Articles: intensive-care-units.
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Klinische Pädiatrie · Jan 1994
[Effectiveness and complications of percutaneous central venous catheters in neonatal intensive care].
Low birth weight babies and sick full-term babies, who require total parenteral nutrition and repeated intravenous applications of drugs, which irritate peripheral veins, very often need a reliable central venous catheter. The aim of our paper was to study prospectively the efficiency and the complications of peripheral percutaneous Silastic-catheters. ⋯ The mean duration of use was 13.7 days, the catheter-induced septicaemia-rate was 3.5%. We never saw serious complications of a central venous catheter, the most common complication was an intravasal central obstruction, but we found no relation between the occurrence-risk of complications, the duration of use and the infusion flow rate.
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Scoring systems used to predict clinical outcomes for critically ill patients have been refined in the past decade, yet even the most recently developed systems contain flaws that limit their application. In general, prediction rules are derived by defining an association between a number of clinical variables and a particular outcome in a reference patient population. By systematically examining the qualities of the independent variables and the size and scope of the derivation data set, potential sources of error and bias can be identified. Existing and future predictive systems must be validated on large groups of patients and continuously updated to keep pace with new approaches to the practice of critical care medicine.
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Emergency medicine is subjected worldwide to financial stringencies and organizational evaluations of cost-effectiveness. The various links in the chain of survival are affected differently. Bystander assistance or bystander CPR is available in only 30% of the emergencies, response intervals--if at all required by legislation--are observed to only a limited degree or are too extended for survival in cardiac arrest. ⋯ Efficiency of emergency physician activities can be demonstrated in polytraumatized patients or in patients with ventricular fibrillation or acute myocardial infarction, in patients with acute myocardial insufficiency and other emergency clinical pictures. Cost effectiveness is clearly in favor of emergency medicine. Future developments will be characterized by the consequences of new health care legislation and by effects of financial stringencies on the emergency medical services.