Journal of intensive care medicine
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Lung transplantation currently is the preferred treatment option for a variety of end-stage pulmonary diseases. Remarkable progress has occurred through refinements in technique and improved understanding of transplant immunology and microbiology. As a result, recipients are surviving longer after their transplant. ⋯ It is thus important that the ICU team have a working knowledge of the common complications, when these complications are most likely to occur, and how best to treat them when they do arise. The main focus of this review is to address the variety of potential graft and life-threatening problems that may occur in lung transplant recipients. Because the ICU is also the most common setting where a potential donor is identified, donor issues will briefly be addressed.
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J Intensive Care Med · Mar 2004
Review Case ReportsApplications of bispectral index monitoring in the pediatric intensive care unit.
The bispectral index (BIS) monitor is an electroencephalographic recording device that generates a single numeric value. It has traditionally been used to measure anesthetic depth and avoid awareness in the operating room setting. ⋯ The scenarios presented include use of the BIS monitor during titration of barbiturate coma, procedural sedation, sedation assessment during mechanical ventilation, and sedation while administering potentially confounding medications. Previous reports regarding the use of the BIS monitor in such scenarios and potential future applications are reviewed
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The homeostatic corrections that have emerged in the course of human evolution to cope with catastrophic events involve a complex multisystem endeavor, of which the endocrine contribution is an integral component. Although the repertoire of endocrine changes has been probed in some detail, discerning the vulnerabilities and failure of this system is far more challenging. The ensuing endocrine topics illustrate some of the current issues reflecting attempts to gain an improved insight and clinical outcome for critical illness.
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J Intensive Care Med · Mar 2004
Comparative StudyOutcome prediction for critically ill cirrhotic patients: a comparison of APACHE II and Child-Pugh scoring systems.
Cirrhotic patients admitted to the medical intensive care unit (ICU) are associated with high mortality rates. The prognosis of critically ill cirrhotic patients is determined by the extent of hepatic and extrahepatic organ dysfunction. This study was conducted to assess and compare the accuracy of the Child-Pugh classification and APACHE II scores, obtained on the first day of ICU admission, in predicting hospital mortality in critically ill cirrhotic patients. ⋯ Furthermore, by using the areas under receiver operating characteristic (AUROC) curve, the APACHE II scores demonstrated a better discriminative power (AUROC 0.833 +/- 0.039) than Child-Pugh scores (AUROC 0.75 +/- 0.05) (P=.024). This investigation confirms the grave prognosis for the cirrhotic patients admitted to the ICU. While both Child-Pugh and the APACHE II scores can satisfactorily predict the outcomes for critically ill cirrhotic patients, APACHE II is more powerful in discriminating the survivors from the nonsurvivors.