Critical care medicine
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To identify patient variables that were significantly associated with outcome in the ICU. ⋯ For patients who remain in the ICU for greater than 72 hrs, events occurring after ICU admission are negatively associated with ICU outcome, more so than ICU admission status as reflected by such indices as APACHE II scores. Iatrogenic complications, often due to inappropriate drug therapy, have a significant association with adverse outcome by multivariate analysis. We suggest that iatrogenic complications influence ICU outcome, and that they are potentially preventable. By lessening their frequency, ICU outcome may be improved.
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Critical care medicine · Jul 1992
A novel score for predicting the mortality of septic shock patients.
To establish a prognostic scoring system for septic shock patients. ⋯ The Simplified and the Complete Septic Shock Scores are simple scoring systems that appear to predict the outcome of septic shock patients more accurately than general scoring systems, such as the Simplified Acute Physiology Score and APACHE II score. These septic shock scores might be useful in assessing the severity of septic shock patients.
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Critical care medicine · Jul 1992
Nonphysician transport of intubated pediatric patients: a system evaluation.
To evaluate the occurrence of complications and patient deteriorations during the air and ground transportation of intubated pediatric patients, performed by a nonphysician-based team under the direction of an intensive care attending physician or fellow. ⋯ Under proper medical guidance, well-trained nonphysician personnel can provide low-risk transport of intubated pediatric patients. Use of sedatives and paralytic drugs did not increase the risk of complications or patient deterioration.
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a) To assess perioperative changes in tissue oxygenation parameters during liver transplantation; b) to evaluate the need for venovenous bypass as hemodynamic support; and c) to assess the efficacy of mixed venous oxygen saturation monitoring and the importance of lactate determinations in the management of patients following liver transplantation. ⋯ The Vo2-Do2-dependent relationship and mixed venous oxygen saturation-Do2 correlation noted in the 68 studied patients suggest the need for venovenous bypass and the reliability of mixed venous oxygen saturation monitoring in all patients scheduled for liver transplantation. However, a sharper comparison between hyperdynamic and normodynamic patients demonstrated the lack of efficacy of mixed venous oxygen saturation monitoring in predicting adequate tissue oxygenation in the first group and the mandatory need for venous shunting to limit tissue hypoxia which occurred despite its use only in these patients. Lactic acidosis appeared similarly in both groups and could not be linked to tissue hypoxia.
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To characterize the course of open-heart surgery patients who require prolonged (greater than 72 hrs) mechanical ventilation and to define the role and timing of tracheostomy. ⋯ Open-heart surgery patients requiring prolonged mechanical ventilation are a desperately ill subset of cardiac surgery patients. Those patients who survive are either extubated in less than 14 days or require prolonged mechanical ventilation beyond that point. In our opinion, patients should be given 1 wk to recover and one trial of weaning from the ventilator. If this approach fails, then they should undergo elective tracheostomy.