Critical care medicine
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Procalcitonin, the precursor peptide of calcitonin, has been shown to be a serum marker of the severity and mortality of several systemic inflammatory response syndromes. This study addressed the correlation of serum procalcitonin with the course of classic (nonexertional) heatstroke. ⋯ Classic heatstroke is associated with increased concentrations of serum procalcitonin, particularly among survivors. Further studies are required to elucidate the source and action(s) of procalcitonin as well as its relationship to cytokine activation.
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Critical care medicine · Aug 1997
A retrospective review of a large cohort of patients undergoing the process of withholding or withdrawal of life support.
To determine the proportion of patients who died as a result of the withdrawal or withholding of life support (WD/WHLS) in the intensive care units (ICUs) of three teaching hospitals and to describe the process involved by determining: a) why the decision was made to withdraw support (WDLS); b) when WDLS took place; and c) how the WDLS process was conducted. ⋯ Similar to other studies, WD/WHLS was the most common cause of death in academic ICUs and poor patient prognosis was considered the most important factor in deciding on WDLS. However, in contrast to other studies, future quality of life was not as frequently cited a reason for WDLS and larger amounts of morphine were used during WDLS. These discrepancies suggest areas for potential future research.
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Critical care medicine · Aug 1997
Survival and functional outcome of children requiring endotracheal intubation during therapy for severe traumatic brain injury.
To determine the predictors of survival and functional outcome of pediatric patients with traumatic brain injury severe enough to require endotracheal intubation and mechanical ventilation. ⋯ Children with severe traumatic brain injury who survive to hospital discharge will continue to improve in their functional status over the next few years. Although low Glasgow Coma Score is strongly associated with death or poor functional outcome after therapy for traumatic brain injury, many patients with Glasgow Coma Score of < or = 5 can survive with good function. PRISM scores add to the power of Glasgow Coma Score to predict survival and functional outcome in tracheally intubated pediatric patients with Glasgow Coma Score of < or = 5.
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Critical care medicine · Aug 1997
Comparative StudyCan hospital discharge diagnoses be used for intensive care unit administrative and quality management functions?
To determine whether hospital discharge diagnoses can be used for intensive care unit (ICU)-related activities. ⋯ The primary discharge diagnosis often failed to reflect the reason for ICU admission, making it impossible to consistently establish the reason for ICU admission from the discharge data. The reason for ICU admission was also frequently not included among the secondary discharge diagnoses. Administrative data are therefore not useful for ICU quality management and other functions. Intensivists need to establish their own databases.
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Critical care medicine · Aug 1997
Relationship between leukocyte count and patient risk for excessive blood loss after cardiac surgery.
To evaluate the relationship between leukocyte counts and risk for excessive blood loss after cardiac surgery when including numerous demographic, operative, and laboratory factors in the comparison. ⋯ On-site measurements of white blood cell count, as an index of the inflammatory response to extracorporeal circulation, may be useful in identifying patients at increased risk for excessive bleeding. Further studies are needed to examine whether white blood cell counts during multiple cardiopulmonary bypass periods may identify patients with an exaggerated inflammatory response to extracorporeal circulation. By using this information, physicians may be able to intervene with anti-inflammatory medications and blood preservation techniques.