Critical care medicine
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Critical care medicine · Aug 1990
Randomized Controlled Trial Comparative Study Clinical TrialUse of a nasal continuous positive airway pressure mask in the treatment of postoperative atelectasis in aortocoronary bypass surgery.
Pulmonary oxygen transfer, defined by PaO2/FIO2, and radiologic presence of atelectasis were measured pre-, intra-, and postoperatively to postoperative day 9 in elective cardiac aortocoronary bypass surgical patients, who were randomly allocated either to receive 18 h PEEP while on the ventilator followed by 12 h of nasal continuous positive airway pressure (nasal CPAP) or to be control subjects. The two groups were comparable in age, sex, forced expiratory volume in 1 sec (FEV1), the ratio of FEV1 over forced vital capacity (FVC), time on pump, units of blood transfused, New York Heart Association grading, and cardiac performance indices. ⋯ We conclude that nasal CPAP is well tolerated as a treatment of hypoxemia in the immediate postoperative period of aortocoronary bypass patients. CPAP does not change the course of postoperative atelectasis.
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The purpose of this study was to measure the predictive power of Acute Physiology and Chronic Health Evaluation (APACHE II) with respect to mortality in a group of seriously injured patients and to compare this predictive power with that of the Trauma Score (TS) and the Injury Severity Score (ISS). Six hundred ninety-one helicopter-transported patients were studied. ⋯ Areas under the receiver operating curves for the three scores were not significantly different (TS 0.8116, SD 0.0245; APACHE II 0.8515, SD 0.0204; ISS 0.7967; SD 0.0223). APACHE II is a good predictor of mortality, and its predictive power is complemented by TS and ISS.
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Critical care medicine · Aug 1990
Impact of encephalopathy on mortality in the sepsis syndrome. The Veterans Administration Systemic Sepsis Cooperative Study Group.
Sepsis, an important cause of hospital mortality, continues to be a diagnostic and therapeutic challenge. To define more clearly the impact of encephalopathy on the course of sepsis, the various clinical signs of sepsis, blood culture results, and mortality rates were examined in relation to mental status in septic patients. Patients were classified as having an acutely altered mental status due to sepsis (AAMS), preexisting altered mental status (PAMS), or normal mental status (NMS). ⋯ Multivariate analysis disclosed that altered mental status, hypothermia, hypotension, thrombocytopenia, and the absence of shaking chills were independent predictors of increased mortality in the sepsis syndrome. Patients with Gram-negative bacteremia (28%) were as likely to have AAMS as patients with Gram-positive bacteremia (25%) or patients with negative blood cultures (23%). In summary, alterations in mental status are common in septic patients, and are associated with significantly higher mortality.
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Critical care medicine · Aug 1990
Case ReportsKetamine by continuous infusion for sedation in the pediatric intensive care unit.
ICU physicians generally rely on either narcotics or benzodiazepines to provide analgesia and sedation. We describe five patients in whom ketamine administered as a bolus dose of 0.5 to 1.0 mg/kg, followed by a continuous infusion of 10 to 15 micrograms/kg.min, provided effective sedation and analgesia without significantly compromising cardiorespiratory function. ⋯ With ketamine, no reduction in mean arterial pressure from baseline was noted in any patient. As with any form of iv anesthesia, ketamine can have cardiorespiratory side-effects; therefore, the means to manage these effects should be readily available.
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The FFB may facilitate airway management and offers utilization in intubation, extubation, diagnosis of airway damage, ET tube changing, and simultaneous diagnosis and therapeutic intervention in UAO. The FFB may also be used to facilitate insertion of a double-lumen EB tube to initiate dual lung ventilation. In addition to development of technical skills, the ICU physician should know the indications and complications of FOB in the critically ill patient.