Articles: critical-care.
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Critical care medicine · Jan 2005
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialEffect of airway pressure display on interobserver agreement in the assessment of vascular pressures in patients with acute lung injury and acute respiratory distress syndrome.
Previous investigations have identified significant interobserver variability in the measurements of central venous pressure and pulmonary artery occlusion pressure in critically ill patients. Large interobserver variability in the measurement of vascular pressures could potentially lead to inappropriate treatment decisions. ⋯ Paw display is a simple, inexpensive method to facilitate the identification of end-expiration that can significantly improve interobserver agreement.
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Critical care medicine · Jan 2005
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialAcute effects of tidal volume strategy on hemodynamics, fluid balance, and sedation in acute lung injury.
To examine the effects of mechanical ventilation with a tidal volume of 6 mL/kg compared with 12 mL/kg predicted body weight on hemodynamics, vasopressor use, fluid balance, diuretics, sedation, and neuromuscular blockade within 48 hrs in patients with acute lung injury and acute respiratory distress syndrome. ⋯ When compared with ventilation with 12 mL/kg predicted body weight, patients treated with the lung-protective 6 mL/kg predicted body weight tidal volume protocol had no difference in their supportive care requirements. Therefore, concerns regarding potential adverse effects of this protocol should not preclude its use in patients with acute lung injury or the acute respiratory distress syndrome.
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Critical care medicine · Jan 2005
Randomized Controlled Trial Comparative Study Clinical TrialPharmacokinetics and intrapulmonary diffusion of levofloxacin in critically ill patients with severe community-acquired pneumonia.
To determine the steady-state plasma and epithelial lining fluid concentrations of intravenous levofloxacin, 500 mg, administered once or twice daily in critically ill patients with severe community-acquired pneumonia. ⋯ Our results suggest that in critically ill patients who are receiving mechanical ventilation and have severe community-acquired pneumonia and creatinine clearance of >40 mL/min, the administration of 500 mg of intravenous levofloxacin once and twice daily allows for the exceeding of pharmacodynamic thresholds predictive of outcome (i.e., peak concentration to minimum inhibitory concentration ratio of >10 or area under concentration-time curve to minimal inhibitory concentration ratio of >125 hrs) both in serum and epithelial lining fluid for pathogens with minimum inhibitory concentration values of < or =1 mg/L and >1 mg/L, respectively.
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Critical care medicine · Jan 2005
Randomized Controlled Trial Comparative Study Clinical TrialRandomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% saline/6% dextran solution on increased intracranial pressure after brain injury.
The aim of this pilot study was to compare the effects of equimolar doses of hypertonic saline and dextran solution (HSD, Rescueflow) with 20% mannitol solution for reduction of increased intracranial pressure. ⋯ When given in an equimolar, rapid, intravenous infusion, HSD reduces intracranial pressure more effectively than mannitol.
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Critical care medicine · Jan 2005
Randomized Controlled Trial Comparative Study Clinical TrialVentilator-associated pneumonia using a closed versus an open tracheal suction system.
The aim of this study was to analyze the prevalence of ventilator-associated pneumonia (VAP) using a closed-tracheal suction system vs. an open system. ⋯ We conclude that in our study, the closed-tracheal suction system did not reduce VAP incidence, even for exogenous pneumonia.