Critical care medicine
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Critical care medicine · Jun 1995
Long-term survival after intensive care unit admission with sepsis.
To evaluate the long-term survival of critically ill patients with sepsis and to assess the factors predictive of long-term survival (> 1 month after admission date). ⋯ The most critical period for surveillance of bacteremic patients was in months 2 through 6 after discharge, during which time, the percentage of patients surviving decreased dramatically. The degree of physiologic derangement, as measured by the Acute Physiology Score, was a useful measure of prognosis within the first month after the score was assessed at ICU admission. However, beyond this period, prognostic utility decreased significantly. Healthcare providers should use caution concerning the expected survival of hospitalized patients with human immunodeficiency virus, based on experience with distinct conditions, such as malignancies.
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Critical care medicine · Jun 1995
Serial somatosensory and brainstem auditory evoked potentials in monitoring of acute supratentorial mass lesions.
To determine the relevance of serial evoked potentials (brainstem auditory evoked potentials and somatosensory evoked potentials) and clinical parameters (pupillary response and intracranial pressure) in patients with acute supratentorial mass lesions. ⋯ Shortly after manifestation of supratentorial mass lesions, the results of evoked potentials and clinical parameters indicate increased intracranial pressure and incipient transtentorial herniation but do not predict sequelae. Our results indicate that after institution of effective therapy, pupillary abnormalities and brainstem auditory evoked potentials serve as valuable prognostic predictors. In contrast, somatosensory evoked potentials reflect neither therapeutic efficacy nor outcome in our patient population.
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Critical care medicine · Jun 1995
Triage considerations for patients with acute gastrointestinal hemorrhage admitted to a medical intensive care unit.
To determine whether previously identified clinical criteria, available at the time of triage, can predict clinical outcomes for patients with acute gastrointestinal (GI) hemorrhage. ⋯ These data suggest that objective clinical criteria, available at the time of triage determination, can be utilized to identify a low-risk group of patients with acute GI hemorrhage, having favorable outcomes and potentially no need for intensive care unit services.
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Critical care medicine · Jun 1995
Variability of intrinsic positive end-expiratory pressure in patients receiving mechanical ventilation.
Since variations in breathing pattern may affect the level of intrinsic positive end-expiratory pressure (PEEP), breath-to-breath variation of intrinsic PEEP was assessed. ⋯ We conclude that the occurrence rate of intrinsic PEEP in mechanically ventilated patients is high. The degree of variability in intrinsic PEEP on a breath-to-breath basis is also high. It may be difficult to find a specific level of intrinsic PEEP. Addition of external positive end-expiratory pressure without considering the breath-to-breath variability may lead to overdistention of the lung.
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Critical care medicine · May 1995
Editorial Comment ReviewResuscitation following trauma and hemorrhagic shock: is hydroxyethyl starch safe?