Critical care medicine
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Critical care medicine · Aug 2000
Prior healthcare utilization as a predictor of survival for medical intensive care unit patients.
To determine whether measures of inpatient care utilization from the year preceding admission to a medical intensive care unit (MICU) improve physiology-based predictions of hospital and 1-yr survival. ⋯ Chronic illness, as gauged by a need for frequent inpatient care in the year before MICU admission, is not independently predictive of poor short- or long-term survival. Clinicians should not attempt to predict survival of prospective MICU patients by the extent of previous inpatient care.
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Critical care medicine · Aug 2000
Development of a survey to measure parent satisfaction in a pediatric intensive care unit.
To use classic survey methodology to develop a specific survey tool that can assess parent satisfaction with medical care in a pediatric intensive care setting. ⋯ Classic survey design methodology was applied to develop a specific satisfaction survey in a pediatric inpatient setting. This stepwise method yielded a parent survey specific to one type of inpatient unit, and the resultant survey tool reliably measured levels of parent satisfaction with medical care in that area. This study demonstrates the feasibility of applying classic survey methodology to develop a statistically analyzed parent satisfaction survey for an inpatient setting.
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Critical care medicine · Aug 2000
Randomized Controlled Trial Clinical TrialA lipid A analog, E5531, blocks the endotoxin response in human volunteers with experimental endotoxemia.
Endotoxin (lipopolysaccharide [LPS]) has been associated with sepsis and the high mortality rate seen in septic shock. The administration of a small amount of LPS to healthy subjects produces a mild syndrome qualitatively similar to that seen in clinical sepsis. We used this model to test the efficacy of an endotoxin antagonist, E5531, in blocking this LPS-induced syndrome. ⋯ E5531 blocks the symptoms and signs and cytokine, white blood cell count, C-reactive protein, and cardiovascular response seen in experimental endotoxemia. This agent is a potent inhibitor of endotoxin challenge in humans and may be of benefit in the prevention or treatment of sepsis and septic shock.
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Critical care medicine · Aug 2000
Comparative Study Clinical TrialNoninvasive whole-body electrical bioimpedance cardiac output and invasive thermodilution cardiac output in high-risk surgical patients.
To evaluate the reliability of whole-body impedance cardiography with two electrodes on either both wrists or one wrist and one ankle for the measurement of cardiac output compared with the thermodilution method. ⋯ Agreement between whole-body impedance cardiography and thermodilution in the measurement of cardiac output was unsatisfactory. Factors that can explain these differences are differences between the populations used for calibration of nCO and the study population, the influence of changing peripheral perfusion, and the effect of a supranormal hemodynamic state on the bioimpedance signal. Whole-body impedance cardiography cannot be recommended for assessing the hemodynamic state of high-risk surgical patients as studied in this investigation.
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Critical care medicine · Aug 2000
Clinical TrialEffects of helium-oxygen on intrinsic positive end-expiratory pressure in intubated and mechanically ventilated patients with severe chronic obstructive pulmonary disease.
To test the hypothesis that replacing 70:30 nitrogen: oxygen (Air-O2) with 70:30 helium:oxygen (He-O2) can decrease dynamic hyperinflation ("intrinsic" positive end-expiratory pressure) in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD), and to document the consequences of such an effect on arterial blood gases and hemodynamics. ⋯ In mechanically ventilated COPD patients with intrinsic positive end-expiratory pressure, the use of He-O2 can markedly reduce trapped lung volume, intrinsic positive end-expiratory pressure, and peak and mean airway pressures. No effect was noted on hemodynamics or arterial blood gases. He-O2 might prove beneficial in this setting to reduce the risk of barotrauma, as well as to improve hemodynamics and gas exchange in patients with very high levels of intrinsic positive end-expiratory pressure.