Critical care medicine
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Critical care medicine · Jan 1988
Improving the outcome and efficiency of intensive care: the impact of an intensivist.
Data from two 3-month time periods before and after the arrival of a pediatric intensivist were collected prospectively and compared to determine the intensivist's impact on ICU mortality, use of monitoring and therapeutic modalities, and efficiency of ICU bed utilization. Severity of illness and care modalities were determined daily for all patients with the Physiologic Stability Index and the Therapeutic Intervention Scoring System. The only major organizational change in the postintensivist period was the organization and implementation of a daytime ICU team. ⋯ The severity of the illness-adjusted ICU mortality rate was significantly higher in the pre-intensivist period than in the postintensivist period (weighted mean mortality difference 5.3 +/- 2.6%; p less than .05). The incidence of both therapeutic and monitoring modalities increased in the postintensivist period. These results indicate that a pediatric intensivist can improve mortality rates and efficiency of bed utilization in the pediatric ICU.
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Critical care medicine · Jan 1988
Comparative StudyPrototype volume-controlled neonatal/infant resuscitator.
Face mask or bag endotracheal tube manual ventilation of neonates and infants has relied primarily on the use of self-inflating resuscitation devices (SIRs). While SIRs have the advantage of being simple to use and, therefore, require minimal training, recent research has demonstrated significant drawbacks to these devices. These drawbacks have included their large physical size, the tendency of such devices to cause significant hyperventilation, and the extreme variability of pressures necessary to activate the pop-off valve safety feature. ⋯ We then compared the VCD to the SIRs in a cat model using blinded volunteer health care personnel previously familiar with SIRs only. Ventilation of the cat with the VCD yielded arterial and end-tidal CO2 values more closely resembling the physiologic state at a lower mean airway pressure. The data suggest that a human trial of manual ventilation with the prototype VCD is warranted.