Articles: critical-care.
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Critical care medicine · Oct 1997
Randomized Controlled Trial Comparative Study Clinical TrialClinical utility of hygroscopic heat and moisture exchangers in intensive care patients.
To compare the degree of bacterial circuit colonization, frequency of ventilator-associated pneumonia (VAP), character of respiratory secretions, rewarming of hypothermic patients, disposable costs, and air flow resistance in intensive care patients ventilated using either a heat and moisture exchanger (HME) or hot water (HW) humidifier circuit. ⋯ Circuits with a bacterial-viral filtering HME are less readily colonized by bacteria. Contamination is a random event. Humidification technique has no influence on the frequency rate of VAP, the effectiveness of rewarming, nor the character of the respiratory secretions. Breathing resistance is generally low and disposable costs are reduced when an HME is used.
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Randomized Controlled Trial Clinical Trial
A prospective randomized trial of preoperative "optimization" of cardiac function in patients undergoing elective peripheral vascular surgery.
Previous investigations have suggested that preoperative invasive hemodynamic monitoring with "optimization" of cardiovascular function may favorably affect the outcome among patients undergoing peripheral vascular surgery. The purpose of this study was to evaluate the effect of preoperative optimization of hemodynamic parameters on outcome in patients undergoing aortic reconstruction (AR) or limb salvage procedures (LSP) in a randomized, prospective clinical trial. ⋯ These data suggest that preoperative optimization of cardiovascular function by using achievement of SvO2 above 65% as the end point does not result in any reduction of intraoperative or perioperative cardiac complications in patients undergoing PVS. Further studies with alternative assessments and manipulation of different cardiopulmonary parameters may yield additional information.
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Randomized Controlled Trial Comparative Study Clinical Trial
A cost analysis of alfentanil+propofol vs morphine+midazolam for the sedation of critically ill patients.
Morphine + midazolam and alfentanil + propofol are regimens offering well tolerated and effective sedation for critically ill patients. However, morphine + midazolam is associated with accumulation in these patients, resulting in prolonged recovery characteristics. Alfentanil+propofol, although more expensive, has a shorter elimination half-life, is not associated with accumulation problems and results in a rapid recovery. ⋯ The total costs (at the time of the study Pounds 1 was equivalent to $US1.59) for ICU hospital stay per patient for alfentanil + propofol and morphine + midazolam were 3063 Pounds and 9511 Pounds, respectively, because the shorter recovery characteristics of alfentanil + propofol led to a reduction in ICU stay. Corresponding costss for total hospital stay were 6063 Pounds and 13735 Pounds, respectively. In conclusion, alfentanil + propofol has a better pharmacoeconomic profile than morphine + midazolam for sedating critically ill patients in the ICU setting.
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Intensive care medicine · Aug 1997
Randomized Controlled Trial Clinical TrialImprovement of internal jugular vein cannulation using an ultrasound-guided technique.
To determine whether ultrasound guidance can help operators to improve the results of jugular vein access in the ICU. ⋯ Ultrasound guidance improved the success rate of jugular vein cannulation in ICU patients. Our results suggest that ultrasound guidance should be used when the internal jugular vein has not been successfully cannulated within 3 min by the external landmark-guided technique.
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Critical care medicine · Jul 1997
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialA comparison of cisatracurium (51W89) and atracurium by infusion in critically ill patients.
To evaluate and compare the safety and efficacy of cisatracurium (51W89) and atracurium administered by continuous infusion to critically ill patients requiring neuromuscular blocking agents to facilitate mechanical ventilation. ⋯ Cisatracurium, an isomer of atracurium, appears to be a suitable agent for providing muscle relaxation in critically ill patients.