Articles: critical-care.
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Critical care medicine · Oct 1993
Randomized Controlled Trial Clinical TrialSelective decontamination of the digestive tract in neurosurgical intensive care unit patients: a double-blind, randomized, placebo-controlled study.
The aim of this study was to assess, in a selected population, the effects of selective decontamination of the digestive tract on colonization of the oropharynx, trachea, stomach and rectum, and on the infection rate. An economical assessment was also performed. ⋯ Selective decontamination of the digestive tract is an effective technique in reducing infectious morbidity in comatose neurosurgical patients. Because of its cost, this technique should be used only in selected populations.
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Critical care medicine integrates various treatment modalities to provide care of patients with multiple system dysfunction or failure and to determine the diagnosis of the particular condition. The pulmonary artery catheter advanced from a simple tool to measure intracardiac pressures and output to methodology enabling clinicians to understand the balance between oxygen delivery and utilization. Critical care developed new concepts in the treatment of respiratory failure including not only forms of mechanical ventilation such as pressure control but also methods such as ECMO and surfactant therapy which may preclude the need for mechanical ventilation or minimize its needs. ⋯ Continued development of genetically engineered drugs may ultimately improve survival and reduce complications. Critical care has become a subspecialty, synthesizing the basic knowledge from anesthesiology, internal medicine, pediatrics and surgery. Its multidisciplinary delivery represents the way of the future.
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Three areas of particular importance in dealing with critical complications of trauma are pharmacology, monitoring, and nutritional support. This article deals with each of these from the perspective of the doctor or nurse at the bedside. This survey stands as a sampler and guidebook to these subjects as they pertain to the critically ill multiple trauma patient.
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A great deal of progress has been made regarding improved prehospital transport, the quality of trauma care, and injury prevention research. The analysis of the four determinants of outcome in the trauma victim allowed for the discovery of subgroups who may benefit from a change in triage, resuscitation, or management. Our recent investigation into the effect of host factors on mortality resulted in the discovery that pre-existing illness predicts outcome independent of other determinants, including age and ISS. ⋯ The bottom line in care of any trauma victim is that all deviations from normal must be noted, but they should be evaluated properly with respect to the acute injuries. It is the authors' hope that this overview will guide the intensivist in focusing on the treatment of acute injuries without losing sight of the importance of both recognizing and managing chronic illnesses so their detrimental effect on patient outcome can be minimalized. A large multicenter investigation is needed to see whether these recommendations will, in fact, positively impact on trauma victim outcome.
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Pediatric emergency care · Oct 1993
Critical care pediatrician-led aeromedical transports: physician interventions and predictiveness of outcome.
This article reviews the one-year experience (March 28, 1987 to March 27, 1988) of the pediatric transport service of the University of Wisconsin Hospital and Clinics (UWHC). The UWHC pediatric transport team consisted of a critical care flight nurse and a pediatric critical care attending physician or fellow. The aims of the study were to: 1) determine the types and number of interventions performed by the physicians to gauge the need for physician presence on transport; and 2) determine which variables (severity of illness scores, age, gender, distance from hospital) recorded at the time of the referral telephone call best predicted outcome of the patient. ⋯ Among trauma patients, if gender, age, distance from UWHC, and telephone PRISM scores were known, outcome could be predicted 74% of the time. Unless studies show the benefit of pediatrician-accompanied transport, transports could probably be done without critical care pediatricians. Severity of illness scoring at this time is probably not sufficiently accurate to warrant its use for deciding the appropriateness of transport of pediatric patients.