Critical care medicine
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Critical care medicine · Sep 1997
Randomized Controlled Trial Multicenter Study Clinical TrialEarly postoperative enteral immunonutrition: clinical outcome and cost-comparison analysis in surgical patients.
To determine if early postoperative feeding of patients with upper gastrointestinal malignancy, using an enteral diet supplemented with arginine, dietary nucleotides, and omega-3 fatty acids (IMPACT, Sandoz Nutrition, Bern, Switzerland) results in an improved clinical outcome, i.e., reduced infectious and wound complications and decreased treatment costs when compared with an isocaloric, isonitrogenous control diet. ⋯ Early enteral feeding with an arginine, dietary nucleotides, and omega-3 fatty acids supplemented diet, as well as an isonitrogenous, isocaloric control diet (placebo) were well tolerated in patients who underwent upper gastrointestinal surgery. In patients who received the supplemented diet, a significant reduction in the frequency rate of late postoperative infectious and wound complications was observed. Thereby, the treatment costs were substantially reduced in the immunonutrition group as compared with the control group.
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Critical care medicine · Sep 1997
ReviewAnalyzing intensive care unit length of stay data: problems and possible solutions.
To explore methods of evaluating the length of stay patterns of intensive care unit (ICU) patients. It was hypothesized that the mean does not adequately describe the typical length of stay (central tendency) because distribution patterns are often markedly skewed by patients with extended stays. Therefore, other descriptors are needed. In addition, ways are needed to identify outliers-patients with stays longer or shorter than the bulk of the data. ⋯ When analyzing length of stay data it is important to visually examine the frequency distribution because it is often skewed to the right. This skewness renders traditional parameters such as the mean and standard deviation less useful for describing the typical length of stay. Instead, the median, mode, and harmonic mean should be used. When reporting length of stay, some indication of the characteristics of the data should be presented. A graph of the frequency distribution rapidly allows the reader to determine its shape. A simple method is to report the mean, median, and range.
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Critical care medicine · Sep 1997
Case Reports Clinical Trial Controlled Clinical TrialInitial evaluation of diaspirin cross-linked hemoglobin (DCLHb) as a vasopressor in critically ill patients.
To evaluate the hemodynamic effects and any toxicologic effects of diaspirin cross-linked hemoglobin (DCLHb) in critically ill patients. ⋯ This preliminary study demonstrated that diaspirin cross-linked hemoglobin is a potent vasopressor agent in critically ill patients with septicemic shock or systemic inflammatory response syndrome. This vasopressor characteristic of diaspirin cross-linked hemoglobin may have future clinical applications.
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Critical care medicine · Sep 1997
Multicenter StudyOutcome of pediatric intensive care at six centers in Mexico and Ecuador.
To improve understanding of the causes of morbidity and mortality among critically ill children in the countries studied. ⋯ For six pediatric ICUs in Mexico and Ecuador, mortality was significantly higher than predicted among lower-risk patients. Tracheal intubation, central catheters, pneumonia, sepsis, and nonsurgical status were associated with poor outcome for low-risk groups. We speculate that reducing the use of invasive central catheters and endotracheal intubation for lower-risk patients, coupled with improved infection control, could lower mortality rates in the population studied.
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Critical care medicine · Sep 1997
Randomized Controlled Trial Comparative Study Clinical TrialThyroid function in infants following cardiac surgery: comparative effects of iodinated and noniodinated topical antiseptics.
Cardiopulmonary bypass has profound effects on thyroid hormone metabolism. These effects may be exacerbated in infants because they are able to absorb large quantities of iodine transcutaneously. The purpose of this study was to test the hypothesis that preoperative povidone-iodine contributes to postoperative thyroid depression in infants who undergo cardiac surgery. ⋯ Cardiopulmonary bypass has a more significant effect on thyroid hormone metabolism than does the preoperative antiseptic.