Showing papers in "Critical Care Medicine in 1994"
TL;DR: Cardiac arrests on the general wards of the hospital are commonly preceded by premonitory signs and symptoms, and strategies to prevent cardiac arrest should include training for nurses and physicians that concentrates on cardiopulmonary stabilization and how to respond to neurologic and respiratory deterioration.
Abstract: ObjectivesTo determine: a) the frequency of premonitory signs and symptoms before cardiac arrest in patients on the general medical wards of a hospital; b) any characteristic patterns in nurse and physician responses to these signs and symptoms; and c) whether cardiac arrests on the ward occur more
644 citations
TL;DR: To evaluate the outcome in patients with severe adult respiratory distress syndrome managed with limitation of peak inspiratory pressure to 30 to 40 cm H2O, low tidal volumes, spontaneous breathing using synchronized intermittent mandatory ventilation from the start.
Abstract: Objectives:To evaluate the outcome in patients with severe adult respiratory distress syndrome (ARDS) managed with limitation of peak inspiratory pressure to 30 to 40 cm H2O, low tidal volumes (4 to 7 mL/kg), spontaneous breathing using synchronized intermittent mandatory ventilation from the start
605 citations
TL;DR: This initial evaluation suggests that human recombinant IL‐lra is safe and may provide a dose‐related survival advantage to patients with sepsis syndrome.
Abstract: Objectives:To evaluate the safety, pharmacokinetics, and efficacy of human recombinant interleukin-1 receptor antagonist (IL-lra) in the treatment of patients with sepsis syndrome.Design:Prospective, open-label, placebo-controlled, phase II, multicenter clinical trial using three different doses of
479 citations
TL;DR: Over 94% of alarm soundings in a pediatric ICU may not be clinically important, suggesting present monitoring systems are poor predictors of untoward events.
Abstract: OBJECTIVE To determine the predictive value of patient monitoring alarms as a warning system in a pediatric intensive care unit (ICU). DESIGN Prospective, observational study. SETTING Pediatric ICU of a university affiliated children's hospital. INTERVENTIONS During a 7-day period, ICU staff were asked to record the type and number of alarm soundings. Alarms were recorded as false, significant (resulted in change in therapy), or induced (by staff manipulations; not significant). MEASUREMENTS AND MAIN RESULTS Sixty-six percent of nursing shifts (928 patient hours of care) responded. There were 2,176 alarms soundings: 1,481 (68%) false, 119 (5.5%) significant, and 576 (26.5%) induced. Alarm origins were: 44% pulse oximeter, 1% end-tidal PCO2, 31% ventilator, and 24% electrocardiograph (EKG). The positive predictive value of alarms were: 7% pulse oximeter, 16% end-tidal PCO2, 3% ventilator, and 5% EKG. The negative predictive value of all alarms were > 97%. More alarms sounded during the 7:00 am to 3:00 pm shift than during the 3:00 pm to 11:00 pm or 11:00 pm to 7:00 am shifts (167 +/- 19 vs. 64 +/- 39 vs. 75 +/- 43, p < .05, respectively). When corrected for number of patients/shift, the occurrence of soundings differed only between day and night (11.4 +/- 1.5/patient/shift vs. 6.1 +/- 1.0, p < .05). CONCLUSIONS Over 94% of alarm soundings in a pediatric ICU may not be clinically important. Present monitoring systems are poor predictors of untoward events.
438 citations
TL;DR: The results indicate that high‐frequency oscillatory ventilation, utilizing an aggressive volume recruitment strategy, results in significant improvement in oxygenation compared with a conventional ventilatory strategy designed to limit increases in peak airway pressures.
Abstract: Objective:To compare the effectiveness of high-frequency oscillatory ventilation with conventional mechanical ventilation in pediatric patients with respiratory failure.Setting:Five tertiary care pediatric intensive care units.Design:A prospective, randomized, clinical study with crossover.Patients:
411 citations
TL;DR: These data suggest that thermal pretreatment, associated with the synthesis of heat shock proteins, reduces organ damage and enhances animal survival in experimental sepsis-induced acute lung injury.
