Abstract:
OBJECTIVES:To determine if vecuronium doses individualized by peripheral nerve stimulation are lower than those doses chosen by standard clinical techniques; and to determine whether patients monitored by peripheral nerve stimulation exhibit shorter recovery times and less prolonged neuromuscular blockade after discontinuation of vecuronium than control patients. DESIGN:A prospective, randomized, controlled, single-blind trial. SETTING:Two ten-bed medical intensive care units of a 937-bed tertiary care, not-for-profit, teaching hospital and health system. PATIENTS:Mechanically ventilated patients requiring continuous neuromuscular blockade as part of their therapy. INTERVENTIONS:After obtaining written, informed consent and baseline neurologic examinations, patients were randomized to treatment, where dosing was individualized by peripheral nerve stimulation or standard clinical assessment. Doses in the peripheral nerve stimulation group were adjusted to 90% blockade (Train-of-Four of 1/4). The standard clinical dosing group received doses individualized to clinical response by the medical team (blinded to Train-of-Four). Differences between groups were evaluated by Wilcoxon matched-pairs signed rank test. MEASUREMENTS AND MAIN RESULTS:A total of 77 patients (35 standard clinical patients vs. 42 peripheral nerve stimulation patients) were enrolled in the study. Despite no difference in initial doses and time to reach 90% blockade or clinical response between groups, the peripheral nerve stimulation group used less drug than the standard clinical group (0.040 +/- 0.028 vs. 0.070 +/- 0.030 mg/kg/hr, respectively, p = .001). The total cumulative amount of vecuronium for the episode of paralysis was greater in the control group (285.8 +/- 246.6 vs. 137.1 +/- 106.4 mg, p = .001). The peripheral nerve stimulation group recovered neuromuscular function (relative risk of 1.85, with 95% confidence interval [CI] of 1.02-3.35, p = .039) and spontaneous ventilation (relative risk of 1.86, 95% CI 1.00-3.45, p = .047) faster than the control group. In patients, adjusting for renal dysfunction, the likelihood of a faster recovery in the peripheral nerve stimulation group increased for neuromuscular function (relative risk of 1.89, 95% CI of 1.07-3.32, p = .018) and spontaneous ventilation (relative risk of 2.27, 95% CI of 1.23-4.21, p = .019). Patients with combined renal and liver failure similarly demonstrated a faster recovery in the peripheral nerve stimulation group. The recovery was affected to a lesser extent by adjusting for concurrent aminoglycoside and corticosteroid administration. CONCLUSIONS:Use of peripheral nerve stimulation for monitoring the degree of blockade and adjusting drug doses in continuously paralyzed critically ill medical patients results in lower doses of vecuronium to maintain a desired depth of paralysis, and allows a faster recovery of neuromuscular function and spontaneous ventilation.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Rudis MI,Sikora CA,Angus E,Peterson E,Popovich J Jr,Hyzy R,Zarowitz BJdoi
10.1097/00003246-199704000-00005subject
Has Abstractpub_date
1997-04-01 00:00:00pages
575-83issue
4eissn
0090-3493issn
1530-0293journal_volume
25pub_type
临床试验,杂志文章,随机对照试验abstract:OBJECTIVES:Monocytes and macrophages produce interleukin-1β by inflammasome activation which involves adenosine triphosphate release, pannexin-1 channels, and P2X7 receptors. However, interleukin-1β can also be produced in an inflammasome-independent fashion. Here we studied if this mechanism also involves adenosine tr...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003446
更新日期:2018-12-01 00:00:00
abstract:OBJECTIVE:The equipment, monitor alarms, and acuity of patients in ICUs make it one of the loudest patient care areas in a hospital. Increased sound levels may contribute to worsened outcomes in these particularly vulnerable patients. Our objective was to determine whether ambient sound levels in surgical ICUs comply w...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001378
更新日期:2016-01-01 00:00:00
abstract:OBJECTIVE:To study the epidemiology, style of management, and outcome of intensive care patients with acute renal failure requiring replacement therapy in Australia. DESIGN:Prospective epidemiologic study. SETTING:Australian adult intensive care units providing acute renal replacement therapy. PATIENTS:Adult intensi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200110000-00010
更新日期:2001-10-01 00:00:00
abstract:OBJECTIVE:To evaluate the use of the selective alpha 1-adrenergic receptor agonist phenylephrine in the hemodynamic support of patients with septic shock. DESIGN:Retrospective analysis of clinical use of phenylephrine. SETTING:Surgical ICU in a university hospital. PATIENTS:Thirteen patients with septic shock (diagn...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199111000-00016
更新日期:1991-11-01 00:00:00
abstract:OBJECTIVE:To review recent advances in the use of transforming growth factor (TGF)-beta in acute lung injury and to apply this knowledge to understanding the pathophysiology of this syndrome. DATA SOURCES AND STUDY SELECTION:Published research and review articles in the English language related to the role of TGF-beta...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000057901.92381.75
