Critical care medicine
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Critical care medicine · Jun 2007
Effect of interhospital transfer on resource utilization and outcomes at a tertiary care referral center.
Mortality and length of stay are two outcome variables commonly used as benchmarks in rating the performance of medical centers. Acceptance of transfer patients has been shown to affect both outcomes and the costs of health care. Our objective was to compare observed and predicted lengths of stay, observed and predicted mortality, and resource consumption between patients directly admitted and those transferred to the intensive care unit (ICU) of a large academic medical center. ⋯ Patients transferred to a tertiary care ICU are generally more severely ill and consume more resources. However, they have similar adjusted mortality outcomes when compared with directly admitted patients. The difference in resource consumption is mainly attributable to the group of patients in the lowest predicted risk bracket.
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Critical care medicine · Jun 2007
Static and dynamic components of esophageal and central venous pressure during intra-abdominal hypertension.
To investigate the effects of intra-abdominal hypertension on esophageal and central venous pressure considering values obtained at end-expiration (i.e., in static conditions) and during tidal volume delivery (i.e., in dynamic conditions). ⋯ Dynamic changes of esophageal pressure occurred during intra-abdominal hypertension, whereas end-expiratory pressure was affected by high positive end-expiratory pressure levels. Provided that central venous pressure changes reflect esophageal pressure, central venous pressure itself cannot be relied on to guide resuscitation in patients with intra-abdominal hypertension, particularly when abdominal pressures are changing over short periods of time.
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Critical care medicine · Jun 2007
Sustained activation of nuclear factor-kappaB by reactive oxygen species is involved in the pathogenesis of stress-induced gastric damage in rats.
Stress ulceration is a common complication in critically ill patients, but the mechanisms involved are poorly understood. In this study we investigated the temporal activation of the redox-sensitive transcription factor nuclear factor-kappaB and its roles in an experimental model of cold immobilization stress-induced gastric mucosal lesions. ⋯ Sustained activation of nuclear factor-kappaB by reactive oxygen species is an important in vivo mechanism mediating stress-induced gastric inflammatory damage in rats.