Abstract: ObjectiveTo test the hypothesis that induction of heat shock proteins before the onset of sepsis could prevent or reduce organ injury and death in a rat model of intra-abdominal sepsis and sepsis-induced acute lung injury produced by cecal ligation and perforationDesignProspective, blind, randomize
327 citations
TL;DR: The mortality rate was significantly lower for patients in groups who reached supranormal values of Do2I whether treated or self-generated as compared with patients who reached normal Do2i values, and there was no statistical differences between the two groups in mortality, development of organ failure, ICU days, and hospital days.
Abstract: Objective To determine the effects of optimizing oxygen delivery (DO2) to "supranormal" levels on morbidity and mortality in patients with sepsis, septic shock, and adult respiratory distress syndrome. Design A prospective, randomized, controlled trial. Setting A 16-bed surgical intensive care unit (ICU) and 14-bed mixed medical/surgical ICU in two separate hospitals in the University of Hawaii Surgical and Internal Medicine Residency programs. Patients During a 1-yr period, 67 patients who had pulmonary artery catheters and who met the criteria for sepsis or septic shock, adult respiratory distress syndrome, or hypovolemic shock were enrolled in the study. Patients admitted to the ICU who were Interventions Patients were randomized into treatment and control groups. The treatment group was assigned a therapeutic DO2 indexed (DO2I) goal of > 600 mL/min/m2. Interventions to attain this goal included fluid boluses, administration of blood products, and the use of inotropes. The control group was not assigned to a specific therapeutic goal other than "normal" values of DO2I of 450 to 550 mL/min/m2. Every attempt was made to reach the therapeutic goals within the first 24 hrs after entry into the study. Hemodynamic measurements were obtained on study patients every 4 hrs until the end of the study. The severity of illness was evaluated using the Therapeutic Intervention Scoring System, and the Acute Physiology and Chronic Health Evaluation II scoring system. Measurements and main results There were 32 patients in the control group and 35 patients in the treatment group. The groups were similar in age, sex, number of organ dysfunctions, Acute Physiology and Chronic Health Evaluation II and Therapeutic Intervention scores. There were no statistical differences between the two groups in mortality, development of organ failure, ICU days, and hospital days. Upon analysis, it became apparent that the patients comprised clinically distinct subgroups, including: a) a treatment group who achieved supranormal DO2I; b) a control group with normal DO2I; c) a treatment group who failed to reach target DO2I; d) a control group who self-generated to high DO2I values; and e) a small number of patients who could not even reach a normal DO2I of 450 mL/min/m2. These subgroups were found to be similar and matched. The mortality rate was significantly lower for patients in groups who reached supranormal values of DO2I whether treated or self-generated as compared with patients who reached normal DO2I values (14% vs. 56%, p = .01). Conclusions Although there was no statistically significant difference in the control vs. treatment groups, subgroup analysis demonstrated a strong, significant difference between patients with supranormal values of oxygen transport vs. patients with normal levels of DO2. Supranormal values of DO2I, whether self-generated or as a result of treatment, resulted in a statistically significant decrease in mortality rate. This study adds to the weight of evidence that current standard of care of treating critically ill patients to normal DO2I should be reconsidered, and that maximizing to high DO2I might be a more appropriate therapeutic end-point.
319 citations
TL;DR: Patients who failed nasal mechanical ventilation appeared to have a greater severity of illness; they were unable to minimize the amount of mouth leak (because of lack of teeth, secretions, or breathing pattern) and were able to coordinate with the ventilator.
