Critical care medicine
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To describe the clinical and laboratory parameters of patients with septic shock following infection with Coccidioides immitis, estimate the incidence of septic shock from coccidioidomycosis, and outline clues that may be helpful in early diagnosis of this syndrome. ⋯ Septic shock following infection with C. immitis is an ominous yet underrecognized condition. Hemodynamic parameters and cytokine concentrations were not significantly different from values seen in gram-negative septic shock. Clinical clues to the diagnosis include duration of illness and conspicuous pulmonary involvement. Patient outcome in this series was poor but may improve with increased recognition of septic shock in infections from C. immitis.
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Critical care medicine · Jan 1998
Comparative StudyEffect of clinical outcomes data on intensive care unit utilization by bone marrow transplant patients.
To determine if a program to educate referring physicians as to the poor outcome of mechanically ventilated bone marrow transplant patients would result in a change in intensive care unit (ICU) utilization. ⋯ Simple educational interventions are not a powerful mechanism by which to alter the practice of physicians regarding the utilization of scarce and expensive resources, even when the physicians generally agree that the use of those resources results in dismal patient outcomes.
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Critical care medicine · Jan 1998
Comparative StudyIn vitro evaluation of a new lithium dilution method of measuring cardiac output and shunt fraction in patients undergoing venovenous extracorporeal membrane oxygenation.
To evaluate, in vitro, a method of measuring cardiac output and shunt fraction during venovenous extracorporeal membrane oxygenation (ECMO). ⋯ This method would allow cardiac output and shunt flow to be measured in patients undergoing venovenous ECMO. It could result in better patient management and improved cannula design.
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Critical care medicine · Jan 1998
Multicenter Study Comparative StudyMortality prediction in head trauma patients: performance of Glasgow Coma Score and general severity systems.
To assess the performance of general severity systems (Acute Physiology and Chronic Health Evaluation [APACHE] II, Simplified Acute Physiology Score [SAPS] II, and Mortality Probability Models [MPM] II) for head trauma patients and to compare these systems with the Glasgow Coma Score, in order to obtain a good estimate of severity of illness and probability of hospital mortality. ⋯ The MPM II system performs better than APACHE II, SAPS II, and Glasgow Coma Score for head trauma patients. If our results are supported by other studies, MPM II would be an appropriate tool to assess severity of illness in head trauma patients, with applications to clinical practice and clinical research.
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Critical care medicine · Jan 1998
Multicenter StudyConfidence in life-support decisions in the intensive care unit: a survey of healthcare workers. Canadian Critical Care Trials Group.
To examine the relationship between intensive care unit (ICU) healthcare workers' confidence and their decision to withdraw life support. ⋯ While confidence in decisions about withdrawal of life support increases with seniority and authority, consistency of decisions may not. When given standard information, healthcare workers can make contradictory decisions yet still be very confident about the level of care they would administer.