Critical care medicine
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Critical care medicine · Sep 1999
Cannulation of the internal jugular vein: is postprocedural chest radiography always necessary?
To determine whether clinical features can be used in a decision rule to prospectively identify a subgroup of internal jugular catheter placements that are correctly positioned and free from mechanical complications, thus obviating the need for routine postprocedural chest radiographs in selected patients. ⋯ In experienced hands, internal jugular venous catheterization is a safe procedure. However, the incidence of axillary vein or right atrial catheter malposition is 14%, and clinical factors alone will not reliably identify malpositioned catheters. Chest radiographs are necessary to ensure correct internal jugular catheter position.
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Critical care medicine · Sep 1999
Mortality and the increase in length of stay attributable to the acquisition of Acinetobacter in critically ill patients.
To determine the impact of Acinetobacter baumannii (AB) acquisition in intensive care unit (ICU) patients on mortality and length of stay (LOS). ⋯ AB acquisition involved an excess LOS in ICU patients and increased risk of death, but the latter could be found only in patients with proven infection.
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Critical care medicine · Sep 1999
Quality, cost, and outcome of intensive care in a public hospital in Bombay, India.
To study the quality, cost, and benefits of intensive care in a public hospital in Bombay, India. ⋯ Intensive care in India is cheaper than in the West; however, mortality is 1.67 times that for patients with similar APACHE II scores in ICUs in the United States. This finding may be attributable to the lesser intensity of care per patient (lower day-1 TISS points), lower nurse-to-patient ratio because of shortage of trained personnel and budgetary constraints, and higher workload per nurse (64.2 TISS points per nurse, compared with 40 points per nurse in the West). In addition, the APACHE II scores may underestimate mortality for Indian patients because of differences in case mix, higher lead time between onset of admission and treatment before ICU admission, and possible inappropriateness of age points derived from American patients for Indian subjects because of a higher burden of diseases at lower ages in Indian patients.
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Critical care medicine · Sep 1999
Impact of respiratory syncytial virus infection on surgery for congenital heart disease: postoperative course and outcome.
a) To describe the postoperative course and outcome of cardiac surgery in children with recent respiratory syncytial virus (RSV) infection; and b) to evaluate whether timing of surgery has any impact on the outcome. ⋯ Cardiac surgery performed during the symptomatic period of RSV infection is associated with a high risk of postoperative complications, especially postoperative pulmonary hypertension. These complications appeared to be more frequent and of greater severity in patients who had earlier surgery compared with those who had later surgery. More studies are needed regarding the proper timing of cardiac surgery in patients with congenital heart disease and RSV infection.
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Critical care medicine · Sep 1999
Effect of short-term enteral feeding with eicosapentaenoic and gamma-linolenic acids on alveolar macrophage eicosanoid synthesis and bactericidal function in rats.
Because vasoactive eicosanoids derived from arachidonic acid present in immune cell phospholipids promote lung inflammation in critically ill patients, novel experimental diets containing eicosapentaenoic acid from fish oil and gamma-linolenic acid from borage oil have been designed to limit arachidonic acid metabolism. However, excess dietary eicosapentaenoic acid impairs superoxide formation and bacterial killing by immune cells. The present study determined whether short-term enteral feeding with diets enriched with either eicosapentaenoic acid alone or in combination with gamma-linolenic acid would modulate alveolar macrophage eicosanoid synthesis without compromising bactericidal function. ⋯ Short-term enteral feeding with an eicosapentaenoic acid-enriched or eicosapentaenoic with gamma-linolenic acid-enriched diet rapidly modulated the fatty acid composition of alveolar macrophage phospholipids, promoted a shift toward formation of less inflammatory eicosanoids by stimulated macrophages, but did not impair alveolar macrophage bactericidal function relative to responses observed after feeding a linoleic acid diet.