J Trauma
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Randomized Controlled Trial Clinical Trial
Hemodynamic and ventilatory effects associated with increasing inverse inspiratory-expiratory ventilation.
Increasing the percentage of inspiratory time during mechanical ventilation (i.e., inverse inspiratory-expiratory (I:E) ventilation) is frequently used to improve oxygenation in patients with acute respiratory distress syndrome; however, an optimal I:E ratio is unknown. ⋯ These findings demonstrate the effectiveness of increasing inspiratory time to improve oxygenation, yet to the detriment of ventilation. This suggests that within the parameter confines of this study, the preferential I:E ratio is a balance between oxygen demands and ventilatory requirements.
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Randomized Controlled Trial Comparative Study Clinical Trial
Minimally displaced distal radius fractures: do they need plaster treatment?
In a prospective, randomized trial, minimally displaced distal radius fractures were divided into two groups: those treated with plaster immobilization for 1 week compared with 3 weeks. Functional Cooney scores were determined at 6 weeks, 3 months, 6 months, and 1 year. ⋯ No further dislocation occurred, and all patients experienced eventful healing with good and excellent results in 92% of the cases. We believe, therefore, that only minimal immobilization is required in these fractures and that they should be mobilized as soon as comfort allows.
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Insulin plus glucose, given for 7 days to hypermetabolic burn patients, has been shown to stimulate limb protein anabolism. We hypothesized that insulin plus glucose given to burn patients would also stimulate wound healing. ⋯ Data indicate that high doses of insulin and glucose can be safely administered to massively burned patients to improve wound matrix formation.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Hypertonic saline resuscitation of patients with head injury: a prospective, randomized clinical trial.
Experimental and clinical work has suggested that hypertonic saline (HTS) would be better than lactated Ringer's solution (LRS) for the resuscitation of patients with head injuries. No clinical study has examined the effect of HTS infusion on intracranial pressure (ICP) and outcome in patients with head injuries. We hypothesized that HTS infusion would result in a lower ICP and fewer medical interventions to lower ICP compared with LRS. ⋯ As a group, HTS patients had more severe head injuries. HTS and LRS used with other therapies effectively controlled the ICP. The widely held conviction that sodium administration will lead to a sustained increase in ICP is not supported by this work.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomized, prospective comparison of increased preload versus inotropes in the resuscitation of trauma patients: effects on cardiopulmonary function and visceral perfusion.
To evaluate the effects of maintaining increased levels of preload on cardiopulmonary function and visceral perfusion during resuscitation. ⋯ Patients resuscitated at higher levels of preload have significantly better visceral perfusion than those resuscitated at normal preload with addition of inotropes. This higher preload does not adversely affect pulmonary function.