized Controlled Trial Clinical Trial
Atrial natriuretic peptide infusion and nitric oxide inhalation in patients with acute respiratory distress syndrome.
To study the effects of infusion of atrial natriuretic peptide (ANP) versus the inhalation of nitric oxide (NO) in patients with an early acute respiratory distress syndrome (ARDS). ⋯ This study shows that, in contrast to NO inhalation, infusion of ANP neither improves oxygenation nor attenuates pulmonary hypertension or pulmonary edema in patients with severe ARDS.
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Intensive-care units (ICUs) must be utilised in the most efficient way. Greater input of intensivists leads to better outcomes and more efficient use of resources. 'Closed' ICUs operate as functional units with a competent on-site team and their own management under the supervision of a full-time intensivist directly responsible for the treatment. ⋯ At night, the on-site physicians need not necessarily be specialists as long as an experienced intensivist is on call. Because of the shortage of intensivists, such standards will be difficult to maintain everywhere, but they should, at least, be mandatory for larger hospitals serving as regional centres.
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Randomized Controlled Trial Clinical Trial
Biphasic positive airway pressure ventilation (PeV+) in children.
Biphasic positive airway pressure (BIPAP) (also known as PeV+) is a mode of ventilation with cycling variations between two continuous positive airway pressure levels. In adults this mode of ventilation is effective and is being accepted with a decrease in need for sedatives because of the ability to breathe spontaneously during the entire breathing cycle. We studied the use of BIPAP in infants and children. ⋯ BIPAP is an effective, safe and easy to use mode of ventilation in infants and children.
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The upper airway is an organ not often investigated. Relatively little is known about its complex functions, and misunderstandings abound. The paper by Thomachot et al in this issue provides an opportunity to ponder on this important organ. Although the main result seems to be negative, the study provides some interesting physiological information on the upper airway and how it works.