Articles: critical-care.
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Our study objective was to assess economic and clinical outcomes of use of a point-of-care (POC) blood analysis device for postoperative coronary artery bypass graft (CABG) patients. A decision analytic model was developed for patients with high expected use of blood analysis, high potential benefit from rapid turn around time of results, a large annual volume of patients, and substantial expense associated with surgery. Published literature and clinical experts provided incidence, outcome, and cost estimates associated with four clinical scenarios potentially influenced by POC testing (ventricular arrhythmias, cardiac arrest, severe postoperative bleeding, and iatrogenic anemia). ⋯ The positive clinical impact of using POC testing was consistently associated with a positive economic impact. POC blood gas analysis may be associated with decreased incidence of adverse clinical events or earlier detection of such events, resulting in significant cost savings. This study also supports previous findings that the costs of STAT blood analysis are more personnel-related than equipment-related.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 1998
Comparative Study[Level concept of analgesic dosing in intensive care medicine with sufentanil].
The efficacy of a 3-level regimen of analgesia and sedation was investigated in a clinical setting. Level 1 consisted of continuous administration of sufentanil, in level 2 continuous administration of midazolam and level 3 continuous administration of midazolam and clonidine was added according to patients' needs. ⋯ Continuous infusion of sufentanil only for analgesia and sedation is suitable for intensive-care patients with a short stay in the ICU. Respiratory depression during spontaneous breathing is not significant. The supplementary administration of midazolam and clonidine according to the presented regimen was shown to be of advantage for patients with a longer stay in ICU.
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Off J Can Assoc Crit Care Nurs · Jan 1998
ReviewPositioning and intracranial hypertension: implications of the new critical pathway for nursing practice.
Evidence based practice in nursing requires careful scrutiny of research studies to determine if there is support to continue existing protocols or if a change in clinical practice is warranted. Current nursing practice in critical care includes the routine elevation of the head of the bed (HOB) to 30 degrees or 45 degrees for patients with cerebral edema. Intracranial hypertension is a common complication of cerebral edema. ⋯ The author of this article will critically appraise the research examining the impact of elevating the HOB on patients with intracranial hypertension within the context of the critical pathway parameters. Recommendations for positioning, in keeping with the new critical pathway for intracranial hypertension, will be suggested. Future research directions will be identified.
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Circulatory deficiencies and the effectiveness of transfusion and fluid therapy may be evaluated by invasive and noninvasive monitoring after high risk surgery, hemorrhage, trauma, and sepsis in the ED, OR, and ICU. Earlier recognition and therapy of circulatory problems in emergency and critically ill patients to achieve optimal goals empirically defined by the survivors' patterns is recommended to improve outcome. WB, Prbc, and colloids markedly and statistically significantly improved pressure, flow, and tissue perfusion and best achieved these goals. Noninvasive monitoring may be used in the ED and OR shortly after admission to identify circulatory deficiencies and to titrate therapy, or they may be used initially as the front-end of subsequent invasive monitoring.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
Randomized Controlled Trial Clinical Trial[Cause-oriented prevention of nosocomial pneumonia: the HI-LO EVAC tube].
Surgical high-risk patients were studied in a prospective randomized trial regarding nosocomial pneumonia (NP) using a subglottic lavage (SL). A total of 100 patients were investigated, in whom the primary infection was localized in the oropharynx. Independent of the kind of stress ulcer prophylaxis, intermittent subglottic lavage reduces the incidence of NP drastically to 3%, which is however, without statistical significance.