Critical care medicine
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Critical care medicine · Dec 1994
Joint position statement: essential provisions for critical care in health system reform. Society of Critical Care Medicine. American Association of Critical Care Nurses.
Production of a statement defining the essential provisions of health system reform as determined by the Society of Critical Care Medicine (SCCM) and the American Association of Critical-Care Nurses (AACN). This document is the only nurse-physician joint statement to result from the 1994 health system reform debate. ⋯ SCCM and AACN agreed that health system reform should ultimately achieve universal coverage, access, control cost, and should improve the quality of care. SCCM and AACN endorsed improved access to and coverage for preventive care services. Recognizing that critical illness and injury cannot be prevented entirely, SCCM and AACN agreed that a reformed system must foster improved care of the critically ill and injured as described below.
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Critical care medicine · Dec 1994
Multicenter Study Comparative Study Clinical TrialMulticenter trial of a new thoracic electrical bioimpedance device for cardiac output estimation.
To evaluate the capacity of a new thoracic electric bioimpedance system to estimate cardiac output compared with the conventional thermodilution method. ⋯ The new bioimpedance system satisfactorily estimated cardiac output as measured by the thermodilution technique. The difference between the two estimations is more than made up for by the continuous noninvasive capability of the impedance system.
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Critical care medicine · Dec 1994
Randomized Controlled Trial Clinical TrialInfluence of pressure- and flow-triggered synchronous intermittent mandatory ventilation on inspiratory muscle work.
To determine the effect of pressure- and flow-triggered synchronous intermittent mandatory ventilation on inspiratory muscle work. ⋯ During synchronous intermittent mandatory ventilation, the method of ventilator triggering has a significant effect on the total work rate and inspiratory muscle work of the spontaneous breaths, particularly at lower machine support levels. Conversely, the method of ventilator triggering has no significant effect on inspiratory muscle work of the mandatory breaths.
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Critical care medicine · Dec 1994
Randomized Controlled Trial Comparative Study Clinical TrialRenal support in critically ill patients: low-dose dopamine or low-dose dobutamine?
Low-dose dopamine has been used in critically ill patients to minimize renal dysfunction without sufficient data to support its use. The aim of this study was to determine whether low-dose dopamine improves renal function, and whether dobutamine, a nondopaminergic inotrope, improves renal function. ⋯ In stable critically ill patients, dopamine acted primarily as a diuretic and did not improve creatinine clearance. Dobutamine improved creatinine clearance without a significant change in urine output.
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Critical care medicine · Dec 1994
Randomized Controlled Trial Comparative Study Clinical TrialMechanical ventilators optimized for pediatric use decrease work of breathing and oxygen consumption during pressure-support ventilation.
a) To investigate whether the patient work of breathing needed to trigger inspiration is affected by the type of ventilator delivering pressure-support ventilation for mechanically ventilated pediatric patients. b) To determine whether changes in oxygen consumption (VO2) trend with changes in work of breathing and would thus be helpful in tracking work of breathing. ⋯ We conclude that VO2 and work of breathing may be reduced significantly using the latest generation of mechanical ventilators optimized for infant and pediatric use. Because work of breathing is less with the Bird VIP than the other two ventilators tested, leading to a corresponding decrease in VO2, we suggest that the Bird VIP better adapts the patient to the ventilator and may facilitate weaning from ventilatory support. We also suggest that changes in VO2 might be helpful in tracking changes in work of breathing.