She also was noted to have high peak airway pressures (> 40 cm H 2O), a low end-tidal carbon dioxide level (approximately 22 mmHg), and Sp O 2around 95%. Prompt intubation, ventilation with oxygen at a fraction of inspired oxygen of 1.0 atm, and confirmation of tube placement, both by auscultation as well as by positive end-tidal carbon dioxide, did not succeed in restoring her Sp O 2to the preanesthesia level. ![]() Her systolic blood pressure also decreased to 90 mmHg from a preanesthesia value of 130/70 mmHg. ![]() After injection of induction agents but before insertion of an endotracheal tube, the pulse oximeter reported a near instantaneous decrease from 100% to approximately 75% (despite the administration of 100% oxygen). The medications included thiopental and succinylcholine. General anesthesia was induced using a rapid-sequence technique. The sequential device was turned on just before the induction of anesthesia with inflation pressures around 45 mmHg. A sequential compression device with long sleeves (Sequel model 6325 Kendall Company, Mansfield, MA) was applied to both legs as part of routine practice for any surgery lasting over 3 h. Because the incidence of DVT in the control group was lower than an expected 7%, this trial was underpowered to detect a difference if it truly exists.After fluid resuscitation and administration of antibiotics, the patient was taken to the operating room, where her initial vital signs and oxygen saturation (Sp O 2) were within normal limits. There were no significant differences detected in any secondary outcomes, including pulmonary embolisms, death, or skin injuries related to pneumatic compression. The primary outcome of new proximal lower limb DVT did not differ significantly between the two groups (3.9% in the pneumatic compression group vs. The two groups were balanced at baseline: the mean age was 58 years, almost 80% of patients were medical admissions to the ICU, and two-thirds were receiving mechanical ventilation. Proximal venous ultrasonography of the lower limbs was performed 48 hours after randomization and then twice weekly if DVT was clinically suspected. In the control group, pneumatic compression was only permitted during times when pharmacologic thromboprophylaxis was interrupted. Although sequential compression devices with thigh-length sleeves were preferred, nonsequential devices and knee-length sleeves, as well as foot pumps, were permitted. In the pneumatic compression group, patients also received intermittent compression to both lower limbs for at least 18 hours per day. Both groups received pharmacologic thromboprophylaxis with unfractionated heparin or low-molecular-weight heparin. Adult patients expected to be in the intensive care unit (ICU) for at least 72 hours were randomized, using concealed allocation, to receive pneumatic compression (n = 991) or pharmacologic thromboprophylaxis alone (n = 1,012). ![]() In this international multicenter study, researchers investigated whether the addition of mechanical thromboprophylaxis with intermittent pneumatic compression would further reduce the risk of DVT in these patients. Current guidelines recommend pharmacologic thromboprophylaxis in all critically ill patients.
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