更新日期:2003-04-01 00:00:00
abstract:OBJECTIVE:To describe the current status and the clinical data related to the effects of tight glucose control by intensive insulin therapy in critically ill patients. DESIGN:Review article. SETTING:University hospital. PATIENTS:Medical and surgical critically ill patients in whom a correlation between blood glucose...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000278046.24345.C7
更新日期:2007-09-01 00:00:00
abstract:OBJECTIVES:In-hospital pediatric sepsis mortality has decreased substantially, but long-term mortality and morbidity among children initially surviving sepsis, is unknown. Accordingly, the Life After Pediatric Sepsis Evaluation investigation was conducted to describe the trajectory of mortality and health-related quali...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004123
更新日期:2020-03-01 00:00:00
abstract:OBJECTIVES:Swallowing disorders may be associated with adverse clinical outcomes in patients following invasive mechanical ventilation. We investigated the incidence of dysphagia, its time course, and association with clinically relevant outcomes in extubated critically ill patients. DESIGN:Prospective observational t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002765
更新日期:2017-12-01 00:00:00
abstract:OBJECTIVE:We investigated whether serum levels of neuron-specific enolase (NSE) and S-100beta protein could be used to evaluate cerebral injury and to predict outcome in severe sepsis and severe septic shock. DESIGN:Prospective study. SETTING:University hospital. PATIENTS AND MEASUREMENTS:In 170 consecutively enroll...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000217218.51381.49
更新日期:2006-07-01 00:00:00
abstract:OBJECTIVE:To describe the experience of pediatric intensive care hospitalization from the perspective of a parents of children with severe, antecedent disability. DESIGN:Qualitative analysis of data obtained through semistructured interviews. SETTING:Pediatric intensive care unit (PICU) in a children's hospital. SUB...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181a00578
更新日期:2009-06-01 00:00:00
abstract::We compared the blood culture results obtained either by venipuncture or through an arterial catheter in 51 critically ill patients with 217 clinically suspected episodes of bacteremia. During each episode, three blood culture samples, two arterial and one venous, were drawn within 1 h. One or more cultures were posit...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:
更新日期:1985-08-01 00:00:00
abstract:OBJECTIVE:To assess protective and risk factors for mortality among pediatric patients during initial care after hematopoietic stem cell transplantation (HSCT) and to evaluate changes in hospital mortality. DESIGN:Retrospective cohort using the 1997, 2000, and 2003 Kids Inpatient Database, a probabilistic sample of ch...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0B013E318161FAC1
更新日期:2008-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the in vivo production of prostacyclin and thromboxane A2 during the initial phase of experimental fat embolism as assessed, respectively, by determinations of urine 2,3-dinor-6-ketoprostaglandin F1alpha and 11-dehydrothromboxane B2 excretion. DESIGN:Randomized, controlled trial. SETTING:Animal ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199707000-00025
更新日期:1997-07-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to evaluate the long-term cardiopulmonary outcome at ages 10-15 yrs following neonatal extracorporeal membrane oxygenation (ECMO). The specific aims of the study were to assess baseline aerobic capacity, cardiac function, and pulmonary function in neonatal ECMO survivors using gr...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000084856.00372.CE
更新日期:2003-09-01 00:00:00
abstract:OBJECTIVE:To determine if exogenous interleukin (IL)-10 will decrease the morbidity or mortality of sepsis induced by cecal ligation and puncture. DESIGN:Prospective, randomized, controlled study. SETTING:University research laboratory. SUBJECTS:Adult, female, Balb¿c mice. INTERVENTIONS:Balb¿c mice were subjected t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199805000-00025
更新日期:1998-05-01 00:00:00
abstract:OBJECTIVE:To evaluate the accuracies of the respiratory rate/tidal volume ratio (rate/volume ratio), minute volume, and negative inspired force in predicting weaning outcome in postoperative mechanically ventilated patients. DESIGN:A prospective, observational study. SETTING:Surgical intensive care unit of a 270-bed ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199702000-00010
更新日期:1997-02-01 00:00:00
abstract:OBJECTIVE:To compare two forms of continuous renal replacement therapy, continuous venovenous hemofiltration (CVVH) vs. continuous venovenous hemodialysis (CVVHD), in terms of the removal of inflammatory mediators from the blood of patients with systemic inflammatory response syndrome and acute renal failure. DESIGN:R...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199812000-00027
更新日期:1998-12-01 00:00:00
