Intensive care medicine
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Intensive care medicine · Dec 2000
Clinical Trial Controlled Clinical TrialPlasma cortisol levels before and during "low-dose" hydrocortisone therapy and their relationship to hemodynamic improvement in patients with septic shock.
To compare cortisol levels during "low-dose" hydrocortisone therapy to basal and ACTH-stimulated endogenous levels and to assess whether clinical course and the need for catecholamines depend on cortisol levels and/or pretreatment adrenocortical responsiveness. ⋯ (a) During proposed regimens of "low-dose" hydrocortisone therapy, initially achieved plasma cortisol concentrations considerably exceed basal and ACTH stimulated levels. (b) Cortisol concentrations decline subsequently, despite continuous application of a constant dose. (c) "Inadequate" endogenous steroid production appears to sensitize patients to the hemodynamic effects of a "therapeutic rise" in plasma cortisol levels.
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Intensive care medicine · Dec 2000
Outcome of bedside percutaneous tracheostomy with bronchoscopic guidance.
To determine the morbidity and mortality of percutaneous dilational tracheostomy with bronchoscopic guidance when performed by medical intensivists. ⋯ Percutaneous dilational tracheostomy with bronchoscopic guidance is a safe procedure when performed by experienced medical intensive care personnel in tertiary care institutions. Bronchoscopy helps to reduce the risk of major complications and aids in the management of minor complications.
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Intensive care medicine · Dec 2000
Editorial Comment ReviewVO2/DO2 relationship: how to get rid of methodological pitfalls?
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Intensive care medicine · Dec 2000
Comparative StudyRetrospective evaluation of the simplified Therapeutic Intervention Scoring System (TISS-28) in a surgical intensive care unit.
To compare the simplified Therapeutic Intervention Scoring System (TISS-28) with its original version, to provide reference values of daily TISS-28 assessment and to describe its association with severity of illness in surgical patients. ⋯ In a surgical ICU the simplified version of TISS with 28 items (TISS-28) sufficiently reflects the amount of intensive care provided and may provide useful additional information on severity of disease and prognosis. It should replace the original index, at least in these cases.
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Intensive care medicine · Dec 2000
Predictors of short-term mortality in critically ill patients with solid malignancies.
Admission of cancer patients with serious medical complications to the ICU remains controversial primarily because of the high short-term mortality rates in these patients. However, the cancer patient population is heterogeneous regarding age, underlying conditions, and curability of their disease, suggesting that large variations may occur in the effectiveness of intensive care within this subgroup of critically ill patients. ⋯ When transfer to an ICU is considered an option by patients and physicians, 30-day mortality is better estimated by an evaluation of acute organ dysfunction than by the characteristics of the underlying malignancy.