Critical care medicine
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During the course of a critical illness, many patients become ventilator dependent. The standard assessment criteria are not always accurate in predicting potential for extubation. This investigation was designed to analyze whether the work of breathing (WOB) was a more reliable predictor of ventilator dependence. ⋯ These data support the use of WOB determinations in evaluating extubation potential. Using a reference value for the WOB of 15%, this study had a sensitivity of 100% and a specificity of 80%. This proved to be of greater predictive value than traditional criteria.
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Critical care medicine · Feb 1990
Case ReportsLow-frequency positive-pressure ventilation with extracorporeal carbon dioxide removal.
Successful use of a new technique, low-frequency positive-pressure ventilation with extracorporeal CO2 removal (LFPPV-ECCR) is presented. The association of fulminant respiratory failure with CNS hemangioblastoma, described in the present patient, has been reported only once before, in 1928.
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Critical care medicine · Feb 1990
Factors affecting accidental extubations in neonatal and pediatric intensive care patients.
All patients intubated in the neonatal (NICU) and pediatric (PICU) ICUs over a 3-yr period were evaluated prospectively to determine the incidence of accidental extubation (AE) and contributing factors. Two thousand two hundred patients (age range 26 wk gestation to 18 yr) were intubated for a total of 21,222 days. In the PICU and NICU, a total of 153 patients experienced 195 AE. ⋯ One death occurred as an indirect consequence of AE. The data are being reported as a function of number of days intubated in an attempt to standardize reporting techniques. The use of standardized reporting and the identification of high-risk factors may be useful for education and modification of patient care practices.
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Critical care medicine · Feb 1990
Practical use of immunosuppressive drugs in autoimmune rheumatic diseases.
Immunosuppressive drugs are frequently used in the treatment of autoimmune rheumatic diseases when more conventional therapy, including corticosteroids, fail to control the manifestations of disease. The practical use of these drugs in rheumatoid arthritis, systemic lupus erythematosus, and vasculitis (including Wegener's granulomatosis and Sjögren's syndrome) are reviewed. The focus is on the indications for the administration of these agents and proper monitoring of their effect on disease activity.