abstract:BACKGROUND AND METHODS:To determine the effects of reduced cerebral perfusion pressures produced by hemorrhage alone or in combination with intracranial hypertension on thromboxane A2 (TxA2) production, we undertook a randomized study in 38 anesthetized, mongrel dogs. Animals were subjected to 30 mins of hemorrhagic sh...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199104000-00013
更新日期:1991-04-01 00:00:00
abstract:OBJECTIVE:To examine the effect of hypertonic saline on bacterial translocation and the number and function of natural killer and T cells in controlled hemorrhagic shock. DESIGN:Randomized controlled study. Duration of follow-up was 24 hrs. SETTING:University research laboratory. SUBJECTS:Adult male Sprague-Dawley r...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200204000-00025
更新日期:2002-04-01 00:00:00
abstract:OBJECTIVE:To determine whether a correlation exists between concentrations of intracellular and extracellular potassium and to determine the frequency of ventricular ectopy in patients after cardiac operations. DESIGN:Prospective, observational clinical evaluation. SETTING:Surgical-respiratory intensive care unit of ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199911000-00018
更新日期:1999-11-01 00:00:00
abstract:OBJECTIVE:Expert task forces have proposed that adult critical care medicine services should be regionalized in order to improve outcomes. However, it is currently unknown if high intensive care unit (ICU) patient volumes are associated with reduced mortality rate. The objective was to investigate whether high-volume I...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000226415.93237.84
更新日期:2006-07-01 00:00:00
abstract:OBJECTIVE:Our knowledge of the molecular mechanisms of sepsis has attained exponential growth. Yet, the pillars of its care remain antibiotics, fluid resuscitation, and physiologic support of failing organ systems. The inability to bring biologic breakthroughs to the bedside is not for lack of effort. Over 60 clinical ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0000000000003271
更新日期:2018-09-01 00:00:00
abstract:OBJECTIVES:A recent post hoc analysis suggested that driving pressure may be more important than traditional ventilatory variables in determining outcome in mechanically ventilated patients with acute respiratory distress syndrome. We conducted a systematic review and meta-analysis to summarize the risk of mortality fo...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析
doi:10.1097/CCM.0000000000002838
更新日期:2018-02-01 00:00:00
abstract:OBJECTIVE:Restoration of myocardial blood flow after ischemia triggers an inflammatory response involving toll-like receptors. Toll-like receptor 2 deficiency is associated with a reduced infarct size after myocardial ischemia and reperfusion. Because a marked mortality was observed in C3HeN wild-type mice, which was a...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181ef455b
更新日期:2010-10-01 00:00:00
abstract::In the development of triage and bypass protocols, many different scoring systems and triage criteria are being used. Our purpose was to evaluate the Revised Trauma Index (RTI) as a triage tool for both its severity prediction ability and triage accuracy. A total of 2,340 trauma admissions were evaluated using the RTI...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199002000-00010
更新日期:1990-02-01 00:00:00
abstract::Perfluorocarbon (PFC) emulsions are promising oxygen-carrying blood supplements for the treatment of shock and in organ preservation for transplantation. We used the isolated, blood-perfused, canine right lower lung lobe (RLL) to determine the effect of a PFC emulsion, Oxypherol (FC-43), upon lung fluid balance and he...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198512000-00006
更新日期:1985-12-01 00:00:00
abstract::Prolonged artificial ventilation may result in worsening gas exchange and pulmonary compliance in patients with otherwise normal lungs. Prolonged hyperinflations to 40 cm H2O can completely reverse deterioration of gas exchange and compliance in such patients. Similar efforts have effectively recruited atelectatic lun...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198712000-00001
更新日期:1987-12-01 00:00:00
abstract:OBJECTIVE:To improve control of blood glucose concentrations in critically ill patients through use of a bedside, nurse-managed, intravenous insulin nomogram. DESIGN:Retrospective, before-after cohort study. SETTING:Fifteen-bed mixed medical/surgical intensive care unit in a tertiary, teaching hospital. PATIENTS:A t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200109000-00010
更新日期:2001-09-01 00:00:00
abstract:OBJECTIVES:We examined recommendations within critical care guidelines to describe the pairing patterns for strength of recommendation and quality of evidence. We further identified recommendations where the reported strength of recommendation was strong while the reported quality of evidence was not high/moderate and ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003467
更新日期:2019-01-01 00:00:00
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 and healthcare costs...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:
更新日期:1994-12-01 00:00:00