Critical care medicine
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Critical care medicine · Oct 1993
Eliminating needless testing in intensive care--an information-based team management approach.
To determine if the application of an information-based management system in adult intensive care units (ICU) can produce sustained decreases in the use of laboratory resources and costs. ⋯ Application of an information-based multidisciplinary management system in the ICU can produce marked and sustained reductions in unnecessary testing in a cost-effective manner. Although rationing of intensive care services may be necessary, reducing needless testing can be a safe and effective cost-containment strategy in the ICU.
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To review the role of tumor necrosis factor (TNF) in the pathogenesis of the septic shock syndrome. ⋯ TNF plays a major role in the pathogenesis of the septic shock syndrome. TNF exerts a range of beneficial and injurious effects that may ultimately lead to organ dysfunction and death. The burst of TNF release after endotoxemia promotes the progression of the shock syndrome even in the absence of further TNF release. New therapies targeted to the attenuation of TNF may hold promise for the management of patients with septic shock syndrome.
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Critical care medicine · Oct 1993
Hypertonic saline infusion in hemorrhagic shock treated by military antishock trousers (MAST) in awake sheep.
To determine the effect of military antishock trousers (MAST) combined with hypertonic saline in controlled hemorrhagic shock in an awake sheep model. ⋯ In hemorrhagic shock, the combination of MAST and hypertonic saline increases mean arterial pressure, improves cardiac output and tissue perfusion during the application of MAST, and also prolongs for > 2 hrs the short beneficial effect of hypertonic saline on mean arterial pressure.
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Critical care medicine · Oct 1993
Glasgow Coma Scale score in the evaluation of outcome in the intensive care unit: findings from the Acute Physiology and Chronic Health Evaluation III study.
To investigate the ability of the Glasgow Coma Scale score to predict hospital mortality rate for adult medical-surgical intensive care unit (ICU) patients without trauma. ⋯ We demonstrated the prognostic importance of admission levels of consciousness as measured by the Glasgow Coma Scale score on ICU and hospital mortality rates. We concluded that the Glasgow Coma Scale score may be used to stratify and predict mortality risk in general intensive care patients, but lack of sensitivity in the intermediate range of Glasgow Coma Scale Score should be noted. Ideally, the Glasgow Coma Scale score should also be applied in the context of other physiologic information and the patient's specific diagnosis. Variation in the use of sedatives in different ICUs means that imputing or substituting a value other than normal for an unobtainable Glasgow Coma Scale score may introduce a substantial treatment bias into subsequent outcome predictions.
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Critical care medicine · Oct 1993
Comparative StudyAccuracy of a new bedside method for estimation of circulating blood volume.
To evaluate the accuracy of a modification of the carbon monoxide method of estimating the circulating blood volume. ⋯ Determination of circulating blood volume can be performed with sufficient accuracy using an amount of carbon monoxide that gives rise to an unharmful increase in the carboxyhemoglobin concentration.