Critical care medicine
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Critical care medicine · Aug 2000
Discrimination of sepsis and systemic inflammatory response syndrome by determination of circulating plasma concentrations of procalcitonin, protein complement 3a, and interleukin-6.
To evaluate whether plasma concentrations of procalcitonin (PCT), interleukin-6 (IL-6), protein complement 3a (C3a), leukocyte elastase (elastase), and the C-reactive protein (CRP) determined directly after the clinical onset of sepsis or systemic inflammatory response syndrome (SIRS) discriminate between patients suffering from sepsis or SIRS and predict the outcome of these patients. ⋯ Our data show that the determination of PCT, IL-6, and C3a is more reliable to differentiate between septic and SIRS patients than the variables CRP and elastase, routinely used at the intensive care unit. The determination of PCT and C3a plasma concentrations appears to be helpful for an early assessment of septic and SIRS patients in intensive care.
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Critical care medicine · Aug 2000
Comparative StudyCombining physician's subjective and physiology-based objective mortality risk predictions.
None of the currently available physiology-based mortality risk prediction models incorporate subjective judgements of healthcare professionals, a source of additional information that could improve predictor performance and make such systems more acceptable to healthcare professionals. This study compared the performance of subjective mortality estimates by physicians and nurses with a physiology-based method, the Pediatric Risk of Mortality (PRISM) III. Then, healthcare provider estimates were combined with PRISM III estimates using Bayesian statistics. The performance of the Bayesian model was then compared with the original two predictions. ⋯ The results of this study demonstrated that healthcare providers' subjective mortality predictions and PRISM III mortality predictions perform equally well. The Bayesian model that combined provider and PRISM III mortality predictions was more accurate than either provider or PRISM III alone and may be more acceptable to physicians. A methodology using subjective outcome predictions could be more relevant to individual patient decision support.
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Critical care medicine · Aug 2000
End-of-life care in the pediatric intensive care unit after the forgoing of life-sustaining treatment.
To describe the attitudes and practice of clinicians in providing sedation and analgesia to dying patients as life-sustaining treatment is withdrawn. ⋯ Clinicians frequently escalate the dose of sedatives or analgesics to dying patients as life-sustaining treatment is withdrawn, citing patient-centered reasons as their principle justification. Hastening death is seen as an unintended consequence of appropriate care. A large majority of physicians and nurses agreed with patient management and were satisfied with the care provided. Care of the dying patient after the forgoing of life-sustaining treatment remains underanalyzed and needs more rigorous examination by the critical care community.
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Critical care medicine · Aug 2000
Teaching critical appraisal during critical care fellowship training: a foundation for evidence-based critical care medicine.
To determine whether fellowship training in critical care medicine with critical appraisal exercises improves the ability and confidence of fellows to evaluate the medical literature. ⋯ Critical appraisal exercises used in the training of critical care medicine fellows appear to improve both ability and confidence to appraise relevant medical literature.
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Critical care medicine · Aug 2000
Performance of the Mortality Probability Models in assessing severity of illness during the first week in the intensive care unit.
To extend the Mortality Probability Models (MPM) II severity system to time periods between 4 and 7 days after admission to the intensive care unit (ICU). ⋯ If the patient's condition stays the same day after day, the probability of dying in the hospital increases until 72 hrs, and then stabilizes. A severity measure that performs well at 72 hrs can be a useful tool for measuring severity at later time periods.