Intensive care medicine
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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.
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Intensive care medicine · Jan 2001
Multicenter StudyA cost-effectiveness analysis of stays in intensive care units.
To evaluate patient outcome and the efficiency of stays in intensive care units (ICUs). ⋯ This work provides medical and economic information on ICU stays in teaching hospitals and enables comparisons with other health-care options.
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Intensive care medicine · Jan 2001
Comparative StudyAre transoesophageal Doppler parameters a reliable guide to paediatric haemodynamic status and fluid management?
Transoesophageal Doppler (TOD) has been used in adults to optimise left ventricular filling on the basis of the waveform parameters. We wished to see if a similar relationship exists in children, specifically: (a) whether change in thermodilution stroke volume (SV) following a fluid bolus corresponded to change in Doppler stroke distance, Doppler corrected flow time (FTc), or central venous pressure (CVP); (b) whether a response to fluid challenge (defined as an increase in SV of greater than 10%) can be predicted on the basis of an absolute value for FTc or CVP prior to fluid bolus; and (c) the relationship between FTc and systemic vascular resistance index. ⋯ TOD stroke distance is able to follow changes in SV following fluid bolus amongst ventilated children, and can predict when further volume loading is unlikely to improve SV amongst general, but not cardiac ICU patients. CVP is a poor discriminator of volume status in this group of patients.
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Intensive care medicine · Jan 2001
Comparative StudyChanges in quality of life after medical intensive care.
To determine outcome and changes in health-related quality of life (QOL) in medical intensive care patients. ⋯ Six months after admission to a medical ICU most survivors had regained their preadmission health-related QOL. Multivariate analysis showed that preadmission QOL, age, and severity of illness were most strongly associated with follow-up QOL. Of the survivors 86 % were living at home, and all but one of those previously in employment had returned to their former work. Most patients (94%) would undergo ICU treatment again if necessary.