Critical care medicine
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Critical care medicine · Nov 1998
Comparative StudyNeither dopamine nor dobutamine corrects mesenteric blood flow depression caused by positive end-expiratory pressure in a rat model of acute lung injury.
To determine if either dopamine or dobutamine would counteract the deleterious effect that positive end-expiratory pressure (PEEP) has on cardiac output and mesenteric blood flow in a rat model of acute lung injury. ⋯ The higher doses of dopamine and dobutamine partially, but insignificantly, corrected the cardiac output depression caused by PEEP in a model of acute lung injury. Neither dose of dopamine nor dobutamine was able to improve PEEP-induced mesenteric blood flow depression.
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Critical care medicine · Nov 1998
Comparative StudyRight ventricular end-diastolic volume index as a predictor of preload status in patients on positive end-expiratory pressure.
To evaluate the clinical utility of right ventricular end-diastolic volume index (RVEDVI) and pulmonary artery occlusion pressure (PAOP) as measures of preload status in patients with acute respiratory failure receiving treatment with positive end-expiratory pressure. ⋯ CI correlates significantly better with RVEDVI than PAOP at all levels of PEEP up to 50 cm H2O. RVEDVI is a more reliable predictor of volume depletion and preload recruitable increases in CI, especially in patients receiving higher levels of PEEP where PAOP is difficult to interpret.
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Critical care medicine · Nov 1998
Comparative StudyIntensive care unit prognostic scoring systems to predict death: a cost-effectiveness analysis.
To evaluate the cost-effectiveness, using the technique of decision analysis, of withdrawing care from patients in the intensive care unit (ICU) who are predicted to have a high probability of death (>90%) after 48 hrs using a mortality risk estimate based on daily Acute Physiology and Chronic Health Evaluation (APACHE) III scores. ⋯ Unless daily mortality risk estimates based on APACHE III can be shown to retain the same level of predictive power in ICUs outside the development database, it is unlikely that the incremental cost-effectiveness gained by using them as the basis to withdraw care is sufficient to justify their use in this manner.
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Critical care medicine · Nov 1998
Multicenter Study Comparative StudyPatients readmitted to the intensive care unit during the same hospitalization: clinical features and outcomes.
To determine the clinical features and outcomes of patients readmitted to the intensive care unit (ICU) during the same hospital stay and the causes for these readmissions. ⋯ Patients with GI and neurologic diseases are at greatest risk of requiring ICU readmission. Respiratory diseases are the major reason for readmission due to new complications. Readmitted patients have a high risk of hospital death that may be underestimated by the usual physiologic indicators on either initial admission or readmission. Further studies are required to determine if patients at risk for readmission can be identified early to improve the outcome.