Articles: critical-illness.
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Am. J. Respir. Crit. Care Med. · Oct 2002
Randomized Controlled Trial Multicenter Study Clinical TrialInfluence of combined intravenous and topical antibiotic prophylaxis on the incidence of infections, organ dysfunctions, and mortality in critically ill surgical patients: a prospective, stratified, randomized, double-blind, placebo-controlled clinical trial.
We prospectively studied the impact of an antibiotic prophylaxis regimen on the incidence of infections, organ dysfunctions, and mortality in a predominantly surgical and trauma intensive care unit (ICU) population. A total of 546 patients were enrolled and stratified according to Acute Physiology and Chronic Health Evaluation (APACHE)-II scores. They were then randomized to receive either 2 x 400 mg of intravenous ciprofloxacin for 4 days, together with a mixture of topical gentamicin and polymyxin applied to the nostrils, mouth, and stomach throughout their ICU stay or to receive intravenous and topical placebo. ⋯ Within 5 days after admission, 24 patients died in each group, whereas 28 patients receiving prophylaxis and 51 receiving placebo died in the ICU thereafter (p = 0.0589; RR, 0.640; 95% CI, 0.402-1.017). The overall ICU mortality was not statistically different (52 versus 75 fatalities), but the mortality was significantly reduced for 237 patients of the midrange stratum with APACHE-II scores of 20-29 on admission (20 versus 38 fatalities, p = 0.0147; RR, 0.508; 95% CI, 0.295-0.875); there was still a favorable trend after 1 year (51 versus 60 fatalities; p = 0.0844; RR, 0.720; 95% CI, 0.496-1.046). Surveillance cultures from tracheobronchial, oropharyngeal, and gastric secretions and from rectal swabs did not show any evidence for the selection of resistant microorganisms in the patients receiving prophylaxis.
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Rev Esp Anestesiol Reanim · Oct 2002
Randomized Controlled Trial Comparative Study Clinical Trial[Metamizol versus propacetamol: comparative study of the hemodynamic and antipyretic effects in critically ill patients].
To compare the antipyretic and hemodynamic effects of metamizol and propacetamol in critically ill patients with fever. ⋯ Both metamizol and propacetamol are effective antipyretics at the doses tested. However, both have adverse hemodynamic side effects that may be poorly tolerated by critically patients.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Effect of a glutamine-enriched enteral diet on intestinal permeability and infectious morbidity at 28 days in critically ill patients with systemic inflammatory response syndrome: a randomized, single-blind, prospective, multicenter study.
We investigated the effect of a glutamine-enriched enteral diet on intestinal permeability and infectious morbidity and mortality in critically ill patients who developed systemic inflammatory response syndrome after an acute event. Eleven intensive care units in tertiary-care hospitals participated in a prospective, randomized, single blind, multicenter trial. Eighty-four patients with systemic inflammatory response syndrome of any etiology were randomly allocated to receive a glutamine-enriched enteral diet or a control diet without glutamine. ⋯ There were no differences with respect to other infections, mortality, or length of stay. Intestinal permeability as assessed by the lactulose-mannitol test was unchanged in both groups. Glutamine-enriched enteral diets can decrease nosocomial infections in patients with systemic inflammatory response syndrome.
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Jpen Parenter Enter · May 2002
Randomized Controlled Trial Clinical TrialContinuation of transpyloric feeding during weaning of mechanical ventilation and tracheal extubation in children: a randomized controlled trial.
Nutrition support is essential in the management of critically ill children. There is no current literature to support the common practice of discontinuing enteral nutrition delivered through a transpyloric feeding tube during the tracheal extubation process. We conducted a prospective, randomized controlled trial in mechanically ventilated children to examine the safety and efficacy of continuous transpyloric feeding compared with interrupted transpyloric feeding at the time of tracheal extubation. ⋯ Continuous transpyloric feeding during weaning from the ventilator and tracheal extubation is safe and results in the delivery of more optimal nutrition.
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Critical care medicine · Apr 2002
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialMulticenter, prospective, randomized, single-blind study comparing the efficacy and gastrointestinal complications of early jejunal feeding with early gastric feeding in critically ill patients.
To compare the incidence of enteral nutrition-related gastrointestinal complications, the efficacy of diet administration, and the incidence of nosocomial pneumonia in patients fed in the stomach or in the jejunum. ⋯ Gastrointestinal complications are less frequent in ICU patients fed in the jejunum. Nevertheless, it seems to be a necessary learning curve to achieve better results with a postpyloric access. Early enteral nutrition using a nasojejunal route seems not to be an efficacious measure to decrease nosocomial pneumonia in critically ill patients.