Articles: critical-care.
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Antimicrob. Agents Chemother. · Sep 1996
Randomized Controlled Trial Multicenter Study Clinical TrialGamma radiation-sterilized, triple-lumen catheters coated with a low concentration of chlorhexidine were not efficacious at preventing catheter infections in intensive care unit patients.
In a randomized, double-blind trial, gamma radiation-sterilized, chlorhexidine-coated triple-lumen catheters were compared with uncoated control catheters for their ability to prevent catheter infection in 254 intensive care unit patients. The chlorhexidine coating was not efficacious, and a rabbit model demonstrated that reduction of chlorhexidine activity by gamma radiation sterilization was the likely explanation for the failure.
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A Care Multidisciplinary Action Plan was developed at a 300-bed rural medical center in 1994. Once a potential organ donor is identified and referred to the organ procurement organization and the family has consented to donation, the ICU nurse initiates the Care Multidisciplinary Action Plan, which is based on an 8-hour time frame for ICU care that may be adjusted as needed. ⋯ Collaborative issues such as donor family support also are addressed. ICU nurses who used the donor care Multidisciplinary Action Plan were interviewed to determine its effectiveness.
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Critical care medicine · Sep 1996
A pharmacokinetically based propofol dosing strategy for sedation of the critically ill, mechanically ventilated pediatric patient.
To assess the pharmacokinetics and pharmacodynamics of propofol sedation of critically ill, mechanically ventilated infants and children. ⋯ We conclude that a descending propofol dosing strategy, which maintains the propofol concentration constant in the central compartment (V1) while drug accumulates in V2 and V3 to intercompartmental steady-state, is necessary for effective propofol sedation in the pediatric ICU. Our proposed dosing scheme to achieve and maintain the blood propofol concentration of 1 mg/L would appear effective for sedation of most clinically stable, mechanically ventilated pediatric patients.
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Organizational structure and process are thought to affect patient care outcomes beyond the effects of expert clinical care. ⋯ With experienced critical care practitioners, unit-level structure and process factors were better predictors of organizational outcomes than of clinical outcomes.
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To determine survival and changes in quality of life (QOL) after hospital discharge in patients who had stayed in an intensive care unit (ICU). ⋯ After hospital discharge, the survival of ICU-admitted patients is comparable to that of the general population and not related to ICU treatments. Most patients maintain their physical activity and social status at the preadmission level. Any worsening, if present, is slight and does not influence perceived QOL.