Abstract: OBJECTIVES To evaluate the efficacy of nasal mechanical ventilation in patients with chronic obstructive pulmonary disease and hypercapnic respiratory failure and to identify predictors of success or failure of nasal mechanical ventilation. DESIGN Prospective case series. SETTING Medical intensive care unit in Veterans Administration Medical Center. PATIENTS Twelve chronic obstructive pulmonary disease patients treated during 14 episodes of hypercapnic respiratory failure. INTERVENTIONS Nasal mechanical ventilation in addition to conventional therapy to treat hypercapnic respiratory failure. Patients underwent nasal mechanical ventilation for at least 30 mins, or longer if the therapy was tolerated. Responses to therapy and arterial blood gases were monitored. MEASUREMENTS AND MAIN RESULTS Half of the episodes were successfully treated with nasal mechanical ventilation. There were no differences in age, prior pulmonary function, baseline arterial blood gases, admission arterial blood gases, or respiratory rate between those patients successfully treated and those patients who failed nasal mechanical ventilation. Unsuccessfully treated patients appeared to have a greater severity of illness than successfully treated patients, as indicated by a higher Acute Physiology and Chronic Health Evaluation II score (mean 21 +/- 4 [SD] vs. 15 +/- 4; p = .02). Unsuccessfully treated patients were edentulous, had pneumonia or excess secretions, and had pursed-lip breathing, factors that prevented adequate mouth seal and contributed to greater mouth leaks than in successfully treated patients (the mean volume of the mouth leak was 314 +/- 107 vs. 100 +/- 70 mL; p < .01). Successfully treated patients were able to adapt more rapidly to the nasal mask and ventilator, with greater and more rapid reduction in PaCO2, correction of pH, and reduction in respiratory rate. CONCLUSIONS Patients who failed nasal mechanical ventilation appeared to have a greater severity of illness; they were unable to minimize the amount of mouth leak (because of lack of teeth, secretions, or breathing pattern) and were unable to coordinate with the ventilator. These features may allow identification of poor candidates for nasal mechanical ventilation, avoiding unnecessary delays in endotracheal intubation and mechanical ventilation.
265 citations
TL;DR: Continuous infusion of haloperidol effectively controls severe agitation in critically ill patients, reduces requirements for bolus administration of sedatives and nursing time lost to that task, and may facilitate ventilator weaning.
Abstract: ObjectiveTo evaluate the safety and efficacy of continuous infusion of haloperidol in treating agitated critically ill adult patients.DesignCase series of patients treated with continuous infusion of haloperidol and followed to hospital discharge, during a 6-month period.SettingA 34-bed multidiscipl
255 citations
TL;DR: The studied platelet‐activating factor receptor antagonist (BN 52021) seems to be a safe and promising treatment for patients with severe Gram‐negative sepsis.
Abstract: Objective:To evaluate the safety and efficacy of a natural platelet-activating factor receptor antagonist, BN 52021 (Ginkgolide B), in the treatment of patients with sepsis syndrome.Design:Prospective, randomized, placebocontrolled, double-blind, phase III, multicenter clinical trial.Setting:Twenty-
254 citations
TL;DR: Continuous infusions of fentanyl produce a high occurrence rate of narcotic withdrawal when administered to critically ill children, and this effect is both dose- and duration-dependent.
Abstract: Objective To determine the occurrence of narcotic withdrawal in critically ill children who receive continuous infusions of fentanyl. Design Prospective case series. Setting A university hospital pediatric intensive care unit. Patients Twenty-three children, aged 1 wk to 22 months (mean 6 months), who required assisted mechanical ventilation and who received continuous infusions of fentanyl for > 24 hrs. Interventions None. Measurements and main results Total fentanyl dose received, length of infusion, and peak infusion rate were recorded. Patients were evaluated for narcotic withdrawal by the Neonatal Abstinence Scoring System of Finnegan. Children with scores of > or = 8 were considered to have narcotic withdrawal. Withdrawal was observed in 13 (57%) of 23 infants. Total fentanyl dose (2.96 +/- 4.10 vs. 0.53 +/- 0.37 mg/kg, p 2.5 mg/kg or a duration of infusion of > 9 days was 100% predictive of withdrawal. Conclusions Continuous infusions of fentanyl produce a high occurrence rate of narcotic withdrawal when administered to critically ill children. This effect is both dose- and duration-dependent.
TL;DR: In septic patients, high amounts of circulating IL-8 concentrations correlate with fatal outcome, whereas only low plasma concentrations of IL-9 are present in patients with nonseptic, multiple organ failure, which suggests that the signals involved in the exacerbation ofIL-8 production are different, depending on infectious or noninfectious etiology.
