Articles: intensive-care-units.
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Clinical Trial
Selective decontamination with nystatin for control of a Candida outbreak in a neonatal intensive care unit.
Selective decontamination of the digestive tract (SDD) with oral nystatin was evaluated as a measure to control an outbreak of Candida infection in a neonatal intensive care unit (NICU). Seventy-six out of 106 neonates who carried Candida spp. received the main study manoeuvre (the application of oral nystatin in the throat and stomach) during the 12-month open trial. One third of the neonates weighed < 1500 g whilst about half were being ventilated. ⋯ The observation that all other clinical diagnostic samples were free from Candida suggests that translocation from throat or gut into the systemic circulation occurred. SDD with oral nystatin was effective in reducing the yeast carriage index (mean index 1.93, before SDD; 0.45, after SDD; P < 0.001). A significant reduction of carriage, both in rates and indices, is thought to have contributed to the control of this candida outbreak.
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Bedside percutaneous dilational tracheostomy was performed by critical care attending physicians or supervised pulmonary and critical care fellows on 100 patients in the ICU at Cook County Hospital, Chicago, over a 3-year period. A needle is inserted in the first or second tracheal interspace followed by a guidewire. The tract is enlarged with a series of dilators to allow placement of a standard tracheostomy tube. ⋯ Comparison of percutaneous dilational tracheostomy with two other techniques of percutaneous tracheostomy reveals a similar success rate with a lower incidence of serious complications. Bedside percutaneous dilational tracheostomy can be performed in the ICU by trained physicians with a low complication rate. We believe it to be the procedure of choice for many critically ill patients who require tracheostomies.
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Comput. Biomed. Res. · Aug 1993
A time-series approach to predict outcome from pediatric intensive care.
Daily assessment of the physiologic status of intensive care unit (ICU) patients by a validated score is used to predict their discharge as either alive or dead. Daily scores were decorrelated by time-series analysis techniques to establish a predictor of the next day's score. ⋯ Using the highest predicted score observed in any survivor from this data base as a threshold value, this predictor correctly identified 21.9% (sensitivity) of the nonsurvivors with no errors in predicting a fatal outcome (100% specificity). This performance is significantly (P < 0.001) better than that with a static predictor based on the first- or second-day scores only (6.6 or 7.4% sensitivity, respectively), or a known empirical dynamic model using the scores of the 2 most recent days (10.3% sensitivity, P < 0.002).