Articles: critical-care.
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Intensive care medicine · Aug 1998
Randomized Controlled Trial Clinical TrialGastric intramucosal pH-guided therapy in patients after elective repair of infrarenal abdominal aneurysms: is it beneficial?
To determine if gastric intramucosal pH (pHi)-guided therapy reduces the number of complications and length of stay in the intensive care unit (ICU) or the hospital after elective repair of infrarenal abdominal aortic aneurysms. ⋯ Low pHi values (< 7.32) and their persistence are predictors of major complications. Treatment to elevate low pHi values does not improve postoperative outcome. Based on these data, we cannot recommend the routine use of gastric tonometers for pHi-guided therapy in these patients. Further studies are warranted to determine adequate treatment of low pHi values that results in beneficial effects on the patient's postoperative course and outcome.
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Randomized Controlled Trial Clinical Trial
Role of written advance directives in decision making: insights from qualitative and quantitative data.
To understand the role of written advance directives (ADs) in medical decision making through examination of qualitative and quantitative data sources. We specifically wanted to address whether physicians unilaterally disregard advance directives. ⋯ Our findings indicate that physicians are not unilaterally disregarding patients' ADs. Despite the patients' serious illnesses, family members and physicians did not see them as "absolutely, hopelessly ill." Hence, ADs were not considered applicable to the majority of these cases. Cases in which ADs had an impact evidenced open negotiation with a surrogate that yielded a transition in the goals of care.
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Arch Phys Med Rehabil · Jul 1998
Randomized Controlled Trial Clinical TrialRehabilitation of patients admitted to a respiratory intensive care unit.
Pulmonary rehabilitation has been shown to be of benefit to clinically stable patients with chronic obstructive pulmonary disease (COPD). This study examined the effect of pulmonary rehabilitation on some physiologic variables in COPD patients recovering from an episode of acute respiratory failure. ⋯ COPD patients who were admitted to a RICU in critical condition after an episode of acute respiratory failure and who, in most cases, required mechanical ventilation benefited from comprehensive early pulmonary rehabilitation, compared with patients who received standard medical therapy and progressive ambulation.
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Critical care medicine · Jun 1998
Randomized Controlled Trial Comparative Study Clinical TrialRelationship of mortality to increasing oxygen delivery in patients > or = 50 years of age: a prospective, randomized trial.
To investigate the relationship of mortality to early resuscitation using two levels of oxygen delivery (DO2) in critically ill surgical patients > or =50 yrs of age who were stratified into groups: age < or =75 yrs (age 50 to 75 yrs group); and age >75 yrs (age >75 yrs group). ⋯ Patients 50 to 75 yrs of age receiving a DO2 of > or =600 mL/min/m2 demonstrated a statistically significant (p=.01) improved survival rate over patients in the control group. Patients >75 yrs of age demonstrated no benefit from attempts to increase DO2 to >600 mL/min/m2, and they may have been overtreated as reflected by the lower O2ER values in this age group. Treating to an O2ER that reflects a balance between oxygen consumption and DO2 may be an alternative goal that allows individual titration.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of two methods of securing an endotracheal tube.
While a variety of methods exist for securing an endotracheal tube (ETT), there has been little research on their safety and efficacy. This study aimed to test the equivalence of two methods in three critical care settings by randomly assigning patients to receive either the knot, which requires scissors or blade to remove the ETT tape, or the bow, which can be removed manually. These methods were evaluated by comparing ETT movement, malposition, dislodgement, inadvertent extubation, reduced skin integrity, the cutting of the pilot tube and nurse satisfaction. ⋯ Nurses found that patient mouth care was easier and patient comfort and skin integrity enhanced with the bow method. On the other hand, nurses perceived the knot-tying method to be more secure and easier to apply. Given the equivalence of the two methods, the bow would seem preferable for reasons of safety and comfort.