American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Jan 1997
Multicenter StudyIntensive care of patients with HIV infection: utilization, critical illnesses, and outcomes. Pulmonary Complications of HIV Infection Study Group.
To examine intensive care unit (ICU) admission rates and diagnoses of patients with HIV infection, and to determine the outcomes of different critical illnesses, we analyzed data derived from the 63 patients who were admitted to an ICU from among the 1,130 adults with HIV infection who did not have AIDS at the time of enrollment in a multicenter prospective study. Patients were admitted and treated according to the judgment of their physicians. During 4,298 patient-years of follow-up for the entire cohort, there were 1,320 hospital admissions, of which 68 (5%) included admission to an ICU. ⋯ In conclusion, the range of indications for critical care in patients with HIV infection is diverse. PCP accounted for only 16% of the ICU admissions, and mechanical ventilation for PCP and other pulmonary disorders was associated with a high mortality rate. In contrast, mechanical ventilation for nonpulmonary disorders, and admission to the ICU for nonpulmonary diagnoses was associated with a more favorable outcome.
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Am. J. Respir. Crit. Care Med. · Jan 1997
Comparative StudyNoninvasive monitoring of cardiac output in critically ill patients with thoracocardiography.
Thoracocardiography noninvasively estimates changes in cardiac output by recording ventricular volume curves from an inductive plethysmographic transducer placed around the chest near the xiphoid process. We evaluated performance of thoracocardiography for estimation of cardiac output in 21 critically ill patients in comparison to thermodilution. A total of 201 paired cardiac output measurements were obtained over periods of 35 to 254 min. ⋯ The mean difference (bias) of cardiac output (thoracocardiography - thermodilution) was 0.0 L/min, the limits of agreement (bias +/- 2 SD) included a range from -1.5 to +1.6 L/min. For estimations of relative changes in cardiac output by thoracocardiography and thermodilution the bias was 0%, and the limits of agreement -21 and +22%. We conclude that thoracocardiography is a promising noninvasive technique for monitoring cardiac output in critically ill patients.
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Am. J. Respir. Crit. Care Med. · Jan 1997
Review Case ReportsBronchial casts in children: a proposed classification based on nine cases and a review of the literature.
Bronchial casts are characterized by the formation of obstructive airway plugs that may be large enough to fill the branching pattern of an entire lung. The condition is rare but can occur at any age. Casts may be secondary to underlying diseases such as asthma and cystic fibrosis, but there are often no predisposing factors. ⋯ Survivors of Type 1 casts seem to be well controlled with inhaled steroids. Optimal therapy for patients with Type 2 casts is not clear; the prognosis probably depends on underlying cardiac status. We hope that this simple classification will provide a framework for further study of this obscure condition.
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Am. J. Respir. Crit. Care Med. · Jan 1997
Nosocomial pneumonia and tracheitis in a pediatric intensive care unit: a prospective study.
We conducted a prospective study in the multidisciplinary pediatric intensive care unit (pediatric ICU) of a tertiary-care university hospital in order to determine the incidence, risk markers, risk factors, and complications related to bacterial nosocomial pneumonia (BNP) and tracheitis (BNT) in children. A cohort of 1,114 consecutive admissions to the pediatric ICU was enrolled over a 56-wk period; 154 cases were excluded mostly (75%) because they already had a respiratory infection at entry. The final sample included 960 admissions (831 patients). ⋯ In BNT, the reintubation rate was 24%. Nosocomial bacterial respiratory infections are rare in critically ill children. However, BNP causes significant complications, and more attention should be focused on BNT in the critically ill child.
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Am. J. Respir. Crit. Care Med. · Jan 1997
Increasing incidence of withholding and withdrawal of life support from the critically ill.
To determine whether limits to life-sustaining care are becoming more common, we attempted to quantify the incidence of recommendations to withhold or withdraw life support from critically ill patients, to describe how patients respond to these recommendations, and to examine how conflicts over these recommendations are resolved. In 1992 and 1993 we prospectively enrolled 179 consecutive patients from two intensive care units (ICUs) for whom a recommendation was made to withhold or withdraw life support. Where possible, we compared results with data collected in the same units over a similar time period in 1987 and 1988. ⋯ Ninety percent of patients agreed within less than 5 d, and only eight patients (4%) refused physicians' recommendations to limit life support. In cases of conflict, physicians in 1992 and 1993 deferred to patients with one exception: physicians were willing to refuse surrogate requests for resuscitation of patients they considered hopelessly ill. We conclude that 90% of patients who die in these ICUs now do so following a decision to limit therapy, that this represents a major change in practice in these institutions over a period of 5 yr, that most patients and surrogates accept an appropriate recommendation to withhold or withdraw life support, and that physicians will refuse surrogate requests in certain circumstances.