Intensive care medicine
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Intensive care medicine · Oct 2002
Multicenter StudyA multicenter survey of visiting policies in French intensive care units.
To determine the visiting policies of French intensive care units. ⋯ Responding ICUs provide homogeneously restrictive visiting policies concerning visiting hours, number and type of visitors. However, family reception cannot be reduced to some quantitative factors and depends on multiple other parameters such as the organization of family meetings and the use of an information leaflet. These results should be an interesting starting point to observe any change in mentalities and practices in the future.
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Intensive care medicine · Oct 2002
Randomized Controlled Trial Clinical TrialPlasmapheresis in severe sepsis and septic shock: a prospective, randomised, controlled trial.
To determine the therapeutic efficacy and safety of plasmapheresis in the treatment of patients with severe sepsis and septic shock. ⋯ Plasmapheresis may be an important adjuvant to conventional treatment to reduce mortality in patients with severe sepsis or septic shock. Plasmapheresis is a safe procedure in the treatment of septic patients. A prospective randomised multicentre trial is warranted to confirm our results and to determine which subgroups of septic patients will benefit most from this treatment modality.
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Intensive care medicine · Oct 2002
Direct costs of severe sepsis in three German intensive care units based on retrospective electronic patient record analysis of resource use.
To determine the direct costs of severe sepsis patients in German intensive care units (ICUs). ⋯ A bottom-up approach was used to determine the direct ICU cost on actual resource use (medication, laboratory tests, microbiological analysis, disposables, and clinical procedures) for patients with severe sepsis. To determine the total direct costs, center-specific personnel and basic bed ("hotel") costs were added to total resources consumed. Average hospital mortality of severely septic patients was 42.6%. Mean ICU length of stay (LOS) was 16.6 days. Survivors stayed on average 4 days longer than nonsurvivors. The mean direct ICU costs of care were 23,297+/-18,631 euros per patient and 1,318 euros per day. In comparison, average daily charges being paid for an ICU patient by the health care system in Germany are 851 euros (based on official statistics). Nonsurvivors were more expensive than survivors in total direct costs (25,446 vs. 21,984 euros) and in per day direct cost (1,649 vs. 1,162 euros). Medication makes up the largest part of the direct costs, followed by expenses for personnel. CONCLUSIONS. Patients with severe sepsis have a high ICU mortality rate and long ICU LOS and are substantially expensive to treat. Nonsurviving septic patients are more costly than survivors despite shorter ICU LOS. This is due to higher medication costs indicating increased efforts to keep patients alive.
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Intensive care medicine · Oct 2002
Randomized Controlled Trial Clinical TrialProphylactic use of the phospodiesterase III inhibitor enoximone in elderly cardiac surgery patients: effect on hemodynamics, inflammation, and markers of organ function.
Elderly patients appear prone to develop overwhelming post-bypass inflammation and organ dysfunction. We assessed the effect of prophylactic administration of the phosphodiesterase III inhibitor enoximone on inflammation and organ function. ⋯ . Prophylactic use of enoximone in cardiac surgery patients aged over 80 years resulted in less post-bypass inflammation and improvement in markers of organ function than in the placebo group. The exact mechanisms by which enoximone exerts its beneficial effects in these patients remains to be elucidated.
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Intensive care medicine · Oct 2002
Randomized Controlled Trial Clinical TrialEffects of spontaneous breathing during airway pressure release ventilation on renal perfusion and function in patients with acute lung injury.
Controlled mechanical ventilation can impair systemic and renal blood flow and function, which may be aggravated by respiratory acidosis. We hypothesized that partial ventilatory support using airway pressure release ventilation (APRV) with spontaneous breathing provides better cardiopulmonary and renal function than full ventilatory support using APRV without spontaneous breathing. ⋯ Spontaneous breathing during APRV was associated with better renal perfusion and function than APRV without spontaneous breathing applying either the same V(E) or the same Paw limits. Maintaining spontaneous breathing during ventilatory support may, therefore, be advantageous in preventing deterioration of renal function in patients with ALI.