Abstract: Objectives: Interleukin (IL)-8, a pro-inflammatory cytokine, is a potent chemoattractant factor and an activator of neutrophils produced by many cell types after stimulation by IL-1, tumor necrosis factor (TNF), or microbial products such as endotoxins. We investigated whether the presence of measurable IL-8 in plasma was associated with the clinical status of severely ill septic or nonseptic patients susceptible to the development of multiple organ failure. Design: Cohort study. Setting: A collaborative study between an intensive care unit and a research laboratory. Subjects: Circulating IL-8 concentrations were measured in the plasma of 27 patients with sepsis syndrome and in 16 patients with noninfectious shock because these two conditions put patients at risk for the development of multiple organ failure
TL;DR: It is suggested that oxygen utilization within skeletal muscle decreased with deterioration of sepsis, thereby increasing skeletal muscle Po2.
Abstract: Objective: In order to obtain direct evidence for tissue hyposa in patients with sepsis oxygen, partial pressure was measured within skeletal muscle. Furthermore, serial intermittent and continuous measurements of skeletal muscle Po 2 in patients with sepsis were used to find out whether skeletal muscle oxygenation may change in the course of sepsis and depends on the severity of sepsis. Design. Prospective study. Setting: Intensive care unit of a university hospital. Patients: Intensive care patients (n=98) with sepsis (group 1, n=39; group 4, n=28), limited infection (group 2, n=16), and cardiogenic shock (group 3, n=15). Interventions: Pulmonary artery catheterization; standard antibiotic therapy and volume replacement
TL;DR: Until customized Health Care Financing Administration analyses become available, nationwide ICU costs are best determined by the Russell equation, and Department of Veterans Affairs' ICUs have a consistent cost advantage over nationwide ICUs.
Abstract: Objectives:To establish Department of Veterans Affairs' intensive care unit (ICU) costs from a database and to use this information to validate the Russell equation, the most commonly used method of calculating ICU costs. To compare and trend Department of Veterans Affairs' and nationwide (USA) ICU
TL;DR: This is the first published study to compare two models of pediatric transport using identical definitions of severity and morbidity, and concludes that specialized pediatric teams can reduce transport morbidity.
Abstract: OBJECTIVE We prospectively compared the occurrence of morbidity during high-risk interhospital transport in two types of transport systems: specialized tertiary center-based vs. nonspecialized, referring hospital-based. DESIGN Concurrent, prospective comparison of morbidity at two pediatric centers that use different types of transport team. SETTING Two tertiary care pediatric intensive care units (ICU). The specialized team consisted of a pediatric resident, pediatric intensive care nurse, and a pediatric respiratory therapist. Comparison was made with referring institution transports by nonspecialized personnel to a second center. The two centers were similar in size and patient mix, with referral areas of similar population and rural/urban ratio. PATIENTS One hundred forty-one patients transported to two tertiary pediatric ICUs. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Two types of events were assessed: vital signs and other observable clinical events were described as "physiologic deteriorations." Events such as loss of intravenous access, endotracheal tube mishaps, and exhaustion of oxygen supply were described as "intensive care-related adverse events." Pretransport severity of illness and therapy were described by Pediatric Risk of Mortality (PRISM) and Therapeutic Intervention Scoring System (TISS) scores. Only high-risk patients with PRISM scores of > or = 10 were analyzed. Intensive care-related adverse events occurred in one (2%) of 49 transports by the specialized team and 18 (20%) of 92 transports by nonspecialized personnel. The difference is statistically significant (p < .05). Physiologic deterioration was similar in the two groups occurring in five (11%) of 47 specialized team transports and 11 (12%) of 92 transports by the nonspecialized team. CONCLUSION We conclude that specialized pediatric teams can reduce transport morbidity. This is the first published study to compare two models of pediatric transport using identical definitions of severity and morbidity.
TL;DR: Cross-indexing of clinical and economic ICU performance is easy to calculate and has potential as a research and evaluation tool used by physicians, hospital administrators, payers, and others.
Abstract: ObjectivesTo present an approach for assessing intensive care unit (ICU) performance which takes into account both economic and clinical performance while adjusting for severity of illness. To present a graphic display which permits comparisons among a group of hospitals.DesignA multicenter, incepti
TL;DR: Equations using initial and repeated physiologic measurements provide a high degree of explanatory power for subsequent hospital mortality rate and deserve evaluation for their potential role in improving the process and outcome from clinical decision-making.
