Critical care medicine
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Critical care medicine · Jan 1994
Comparative StudyInfluence of nosocomial infection on mortality rate in an intensive care unit.
To assess the impact of nosocomial infection on the mortality rate in an intensive care unit (ICU). ⋯ Nosocomial infection increases the risk of death. The effect is stronger in younger and less severely ill patients.
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Critical care medicine · Jan 1994
Optimal sedation of mechanically ventilated pediatric critical care patients.
To derive a target range of optimal sedation for the COMFORT Scale and to prospectively test that target range against intensivist assessment of adequacy of sedation. ⋯ Adequacy of sedation is measured more consistently by observers using the COMFORT Scale than by intensivist global assessment.
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Critical care medicine · Jan 1994
Pretransport Pediatric Risk of Mortality (PRISM) score underestimates the requirement for intensive care or major interventions during interhospital transport.
To test the hypothesis that a pretransport Pediatric Risk of Mortality (PRISM) score underestimates the requirement for both intensive care and interventions during pediatric interhospital transport. ⋯ PRISM scores determined before interhospital transfer of pediatric patients underestimated the requirement for intensive care and the performance of major interventions in the pretransport setting. Many patients with low PRISM scores required intensive care on admission to the receiving hospital and major interventions during the transport process, and, therefore, were not at "low risk" for clinical deterioration. The PRISM score should not be used as a severity of illness measure or triage tool for pediatric interhospital transport.
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Critical care medicine · Jan 1994
Randomized Controlled Trial Multicenter Study Clinical TrialInitial evaluation of human recombinant interleukin-1 receptor antagonist in the treatment of sepsis syndrome: a randomized, open-label, placebo-controlled multicenter trial.
To evaluate the safety, pharmacokinetics, and efficacy of human recombinant interleukin-1 receptor antagonist (IL-1ra) in the treatment of patients with sepsis syndrome. ⋯ This initial evaluation suggests that human recombinant IL-1ra is safe and may provide a dose-related survival advantage to patients with sepsis syndrome. A larger, definitive clinical trial is needed to confirm these findings.
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Critical care medicine · Jan 1994
Randomized Controlled Trial Comparative Study Clinical TrialRandomized, prospective trial of pressure-limited versus volume-controlled ventilation in severe respiratory failure.
Volume-controlled ventilation is frequently chosen as the initial mode of ventilatory support in patients with hypoxic respiratory failure. Recent data, however, suggest that pressure-limited ventilation, using a rapidly decelerating flow delivery pattern, may produce a more desirable clinical effect through reduced peak airway pressures and increased static compliance, tissue oxygen delivery, and consumption. This study was performed to assess the feasibility and utility of early and sustained use of pressure-limited ventilation in patients with this clinical syndrome. ⋯ Pressure-limited ventilation can be used safely and is well tolerated as an initial mode of ventilatory support in patients with acute hypoxic respiratory failure. Because the early initiation of pressure-limited ventilation is associated with lower peak airway pressure and more rapid improvement in static thoracic compliance than volume-controlled ventilation, pressure-limited ventilation may have a beneficial role when used as the primary ventilatory modality in patients with this clinical condition.