Articles: intensive-care-units.
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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.
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Ethical debate abounds in the literature relative to treatment decisions for the high risk neonate in the intensive care nursery. A systematic examination of the parents' perspective is missing. ⋯ This concept evolved through the parents' reflection on conflict naming, content of decision-making, context of decision-making, information sharing and perception of infant status. These concerns differ profoundly from those of health professionals, philosophers, theologians and others active in this debate who cite lower limits of viability, iatrogenic effects of treatment, use of multiple invasive procedures, and the role of paternalism as ethical issues.
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Improving survival of burned patients has been reported by the majority of burn units over the past decade. Although many sophisticated studies have attempted to delineate the major factors responsible for this improvement, no single factor has emerged as being clearly dominant. On the MUSC burn service, increased survival has been particularly apparent in patients with burns involving 50-90% of the BSA. ⋯ Attributing the increased survival of burned patients to any one of these factors alone currently does not seem to be clearly supported by data reported in the literature nor by our own experience. It is to be hoped that as the quality of skin substitutes and techniques of culturing skin improve, inroads into the extremely high mortality of burns involving more than 90% of the BSA can be made. The MUSC burn service is currently investigating the place of aggressive early burn wound excision and grafting with cultured epithelial autografts in achieving this goal.
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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.