Journal of critical care
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Journal of critical care · Jun 2006
Comparative StudyDaily evaluation of organ function during renal replacement therapy in intensive care unit patients with acute renal failure.
The aim of this study was to assess changes in organ function in acute renal failure patients during renal replacement therapy and relate them to outcome. ⋯ Assessment of these factors in the first 24 hours of renal replacement therapy could help identify patients at higher risk of mortality early during their ICU admission.
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Journal of critical care · Jun 2006
Blood glucose on day of intensive care unit admission as a surrogate of subsequent glucose control in intensive care.
The aim of the study was to test whether the mean of the highest and lowest glucose values on day 1 (Glu(1)) is a useful surrogate marker of mean blood glucose during the totality of intensive care unit (ICU) stay (Glu(tot)). ⋯ Glu(1) was a good predictor of Glu(tot) across all study hospitals. This observation makes it possible to use Glu(1) as a surrogate of glucose control during ICU stay and opens the door to understanding ICU glucose control across the whole of Australia and New Zealand.
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Journal of critical care · Jun 2006
Comparative StudyProspective comparative study on the hemodynamic and functional consequences of arterial monitoring catheters in intensive care patients on the short and long term.
In intensive care wards, arterial catheters are a relevant instrument to monitor vital functions. However, the effect of arterial catheterization on hemodynamic function in elective patients in the short and long term is unknown. ⋯ There is significant change in the hemodynamic function of the artery 1 day and 5 days after removal, but this significant change disappears after 30 days. An arterial monitoring catheter causes a functional arterial change in the affected arm in the short term and no significant difference in the long term. Therefore, arterial catheterization is a safe procedure after short-term cannulation. Second, the systolic blood pressure ratio of the a. radialis/a. ulnaris is a valuable tool in the assessment of the hemodynamic function of the a. radialis after radial cannulation.
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Journal of critical care · Jun 2006
Comparative StudyEconomic evaluation in critical care medicine.
Scarce resources are a reality in all health care systems. There is a constant challenge to maximize health benefits within the resources available. This is particularly relevant when caring for critically ill patients, given the resource-intensive technologies and medicines used and the highly specialized professionals required. ⋯ This article illustrates how the basic principles of health economics can be applied to health care decision making through the use of economic evaluation. We demonstrate how economic evaluation can link medical outcomes, quality of life, and costs in a common index, even for therapies for different medical conditions and with different health outcomes. This article highlights the need for randomized clinical trials and economic evaluations of therapies in critical care medicine for which the effect of the therapy on health outcomes and/or costs are unknown.
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Journal of critical care · Jun 2006
Predictors of extubation failure in patients with chronic obstructive pulmonary disease.
Few studies have focused on extubation outcome in patients with chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation (MV). We conducted a study using prospectively collected data in a cohort of patients with COPD requiring invasive MV to identify variables associated with extubation failure. Use of noninvasive or invasive MV within 48 hours after extubation was defined as extubation failure. ⋯ Despite high rate of extubation failure, survival to ICU discharge was 91% of the studied population. Extubation failure in patients with COPD remains high despite a successful spontaneous breathing on T piece. Simplified Acute Physiology Score II at ICU admission, home noninvasive MV, and isolated pathogens on quantitative cultures of tracheobronchial secretions within 72 hours preceding extubation were predictors of extubation failure in the study population.