Critical care medicine
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Critical care medicine · Sep 1994
Multicenter StudyA method for assessing the clinical performance and cost-effectiveness of intensive care units: a multicenter inception cohort study.
To present an approach for assessing intensive care unit (ICU) performance which takes into account both economic and clinical performance while adjusting for severity of illness. To present a graphic display which permits comparisons among a group of hospitals. ⋯ Cross-indexing of clinical and economic ICU performance is easy to calculate. It has potential as a research and evaluation tool used by physicians, hospital administrators, payers, and others.
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Critical care medicine · Sep 1994
Comparative Study Clinical TrialDemand-flow airway pressure release ventilation as a partial ventilatory support mode: comparison with synchronized intermittent mandatory ventilation and pressure support ventilation.
To evaluate airway pressure release ventilation as a partial ventilatory support mode by comparing a demand-flow airway pressure release ventilation system with synchronized intermittent mandatory ventilation and pressure support ventilation. ⋯ We conclude that for patients who do not have chronic obstructive pulmonary disease, demand-flow airway pressure release ventilation can provide effective partial ventilatory support with lower peak airway pressure when compared with pressure support ventilation and synchronized intermittent mandatory ventilation. However, this airway pressure release ventilation system may be less comfortable than the other two modes, and asynchrony may occur in some patients.
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Critical care medicine · Sep 1994
ReviewUnderstanding the pressure cost of ventilation: why does high-frequency ventilation work?
To understand when the use of high-frequency ventilation would be advantageous, we formulated the problem of achieving adequate alveolar ventilation at minimal pressure cost by dividing it into two simpler problems: a) the pressure cost per unit of convective oscillatory flow; and b) the convective flow cost necessary to achieve a unit of alveolar ventilation. ⋯ This analysis illustrates the importance of using high-frequency ventilation in infant respiratory distress syndrome and of optimizing the amount of PEEP. It also points out the danger of barotrauma in the derecruited lung. When the lungs are in a derecruited state, the combinations of frequency, PEEP, and tidal volume that yield adequate ventilation with safe distention of recruited alveoli are severely limited.
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Critical care medicine · Sep 1994
Predictors of acute respiratory failure after bone marrow transplantation in children.
To determine factors associated with acute respiratory failure after bone marrow transplantation which can be identified before the onset of lung disease. ⋯ Renal and liver dysfunction preceded clinical evidence of lung disease in bone marrow transplant patients who developed respiratory failure. Lung disease leading to respiratory failure and adult respiratory distress syndrome appears to develop as one component of the multiple organ failure syndrome in pediatric bone marrow transplant patients.
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Critical care medicine · Sep 1994
Early, routine paralysis for intracranial pressure control in severe head injury: is it necessary?
To investigate the efficacy of early, routine use of neuromuscular blocking agents for intracranial pressure management in patients with severe head injury. ⋯ Our findings suggest that early, routine, long-term use of neuromuscular blocking agents in patients with severe head injuries to manage intracranial pressure does not improve overall outcome and may actually be detrimental because of the prolongation of their ICU stay and the increased frequency of extracranial complications associated with pharmacologic paralysis. We suggest that routine early management of the head-injured patient in the ICU should be accomplished using sedation alone and that neuromuscular blockade should be generally reserved for patients with intracranial hypertension who require escalation of treatment intensity.