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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 10 (1984), S. 133-137 
    ISSN: 1432-1238
    Keywords: Adrenoceptor blocking agents: labetalol ; Multiple trauma ; Hyperdynamic state
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A hyperdynamic state, characterized by an elevated blood pressure and tachycardia is frequently seen during the first few days following severe multiple trauma. We examined the cardiovascular effects of the alpha and beta adrenoceptor blocking agent labetalol in patients presenting a hyperdynamic cardiovascular state some days after major trauma. Ten patients with a heart rate-systolic blood pressure product (RPP) of more than 2000 during 6 consecutive hours, despite normovolaemia, adequate ventilation, analgesia and sedation were investigated. After a mean dose of 2.1±1.2 mg·kg-1 (mean±SD) of labetalol injected intravenously over a 10-min period, heart rate decreased from 117±28 to 102±19 beats·min-1, systolic arterial pressure from 25±3.5 to 18.5±2.7 kPa, diastolic pressure from 11±1.7 to 9.5±1.7 kPa, mean arterial blood pressure from 15.5±2.1 to 12.4±2.1 kPa, and the RPP from 2880±867 to 1853±373. The beneficial effect of this dose lasted 24 h in 8 of 10 patients without additional administration. No important side effects such as cardiac arrhythmias, hypotension, or bronchospasm were noted. We conclude that labetalol used in fractional intravenous doses permits an adequate treatment of a “hypertension-tachycardia syndrome” in severely injured patients.
    Type of Medium: Electronic Resource
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  • 2
    Publication Date: 2015-07-28
    Description: Background and Purpose— We developed a new postdischarge system of care comprising a structured assessment covering longer-term problems experienced by patients with stroke and their carers, linked to evidence-based treatment algorithms and reference guides (the longer-term stroke care system of care) to address the poor longer-term recovery experienced by many patients with stroke. Methods— A pragmatic, multicentre, cluster randomized controlled trial of this system of care. Eligible patients referred to community-based Stroke Care Coordinators were randomized to receive the new system of care or usual practice. The primary outcome was improved patient psychological well-being (General Health Questionnaire-12) at 6 months; secondary outcomes included functional outcomes for patients, carer outcomes, and cost-effectiveness. Follow-up was through self-completed postal questionnaires at 6 and 12 months. Results— Thirty-two stroke services were randomized (29 participated); 800 patients (399 control; 401 intervention) and 208 carers (100 control; 108 intervention) were recruited. In intention to treat analysis, the adjusted difference in patient General Health Questionnaire-12 mean scores at 6 months was –0.6 points (95% confidence interval, –1.8 to 0.7; P =0.394) indicating no evidence of statistically significant difference between the groups. Costs of Stroke Care Coordinator inputs, total health and social care costs, and quality-adjusted life year gains at 6 months, 12 months, and over the year were similar between the groups. Conclusions— This robust trial demonstrated no benefit in clinical or cost-effectiveness outcomes associated with the new system of care compared with usual Stroke Care Coordinator practice. Clinical Trial Registration— URL: http://www.controlled-trials.com . Unique identifier: ISRCTN 67932305.
    Keywords: Health policy and outcome research, Rehabilitation, Stroke
    Print ISSN: 0039-2499
    Electronic ISSN: 1524-4628
    Topics: Medicine
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