Articles: critical-care.
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Dimens Crit Care Nurs · Jan 1996
Case ReportsParental participation in treatment decisions for pediatric oncology ICU patients.
Ethical dilemmas involving treatment decisions are increasing in frequency as medical technology continues to provide the ability to prolong life. When the dilemmas involve treatment decisions for children, the added dimension of parental participation makes the issue even more complex. The author describes a pilot study showing the extent of documentation of parents' participation in treatment decisions for pediatric oncology ICU patients.
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Wien. Klin. Wochenschr. · Jan 1996
Intensive care management of acute pancreatitis: recognition of patients at high risk of developing severe or fatal complications.
The clinical spectrum of acute pancreatitis ranges from mild, self-limiting disease of fulminant illness that may rapidly lead to multiple organ failure and death. To identify factors associated with a subsequent severe course and/or high mortality we investigated retrospectively 91 patients admitted to the medical intensive care unit (ICU) with acute pancreatitis during a 2 year period. 67% of the attacks were mild (< or = 1 complication). The overall mortality rate was 9%, whereby 3% of patients with alcoholic and 13% with biliary pancreatitis died. 75% of the patients in the group with a fatal outcome were aged over sixty and 30% in the group with a mild course (p < 0.05). ⋯ The RANSON scoring system provided further a significant differentiation between survivors with a severe course of pancreatitis when compared to deaths on day 2, whereas the APACHE-III scoring system did not. Advanced age, female sex, biliary obstruction and elevated RANSON and APACHE-III scores are risk factors for an increased rate of life-threatening complications in acute pancreatitis. The daily assessment of such scoring systems may allow the recognition of such patients and may be helpful in the routine clinical management and monitoring of acute pancreatitis.
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Increasing emphasis will be placed on the efficient delivery of healthcare. This article concentrates on recommendations for cost containment including increased cost consciousness, elimination of waste, improved quality of care, and use of the team approach to cost containment. The resources over which bedside nurses and managers in critical care have direct or indirect control are the focus of this discussion.
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Ann Fr Anesth Reanim · Jan 1996
[Blood loss from diagnostic laboratory tests performed in intensive care units. Preliminary study].
To assess the volume of blood samples withdrawn for laboratory testing in intensive care unit (ICU) patients and to determine the influence of the resulting blood loss on transfusion requirements in patients staying in the ICU for more than seven days. ⋯ Blood losses from blood withdrawal for laboratory tests are important and in agreement with the results of other reports. It is generally accepted that iatrogenic blood loss of this magnitude can cause anaemia if repeated over a prolonged period. Conversely, our data suggest that blood sampling does not contribute significantly to anaemia and transfusion requirements in patients with a prolonged ICU stay.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1996
Comparative Study[Monitoring critically ill intensive care patients by semi-invasive COLD (Cardiac-Output-Liver-Diseases) monitoring instead of pulmonary artery catheterization].
The routine application of an arterial thermal-dye-dilution technique (so called COLD-Monitoring) offers new perspectives in the hemodynamic management of critically ill patients using a small invasive technique. COLD-Monitoring employs a computerized analysis of a double-indicator (temperature and dye) dilution technique which requires only a central venous catheter and a special fibre optic catheter with a temperature probe applied to the femoral artery. Especially in critically ill patients with septic course or multiple organ failure (MOF) COLD-monitoring serves to exactly measure volume and therefore distribution, to objectify capillary leakage by extravascular lung water index, to check the excretoric liver-function by plasma-deviation-rate of ICG and to perform a well controlled epinephrine therapy by measuring cardiac function index and systemic vascular resistance index.