Critical care medicine
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Critical care medicine · Sep 1996
Comparative Study Clinical Trial Controlled Clinical TrialComparison of infrared ear thermometer derived and equilibrated rectal temperatures in estimating pulmonary artery temperatures.
To investigate the clinical accuracy of infrared ear thermometer derived and equilibrated rectal temperatures in estimating core body temperature. The clinical bias (i.e., mean difference between body sites), and variability (SD of the differences) of simultaneous temperatures were compared with pulmonary artery temperatures. Clinical repeatability (pooled SD of triplicate reading differences) was also examined for three ear infrared thermometers. ⋯ The three infrared ear thermometers studied provided a closer estimate of core body temperature than equilibrated rectal temperature. Clinical bias was greatest in febrile vs. afebrile intensive care unit patients.
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Critical care medicine · Sep 1996
Comparative StudyPoor discriminatory performance of the Pediatric Risk of Mortality (PRISM) score in a South African intensive care unit.
The use of the Pediatric Risk of Mortality (PRISM) score or other scoring systems in the intensive care unit (ICU) is of great importance for evaluating the efficacy and efficiency of a particular ICU. However, the PRISM score was developed and validated in the United States and subsequently validated in Europe, but has not been evaluated in a less affluent society. In general, scoring systems should be used only in populations similar to the reference population in which the prediction model was developed. We set out to determine the applicability of the PRISM score at Baragwanath Hospital, South Africa. ⋯ The PRISM score needs to be recalibrated or recalculated for our patient population in view of the high discrepancy and poor discriminatory function shown. Part of the inaccuracy may derive from different demographic characteristics of our ICU population and a different pattern of diseases. It appears that PRISM is not population independent.
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Critical care medicine · Sep 1996
Effect of tube feedings on the measurement of gastric intramucosal pH.
To determine the effect of enteral tube feedings on the measurement of gastric intramucosal pH. ⋯ Enteral feeding stimulates the secretion of hydrogen ions, which are then buffered by ionized bicarbonate secreted by the nonparietal gastric cells generating CO2. In addition, the enzymatic digestion of nutrients in the stomach may also generate CO2. The increased intraluminal CO2 following enteral feeding results in a spuriously low gastric intramucosal pH reading. Our data suggest that tube feedings should be temporarily discontinued for at least 1 hr when measuring the gastric intramucosal pH. These data should, however, be used with caution when extrapolating to hemodynamically unstable patients. Furthermore, the consequences of frequent interruptions of enteral feeding need to be weighed against the possible benefits derived from the use of this monitoring tool.
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Critical care medicine · Sep 1996
The 67gallium pulmonary leak index in assessing the severity and course of the adult respiratory distress syndrome.
To establish the value of the 67Gallium (Ga) pulmonary leak index, a marker of increased permeability edema of the lungs, in assessing the severity and course of the adult respiratory distress syndrome (ARDS). ⋯ The 67Ga pulmonary leak index may be a clinically useful tool to quantify the severity and course of ARDS, since clinical recovery from the syndrome may be characterized by amelioration of increased microvascular permeability.
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Critical care medicine · Sep 1996
Ventilation with positive end-expiratory pressure reduces extravascular lung water and increases lymphatic flow in hydrostatic pulmonary edema.
To analyze the effect of different levels of positive end-expiratory pressure (PEEP) on extravascular lung water and on lymphatic drainage through the thoracic duct during hydrostatic pulmonary edema. ⋯ a) The application of PEEP levels of between 10 and 20 cm H2O limits the increase of extravascular lung water in cases of hydrostatic pulmonary edema; and b) the application of 10 cm H2O of PEEP increases the lymphatic flow through the thoracic duct.