Critical care medicine
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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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To alert the physicians to the possibility of a late-onset inborn error of metabolism in an apparently previously healthy patient with acute clinical presentation. ⋯ The diagnosis of cblB methylmalonic aciduria was made in a postmortem patient who died with a misdiagnosis of insulin-dependent diabetes mellitus. Unclear biochemical findings and positive family history should strongly lead to suspicion of an inborn error of metabolism in an apparently previously healthy critically ill patient.
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Critical care medicine · Jun 2000
Clinical TrialPrediction of nosocomial sepsis in neonates by means of a computer-weighted bedside scoring system (NOSEP score)
To develop an easy-to-use bedside scoring system, composed of clinical variables, hematologic variables, and risk factors of infection, to predict nosocomial sepsis in neonatal intensive care unit patients. ⋯ The simple bedside scoring system NOSEP-1 composed of C-reactive protein, neutrophil fraction, thrombocytopenia, fever, and prolonged parenteral nutrition exposure provides a valuable tool for early identification of nosocomial sepsis. Its predictive power can be improved by adding central vascular catheter insertion site and hub colonization to the score.
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Critical care medicine · Jun 2000
Systemic hemodynamics, gastric intramucosal PCO2 changes, and outcome in critically ill burn patients.
To define the hemodynamic and gastric intramucosal PCO2 (PiCO2) changes during the first 48 hrs after burn trauma and to analyze their relationship with outcome. ⋯ Our data indicate that there are hemodynamic and biochemical changes that occur early after burn trauma that are associated with prognosis after an apparently successful resuscitation. Particularly, a hemodynamic profile characterized by systemic acidosis, low systemic blood flow, and systemic and pulmonary vasoconstriction early after trauma is associated with a poor outcome. Additionally, intestinal mucosal acidosis occurs after burn trauma, is influenced by inhalation injury, and is a variable related to outcome.
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Critical care medicine · Jun 2000
Incidence and clinical pattern of the abdominal compartment syndrome after "damage-control" laparotomy in 311 patients with severe abdominal and/or pelvic trauma.
To investigate the incidence, main physiologic effects, and therapeutic management of the abdominal compartment syndrome (ACS) after severe abdominal and/or pelvic trauma. ⋯ Risk factors for the occurrence of ACS are severe abdominal and/or pelvic trauma, which require laparotomy and packing for the control of hemorrhage. The ACS occurs within hours and causes life-threatening physiologic derangements and a critical rise in intracranial pressure in patients with combined abdominal/pelvic and head trauma. Decompressive laparotomy immediately restores impaired organ functions. In patients at risk, the continuous measurement of urinary bladder pressure as a simple, noninvasive, and less expensive diagnostic tool for early detection of elevated intra-abdominal pressure is mandatory.