Critical care medicine
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Critical care medicine · Mar 2006
Randomized Controlled Trial Multicenter Study Comparative StudyA comparison between fenoldopam and low-dose dopamine in early renal dysfunction of critically ill patients.
Fenoldopam mesylate is a selective dopamine-1 agonist, with no effect on dopamine-2 and alpha1 receptors, producing a selective renal vasodilation. This may favor the kidney oxygen supply/demand ratio and prevent acute renal failure. The aim of the study was to investigate if fenoldopam can provide greater benefit than low-dose dopamine in early renal dysfunction of critically ill patients. ⋯ In critically ill patients, a continuous infusion of fenoldopam at 0.1 microg/kg/min does not cause any clinically significant hemodynamic impairment and improves renal function compared with renal dose dopamine. In the setting of acute early renal dysfunction, before severe renal failure has occurred, the attempt to reverse renal hypoperfusion with fenoldopam is more effective than with low-dose dopamine.
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Critical care medicine · Mar 2006
ReviewTeam model: advocating for the optimal method of care delivery in the intensive care unit.
To review published data on the team model of intensive care unit (ICU) care delivery. ⋯ Current and looming shortages of all ICU healthcare providers is a barrier to universal implementation of the team model. Advocating for the ICU team model for critical care delivery requires local, regional, national, and international activities for success.
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Critical care medicine · Mar 2006
ReviewCritical care nursing: workforce issues and potential solutions.
To review the history and development of critical care nurses, the supply and demand issues related to critical care nursing, critical care nursing's contribution to patient outcomes, and recommendations to ensure a steady and strong workforce. ⋯ Critical care nurses are an essential and vital aspect of the critical care team. Nurses contribute to improved patient outcomes, reduced morbidity and mortality, reduced complications and errors, and reduced overall costs. More than 400,000 nurses practice in critical care, and additional opportunities exist and will develop. The challenge is to ensure an adequate supply of appropriately trained staff.
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Critical care medicine · Mar 2006
Review Meta Analysis Comparative StudyMortality predictions in the intensive care unit: comparing physicians with scoring systems.
Risk-prediction models offer potential advantages over physician predictions of outcomes in the intensive care unit (ICU). Our systematic review compared the accuracy of ICU physicians' and scoring system predictions of ICU or hospital mortality of critically ill adults. ⋯ Observational studies suggest that ICU physicians discriminate between survivors and nonsurvivors more accurately than do scoring systems in the first 24 hrs of ICU admission. The overall accuracy of both predictions of patient mortality was moderate, implying limited usefulness of outcome prediction in the first 24 hrs for clinical decision making.
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Critical care medicine · Mar 2006
Randomized Controlled Trial Multicenter StudyL-alanyl-L-glutamine dipeptide-supplemented total parenteral nutrition reduces infectious complications and glucose intolerance in critically ill patients: the French controlled, randomized, double-blind, multicenter study.
Glutamine (Gln)-supplemented total parenteral nutrition (TPN) improves clinical outcome after planned surgery, but the benefits of Gln-TPN for critically ill (intensive care unit; ICU) patients are still debated. ⋯ TPN supplemented with Ala-Gln dipeptide in ICU patients is associated with a reduced rate of infectious complications and better metabolic tolerance.