Critical care medicine
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Critical care medicine · Jan 2004
Comparative StudyEffect of a multiple-site intensive care unit telemedicine program on clinical and economic outcomes: an alternative paradigm for intensivist staffing.
To examine whether a supplemental remote intensive care unit (ICU) care program, implemented by an integrated delivery network using a commercial telemedicine and information technology system, can improve clinical and economic performance across multiple ICUs. ⋯ The addition of a supplemental, telemedicine-based, remote intensivist program was associated with improved clinical outcomes and hospital financial performance. The magnitude of the improvements was similar to those reported in studies examining the impact of implementing on-site dedicated intensivist staffing models; however, factors other than the introduction of off-site intensivist staffing may have contributed to the observed results, including the introduction of computer-based tools and the increased focus on ICU performance. Although further studies are needed, the apparent success of this on-going multiple-site program, implemented with commercially available equipment, suggests that telemedicine may provide a means for hospitals to achieve quality improvements associated with intensivist care using fewer intensivists.
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Critical care medicine · Jan 2004
Comparative StudyEvaluation of density area in dorsal lung region during prone position using transesophageal echocardiography.
To evaluate the changes of density area in the dorsal lung regions of acute respiratory distress syndrome patients during prone position using transesophageal echocardiography. ⋯ It was possible to observe the change in density area during prone position using transesophageal echocardiography. The change of density area estimated with transesophageal echocardiography during prone position was useful to estimate the effectiveness of the procedure.
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Critical care medicine · Jan 2004
Comparative StudyOral decontamination is cost-saving in the prevention of ventilator-associated pneumonia in intensive care units.
Although the development of ventilator-associated pneumonia (VAP) is assumed to increase costs of intensive care unit stay, it is unknown whether prevention of VAP by means of oropharyngeal decontamination is cost-effective. Because of wide ranges of individual patient costs, crude cost comparisons did not show significant cost reductions. ⋯ This study provides strong evidence that prevention of VAP by means of oropharyngeal decontamination is cost-effective.
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Critical care medicine · Jan 2004
Case ReportsRapidly advancing necrotizing fasciitis caused by Photobacterium (Vibrio) damsela: a hyperaggressive variant.
To describe the first case of Vibrio damsela necrotizing fasciitis in New England, emphasizing the importance of very early operative intervention to achieve source control in this extremely aggressive infection. ⋯ A high index of suspicion is necessary for the diagnosis of this specific pathogen and concordant infection. The willingness to surgically debride and amputate without hesitation at a very early point may be the only intervention capable of saving the lives of patients affected by Photobacterium (Vibrio) damsela.
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Critical care medicine · Jan 2004
Urinary S100B protein measurements: A tool for the early identification of hypoxic-ischemic encephalopathy in asphyxiated full-term infants.
Hypoxic-ischemic encephalopathy (HIE) is one of the major causes of perinatal mortality and morbidity. To date, there are no reliable methods to detect which infants will develop brain damage after asphyxia insult. ⋯ Longitudinal S100B protein measurements in urine soon after birth are a useful tool to identify which asphyxiated infants are at risk of hypoxic-ischemic encephalopathy and its possible neurologic sequelae.