Critical care medicine
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Critical care medicine · Feb 1994
Changing patterns of terminal care management in an intensive care unit.
To empirically describe changes in terminal care management behavior over time with the advent of natural death acts and public dialogue and institutional policy regarding terminal care. ⋯ There is now an increasing probability that impending death will be acknowledged by a formal terminal care decision. Such decisions may become even more frequent with the dialogue generated by the Patient Self Determination Act and the advent of decisions based on physiologic futility.
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Critical care medicine · Feb 1994
Inferior vena caval pressure reliably predicts right atrial pressure in pediatric cardiac surgical patients.
To compare "central venous pressure" in pediatric patients in a clinical setting as measured from catheters in the infrahepatic inferior vena cava and the right atrium. ⋯ We conclude that while "central" venous pressures measured in the inferior vena cava and in the right atrium are not statistically identical, any differences are well within clinically important limits. Placement of central venous pressure catheters in the inferior vena cava by the femoral venous approach is a reliable alternative to cannulating the superior vena cava in pediatric patients without clinically important intra-abdominal pathology and with anatomic continuity of the inferior vena cava with the right atrium. Relatively short femoral vein catheters allow adequate measurement of central venous pressure without concern for exact catheter tip position and without the risk of right atrial perforation, intracardiac arrhythmias, and inadvertent puncture of carotid and intrathoracic structures. Unlike previously reported results in neonates, we found that the phasic changes of venous pressure with the respiratory cycle were similar in both intrathoracic and intra-abdominal recordings, making this an inappropriate clinical indicator of venous catheter tip position.
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Critical care medicine · Feb 1994
Developing strategies to prevent inhospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event.
To determine: a) the frequency of premonitory signs and symptoms before cardiac arrest in patients on the general medical wards of a hospital; b) any characteristic patterns in nurse and physician responses to these signs and symptoms; and c) whether cardiac arrests on the ward occur more frequently in patients discharged from the medical intensive care unit (ICU) than in other patients. ⋯ Cardiac arrests on the general wards of the hospital are commonly preceded by premonitory signs and symptoms. Strategies to prevent cardiac arrest should include training for nurses and physicians that concentrates on cardiopulmonary stabilization and how to respond to neurologic and respiratory deterioration. Special attention should also be devoted to patients who have been discharged from the ICU who are at greater risk for cardiac arrest after ICU discharge than are other medical patients.
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Critical care medicine · Feb 1994
Attitudes of critical care medicine professionals concerning distribution of intensive care resources. The Society of Critical Care Medicine Ethics Committee.
To determine critical care practitioners' attitudes about the importance of various factors in decisions to use intensive care, including age, prognosis, quality of life, patient preference, and medical condition. ⋯ These results suggest that critical care providers, who must occasionally face difficult decisions about how to distribute limited resources among patients with competing needs, were not often inclined, at the time of this survey, to make choices based on estimates of who might benefit most. These critical care physicians' attitudes about triage may not support the optimal use of critical care resources.