Critical care medicine
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Critical care medicine · Jul 1999
Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients.
Subjective scales to assess agitation and sedation in adult intensive care unit (ICU) patients have rarely been tested for validity or reliability. We revised and prospectively tested the Sedation-Agitation Scale (SAS) for interrater reliability and compared it with the Ramsay scale and the Harris scale to test construct validity. ⋯ SAS is both reliable (high interrater agreement) and valid (high correlation with the Harris and Ramsay scales) in assessing agitation and sedation in adult ICU patients. SAS provides additional information by stratifying agitation into three categories (compared with one for the Ramsay scale) without sacrificing validity or reliability.
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Critical care medicine · Jul 1999
Components of energy expenditure in patients with severe sepsis and major trauma: a basis for clinical care.
To obtain accurate values for the components of energy expenditure in critically ill patients with sepsis or trauma during the first 2 wks after admission to the intensive care unit. ⋯ Total energy expenditure is maximal during the second week after admission to the critical care unit, reaching 50 to 60 kcal/kg/day.
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Critical care medicine · Jul 1999
Sublingual capnometry: a new noninvasive measurement for diagnosis and quantitation of severity of circulatory shock.
To investigate the feasibility and predictive value of sublingual Pco2 (P(SL)CO2) measurements as a noninvasive and early indicator of systemic perfusion failure. ⋯ P(SL)CO2 may serve as a technically simple and noninvasive clinical measurement for the diagnosis and estimation of the severity of circulatory shock states.
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Critical care medicine · Jul 1999
Utilization of intensive care unit days in a Canadian medical-surgical intensive care unit.
To analyze the utilization of intensive care unit (ICU) days in a Canadian medical-surgical ICU and to identify ICU patients with prolonged ICU length of stay (LOS). ⋯ In a Canadian medical-surgical ICU, patients with ICU LOS > or = 14 days accounted for 7.3% of total admissions but consumed 43.5% of total ICU days. Identification of patients with prolonged ICU LOS who would ultimately die in the ICU may lead to earlier withdrawal of therapy in these patients, resulting in a substantial reduction in suffering and cost savings. In our study population, outcome prediction using the APACHE II equation did not provide sufficient power to accurately discriminate between nonsurvivors and survivors.
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Critical care medicine · Jul 1999
Effect of arrest time and cerebral perfusion pressure during cardiopulmonary resuscitation on cerebral blood flow, metabolism, adenosine triphosphate recovery, and pH in dogs.
To test the hypothesis that greater cerebral perfusion pressure (CPP) is required to restore cerebral blood flow (CBF), oxygen metabolism, adenosine triphosphate (ATP), and intracellular pH (pHi) levels after variable periods of no-flow than to maintain them when cardiopulmonary resuscitation (CPR) is started immediately. ⋯ A CPP of 25 mm Hg maintains supratentorial blood flow and ATP at 60% to 70% when CPR starts immediately on arrest, but not after a 6-min delay. A higher CPP of 35 mm Hg is required to restore CBF and ATP when CPR is delayed for 6 mins. After a 12-min delay, even the CPP of 35 mm Hg is unable to restore CBF and ATP. Therefore, increasing the arrest time at these perfusion pressures increases the resistance to reflow sufficient to impair restoration of cerebral ATP.