Critical care medicine
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Critical care medicine · Sep 1994
Multicenter StudyImproving intensive care unit discharge decisions: supplementing physician judgment with predictions of next day risk for life support.
To develop predictive equations, estimating the probability that an individual intensive care unit (ICU) patient will receive life support within the next 24 hrs. ⋯ Accurate, objective predictions of next day risk for life support can be developed, using readily available patient information. Supplementing physician judgment with these objective risk assessments deserves evaluation for the role of these assessments in enhancing patient safety and improving ICU resource utilization.
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Critical care medicine · Sep 1994
Early, routine paralysis for intracranial pressure control in severe head injury: is it necessary?
To investigate the efficacy of early, routine use of neuromuscular blocking agents for intracranial pressure management in patients with severe head injury. ⋯ Our findings suggest that early, routine, long-term use of neuromuscular blocking agents in patients with severe head injuries to manage intracranial pressure does not improve overall outcome and may actually be detrimental because of the prolongation of their ICU stay and the increased frequency of extracranial complications associated with pharmacologic paralysis. We suggest that routine early management of the head-injured patient in the ICU should be accomplished using sedation alone and that neuromuscular blockade should be generally reserved for patients with intracranial hypertension who require escalation of treatment intensity.
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To determine the applicability of the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system in predicting outcome in a subgroup of critically ill obstetrical patients. ⋯ Obstetrical patients requiring intensive care in our ICU had a better outcome than predicted, as expressed by a low mortality ratio. Various explanations that may be applicable to any subgroup of critically ill patients with a different mortality ratio are presented. The subgroup itself may be uniquely different, similar to our obstetrical patients with their physiologic changes of pregnancy. Another explanation may relate to an improvement in care of the subgroup and therefore a better outcome.
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Critical care medicine · Sep 1994
Multicenter Study Comparative StudyIntensive Care Society's Acute Physiology and Chronic Health Evaluation (APACHE II) study in Britain and Ireland: a prospective, multicenter, cohort study comparing two methods for predicting outcome for adult intensive care patients.
To compare the ability of two methods--Acute Physiology and Chronic Health Evaluation (APACHE II) and Mortality Prediction Model (MPM)--to predict hospital outcome for a large group of intensive care patients from Britain and Ireland. ⋯ APACHE II demonstrated a higher degree of overall goodness of fit, which was superior to MPM for groups of intensive care patients from Britain and Ireland.
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Critical care medicine · Sep 1994
Randomized Controlled Trial Clinical TrialPropofol versus midazolam for intensive care unit sedation after coronary artery bypass grafting.
To compare the safety and effectiveness of propofol (2,6-diisopropylphenol) to midazolam for sedation of mechanically ventilated patients after coronary artery bypass grafting. ⋯ Both propofol and midazolam provided safe and effective sedation of coronary artery bypass graft patients recovering from high-dose opioid anesthesia. The reduced need for both antihypertensive medication and opioids seen in the propofol group may be advantageous. However, the hypotension seen after the initial bolus dose of propofol may be a concern. No difference between the two drugs could be demonstrated in time to extubation or ICU discharge, although it is probable that time to extubation was governed more by residual operative opioids than the study agents.