Abstract: ObjectiveTo develop daily prognostic estimates for individual patients treated in adult intensive care units (ICU).DesignProspective, multicenter, inception cohort analysis.SettingForty-two ICUs at 40 U.S. hospitals with >200 beds including 20 ICUs in tertiary care centers with major teaching activi
TL;DR: Nosocomial infection increases the risk of death in nosocomially infected patients, and the effect is stronger in younger and less severely ill patients.
Abstract: Objective: To assess the impact of nosocomial infection on the mortality rate in an intensive care unit (ICU) Design: Prospective cohort study Setting: The ICU of the University of Granada Hospital in Spain Patients: All patients (n=279) admitted for ≥48 hrs at the ICU between December 1986 and April 1988 Measurements: Nosocomial infections were diagnosed according to Study on the Efficacy of Nosocomial Infection Control (SENIC) and Centers for Disease Control criteria Patient severity on admission (using Acute Physiology and Chronic Health Evaluation (APACHE II) and Therapeutic Intensity Scoring Systems were also used Results: Mortality risk was 248 times higher in patients with a nosocomial infection than in noninfected patients Relative risk of mortality in nosocomially infected patients was higher in young and less severely ill patients, in those patients with respiratory diseases, and in those patients with longer ICU stays Logistic stepwise regression analysis, adjusting for several confounding factors (affected organ system, APACHE II score, and therapeutic intensity), showed that the risk of death in nosocomially infected patients was 21 times greater (95% confidence interval = 10 to 441) than in patients without such infection Conclusions: Nosocomial infection increases the risk of death The effect is stronger in younger and less severely ill patients (Crit Care Med 1994; 22:55-60)
TL;DR: Prompted by assessment of pulmonary artery catheter measurements in patients with circulatory shock who were unresponsive to standard therapeutic measures, a change in therapy for these patients was associated with an improved prognosis, independent of other variables influencing outcome.
Abstract: Objective: To evaluate physician accuracy in predicting patients' hemodynamic profiles, associated morbidities, rates of change in therapy resulting from catheterization, and the outcome variations associated with such change before the insertion of a pulmonary artery catheter. Design: Prospective, descriptive, cohort study with no interventions. Setting: Medical intensive care unit (ICU) of a university hospital. Patients: One hundred twelve catheterizations performed in 112 patients without acute myocardial infarction. In 43 cases, catheterizations were indicated because of circulatory shock that was responsive to two standard therapeutic measures
TL;DR: The mortality rate associated with multiple organ system failure in pediatric patients is high and the maximum number of simultaneous organ system failures during pediatric ICU stay, age ≤12 months, and the PRISM score on the day of admission are independent risk markers of death.
Abstract: ObjectivesTo describe the timing of onset of organ system failure, multiple organ system failure diagnosis, and the subsequent death in children admitted to a pediatric intensive care unit (ICU). Second, to identify independent risk markers of death in pediatric patients with multiple organ system f
TL;DR: Models developed for use among ICU patients at one time period are not transferable without modification to other time periods, and they are intended for use at specific points in time.
Abstract: ObjectiveTo develop models in the Mortality Probability Model (MPM II) system to estimate the probability of hospital mortality at 48 and 72 hrs in the intensive care unit (ICU), and to test whether the 24-hr Mortality Probability Model (MPM24), developed for use at 24 hrs in the ICU, can be used on
TL;DR: It is concluded that mechanical ventilation via face mask offers an effective, comfortable, and dignified method of supporting patients with end‐stage disease and acute respiratory failure.
