Critical care medicine
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Critical care medicine · Jun 2000
Risk assessment and standardized nosocomial infection rate in critically ill children.
To develop and validate a pediatric nosocomial infection risk (PNIR) assessment model, and to compare the daily trends in risk factors between patients with nosocomial infection (cases) and without nosocomial infection (controls) in the pediatric intensive care unit (ICU). ⋯ The PNIR assessment model incorporates intrinsic factors, such as patient severity of illness, and extrinsic factors contributing to the development of nosocomial infection in this high-risk population. The methodology using intrinsic and extrinsic factors to adjust for nosocomial infections should be taken into consideration when evaluating interhospital comparison of nosocomial infection rates, quality assessment, intervention strategies, and use of treatment modalities.
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To study the incidence and prognosis of thrombocytopenia in adult intensive care unit (ICU) patients. ⋯ Thrombocytopenia is common in ICUs and constitutes a simple and readily available risk marker for mortality, independent of and complementary to established severity of disease indices. Both a low nadir platelet count and a large fall of platelet count predict a poor vital outcome in adult ICU patients.
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Critical care medicine · Jun 2000
Case ReportsRefractory delirium tremens treated with propofol: a case series.
Delirium tremens, the most serious manifestation of alcohol withdrawal, occurs in approximately 5% of hospitalized alcoholics and has a mortality rate approaching 15%. Patients with delirium tremens are usually treated in an intensive care unit in which benzodiazepines form the cornerstone of therapy. In this report, we describe four patients who proved refractory to high doses of benzodiazepines and were successfully treated with a propofol infusion.
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Critical care medicine · Jun 2000
Detection of false lumen perfusion at the beginning of cardiopulmonary bypass in patients undergoing repair of aortic dissection.
In patients undergoing surgical repair of aortic dissection, false lumen perfusion during cardiopulmonary bypass may produce central nervous system damage, myocardial ischemia, aortic rupture, and death. We describe a method to detect false lumen perfusion at the beginning of retrograde aortic perfusion that may prevent these complications. ⋯ Contrast echocardiography allows immediate detection of retrograde aortic perfusion during cardiopulmonary bypass and may help prevent neurologic complications and death in patients with Type I dissection.
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Critical care medicine · Jun 2000
Randomized Controlled Trial Comparative Study Clinical TrialOrnithine alpha-ketoglutarate improves wound healing in severe burn patients: a prospective randomized double-blind trial versus isonitrogenous controls.
To compare the effectiveness on wound healing time in severe burn patients of ornithine alpha-ketoglutarate supplementation of enteral feeding vs. an isonitrogenous control. Previous clinical and experimental studies suggest a beneficial effect of enterally administered ornithine alpha-ketoglutarate supplementation on protein metabolism in burn patients, but few data deal with clinical outcome. ⋯ Ornithine alpha-ketoglutarate supplementation of enteral feeding significantly shortens wound healing time in severe burn patients. In addition, ornithine alpha-ketoglutarate administration was safe and well tolerated and decreased protein hypercatabolism in the less severe burn patients.