Critical care medicine
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Critical care medicine · Feb 2012
Comparative StudyCardiac function in Vietnamese patients with different dengue severity grades.
Dengue continues to cause significant global morbidity and mortality. Severe disease is characterized by cardiovascular compromise from capillary leakage. Cardiac involvement in dengue has also been reported but has not been adequately studied. ⋯ Patients with severe dengue have evidence of systolic and diastolic cardiac impairment with septal and right ventricular wall being predominantly affected.
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Critical care medicine · Feb 2012
Case ReportsCooling the crisis: therapeutic hypothermia after sickle cardiac arrest.
The management of patients with sickle-cell disease and cardiac arrest presents special challenges. Mild therapeutic hypothermia may improve survival and neurologic outcome after cardiac arrest, however, it may also precipitate sickling in patients with sickle-cell disease. Rigorous exchange transfusion may enable mild therapeutic hypothermia after cardiac arrest in patients with sickle-cell disease. ⋯ Therapeutic hypothermia after cardiac arrest is feasible following rigorous exchange transfusion in patients with sickle-cell disease.
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Critical care medicine · Feb 2012
Comparative StudyHigh prevalence of corrected QT interval prolongation in acutely ill patients is associated with mortality: results of the QT in Practice (QTIP) Study.
To test the potential value of more frequent QT interval measurement in hospitalized patients. ⋯ We find QT prolongation to be common (24%), with Torsade de Pointes representing 6% of in-hospital cardiac arrests. Predictors of QT prolongation in the acutely ill population are similar to those previously identified in ambulatory populations. Acutely ill patients with QT prolongation have longer lengths of hospitalization and nearly three times the odds for mortality then those without QT prolongation.
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Critical care medicine · Feb 2012
Comparative StudyNeglect of quality-of-life considerations in intensive care unit family meetings for long-stay intensive care unit patients.
To examine the frequency with which quality of life and treatment limitation were discussed in formal family meetings for long-stay intensive care unit patients with high risk for mortality and morbidity. ⋯ To guide discussion with families of the subset of intensive care unit patients with high risk of mortality and long-term morbidity, quality of life was not consistently addressed. Continued efforts to assist clinicians in routinely including discussions of quality-of-life outcomes is needed.
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Critical care medicine · Feb 2012
Comparative StudyPediatric ventilation in a disaster: clinical and ethical decision making.
Medical resources may be overwhelmed in a mass disaster situation. Intensive care resources may be limited even further. When the demand for a certain resource, like ventilators, exceeds its availability, caregivers are faced with the task of deciding how to distribute this resource.Ethical dilemmas arise when a practical decision necessitates ranking the importance of several ethical principles. In a disaster area, the greatest good for the greatest number principle and the goal of equal distribution of resources may take priority over the needs of the individual. Nonetheless, regardless of the interventions available, it is a prime goal to keep the patients' comfort and dignity as much as possible. ⋯ Applying ethical priorities to analyze the decision-making problems leads to the understanding that an individualized approach with an ongoing assessment of the patient condition and the availability of resources, rather than a strict predefined decision rule, will give patients a better chance of survival, and will assist in allocating scarce resources.