Critical care clinics
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This article discusses the advantages of pulmonary artery catheters, with emphasis on the Swan-Ganz catheter. Various studies and published reports confirming the efficacy of pulmonary artery catheter use are reviewed. In the author's opinion, it is evident that the Swan-Ganz catheter has withstood the test of time and scrutiny.
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Critical care clinics · Jul 1996
ReviewDoes increasing oxygen delivery improve outcome in the critically ill? No.
The strategy of treating critically ill patients by increasing oxygen delivery and consumption to values previously observed among survivors of critical illness (supranormal values) is based on the belief that (1) tissue hypoxia may persist in critically ill patients despite aggressive early resuscitation to traditional endpoints of adequate tissue perfusion and (2) that increasing oxygen delivery can reverse tissue hypoxia. This article addresses the question of whether increasing oxygen delivery improves outcomes in critically ill patients by reviewing the relationship between whole-body oxygen delivery and consumption and by critically examining the randomized controlled trials that have increased oxygen delivery to supranormal values.
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Critical care clinics · Jul 1996
ReviewHypertensive, hypervolemic, hemodilutional therapy for aneurysmal subarachnoid hemorrhage. Is it efficacious? No.
Many neurosurgeons routinely use hypertensive, hypervolemic, hemodilutional, or hyperdynamic therapy (HT) in some form to prevent or to treat vasospasm. Despite the widespread use of this therapy during the past 20 years, however, there are no randomized, prospective, controlled clinical studies demonstrating that HT improves the short- or long-term neurologic outcome or survival after subarachnoid hemorrhage. Guidelines need to be developed to standardize the clinical application of HT, and well-controlled, prospective, randomized clinical trials must be conducted before HT can become an accepted treatment for vasospasm.
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Critical care clinics · Jul 1996
ReviewICU scoring systems allow prediction of patient outcomes and comparison of ICU performance.
Too much time and effort are wasted in attempts to pass final judgment on whether systems for ICU prognostication are "good or bad" and whether they "do or do not" provide a simple answer to the complex and often unpredictable question of individual mortality in the ICU. A substantial amount of data supports the usefulness of general ICU prognostic systems in comparing ICU performance with respect to a wide variety of endpoints, including ICU and hospital mortality, duration of stay, and efficiency of resource use. Work in progress is analyzing both general resource use and specific therapeutic interventions. ⋯ These systems do not dehumanize our decision-making process but, rather, help eliminate physician reliance on emotional, heuristic, poorly calibrated, or overly pessimistic subjective estimates. No decision regarding patient care can be considered best if the facts upon which it is based on imprecise or biased. Future research will improve the accuracy of individual patient predictions but, even with the highest degree of precision, such predictions are useful only in support of, and not as a substitute for, good clinical judgment.
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Critical care clinics · Jul 1996
ReviewNutrition support is not beneficial and can be harmful in critically ill patients.
The introductory remark by Lucretius serves as a reminder that nutrient intake can have very different consequences in different subjects. In the patient with an acute or serious illness, metabolic derangements can transform a substance that is normally a source of energy into a source of metabolic toxins. The potential for organic nutrients to become organic toxins in the diseased host is a phenomenon that deserves more attention in the debate about the value of nutrition support in critically ill patients.