Critical care medicine
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Critical care medicine · Feb 1994
Combining pressure-limiting and volume-cycling features in a patient-interactive mechanical breath.
To combine the patient synchrony effects of pressure-limited breath delivery strategies with the volume guarantee of volume-cycled breath delivery strategies, we designed a positive-pressure breath that incorporates both features. This breath is patient triggered and can be pressure limited. Breath termination (i.e., cycling) can either be flow- or volume-cycled, depending on whether a target volume has been attained. The pressure-limiting features are further enhanced by the capability to adjust demand-valve responsiveness at breath initiation. ⋯ Flow dyssynchrony during fixed-flow, volume-cycled assisted breaths in patients with active ventilatory drives can be improved with this breath design while a guaranteed tidal volume is maintained. In addition, this combination breath can provide a volume "safety net" for patients in whom partial support with pressure-support ventilation is desired.
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Critical care medicine · Feb 1994
Changing patterns of terminal care management in an intensive care unit.
To empirically describe changes in terminal care management behavior over time with the advent of natural death acts and public dialogue and institutional policy regarding terminal care. ⋯ There is now an increasing probability that impending death will be acknowledged by a formal terminal care decision. Such decisions may become even more frequent with the dialogue generated by the Patient Self Determination Act and the advent of decisions based on physiologic futility.
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Critical care medicine · Feb 1994
Developing strategies to prevent inhospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event.
To determine: a) the frequency of premonitory signs and symptoms before cardiac arrest in patients on the general medical wards of a hospital; b) any characteristic patterns in nurse and physician responses to these signs and symptoms; and c) whether cardiac arrests on the ward occur more frequently in patients discharged from the medical intensive care unit (ICU) than in other patients. ⋯ Cardiac arrests on the general wards of the hospital are commonly preceded by premonitory signs and symptoms. Strategies to prevent cardiac arrest should include training for nurses and physicians that concentrates on cardiopulmonary stabilization and how to respond to neurologic and respiratory deterioration. Special attention should also be devoted to patients who have been discharged from the ICU who are at greater risk for cardiac arrest after ICU discharge than are other medical patients.
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Critical care medicine · Feb 1994
Attitudes of critical care medicine professionals concerning distribution of intensive care resources. The Society of Critical Care Medicine Ethics Committee.
To determine critical care practitioners' attitudes about the importance of various factors in decisions to use intensive care, including age, prognosis, quality of life, patient preference, and medical condition. ⋯ These results suggest that critical care providers, who must occasionally face difficult decisions about how to distribute limited resources among patients with competing needs, were not often inclined, at the time of this survey, to make choices based on estimates of who might benefit most. These critical care physicians' attitudes about triage may not support the optimal use of critical care resources.
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Critical care medicine · Jan 1994
Editorial Comment Comparative StudyPressure-limited versus volume-cycled breath delivery strategies.