Articles: critical-illness.
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Randomized Controlled Trial
Autonomous control of inspired oxygen concentration during mechanical ventilation of the critically injured trauma patient.
Transport of mechanically ventilated patients in a combat zone presents challenges including conservation of resources. In the battlefield setting, the provision of adequate oxygen supplies remains a significant issue. Autonomous control of oxygen concentration may allow a reduction in mission load. ⋯ Autonomous control of FIO2 offers the opportunity for a reduction in oxygen usage, allowing a weight and resource reduction, without increasing risk of hypoxemia in ventilated trauma patients.
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Randomized Controlled Trial
A randomized evaluation of bispectral index-augmented sedation assessment in neurological patients.
To assess whether monitoring sedation status using bispectral index (BIS) as an adjunct to clinical evaluation was associated with a reduction in the total amount of sedative drug used in a 12 h period. ⋯ BIS-augmented sedation monitoring resulted in a marked reduction in the total dose of sedative used to achieve the same level of clinical sedation resulting in shortened time to wake up without any measurable adverse effects. Physiologic sedation assessment tools may provide a useful means of improving the care of sedated critically ill patients.
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Randomized Controlled Trial
Intensive insulin treatment improves forearm blood flow in critically ill patients: a randomized parallel design clinical trial.
Intensive insulin treatment of critically ill patients was seen as a promising method of treatment, though recent studies showed that reducing the blood glucose level below 6 mmol/l had a detrimental outcome. The mechanisms of the effects of insulin in the critically ill are not completely understood. The purpose of the study was to test the hypothesis that intensive insulin treatment may influence forearm blood flow independently of global hemodynamic indicators. ⋯ Compared to standard treatment, intensive insulin treatment of critically ill patients increases forearm flow. Flow increase was weakly related to the insulin dose, though not to blood glucose concentration.
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Randomized Controlled Trial Multicenter Study
The PRaCTICaL study of nurse led, intensive care follow-up programmes for improving long term outcomes from critical illness: a pragmatic randomised controlled trial.
To test the hypothesis that nurse led follow-up programmes are effective and cost effective in improving quality of life after discharge from intensive care. ⋯ A nurse led intensive care follow-up programme showed no evidence of being effective or cost effective in improving patients' quality of life in the year after discharge from intensive care. Further work should focus on the roles of early physical rehabilitation, delirium, cognitive dysfunction, and relatives in recovery from critical illness. Intensive care units should review their follow-up programmes in light of these results.
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Randomized Controlled Trial
Electrical muscle stimulation preserves the muscle mass of critically ill patients: a randomized study.
Critically ill patients are characterized by increased loss of muscle mass, partially attributed to sepsis and multiple organ failure, as well as immobilization. Recent studies have shown that electrical muscle stimulation (EMS) may be an alternative to active exercise in chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) patients with myopathy. The aim of our study was to investigate the EMS effects on muscle mass preservation of critically ill patients with the use of ultrasonography (US). ⋯ EMS is well tolerated and seems to preserve the muscle mass of critically ill patients. The potential use of EMS as a preventive and rehabilitation tool in ICU patients with polyneuromyopathy needs to be further investigated.