Critical care medicine
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Critical care medicine · Feb 1999
Comparative StudyEffects of an organized critical care service on outcomes and resource utilization: a cohort study.
To determine whether the presence of an on-site, organized, supervised critical service improves care and decreases resource utilization. ⋯ Critical care interventions are expensive and have a narrow safety margin. It is essential to develop structured and validated approaches to study the delivery of this resource. In this study, the critical care service model performed favorably both in terms of quality and cost.
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Critical care medicine · Feb 1999
Comparative StudyEvaluation of a new continuous thermodilution cardiac output monitor in cardiac surgical patients: a prospective criterion standard study.
To evaluate the accuracy of a new continuous cardiac output monitor in critically ill patients. ⋯ Continuous cardiac output measurement using the thermodilution technique is reasonably accurate, reliable, and applicable in routine clinical practice. The values obtained using the Normal mode of the monitor agreed significantly better with the conventional thermodilution method than the results of the two other modes studied (FastFilter and Urgent). In addition, measurements in two patients with cardiac output values of >10 L/min did not agree with the results of the bolus thermodilution method.
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Critical care medicine · Feb 1999
Comparative StudyThe alveolar space is the site of intense inflammatory and profibrotic reactions in the early phase of acute respiratory distress syndrome.
To determine the concentrations of proinflammatory mediators, collagenases, and procollagen type III peptides in undiluted pulmonary edema fluids and in plasma obtained in patients with early acute respiratory distress syndrome (ARDS) and in control patients with hydrostatic lung edema; and to assess the relationship between these inflammatory and profibrotic markers. ⋯ These results strongly support the conclusion that during the early phase of ARDS, the lung is the site of an intense inflammatory process with sequential activation of cytokines, chemokines, and secretion of proteases, as well as concomitant collagen synthesis. The inflammation is mostly limited to the lung, with low levels of inflammatory mediators in the systemic circulation. Unlike clinical scoring systems (SAPS II and LIS), inflammatory markers differentiate patients with permeability and hydrostatic pulmonary edema.
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Critical care medicine · Feb 1999
Comparative StudyThe relationship of pre mortem diagnoses and post mortem findings in a surgical intensive care unit.
To evaluate pre- and post mortem diagnoses and determine their relationship and the discrepancy rate. ⋯ The overall discrepancy rate as well as the infectious discrepancy rate between pre mortem clinical diagnoses and post mortem findings were substantially higher in a surgical ICU compared with a hospital-wide population. The majority of these discrepancies were undiagnosed infections. The length of time spent in the ICU before death appeared to influence the rate of errors uncovered at the post mortem examination, suggesting that a longer ICU course, as well as the particular type of surgical patient population, may increase the chance of developing an infectious process, only to be uncovered at post mortem examination.
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Critical care medicine · Feb 1999
GuidelineCritical care services and personnel: recommendations based on a system of categorization into two levels of care. American College of Critical Care Medicine of the Society of Critical Care Medicine.
To recommend hospital services and personnel requirements for the provision of optimal care to critically ill patients. Requirements for hospitals with comprehensive resources, as well as for hospitals with limited resources, are addressed. ⋯ By combining the strengths and expertise of multidisciplinary critical care specialists, these guidelines provide a framework in which hospitals of varying resources may optimize the care of critically ill patients.