Articles: critical-illness.
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Critical care medicine · Feb 2003
Randomized Controlled Trial Clinical TrialOutcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control.
Maintenance of normoglycemia with insulin reduces mortality and morbidity of critically ill patients. Here we report the factors determining insulin requirements and the impact of insulin dose vs. blood glucose control on the observed outcome benefits. ⋯ Normoglycemia was safely reached within 24 hrs and maintained during intensive care by using insulin titration guidelines. Metabolic control, as reflected by normoglycemia, rather than the infused insulin dose, was related to the beneficial effects of intensive insulin therapy.
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Nursing in critical care · Jan 2003
Randomized Controlled Trial Comparative Study Clinical TrialCooling strategies for patients with severe cerebral insult in ICU (Part 2).
Critically ill patients who have sustained a severe cerebral insult will be actively cooled should they develop an elevated body core temperature. Patients who require therapeutic hypothermia for neuroprotection may require the same cooling strategies. ⋯ An experimental approach was used to examine the effects of paracetamol and four external cooling strategies on patients with severe cerebral insult It is suggested that paracetamol is effective in reducing body core temperature and that fans may not. However, data obtained from the study of the four external cooling strategies were inconclusive.
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Clinical cornerstone · Jan 2003
Review Randomized Controlled Trial Clinical TrialInsulin therapy for the critically ill patient.
The risk of mortality or significant morbidity is high among critically ill patients who are treated in the intensive care unit (ICU) for > 5 days. These patients are susceptible to sepsis, excessive inflammation, critical illness polyneuropathy, and multiple organ failure, the latter often being the cause of death. Most intensive care patients, even those who did not previously suffer from diabetes, are hyperglycemic, which is presumed to reflect an adaptive development of insulin resistance. ⋯ Logistic regression analysis indicated that control of BG levels, rather than insulin administration itself, likely explains the observed clinical benefits. Use of insulin infusion to maintain normoglycemia using a titration algorithm, at least in populations similar to those in the Leuven study, improves outcome. Further data are needed to establish the applicability of this strategy to other patient groups, such as those in a medical ICU and in general hospital care.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intrahospital transport of critically ill patients using ventilator with patient-triggering function.
To compare a new transport ventilator to manual ventilation in terms of maintaining the respiratory and hemodynamic levels of critically ill patients. ⋯ The transport ventilator that was recently approved by the US Food and Drug Administration reliably provides more stable ventilatory support than does manual ventilation. Generally, the use of this transport ventilator for intrahospital transport is preferable to manual ventilation.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Efficacy of recombinant human erythropoietin in critically ill patients: a randomized controlled trial.
Anemia is common in critically ill patients and results in a large number of red blood cell (RBC) transfusions. Recent data have raised the concern that RBC transfusions may be associated with worse clinical outcomes in some patients. ⋯ In critically ill patients, weekly administration of 40 000 units of rHuEPO reduces allogeneic RBC transfusion and increases hemoglobin. Further study is needed to determine whether this reduction in RBC transfusion results in improved clinical outcomes.