Intensive care medicine
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Intensive care medicine · Jan 2001
Review Practice Guideline GuidelineSource control in the management of sepsis.
The process of surgical decision making is based on both general principles that are amenable to evaluation using rigorous techniques of clinical research and the intangible element of surgical judgment that seeks to apply those principles to the care of an individual patient. The role of surgical judgment is inescapable, even though it is intrinsically subjective and recalcitrant to objective evaluation, for a host of factors modify the application of principle in each patient, and render the circumstances of a given problem sufficiently distinctive, that evidence must be tempered with common sense. We have tried to provide, through an evidence-based approach to a series of questions, the rationale for the basic principles that should guide the clinician in initiating or modifying source control, recognizing that sound clinical judgement demands, at times, that these be set aside. ⋯ Their implementation in practice, however, is more complex, and does not, as a rule, lend itself to simple algorithms that are applicable in all cases. Moreover evidence-based support for these principles is weak. In the final analysis, the elusive process of experienced surgical judgement is invaluable for all but the most straightforward problems.
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Intensive care medicine · Jan 2001
Review Practice Guideline GuidelineOther supportive therapies in sepsis.
Patients who survive the circulatory and organ deficits in sepsis may still fall victim to complications such as pulmonary embolism and stress ulcer bleeding. Although there is no clearcut evidence to quantitate the impact of such complications on mortality, the anticipated impact is grave when considering the compromised physiological reserve of these patients. For this reason it is important to institute effective prophylaxis to minimize the impact. ⋯ Early and adequate nutritional support therefore appears important. There is much controversy and lack of prospective research regarding effect of supportive therapies on outcome in patients with severe sepsis. This research is needed.
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Intensive care medicine · Jan 2001
Randomized Controlled Trial Comparative Study Clinical TrialEvaluation of two processed EEG analyzers for assessment of sedation after coronary artery bypass grafting.
Processed EEG monitoring has been suggested for sedation depth evaluation in intensive care unit (ICU) patients. The present study investigated the efficacy of two processed EEG monitors using SEF90% or SEF95% and BIS to differentiate between conscious (Ramsay score 4) and unconscious sedation (Ramsay score 6). ⋯ The use of processed EEG monitoring cannot be recommended for assessing sedation depth after cardiac surgery.
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Intensive care medicine · Jan 2001
Randomized Controlled Trial Comparative Study Clinical TrialEffects of patient-triggered automatic switching between mandatory and supported ventilation in the postoperative weaning period.
To compare two ventilator settings in the postoperative weaning period. Patient-triggered automatic switching between controlled ventilation and supported spontaneous breathing (Automode, AM) was compared to synchronised intermittent mandatory ventilation (SIMV) with stepwise manual adjustment of mandatory frequency according to the breathing activity. ⋯ Automatic, patient-triggered switching between controlled and supported mode of ventilation can be used for postoperative weaning of neurosurgical patients with healthy lungs. Compared to a SIMV weaning procedure, fewer manipulations on the ventilator are necessary and individual adaptation of ventilation seems to be more accurate.
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Intensive care medicine · Jan 2001
ReviewLow-dose dopamine in neonatal and pediatric intensive care: a systematic review.
To assess the current use of low-dose dopamine (< 5 microg/kg per minute) to improve renal function and urine volume (UV) in neonatal (NICU) and pediatric (PICU) intensive care units, and to assess the available evidence to support this practice. ⋯ The widespread use today of low-dose dopamine in Dutch NICUs and PICUs is not supported in the literature. Evidence from well performed clinical studies to support the use of low-dose dopamine for improving renal function and UV in critically ill neonates and children is largely insufficient. In view of adverse effects, the use of low-dose dopamine in neonatal and pediatric intensive care patients should be reconsidered.