Intensive care medicine
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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.
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Intensive care medicine · Jun 2001
The interpretation of train-of-four monitoring in intensive care: what about the muscle site and the current intensity?
To investigate the effect of current intensity and choice of the stimulated muscle group on train-of-four (TOF) interpretation in the intensive care unit (ICU). ⋯ For a good TOF interpretation in the ICU the current intensity should be tested before onset of blockade. The orbicularis oculi is less sensitive to cisatracurium than adductor pollicis and plantar flexor both at onset and after a prolonged infusion. The recovery from relaxation is faster on orbicularis oculi and plantar flexor than on adductor pollicis.
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Intensive care medicine · Jun 2001
Mortality after discharge from intensive care: the impact of organ system failure and nursing workload use at discharge.
Mortality after ICU discharge accounts for approx. 20-30% of deaths. We examined whether post-ICU discharge mortality is associated with the presence and severity of organ dysfunction/failure just before ICU discharge. ⋯ It is better to delay the discharge of a patient with organ dysfunction/failure from the ICU, unless adequate monitoring and therapeutic resources are available in the ward.