Critical care medicine
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Critical care medicine · Apr 1993
Randomized Controlled Trial Comparative Study Clinical TrialA clinical evaluation of a blood conservation device in medical intensive care unit patients.
This study was designed to a) document the efficacy of a device intended to conserve blood in critically ill patients; b) determine the effect of this blood conservation on hemoglobin concentration and the need for blood transfusions; c) determine if the blood conservation device resulted in interference with arterial pressure waveforms; d) determine if use of the blood conservation device resulted in a difference in the number of accidental needle punctures suffered by healthcare workers. ⋯ The conservation of blood in critically ill patients must be a high-priority concern of all healthcare workers. Our data indicate that the blood conservation system eliminates a significant factor in the decline in hemoglobin concentration. With devices as described here, there is no reason to continue the practice of wasting the blood of critically ill patients in order to prevent preanalytic error.
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Critical care medicine · Apr 1993
ReviewCivilian triage in the intensive care unit: the ritual of the last bed.
To evaluate the numerous problems that exist when there is an acute shortage of trained critical care nurses, no triage officer is available or designated, there is no cooperation among intensive care units (ICUs) or alternative sites, or there is excessive political or financial pressure applied to maintain a referral practice or to fill all the beds, or limited ability to divert ambulances to other hospitals. The Joint Commission on Accreditation of Health Care organizations now mandates a written policy: "when patient load exceeds optimal operational capacity" (1992). ⋯ It is necessary to have public disclosure of the broader issues related to high-level triage. The first issue is recognition that there are periods of time when ICU capacity is exceeded or skilled critical care nurse availability is reduced. The next issue is the decision of who is best suited to make complex and dynamic triage decisions and what kind of oversight should be provided. Other issues relate to whether there should be patient or family consent, and what to do about patients receiving marginal benefit or who are considered hopeless or unsalvageable, yet the family or surrogate decision maker (or perhaps one of the consultants) wants to continue active care in the ICU. In the conflict between individual and community rights and benefits, there should be a nonlitigious approach when a patient is harmed during these periods of high census or limited capacity. In recognition of these complex issues (including potential conflicts among ICUs, hospital administration, individual physicians, and the various medical and surgical programs feeding patients into special care units), the Society of Critical Care Medicine has organized a Task Force on the legal and ethical justification for triage.
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Critical care medicine · Apr 1993
Comparative StudyInitial evaluation of a new intra-arterial blood gas system in humans.
To evaluate the in vivo performance of a continuous intra-arterial blood gas monitor as compared with in vitro arterial blood gases for measurements of PaO2, PaCO2, and arterial pH. ⋯ The performance of this fiberoptic continuous intra-arterial blood gas monitor is comparable to that of blood gas analyzers and compares favorably with previously reported studies utilizing other sensors in reliably and reproducibly approximating PaO2, PaCO2, and arterial pH values. This monitoring capability was accomplished with no patient morbidity. Further study is indicated to confirm these initial results and to establish the role of a continuous intra-arterial blood gas monitor in critically ill patients.
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The aim of this study was to evaluate the possible effect of a severe burn on gastric emptying by determining the absorption kinetics of orally administered acetaminophen. ⋯ We conclude that severe burn injury does not affect the kinetics of gastric emptying, and that 200 mL of water ingested 2 hrs before anesthesia is quite safe in severely burned patients. Also, the absorption kinetics of acetaminophen was not altered by burn injury.
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Critical care medicine · Apr 1993
Exogenous surfactant therapy increases static lung compliance, and cannot be assessed by measurements of dynamic compliance alone.
To study the immediate effects of exogenous surfactant therapy on blood gases, lung volumes, and lung mechanics in adult rabbits with experimentally induced respiratory distress syndrome. ⋯ The findings indicate that during mechanical ventilation, the effects of surfactant therapy on lung mechanics are best characterized by changes in functional residual capacity and maximum compliance obtained from static pressure-volume curves and not by dynamic compliance.