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
Multicenter StudyDaily prognostic estimates for critically ill adults in intensive care units: results from a prospective, multicenter, inception cohort analysis.
To develop daily prognostic estimates for individual patients treated in adult intensive care units (ICU). ⋯ Equations using initial and repeated physiologic measurements provide a high degree of explanatory power for subsequent hospital mortality rate. These daily prognostic estimates deserve evaluation for their potential role in improving the process and outcome from clinical decision-making.
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Critical care medicine · Sep 1994
ReviewUnderstanding the pressure cost of ventilation: why does high-frequency ventilation work?
To understand when the use of high-frequency ventilation would be advantageous, we formulated the problem of achieving adequate alveolar ventilation at minimal pressure cost by dividing it into two simpler problems: a) the pressure cost per unit of convective oscillatory flow; and b) the convective flow cost necessary to achieve a unit of alveolar ventilation. ⋯ This analysis illustrates the importance of using high-frequency ventilation in infant respiratory distress syndrome and of optimizing the amount of PEEP. It also points out the danger of barotrauma in the derecruited lung. When the lungs are in a derecruited state, the combinations of frequency, PEEP, and tidal volume that yield adequate ventilation with safe distention of recruited alveoli are severely limited.
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Critical care medicine · Sep 1994
Predictors of acute respiratory failure after bone marrow transplantation in children.
To determine factors associated with acute respiratory failure after bone marrow transplantation which can be identified before the onset of lung disease. ⋯ Renal and liver dysfunction preceded clinical evidence of lung disease in bone marrow transplant patients who developed respiratory failure. Lung disease leading to respiratory failure and adult respiratory distress syndrome appears to develop as one component of the multiple organ failure syndrome in pediatric bone marrow transplant patients.
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Critical care medicine · Sep 1994
Airway pressure measurements during high-frequency positive pressure ventilation in extremely low birth weight neonates.
Evaluation of a modified, computer-controlled, shutter method to determine the complete intrapulmonary pressure course and to ascertain the expiratory time constant for the respiratory system during high-frequency positive pressure ventilation. ⋯ The computer-controlled shutter method is noninvasive and applicable without impairment, even in preterm neonates with birth weights of < 1000 g. This method provides important information to optimize respiratory therapy, particularly knowledge of the individual time constant. To avoid inadvertent positive end-expiratory pressure and gas trapping, expiratory time should be > 4 time constants.