Critical care medicine
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Critical care medicine · Oct 1995
Comparative StudyHigh-risk intrahospital transport of critically ill patients: safety and outcome of the necessary "road trip".
Intrahospital transport of critically ill patients is often necessary for optimal patient care. However, transport of intensive care unit (ICU) patients within the hospital has been associated with a high rate of potentially detrimental complications. This study was designed to determine the occurrence rate of transport-related complications and to determine if these complications have any effect on patient morbidity and mortality. ⋯ Intrahospital transport of critically ill patients is safe and carries a low risk of detrimental complications. Although patients requiring "high-risk" interventions experienced a higher mortality rate than did APACHE-matched controls, the increase in mortality does not appear to be directly related to the intrahospital transport. Patients requiring transport out of the surgical ICU are a more critically ill group of patients. These patients require a greater length of stay in the surgical ICU and may experience an increased mortality rate by virtue of the severity of their illness.
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Critical care medicine · Oct 1995
Comparative StudyQualitative comparison of carbon dioxide-induced change in cerebral near-infrared spectroscopy versus jugular venous oxygen saturation in adults with acute brain disease.
To compare carbon dioxide-induced changes in cerebral oxy- and deoxyhemoglobin, measured by near-infrared spectroscopy, with those changes in jugular venous oxygen saturation in adult patients with acute brain disease. ⋯ Jugular venous oxygen saturation consistently demonstrates cerebrovascular responsiveness to CO2. The direction and magnitude of changes in cerebral oxyhemoglobin, measured by near-infrared spectroscopy, were similar to those changes in jugular venous oxygen saturation in most of our cases. Interpretation of a negligible change in oxyhemoglobin in one patient, despite an obvious increase in jugular venous oxygen saturation, requires further study comparing near-infrared spectroscopy with standard techniques.
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Critical care medicine · Oct 1995
Comparative StudyEstablishing the relative accuracy of three new definitions of the adult respiratory distress syndrome.
Over the last few years, new definitions of the adult respiratory distress syndrome (ARDS) have been introduced that potentially identify patients earlier in their course of acute lung injury. However, these definitions have never been compared with any of the older and potentially stricter definitions of ARDS to determine if similar patients are eventually identified. We compared new definitions of ARDS--as represented by the Lung Injury Score, a modified Lung Injury Score, and the American-European Consensus Conference definition--against a stricter definition of ARDS to determine their accuracy. ⋯ We conclude that the Lung Injury Score, the modified Lung Injury Score, and the American-European Consensus Conference definition identify similar patients, provided that these methods are applied to patients with clearly defined at-risk diagnoses for ARDS.
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Critical care medicine · Oct 1995
Comparative StudyAirway leak size in neonates and autocycling of three flow-triggered ventilators.
To define the spectrum of airway leak in the neonatal population and examine the occurrence rate of autocycling of three flow-triggered ventilators within the defined spectrum of airleak. ⋯ Flow-triggered ventilators are susceptible to autocycling due to flow compensation to maintain positive end-expiratory pressure levels in the presence of an airway leak. The difference in autocycling is due to the maximum sensitivity setting of each ventilator, and not to intrinsic ventilator flowsensing or other software mechanisms. The 3.3-mL/sec setting was the least prone to autocycling and seems appropriate. The ventilator set at 2.5 mL/sec at the time of this study has been released instead at 4 mL/sec, due to these findings. The ventilator with the maximum setting at 1 mL/sec autocycled readily at leak size of > or = 10%. Since such a leak size was present in 70% of infants, this setting should be used with caution. Using these guidelines, autocycling of all three ventilators is likely to occur mainly in 8% of infants with leak size of > 30%. In these cases, lowering the sensitivity setting and/or positive end-expiratory pressure level may decrease autocycling, or may necessitate reintubation with a larger endotracheal tube.
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Critical care medicine · Oct 1995
Comparative StudyQuality of life measures before and one year after admission to an intensive care unit.
To assess outcome of patients admitted to an intensive care unit (ICU), using a prospective 1-yr follow-up, with special emphasis on various quality of life measures before and after admission to the ICU. ⋯ Patients admitted to intensive care tend to have a decrease in the level of activity and activities of daily living 1 yr after their ICU stay, although in the very elderly, perceived health status increases. As well, the majority (89%) of patients return home.