Intensive care medicine
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Intensive care medicine · Jun 2001
Comparative StudyIntermittent versus continuous renal replacement therapy in the ICU: impact on electrolyte and acid-base balance.
The maintenance of normal serum sodium, potassium and bicarbonate concentrations is a therapeutic goal of renal replacement therapy (RRT) in acute renal failure (ARF). The aim of this study was to determine whether this goal is best achieved with intermittent hemodialysis (IHD) or continuous venovenous hemodiafiltration (CVVHDF). ⋯ Serum sodium and potassium, and arterial bicarbonate, concentrations are frequently abnormal in ARF patients before and during renal replacement. Normalization of these values, however, is achieved more frequently with CVVHDF than with IHD.
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Intensive care medicine · Jun 2001
Clinical TrialIs a short trial of prone positioning sufficient to predict the improvement in oxygenation in patients with acute respiratory distress syndrome?
To determine whether a 1-h trial of prone positioning is sufficient to identify responders. ⋯ A short-term trial of prone positioning does not appear a sufficient method to identify patients who would benefit from the postural treatment.
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Intensive care medicine · Jun 2001
Assessing the effectiveness of critical pathways on reducing resource utilization in the surgical intensive care unit.
To evaluate the effectiveness of procedure-specific surgical critical pathways on reducing resource utilization in a university surgical intensive care unit (ICU). ⋯ Procedure-specific surgical critical pathways are not an effective tool for reducing resource utilization in our ICU. Most of our patients were not eligible for an available pathway, and those who were eligible and were "on" the pathway did not appear to have laboratory utilization guided by the pathway. Future initiatives need to explore other means such as ICU-specific care processes to reduce resource utilization in the ICU.
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Intensive care medicine · Jun 2001
Efficacy of thrombolysis in patients with acute myocardial infarction requiring cardiopulmonary resuscitation.
To evaluate the efficacy and safety of systemic thrombolysis administered to resuscitated patients after cardiac arrest (CA) due to an acute myocardial infarction (AMI), through a study of their mortality and haemorrhagic complications. ⋯ The administration of thrombolysis to patients with AMI who require resuscitation may be efficacious in reducing mortality and is safe, with no increase in haemorrhagic complications.
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Intensive care medicine · Jun 2001
Myocardial injury in meningococcus-induced purpura fulminans in children.
To assess the incidence of myocardial ischemia in meningococcus-induced purpura fulminans in pediatric patients, to compare troponin I (cTnI) levels with changes in electrocardiogram (ECG) and to evaluate whether cTnI is related to myocardial function and contractility, to severe acquired anticoagulant deficiency and to the severity of disease. ⋯ The incidence of myocardial ischemia is increased in acute meningococcemia in pediatric patients and correlates with myocardial dysfunction. High cTnI is associated with severe coagulopathy, but not with clinical prognostic scores or inotropic support. Early recognition of myocardial injury, myocardial support and early replacement therapy with PC, AIII, factor VIII or fibrinogen might improve outcome in acute meningococcemia in children.