Abstract: OBJECTIVE To evaluate the response to noninvasive ventilation in a group of terminally ill patients with acute respiratory failure who refused endotracheal intubation. DESIGN Case series. SETTING Medical intensive care units (ICUs) in a university health science center. PATIENTS Eleven patients, nine with hypercapnic and two with hypoxemic acute respiratory failure. Mean age of patients was 64 yrs. INTERVENTION Mechanical ventilation was delivered via a face mask. The initial ventilatory setting was continuous positive airway pressure mode, with pressure-support ventilation of 10 to 20 cm H2O, titrated to achieve a respiratory rate of < 25 breaths/min and a tidal volume of 5 to 7 mL/kg. Ventilatory settings were adjusted based on results of arterial blood gases. Mean duration of mechanical ventilation was 44 hrs. MEASUREMENTS AND MAIN RESULTS Mechanical ventilation via face mask was effective in correcting gas exchange abnormalities in seven of 11 patients, all of whom survived and were discharged from the ICU. Four patients with hypercapnic acute respiratory failure died. Mechanical ventilation via face mask was effective in improving respiratory acidosis in three patients and had no effect in one patient. Two of the four patients could not be weaned from mechanical ventilation and opted for discontinuation of this method. Removal of the ventilator while retaining the mask for oxygen supplementation was a nontraumatic experience to the patient and family. Even when respiratory failure did not resolve, mechanical ventilation via face mask was effective in lessening dyspnea and allowed the patient to maintain autonomy and continuous verbal communication. CONCLUSIONS We conclude that mechanical ventilation via face mask offers an effective, comfortable, and dignified method of supporting patients with end-stage disease and acute respiratory failure.
TL;DR: Inhaled nitric oxide can be administered precisely and reliably through a variety of delivery systems which can be used in patients of any size, and potential toxicity requires careful monitoring and continued improvement on apparatus design.
Abstract: ObjectiveThe development of a safe, portable, accurate, and adaptable system to deliver nitric oxide to patients with pulmonary hypertension.DesignA prospective, clinical study.SettingTertiary care pediatric intensive care unit and cardiac catheterization laboratory.PatientsOne hundred twenty-three
TL;DR: Gastroduodenal motility is severely impaired in this group of mechanically ventilated patients and the loss of peristaltic activity in the stomach and in the duodenum is consistent with an important role for motility disorders in the occurrence of digestive microbial overgrowth in such patients.
Abstract: OBJECTIVE: To determine the main characteristics of gastroduodenal motility in mechanically ventilated, critically ill patients. DESIGN: Case series; comparison with a parallel control group. SETTING: Intensive care unit in a university teaching hospital. PATIENTS: Twelve adult critically ill patients who required > 2 days of mechanical ventilation as a consequence of neurologic or respiratory disease. Control sample of 12 overnight, fasting, healthy volunteers. MEASUREMENTS AND MAIN RESULTS: Pressure changes in the gastric antrum, proximal duodenum, and distal duodenum were simultaneously recorded during a 4-hr period by a multilumen tube (perfused catheter technique). The migrating motor complex and its three successive phases were identified according to usual definitions (phase 1, period of quiescence; phase 2, period of irregular contractile activity; phase 3 or activity front, period of high-frequency, regular contractions). Contractions and activity fronts at each site were quantified. The mean duration of the migrating motor complex was determined in the duodenum, as well as the contribution of each phase (phases 1, 2, 3) to the length of the complete cycle. The propagation characteristics of each activity front were assessed visually. In the patients, the number of contractions was markedly decreased in the antrum, where activity fronts were totally absent. In the duodenum (proximal and distal), the number of contractions and the occurrence of activity fronts were comparable in both groups. Although the duration of the duodenal migrating motor complex was similar in the two groups, the relative contribution of the quiescence period (phase 1) to the total cycle length increased and the contribution of phase 2 decreased in the patients. Three patients exhibited abnormally propagated (retrograde or stationary) activity fronts in the duodenum. CONCLUSIONS: Gastroduodenal motility is severely impaired in this group of mechanically ventilated patients. Activity fronts of the migrating motor complex never originated in the stomach, which was hypokinetic; qualitative disorders of the migrating motor complex were present in the duodenum. The loss of peristaltic activity in the stomach and, to a lesser degree, in the duodenum is consistent with an important role for motility disorders in the occurrence of digestive microbial overgrowth in such patients.
TL;DR: Whether early invasive monitoring is necessary in young trauma patients at an inner-city, Level I trauma center and whether a normal serum lactate concentration and a state of nonflow-dependent oxygen consumption are achieved is investigated.
Abstract: Objective: To determine whether early invasive monitoring is necessary in young trauma patients. Design: A prospective study. Setting: Surgical intensive care unit (ICU) at an inner-city, Level I trauma center. Patients: Thirty-nine patients 6 units of intraoperative blood. Interventions: Invasive hemodynamic monitoring, with percutaneous insertion of arterial and pulmonary artery catheters. Vital signs, hemodynamic and oxygen transport values, and laboratory tests were obtained at 1, 8, and 24 hrs postoperatively. Oxygen delivery was increased until a normal serum lactate concentration and a state of nonflow-dependent oxygen consumption were achieved
TL;DR: Most animals in the high-dose epinephrine group exhibited a hyperadrenergic state that included severe hypertension and tachycardia immediately postresuscitation, which resulted in a greater early mortality rate.
