Articles: outcome.
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Objective. For patients with refractory angina pectoris, spinal cord stimulation (SCS) is a beneficial and safe adjuvant therapy. However, it has not yet been established whether SCS alters the quality of life (QoL) in these patients. ⋯ QoL in patients with refractory angina pectoris is poor. Both pain and health aspects of QoL improved significantly after 3 months of SCS. Social, mental, and physical aspects of QoL were found improved after 1 year of SCS.
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For logistical reasons sedation studies are often carried out in elective surgical patients and the results extrapolated to the general intensive care unit (ICU) population. We question the validity of this approach. We compared the two sedation regimens used in our general ICU in a trial structured to mimic clinical practice as closely as possible. ⋯ Both regimens produced rapid onset of acceptable sedation but undersedation appeared more common with the cheaper diazepam regimen. At least 140 patients should be studied to provide evidence applicable to the general ICU population. Used alone, a sedation score may be an inappropriate outcome measure for a sedation trial.
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Recent prospective controlled trials of induced moderate hypothermia (32-34 degrees C) for relatively short periods (24-48 h) in patients with severe head injury have suggested improvement in intracranial pressure control and outcome. It is possible that increased benefit might be achieved if hypothermia was maintained for more periods longer than 48 h, but there is little in the literature on the effects of prolonged moderate hypothermia in adults with severe head injury. We used moderate induced hypothermia (30-33 degrees C) in 43 patients with severe head injury for prolonged periods (mean 8 days, range 2-19 days). ⋯ Moderate hypothermia may be induced for more prolonged periods, and is a relatively safe and feasible therapeutic option in the treatment of selected patients with severe traumatic brain injury. Thus, further prospective controlled trials using induced hypothermia for longer periods than 48 h are warranted.
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We analyzed the causes and results of utilization of critical care services in the special care unit in patients after surgical procedures performed by the hepatobiliary surgical service during a 23-month period. ⋯ Respiratory failure was the predominant component of all complications after hepatobiliary surgery. No clinically useful predictors of eventual outcome could be identified.
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Objectives. Prospective studies using specific outcome measures for the treatment of complex regional pain syndromes (CRPS) using spinal cord stimulation are lacking in the literature. The current prospective study followed 19 patients with the objective of analyzing such patients using specific outcome measures including the McGill Pain Rating Index, the Sickness Impact Profile, Oswestry Disability, Beck Depression Inventory, and Visual Analog Scale Scores. ⋯ The Beck Depression Inventory trended toward significant improvement. Conclusions. Patients with CRPS benefit significantly from the use of spinal cord stimulation, based on average follow-up of 7.9 months.