Critical care medicine
-
Critical care medicine · Feb 1984
Results, charges, and benefits of intensive care for critically ill patients: update 1983.
Objective and quantitative methods were used to measure severity of illness and outcome of intensive care in critically ill patients, in terms of success or failure of therapy within the ICU, survival or death at 1 yr, quality of life in survivors, and utilization of resources. One hundred ninety-nine consecutive Class IV critically ill surgical patients hospitalized between 1977 and 1978 at the Massachusetts General Hospital comprised the study population. Although the mortality rate of 69% was close to the 73% rate we recorded for 1972-1973, the survivors' quality of life was significantly better. ⋯ Survival rates and quality of life in survivors did not vary with age. The disease process for which the patient was hospitalized was an important determinant of outcome. Intensive care medicine for critically ill surgical patients does prolong life and enable some patients to return to a productive lifestyle; however, the costs of these benefits are extremely high.
-
Critical care medicine · Feb 1984
Reliability of clinical monitoring to assess blood volume in critically ill patients.
Blood volumes measured by indicator dilution method in over 1500 instances of critically ill patients of various etiologies and at various times throughout their critical illness were compared with the values of concomitantly measured mean arterial pressure (MAP), CVP, pulmonary arterial wedge pressure (WP), Hct, and cardiac output. During resuscitation from hypovolemic shock, the patients' blood volumes and the monitored variables were significantly altered. ⋯ With administration of a fluid load, blood volume and values of the commonly monitored variables improved appropriately, but the correlation coefficients, in general, were not good. The data suggest that the commonly monitored variables, in and of themselves, do not reflect adequately the blood volume status in critically ill patients.
-
Critical care medicine · Feb 1984
Case ReportsHemodynamic pattern in anaphylactic shock with cardiac arrest.
A 41-yr-old man developed anaphylactic or anaphylactoid shock 9 min after infusion of a modified fluid gelatin. The hemodynamic effects of shock from its onset were studied: fall in mean arterial pressure (MAP) and systemic vascular resistance index (SVRI), increase in cardiac index (CI) and stroke index (SI). When the infusion was stopped, a few min after the onset of shock, wedge pressure (WP) fell sharply and the patient experienced cardiac arrest without previous arrhythmia or other ECG anomaly, thus demonstrating the importance of maintaining the left ventricular filling pressure at a normal level in the course of anaphylactic shock.