Critical care medicine
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Critical care medicine · Nov 1990
Effects of clinical maneuvers on sonographically determined internal jugular vein size during venous cannulation.
We sought to define variations in internal jugular vein (IJV) anatomy and the effect of recommended cannulation maneuvers on a population of ICU patients. Maneuvers that decreased IJV lumen cross-sectional area were carotid artery palpation (1.48 to 0.82 cm2, p less than .05) and advancement of the needle (1.57 to 0.75 cm2, p less than .001). The head-down (modified Trendelenburg) position increased IJV lumen cross-sectional area (1.18 to 1.62 cm2, p less than .05). There was wide variability in IJV anatomic features, although most patients had patent veins.
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Critical care medicine · Nov 1990
Comparative StudyStroke volume measurements by electrical bioimpedance and echocardiography in healthy volunteers.
To evaluate the validity of three equations for estimation of thoracic electrical field size in a new bioimpedance algorithm, stroke volume (SV) as calculated by these equations was compared with that calculated by Doppler echocardiography in 48 healthy volunteers, both lean and obese. When the volume of electrically participating tissue was estimated from body height (modified Sramek) or body height corrected for body habitus (Sramek-Bernstein), there was considerable variation between bioimpedance and Doppler stroke volumes. ⋯ We conclude that the original Sramek equation systematically underestimates SV by 15% to 20%, and the modified Sramek and Sramek-Bernstein equations systematically underestimates SV by 15% to 20%, and the modified Sramek and Sramek-Bernstein equations systematically overestimate SV in females by about 15%, but provide SV values in males in the predicted range. Further studies on the current assumption that the electrical field size is a truncated cone may improve precision of the bioimpedance method.
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Critical care medicine · Nov 1990
Timing of intensive care unit admission in relation to ICU outcome.
This study assessed the relationship between admission time (from hospital admission to ICU admission) and mortality predicted by the Mortality Prediction Model (MPM), actual mortality, and resource use. All admissions, except elective surgery patients, to the general medical/surgical ICU of a tertiary care hospital during a 24-month period were studied (n = 1,889). ⋯ Transfers had higher predicted and actual mortality, and used more resources than nontransfer patients. Time from hospital admission to ICU admission can be a potentially useful variable in models of ICU outcome.
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Iatrogenic illness may be an important determinant of the need for pediatric intensive care. We prospectively evaluated consecutive admissions to a pediatric ICU (PICU) over two time periods totaling 6 months. Twenty-five (4.6%) admissions were necessitated by iatrogenic illnesses. ⋯ One (3.7%) patient with iatrogenic illness died. As a group, patients with iatrogenic illness were at a risk of dying similar to other patients. We conclude that iatrogenic illness is a significant cause of PICU admission.