Articles: critical-care.
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Randomized Controlled Trial
Intensive insulin therapy improves survival in critically ill patients: how does it work?
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Anesthesia and analgesia · Apr 2006
Randomized Controlled Trial Comparative StudyA prospective evaluation of opioid weaning in opioid-dependent pediatric critical care patients.
Critically ill children are treated with opioid medication in an attempt to decrease stress and alleviate pain during prolonged pediatric intensive care. This treatment plan places children at risk for opioid dependency. Once dependent, children need to be weaned or risk development of a withdrawal syndrome on abrupt cessation of medication. ⋯ Children exposed to opioids for an average of 3 wk showed no difference in the number of agitation events requiring opioid rescue (3 consecutive neonatal abstinence scores >8 every 2 h) in either wean group. Most of the events requiring rescue occurred on day 5 and 6 of the wean in both treatment groups. Patients may be able to be weaned successfully in 5 days once converted to oral methadone, with a follow-up period after medication wean to observe for a delayed withdrawal syndrome.
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Critical care medicine · Apr 2006
Randomized Controlled Trial Multicenter StudyScoring system for the selection of high-risk patients in the intensive care unit.
Patients admitted to the intensive care unit greatly differ in severity and intensity of care. We devised a system for selecting high-risk patients that reduces bias by excluding low-risk patients and patients with an early death irrespective of the treatment. ⋯ All three indicator variables select high-risk patients, the Severity/Intensity-of-care MIX being the most robust. These stratification criteria can improve case-mix selection for clinical and organizational studies.
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Critical care medicine · Feb 2006
Randomized Controlled Trial Multicenter StudyFeasibility and effects of the semirecumbent position to prevent ventilator-associated pneumonia: a randomized study.
Reducing aspiration of gastric contents by placing mechanically ventilated patients in a semirecumbent position has been associated with lower incidences of ventilator-associated pneumonia (VAP). The feasibility and efficacy of this intervention in a larger patient population, however, are unknown. ⋯ The targeted backrest elevation of 45 degrees for semirecumbent positioning was not reached in the conditions of the present randomized study. The achieved difference in treatment position (28 degrees vs. 10 degrees ) did not prevent the development of VAP.
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Critical care medicine · Jan 2006
Randomized Controlled Trial Comparative StudyShort-stay intensive care after coronary artery bypass surgery: randomized clinical trial on safety and cost-effectiveness.
To evaluate the safety and cost-effectiveness of short-stay intensive care (SSIC) treatment for low-risk coronary artery bypass patients. ⋯ Compared with usual care, SSIC is a safe and cost-effective approach. SSIC can be considered as an alternative for conventional postoperative intensive care treatment for low-risk coronary artery bypass graft patients.