Critical care medicine
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Critical care medicine · Oct 1985
Early extubation after surgical repair of congenital heart disease.
Of 220 pediatric patients recovering from surgical repair of congenital heart disease, 147 (67%) met our criteria for early extubation and were extubated either in the operating room or within 6 h after admission to the surgical ICU. The duration of postoperative mechanical ventilation correlated with the duration of cardiopulmonary bypass during surgical repair. In patients undergoing repair of ventricular septal defect, preoperative measures of pulmonary vascular status (PPA/PAO and RP/RS) also correlated with the duration of mechanical ventilation.
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Critical care medicine · Oct 1985
Comparative StudyAPACHE II: a severity of disease classification system.
This paper presents the form and validation results of APACHE II, a severity of disease classification system. APACHE II uses a point score based upon initial values of 12 routine physiologic measurements, age, and previous health status to provide a general measure of severity of disease. ⋯ When APACHE II scores are combined with an accurate description of disease, they can prognostically stratify acutely ill patients and assist investigators comparing the success of new or differing forms of therapy. This scoring index can be used to evaluate the use of hospital resources and compare the efficacy of intensive care in different hospitals or over time.
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Critical care medicine · Oct 1985
Comparative StudyCompression volume during mechanical ventilation: comparison of ventilators and tubing circuits.
Four ventilators (Puritan-Bennett MA-1 and MA-2, Emerson, and Bear I) and four commercially available disposable and nondisposable tubing circuits (Bennett nondisposable, Becton-Dickinson, Inspiron, and Life-line) were tested on a lung analog for differences in inspiratory-circuit compression volume. The compression ratio (Rc), equal to the gas volume compressed per cm H2O peak airway pressure, was calculated for each combination of ventilator and circuit at each of four compliance settings (0.15, 0.10, 0.05, 0.01 L/cm H2O) on the analog. ⋯ Application of an inspiratory pause on the Bear I ventilator did not affect its compression characteristics. The clinical importance of compression volume and data from other ventilation systems are reviewed.
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Critical care medicine · Oct 1985
Comparative StudyOutcome of critically injured patients treated at Level I trauma centers versus full-service community hospitals.
Critically injured patients were identified by a CRAMS (circulation, respiration, abdomen, motor, speech) score of 6 or less while still in the field. They were prospectively followed as they received their care at the nearest medical facility according to the then-existing district Emergency Medical Services protocols. Those cared for by Level I trauma centers had a significantly reduced mortality rate compared to those treated at the other large full-service community hospitals. The commitment to Level I trauma care improves outcome of the critically injured, and field triage of the critically injured patient to these centers is indicated.