Critical care medicine
-
Critical care medicine · May 1992
ReviewSelective decontamination of the digestive tract in the intensive care unit: current status and future prospects.
To evaluate the available data on selective decontamination of the digestive tract. This therapy aims to prevent infection in critically ill patients admitted to ICUs. Microbial carriage in the oropharynx, stomach, and gut; infection; mortality rate; and antibiotic resistance are the outcome events that are being reviewed. ⋯ There is a general consensus about the efficacy of selective decontamination in diminishing microbial carriage and acquired infection rates, although conclusions about benefits related to mortality rates vary. Differences in mortality rate are found in the selective decontamination studies of patients with curable diseases, including multitrauma and cardiovascular patients. More data on resistance, collected over a longer period of time, are needed. Practical problems of blinding and the major ecological effect of selective decontamination may explain the lack of a randomized, placebo-controlled, double-blind trial.
-
Critical care medicine · May 1992
Process of forgoing life-sustaining treatment in a university hospital: an empirical study.
The difficult decision to forgo (withhold or withdraw) life-sustaining treatment has received extensive commentary. Little attention has been paid to how physicians do, and should, care for dying patients once this decision is made. This study describes the characteristics of patients who forgo treatment, determines the range and sequential process of forgoing treatment, and suggests ethical and public policy implications. ⋯ Forgoing life-sustaining treatment is not a single decision but it often occurs in a sequential manner over several days. A strict analysis of the benefits and burdens of various interventions may be inadequate in deciding what interventions are appropriate in the care of the dying patient.
-
Critical care medicine · May 1992
A simple method for the measurement of intrinsic positive end-expiratory pressure during controlled and assisted modes of mechanical ventilation.
To evaluate a new and simple method for the measurement of intrinsic positive end-expiratory pressure during controlled and assisted modes of mechanical ventilation. ⋯ The manual valve method can be used to determine intrinsic positive end-expiratory pressure during controlled and assisted modes of ventilatory support with current ventilators. The availability of such an approach should facilitate the routine monitoring of intrinsic positive end-expiratory pressure in mechanically ventilated patients, thereby aiding clinical decision-making and management in these critically ill individuals.