Critical care medicine
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The origins of trauma systems in the United States date to the 1960s when physicians returning from wars abroad realized that lessons learned from managing military casualties could be applied to civilian traumatic injury. Over the next several decades, trauma centers and then trauma systems began to be developed in an attempt to improve prehospital and acute care for these patients. Although studies of trauma system effectiveness are fraught with methodologic difficulties, several types of studies (panel reviews of preventable deaths, registry studies, and population-based studies), suggest that there may be improvements in mortality when trauma systems are established. ⋯ Pediatric trauma systems have by necessity developed within the "adult" systems in place. The history of pediatric system development and studies assessing outcomes are also discussed. Continued system development, assessment, and educational efforts about how childhood injuries are different are essential to combat this leading killer of children.
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Critical care medicine · Nov 2002
Comparative StudyPulse oximetry during low perfusion caused by emerging pneumonia and sepsis in rabbits.
This study tested the effects of low perfusion caused by emerging sepsis on the reliability of a new pulse oximetry technology (Masimo SET; IVY 405T) compared with a standard pulse oximeter (Nellcor N-200). ⋯ The pulse oximeter equipped with Masimo SET was less prone to signal loss than the standard pulse oximeter in this sepsis model. Episodes of falsely low Spo2 readings may occur, and deviation of Spo2 from Sao2 may be increased with deteriorating hemodynamics with both devices.
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Critical care medicine · Nov 2002
Multicenter StudyPopulation-based assessment of intensive care unit-acquired bloodstream infections in adults: Incidence, risk factors, and associated mortality rate.
Nosocomial bloodstream infections have been extensively investigated, but relatively few studies have specifically evaluated the epidemiology of intensive care unit-acquired bloodstream infections. The study objective was to define the incidence, risk factors, microbiology, and clinical outcomes of intensive care unit-acquired bloodstream infections. ⋯ One patient in 20 admitted to Calgary Health Region intensive care units acquires bloodstream infection and suffers longer intensive care unit stay and increased mortality rates. In our region, multiple antibiotic-resistant organisms are uncommon causes of bloodstream infections, suggesting that it may be safe to use narrower spectrum empirical treatment regimens than current guidelines recommend.
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Critical care medicine · Nov 2002
Multicenter StudyEffect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia.
The purpose of the study was to determine whether an education initiative could decrease the hospital rate of ventilator-associated pneumonia. ⋯ A focused education intervention can dramatically decrease the incidence of ventilator-associated pneumonia. Education programs should be more widely employed for infection control in the intensive care unit setting and can lead to substantial decreases in cost and patient morbidity attributed to hospital-acquired infections.
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Trauma is the leading cause of both morbidity and mortality in the pediatric population, and traumatic injury causes > 50% of all childhood deaths. Significant mortality rates have been reported for children with traumatic brain injury. ⋯ The costs involved in the care of a child with severe traumatic brain injury, extended over that child's lifetime, are significant. It is unfortunate that despite preventive measures, traumatic brain injury remains the major morbidity and mortality factor for children.