Articles: intensive-care-units.
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Computed tomography (CT) of the chest offers improved resolution and sensitivity for evaluating chest pathologic conditions compared with other imaging techniques. Intensive care unit patients with portable chest findings that diverge from the clinical course may actually have severe intrathoracic disease that can be detected with CT. Our three patients demonstrate chest CT can aid in the diagnosis of significant intrathoracic pathologic conditions which have been significantly underestimated by portable chest roentgenography. We discuss the reasons for this improved detectability by CT, as well as suggest alternative techniques that can be performed at the bedside in patients whose initial portable chest roentgenogram and clinical course do not correlate.
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We evaluated a new combined sensor for monitoring transcutaneous carbon dioxide tension (PtcCO2) and oxygen tension (PtcO2) in 20 critically ill newborn infants. Arterial oxygen tension (PaO2) ranged from 16 to 126 torr and arterial carbon dioxide tension (PaCO2) from 14 to 72 torr. Linear correlation analysis (100 paired values) of PtcO2 versus PaO2 showed an r value of 0.75 with a regression equation of PtcO2 = 8.59 + 0.905 (PaO2), while PtcCO2 versus PaCO2 revealed a correlation coefficient of r = 0.89 with an equation of PtcCO2 = 2.53 + 1.06 (PaCO2). ⋯ The transcutaneous sensor detected 83% of hypoxia (PaO2 less than 45 torr), 75% of hyperoxia (PaO2 greater than 90 torr), 45% of hypocapnia (PaCO2 less than 35 torr), and 96% of hypercapnia (PaCO2 greater than 45 torr). We conclude that the reliability of the combined transcutaneous PO2 and PCO2 monitor in sick neonates is good for detecting hypercapnia, fair for hypoxia and hyperoxia, but poor for hypocapnia. It is an improvement in that it spares available skin surface and requires less handling, but it appears to be slightly less accurate than the single electrodes.
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Baillieres Clin Obstet Gynaecol · Mar 1988
ReviewPrediction of long-term outcome in high-risk infants: the use of objective measures of brain structure and function in the neonatal intensive care unit.
The ability to predict long-term outcome on the basis of objective measures made shortly after the birth of an infant has introduced a completely new approach to the investigation of the aetiology of childhood impairments and disabilities, and the evaluation of the effects of perinatal management regimes designed to avoid or ameliorate them. This approach also has important implications for the management of sick and vulnerable infants, both in the perinatal period and later. From the use of ultrasound brain scanning, a great deal has been learnt about all aspects of the aetiology, evolution and prognosis of GLH, IVH and IPH in very preterm infants; and from autopsy correlation studies, about the underlying pathological processes causing the lesions. ⋯ From these observations it may be deduced that ultrasound brain scanning in the first week of life is a poor predictor of adverse neurodevelopmental outcome at follow-up, depending largely on the diagnosis of haemorrhagic lesions for its 'power'. According to the size of haemorrhage and the outcome considered, the sensitivity may be calculated at 61-73.5% and the positive predictive value at only 32-50% (Stewart ef al, 1987; Cooke, 1987). Nevertheless, the marked echodensities which indicate intraparenchymal haemorrhage (IPH or haemorrhagic PVL) carry a very bad prognosis and thus detect a small group of infants with a probability estimate of serious neurodevelopmental impairment of about 90% (Table 1).(ABSTRACT TRUNCATED AT 400 WORDS)
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Over a 4-year period, 912 patients were admitted to the ICU of the medical oncology service at the Institut Jules Bordet: 574 (63%) were admitted for medical emergencies and 338 (37%) for intensive treatment and/or monitoring. In the first group, the main causes of admission were hypercalcemia, thromboembolic disease, cardiac arhythmias, encephalopathies and pneumopathies. Overall mortality during the ICU stay was 23% (133/574). In the second group, patients were admitted primarily in order to receive, under optimal surveillance, anticancer treatment, either because they were at high risk of complications or because the approach was mainly investigational; several investigations, in the fields of supportive care and anticancer treatment, were successfully conducted within the ICU environment.