Intensive care medicine
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Intensive care medicine · Jun 1997
Predictors of mortality and multiple organ failure in children with sepsis.
To assess the markers of perfusion which best discriminate survivors from non-survivors of childhood sepsis and to compare the information derived from gastric tonometry with conventionally measured haemodynamic and laboratory parameters. ⋯ Blood lactate level was the earliest predictor of outcome in children with sepsis. In this group of patients, gastric tonometry added little to the clinical information that could be derived more simply by other means.
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To evaluate the safety of percutaneous dilatational tracheostomy. ⋯ In the hands of the experienced, percutaneous dilatational tracheostomy is a safe and quick bedside procedure. It is also less expensive and incurs minimal stress for the patient compared with the surgical method. The technique can be easily mastered by non-surgical physicians and we feel that it is the method of choice for elective tracheostomy in the majority of intensive care patients.
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Intensive care medicine · Jun 1997
A new method of accurately identifying costs of individual patients in intensive care: the initial results.
To analyse the patient-related and non-patient-related costs of intensive care using an activity-based costing methodology. ⋯ The use of average costs or scoring systems to cost intensive care is limited, as these methods cannot determine actual resource usage in individual patients. The methodology described here allows all the resources used by an individual patient or group of patients to be identified and thus provides a valuable tool for economic evaluations of different treatment modalities.
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Intensive care medicine · Jun 1997
Validation of the simplified therapeutic intervention scoring system on an independent database.
To evaluate the performance of the Simplified Therapeutic Intervention Scoring System on an independent database and determine its relation with the Therapeutic Intervention Scoring System in the quantification of nursing workload in intensive care. ⋯ TISS-28 was validated on this independent population. The results indicate that TISS-28 can replace TISS-76 for the measurement of the nursing workload in Portuguese ICUs.
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Intensive care medicine · Jun 1997
Comparative StudyNew monitors of intravascular volume: a comparison of arterial pressure waveform analysis and the intrathoracic blood volume.
Two new monitoring techniques, the analysis of arterial pressure waveform during mechanical ventilation and the determination of intrathoracic blood volume, were evaluated for preload assessment in a model of graded hemorrhage. ⋯ The parameters of arterial pressure waveform analysis (SPV and dDOWN) and ITBV were sensitive estimates of cardiac preload during the early stages of hemorrhage. Measurement of SPV and dDOWN, being both sensitive and relatively noninvasive, has advantages over other methods of preload assessment but is limited to patients on controlled mechanical ventilation. ITBV, which supplies quantitative information about cardiac preload, is more invasive but can also be used in patients who are breathing spontaneously or who are on partial ventilatory support.