Critical care medicine
-
Critical care medicine · Aug 1998
Multicenter Study Comparative StudyOutcome of intensive care patients in a group of British intensive care units.
To identify priorities for intensive care unit (ICU) intervention and research. ⋯ Early identification of patients at risk, both before admission and after discharge from the ICU, may allow treatment to decrease mortality. Research and resources may be best directed at patients who die, despite a relatively low predicted mortality. Although these patients are a small percentage of the low-risk admissions, they constitute a large number of ICU deaths. Many patients die after discharge from ICU and this mortality may be decreased by minimizing inappropriate early discharge to the ward, by the provision of high-dependency and step-down units, and by continuing advice and follow-up by the ICU team after the patient has been discharged. Intervention before ICU admission and support of patients after discharge from the ICU should be part of the effort to decrease mortality for ICU patients. Inadequate provision of resources for critically ill patients may result in excess intensive care mortality that is not detected with ICU outcome prediction methods.
-
Critical care medicine · Aug 1998
Comparative StudyNo difference exists in the alteration of circadian rhythm between patients with and without intensive care unit psychosis.
To determine if a difference exists in the circadian rhythm entrainment between patients with and without intensive care unit (ICU) psychosis. ⋯ Either patients who develop ICU psychosis have an increased sensitivity to an alteration of their circadian rhythm, or ICU psychosis develops independent of circadian rhythm abnormalities.
-
Critical care medicine · Aug 1998
Comparative StudyCardiorespiratory effects of manually compressing the rib cage during tidal expiration in mechanically ventilated patients recovering from acute severe asthma.
To determine the cardiorespiratory effects of manual expiratory rib cage compression in mechanically ventilated patients recovering from acute severe asthma; and to extrapolate these findings to emergency asthma management where ventilation cannot be achieved by positive-pressure ventilation. ⋯ The results suggest that manual compression of the rib cage during consecutive tidal expirations would be ineffective in reducing pulmonary hyperinflation during the emergency management of asthma when air flow obstruction is so severe that ventilation cannot be achieved by positive-pressure ventilation.
-
Critical care medicine · Aug 1998
Comparative StudyDetermination of cardiac output during mechanical ventilation by electrical bioimpedance or thermodilution in patients with acute lung injury: effects of positive end-expiratory pressure.
To evaluate the usefulness of transthoracic electrical bioimpedance in sedated and paralyzed patients with acute lung injury during mechanical ventilation with and without early application of positive end-expiratory pressure (PEEP). ⋯ In patients with acute lung injury: a) the agreement between TEB-CO and TD-CO measurements is poor; b) agreement is not clinically improved by application of PEEP; and c) TEB cannot monitor trends in CO.
-
Critical care medicine · Aug 1998
Gastric pH control in critically ill children receiving intravenous ranitidine.
To determine whether the dose of ranitidine recommended in commonly used pediatric drug dosage handbooks (2 to 4 mg/kg/day i.v.) results in successful gastric pH control (pH of >4) in critically ill children. ⋯ The minimum ranitidine dose recommended in commonly used pediatric drug references resulted in unsuccessful gastric pH control in a high percentage of pediatric intensive care unit patients. Critically ill children with normal renal and hepatic function should be treated with a minimum 3 mg/kg/day of intravenous ranitidine and the dose should be titrated to a gastric pH of > or =4.