Journal of critical care
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Journal of critical care · Dec 2002
Predictors for mortality after prolonged mechanical ventilation after cardiac surgery in children.
To identify early mortality-associated clinical risk factors preceding, during, and after cardiac surgery in children. ⋯ Younger age and congestive heart failure were the main preoperative predictors of mortality. Multiorgan dysfunction and septic complication were predictive of an increased risk for death after cardiac surgery. These factors should be investigated in greater depth to assist in guiding aggressive therapeutic approaches for combating early signs of organ system dysfunction and infectious complications in these high-risk patients.
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Journal of critical care · Dec 2002
Noninvasive monitoring of cardiac output in human neonates and juvenile piglets by inductance cardiography (thoracocardiography).
Thoracocardiography has been used in adult patients to noninvasively estimate changes in cardiac output (CO) by analysis of ventricular volume curves recorded by an inductive plethysmographic transducer encircling the chest at the level of the heart. The purpose of this study was to investigate the potential of thoracocardiography to monitor cardiac output in human neonates and in a small animal model, the juvenile piglet. ⋯ In neonates, increases in CO during respiratory phases of periodic breathing are consistent with expected cardiorespiratory interactions. Thoracocardiography monitored changes in CO in piglets with acceptable accuracy. Thoracocardiography holds promise for noninvasive monitoring in human neonates but further validation is required.
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Journal of critical care · Sep 2002
ReviewA review of costing methodologies in critical care studies.
Clinical decision making in critical care has traditionally been based on clinical outcome measures such as mortality and morbidity. Over the past few decades, however, increasing competition in the health care marketplace has made it necessary to consider costs when making clinical and managerial decisions in critical care. Sophisticated costing methodologies have been developed to aid this decision-making process. ⋯ Of the 43 articles that actually counted costs, 37.2% (16 of 43) counted physician costs, 27.9% (12 of 43) counted facility costs, 34.9% (15 of 43) counted nursing costs, 9.3% (4 of 43) counted societal costs, and 90.7% (39 of 43) counted laboratory, equipment, and pharmacy costs. Our conclusion is that despite considerable progress in costing methodologies, critical care studies have not adequately implemented these techniques. Given the importance of financial implications in medicine, it would be prudent for critical care studies to use these more advanced techniques.
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Journal of critical care · Sep 2002
Multicenter StudySystemic candidiasis in intensive care units: a multicenter, matched-cohort study.
To determine the impact of systemic candidiasis on the mortality and length of hospital stay of intensive care unit (ICU) patients and the associated workload. ⋯ Systemic Candida infections increased mortality and morbidity in severely ill patients. Optimizing management of such infections is imperative.
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Journal of critical care · Sep 2002
Multicenter StudyStudying communication about end-of-life care during the ICU family conference: development of a framework.
Family-clinician communication in the intensive care unit (ICU) about withholding and withdrawing life support occurs frequently, yet few data exist to guide clinicians in its conduct. The purpose of this study was to develop an understanding of the way this communication is currently conducted. ⋯ This article describes a qualitative methodology to understand clinician-family communication during the ICU family conference concerning end-of-life care and provides a frame of reference that may help guide clinicians who conduct these conferences. We also identify strategies clinicians use to improve communication and enhance the support provided. Further analyses and studies are needed to identify whether this framework or these strategies can improve family understanding or satisfaction or improve the quality care in the ICU.