Critical Care Alert – July 1, 2004

July 1, 2004

• Should NPPV Be Used in Extubation Failure?

  In this randomized, controlled trial, when patients developed recurrent respiratory failure following extubation, the use of noninvasive ventilation delayed but did not prevent reintubation, and this delay was associated with a higher mortality rate in the ICU.

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• Hyperoxia Ineffective in Preventing Surgical Site Infections

  Patients who received hyperoxia during general surgery had an increase in surgical site infections compared to those who received a lower oxygen concentration.

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• Urokinase, Alteplase, or Reteplase for DVT Thrombolysis?

  This retrospective study determined that catheter-directed thrombolysis was equally effective and safe whether urokinase, alteplase, or reteplase was used, but that costs were substantially less with the newer recombinant drugs.

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• Special Feature: What is the Standard of Care for Mechanical Ventilation?

  The gold standard in the era of EBM is the randomized controlled trial (RCT). A properly designed and carried out RCT, in patients similar to those the practitioner manages and using end points relevant to both practitioner and patient, is more likely to be free from bias and to produce results that will stand up over time than other types of investigation such as retrospective analyses, case-control studies, and unsystematic clinical observations.

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• Pharmacology Watch: Britain to Allow Over-the-Counter Sales of Zocor

  FDA Rejects Plan B Bid; Recombinant Erythropoietin Products May Stimulate Tumor Growth; Rosuvastatin: Markets Most Potent Statin; FDA Actions.

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• Clinical Briefs in Primary Care supplement

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