Acta Clin Belg
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Randomized Controlled Trial Comparative Study
Epidural analgesia decreases intraabdominal pressure in postoperative patients with primary intra-abdominal hypertension.
Surgical decompression is a lifesaving procedure in patients with severe intraabdominal hypertension. However, it involves subsequent management of an open abdomen. Therefore, it is not recommended for moderate intra-abdominal hypertension. Our literature search did not show any studies relating the efficacy of epidural analgesia in decreasing elevated intraabdominal pressure (IAP) in critically-ill surgical patients with primary intra-abdominal hypertension. ⋯ Continuous thoracic epidural analgesia decreases IAP and improves APP without haemodynamic compromise in postoperative critically-ill patients with primary intra-abdominal hypertension.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective, randomised study comparing the efficacy of talc slurry and bleomycin in the treatment of malignant pleural effusions.
In comparative studies with other agents, insufflated talc has been shown to be the most effective agent in achieving chemical pleurodesis in patients with malignant pleural effusions. The objective of this study is to compare the efficacy of talc administered as slurry (5 g in 50 mL saline) via tube thoracostomy with that of bleomycin (1 mg/kg in 50 mL saline) (which is the most effective agent other than talc). In a randomised, prospective comparative study, twenty-six consecutive patients with proven malignant pleural effusions (recurrent after at least two pleuroscenteses) in whom no pleurodesis attempt had yet been made, and who were symptomatic, had a Karnovski index < or = 50, and an expected survival of one year or less, were included. ⋯ There were no major complications (e.g., empyema) or side-effects. In conclusion, talc slurry and bleomycin are equally effective in achieving chemical pleurodesis via thoracostomy in patients with malignant pleural effusions, and the safety profile of both agents is similar. Since talc is substantially less expensive than bleomycin, talc slurry probably represents the agent of choice for chemical tube thoracostomy pleurodesis.