Critical care medicine
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Critical care medicine · Nov 2008
Randomized Controlled TrialRate of reintubation in mechanically ventilated neurosurgical and neurologic patients: evaluation of a systematic approach to weaning and extubation.
To assess whether a systematic approach to weaning and extubation (intervention) is superior to the sole physician's judgment (control) in preventing reintubation secondary to extubation failure in patients with neurologic disorders. ⋯ In patients with neurologic diseases, a systematic approach to weaning and extubation reduces the rate of reintubation secondary to extubation failure without affecting the duration of mechanical ventilation, and is overall positively perceived by intensive care unit professionals.
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Critical care medicine · Nov 2008
Review Comparative StudyRegionalization of medical critical care: what can we learn from the trauma experience?
To review the rationale for the regionalization of adult critical care and discuss how lessons from the trauma experience may be relevant to this debate. ⋯ Variation in the quality of critical care among hospitals has prompted calls for regionalization of care for critically ill patients. Because of similarities between trauma and critical care, trauma is often cited as a model for the regionalization of critical care services. In reality, there are both important similarities and differences between trauma and critical care. In addition, many lessons from the trauma experience directly apply to future efforts to regionalize critical care services. In this article, we review the analogy between the regionalization of trauma and critical care and discuss how the trauma experience both supports and limits the argument for creation of a formal regionalized system of care for the critically ill. If regionalization efforts in critical care are to proceed, the lessons of the trauma experience can inform policy decisions and provide insight into the design and implementation of an effective regionalized system.
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To clarify the role of the pulmonary artery catheter in the intensive care unit. ⋯ The pulmonary artery catheter is still a valuable tool for hemodynamic monitoring when used in selected patients and by physicians adequately trained to correctly interpret and apply the data provided.
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Critical care medicine · Nov 2008
ReviewPreventing cardiac arrest during hemorrhagic shock with vasopressin.
The optimal strategy of stabilizing hemodynamic function in uncontrolled traumatic hemorrhagic shock states is unclear. Although fluid replacement is established in controlled hemorrhagic shock, its use in uncontrolled hemorrhagic shock is controversial, because it may worsen bleeding. ⋯ Especially in patients with severe traumatic brain injury, rapid stabilization of cardiocirculatory function is essential to ensure adequate brain perfusion, thus, to prevent neurologic damage and to improve outcome. In addition, despite wide distribution of highly developed and professional emergency medical systems in western industrialized countries, survival chances of patients with uncontrolled traumatic hemorrhagic shock in the preclinical setting are still poor.
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Critical care medicine · Nov 2008
ReviewCerebral blood flow thresholds for cerebral ischemia in traumatic brain injury. A systematic review.
Reduction of cerebral blood flow plays a crucial role in causing posttraumatic cerebral ischemia. However, the methodologic adequacy of studies from which currently used cerebral blood flow thresholds in traumatic brain injury have been derived has not been evaluated. ⋯ Cerebral blood flow thresholds for the diagnosis of posttraumatic cerebral ischemia are based on weak evidence, and cannot be recommended.