Articles: critical-illness.
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Anaesth Intensive Care · Jun 2000
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialAn investigation of the early effects of manual lung hyperinflation in critically ill patients.
This prospective within-group multicentre study was designed to assess the safety and short-term effectiveness of manual lung hyperinflation in mechanically ventilated patients. Eighteen patients from the intensive care units of two tertiary institutions were included and acted as their own control. Manual lung hyperinflation treatment involved patient positioning (side-lying), suctioning and manual lung hyperinflation. ⋯ Manual lung hyperinflation treatment also cleared a significantly greater wet weight of sputum (P = 0.039). There were no differences between manual lung hyperinflation and side-lying treatment for gas exchange (PaO2/FIO2 and PaCO2), mean arterial pressure or heart rate. In conclusion, total static respiratory system compliance and sputum clearance were improved by the addition of manual hyperinflation to a physiotherapy treatment of positioning and suctioning in mechanically ventilated patients without compromise to cardiovascular stability or gas exchange.
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Randomized Controlled Trial Multicenter Study Clinical Trial
A multi-center trial of the effects of oral nutritional supplementation in critically ill older inpatients. GAGE Group. Groupe Aquitain Geriatrique d'Evaluation.
The purpose of this study was to assess the effect of nutritional supplementation on dietary intake and on pressure ulcer development in critically ill older patients. The multi-center trial involved 19 wards stratified according to specialty and recruitment for critically ill older patients; 9 wards were randomly selected for nutritional intervention (nutritional intervention group), consisting of the daily distribution of two oral supplements, with each supplement containg 200 kcal, for 15 d. Pressure ulcer incidence was prospectively recorded for grades I (erythema), II (superficial broken skin), and III (subcutaneous lesion) for 15 d. ⋯ Multivariate analysis, taking into account all diagnoses, potential risk factors, and the intra-ward correlation, indicated that the independent risk factors of developing a pressure ulcer during this period were: serum albumin level at baseline, for 1 g/L decrease: 1.05 (95% confidence interval: 1.02 to 1.07, P < 0.001); Kuntzmann score at baseline, for 1-point increase: 1.22 (0.32 to 4.58, P = 0.003); lower limb fracture: 2.68 (1.75 to 4.11, P < 0.001); Norton score < 10 versus > 14: 1.28 (1.01 to 1.62, P = 0.04); and belonging to the control group: 1.57 (1.03 to 2.38, P = 0.04). In conclusion, it was possible to increase the dietary intake of critically ill elderly subjects by systematic use of oral supplements. This intervention was associated with a decreased risk of pressure ulcer incidence.
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Multicenter Study
Intensive care nurses' experiences with end-of-life care.
With much attention being focused on how patients die and whether or not they are provided appropriate care, the care of dying patients in intensive care units must be described and improved. ⋯ Disagreement among patients' family members or among caregivers, uncertainty about prognosis, and communication problems further complicate end-of-life care in intensive care units. Changes in the physical environment, education about end-of-life care, staff support, and better communication would improve care of dying patients and their families.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Older age, aggressiveness of care, and survival for seriously ill, hospitalized adults. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments.
Older age is associated with less aggressive treatment and higher short-term mortality due to serious illness. It is not known whether less aggressive care contributes to this survival disadvantage in elderly persons. ⋯ We found a modest independent association between patient age and short-term survival of serious illness. This age effect was not explained by the current practice of providing less aggressive care to elderly patients.
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Critical care medicine · Nov 1999
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialEfficacy of recombinant human erythropoietin in the critically ill patient: a randomized, double-blind, placebo-controlled trial.
To determine whether the administration of recombinant human erythropoietin (rHuEPO) to critically ill patients in the intensive care unit (ICU) would reduce the number of red blood cell (RBC) transfusions required. ⋯ The administration of rHuEPO to critically ill patients is effective in raising their Hct concentrations and in reducing the total number of units of RBCs they require.