Intensive care medicine
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Intensive care medicine · Oct 1996
Comparative StudyImpedance cardiography. Importance of the equation and the electrode configuration.
Electrical impedance cardiography (EIC) has been suggested as a non-invasive method to measure cardiac output. In several studies it proved to be a reliable method, although there were some restrictions. In 1966 Kubicek et al. developed an impedance cardiac output system based upon electrodes and a specific stroke volume formula. In 1983 Sramek et al. developed a new electrode configuration, and a new equation to calculate stroke volume, an equation that was adjusted by Bernstein in 1986. Since then these two methods have been used in clinical medicine. The purpose of the present study was to compare both electrode configurations and both stroke volume calculation equations with each other. The cardiac output (CO) values obtained by means of EIC are compared with CO values obtained by means of thermodilution. ⋯ Simultaneous measurement of CO by means of electrical impedance cardiography (COEIC) and thermodilution (COTD) was performed. COEIC was obtained using the lateral spot electrode configuration (LS) and an adjusted circular electrode configuration (SC). The formulas of Sramek (S), Sramek-Bernstein (SB), Kubicek (K) and an adjusted Kubicek formula (aK) were employed. Using the LS electrode configuration, significant differences were found between COEIC and COTD with the S formula (p < 0.005), the K formula (p < 0.001), and the aK formula (p < 0.05). Using the SC electrode configuration, significant differences between COEIC and COTD were found with the K formula (p < 0.005), the S formula (p < 0.01), and the SB formula (p < 0.05). No significant differences was found between EIC and TD using the LS electrode configuration together with the SB formula or using the SC electrode configuration with the aK formula. In both cases a good correlation was found between COEIC and COTD (r = 0.86, p < 0.001 and r = 0.79, p < 0.001, respectively). The mean difference between EIC and TD was 0.15 +/- 0.96 1/min and 0.19 +/- 1.19 1/min, respectively.
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Intensive care medicine · Oct 1996
Complications of care in a pediatric intensive care unit: a prospective study.
(a) To examine the frequency, type, and severity of complications occurring in a pediatric intensive care unit; (b) to identify populations at risk; and (c) to study the impact of complications on morbidity and mortality. ⋯ Complications have a significant impact on patient care. Patients may be at increased risk earlier in their PICU course, when the number of interventions may be greatest. Complications may increase patient mortality and predict patient death better than other patient variables.
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Intensive care medicine · Oct 1996
Limitation of life support: frequency and practice in a London and a Cape Town intensive care unit.
To examine the frequency of limiting (withdrawing and withholding) therapy in the intensive care unit (ICU), the grounds for limiting therapy, the people involved in the decisions, the way the decisions are implemented and the patient outcome. ⋯ Withdrawal of therapy occurred commonly, most often because of multiple organ failure. Wide consensus was reached before a decision was made, and the time to death was generally short.
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Intensive care medicine · Oct 1996
Randomized Controlled Trial Comparative Study Clinical Trial Retracted PublicationInfluence of different volume therapies on platelet function in the critically ill.
Both albumin and synthetic colloids such as hydroxyethyl starch (HES) solution are used to optimize hemodynamics in the critically ill. The influence of different long-term infusion regimes on platelet function was studied. ⋯ Alterations in hemostasis may occur for several reasons in the critically ill. Human albumin is the preferred first-line volume therapy in patients at risk for coagulation disorders. With respect to platelet function, volume replacement with (lower-priced) low-molecular-weight HES solutions can be recommended in this situation without any risk.