Abstract: To determine whether high-dose epinephrine (0.2 mg/kg) during cardiopulmonary resuscitation (CPR) results in improved outcome, compared with standard-dose epinephrine (0.02 mg/kg).
A prospective, randomized, blinded study.
Research laboratory of a university medical center.
Thirty domestic swine were randomized to receive standard- or high-dose epinephrine during CPR after 15 mins of fibrillatory cardiac arrest. Three minutes of CPR were provided, followed by advanced cardiac life support per American Heart Association guidelines. Animals that were successfully resuscitated were supported for 2 hrs in an intensice care unit (ICU) setting, and then observed for 24 hrs.
Electrocardiogram, aortic blood pressure, right atrial blood pressure, and end-tidal CO2 were monitored continuously until the intensice care period ended. Survival and neurologic outcome were determined.
Return of spontaneous circulation was attained in 14 of 15 animals in each group. Four of 14 high-dose epinephrine pigs died during the ICU period after return of spontaneous circulation vs. zero of the 14 standard-dose pigs (p < .05). Six standard-dose pigs survived 24 hrs vs. four high-dose pigs. Twenty-four-hour survival rate and neurologic outcome were not significantly different.
Within 10 mins of defibrillation, severe hypertension (diastolic pressure >120 mm Hg) occurred in 12 of 14 high-dose pigs vs. two of 14 standard-dose pigs (p 250 beats/min) occurred in seven of 14 high-dose pigs vs. zero of 14 standard-dose pigs (p < .01). All four high-dose epinephrine pigs that died during the ICU period experienced both severe hypertension and tachycardia immediately postresuscitation.
High-dose epinephrine did not improve 24-hr survival rate or neurologic outcome. Immediately after return of spontaneous circulation, most animals in the high-dose epinephrine group exhibited a hyperadrenergic state that included severe hypertension and tachycardia. High-dose epinephrine resulted in a greater early mortality rate. (Crit Care Med 1994; 22:282–290)
TL;DR: The new bioimpedance system satisfactorily estimated cardiac output as measured by the thermodilution technique, and the difference between the two estimations is more than made up for by the continuous noninvasive capability of the impedance system.
Abstract: Objective:To evaluate the capacity of a new thoracic electric bioimpedance system to estimate cardiac output compared with the conventional thermodilution methodDesign:Prospective, multicenter studySetting:A university-run county hospital, a university-run US Veterans Affairs hospital, and a uni
TL;DR: The closed suction method resulted in significantly fewer physiologic disturbances and appears to be an effective and cost-efficient method of endotracheal suctioning that is associated with fewer suction-induced complications.
Abstract: Objective: To examine the physiologic consequences and costs associated with two methods of endotracheal suctioning: closed vs. open. Design: A prospective, randomized, controlled study. Setting: An eight-bed trauma intensive care unit (ICU) in a 460-bed level I trauma center. Patients: The study included 35 trauma/general surgery patients (16 in the open suction group, 19 in the closed suction group) who were treated with a total of 276 suctioning procedures (127 open, 149 closed). Measurements and Main Results: Physiologic data collected after hyperoxygenation, immediately after suctioning, and 30 secs after suctioning, were compared with baseline values. Open endotracheal suctioning resulted in significant increases in mean arterial pressure throughout the suctioning procedure
Journal Article•
TL;DR: Pressure‐limited ventilation can be used safely and is well tolerated as an initial mode of ventilatory support in patients with acute hypoxic respiratory failure and may have a beneficial role when used as the primary ventilatories modality in patientswith this clinical condition.
Abstract: Objective:Volume-controlled ventilation is frequently chosen as the initial mode of ventilatory support in patients with hypoxic respiratory failure Recent data, however, suggest that pressure-limited ventilation, using a rapidly decelerating flow delivery pattern, may produce a more desirable clin