Articles: intensive-care-units.
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It is a most important time for the ACC and AACN to work together to identify mutual interests, concerns and approaches. Securing a short-term and long-term balance between supply and demand is an issue that crosses disciplines. The implementation of solutions requires broader support if we are to be effective in our pursuit of quality, cost-efficient patient care.
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Revista médica de Chile · Jun 1990
[Prolonged hospitalization in the intensive care unit: a worthless effort?].
Hospitalization of a patient in critical care unit for over a month is exceptional and often raises the question of an irreversible disease process. From 2715 consecutive patients admitted to an intensive care unit in the last 4 years we identified 20 patients remaining in the unit for over a month. ⋯ None of the complications developing or the therapeutic procedures used in the first 3 weeks predicted the outcome. In contrast, the presence of respiratory failure, septic shock, requirement of ventilation or parenteral nutrition at day 30 was highly associated with mortality.
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A survey of 11 fire disasters which have occurred since 1970, showed that incidents occurring outdoors resulted in larger numbers of hospital admissions, with more severe injuries, than incidents occurring indoors. While the majority of burn casualties sustained burns covering less than 30 per cent body surface area (BSA), outdoor disasters resulted in the admission of a significant number of patients with burns covering more than 70 per cent BSA. ⋯ However, the scarcity of burn facilities is such that involvement of distant centres may be anticipated following large disasters. While effective early management extends the time available for the dispersal of casualties, delays may be avoided by prior planning, especially if the international transfer of patients is envisaged.
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Critical care medicine · Jun 1990
Trending of impedance-monitored cardiac variables: method and statistical power analysis of 100 control studies in a pediatric intensive care unit.
The NCCOM3-R6 monitor continuously monitors cardiac output and five other cardiovascular variables from the thoracic electrical bioimpedance signal. We averaged data over 5-min intervals for 130 min in 100 control studies in 40 pediatric ICU patients, age 0.04 to 20.39 yr (median 1.39) and weighing 2.0 to 59.5 kg (median 8.8). For individual studies, 99% of the 5-min averages of cardiac output fell within +/- 44% of the baseline cardiac output for that study. ⋯ When we averaged data for 100 studies, 5-min interval observations for each variable did not deviate from baseline over a 2-h period (p greater than .70). With a sample size of 100 studies, we could detect a change in cardiac output of +/- 5% at the p less than .005 level with a power of 0.95. We conclude that with a sufficiently large sample size, studies employing the NCCOM3 can detect clinically significant cardiovascular changes due to pharmacologic or procedural stressors.