Articles: critical-care.
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The purpose of this study was to identify which variables are the best predictors of a do-not-resuscitate (DNR) classification and develop a model to predict the nursing care required by DNR patients in the ICU. Data collected on DNR and non-DNR patients included nursing care requirements, severity of illness, resource allocation and sociodemographic characteristics. One model identified the best predictors of a DNR classification in intensive care as the origin of admission and the severity of illness score on the day of admission to intensive care. The second model identified the best predictors of nursing care requirements for DNR patients in intensive care as the number of days spent in intensive care prior to the DNR order, the average daily resource allocation points after the DNR order, and the severity of illness score on the day the DNR order was designated.
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Respiratory medicine · Jan 1991
Intensive care management of community-acquired Klebsiella pneumoniae.
The clinical features of 18 patients with Klebsiella pneumoniae requiring intensive care unit (ICU) management are presented. All patients required ventilatory support; 17 were given constant positive pressure ventilation and 10 required greater than 10 cm positive end expiratory pressure. ⋯ Septicaemic shock, confusion and uncompensated metabolic acidosis were the presenting clinical features predicting a poor outcome. Antimicrobial chemotherapy, that combined an aminoglycoside and a third generation cephalosporin to ensure adequate early antibiotic serum levels, may help to improve the prognosis.
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Clinical (artificial) nutrition in patients in a surgical intensive care unit (ICU) is a supportive, and not a therapeutic, measure. However, it is as necessary as medical or surgical treatment, because nutrition can prolong life, so that time is bought during which the clinician can start adequate treatment. Studies on the effectiveness of clinical nutrition are rare and difficult, but there is a huge amount of indirect evidence supporting the following basic concept. ⋯ This kind of clinical nutrition obviates the need for concern about the optimal substrate composition. Moreover, enteral nutrition appears to be much simpler and more logical than parenteral nutrition. There is evidence suggesting that there are even clinical advantages of enteral nutrition.
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This paper describes a program for bedside-practicable calculation of APACHE II score, providing an additional option for both a rapid and sensitive screening as well as for a more specific sepsis assessment by the Elebute score in case of a putative diagnosis of sepsis. Thus, diagnostic and prognostic evaluation of septic patients and the assessment of disease progression and classification of "responders" to therapy can be promptly available in the ICU setting. The program is written in BASIC and therefore can easily be adapted to most microcomputers available on the market.
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Acta chirurgiae plasticae · Jan 1991
Transferred triage to a level I trauma center in a mass catastrophe of patients; many of them with burns.
Three airplanes were involved in an airshow accident at the Ramstein military airbase on 28th of August 1988 causing immediate 45 dead and approximate 400 injured people. As a Level I Trauma facility we received 47 patients in different state of distress direct from airfield within an hour. The disaster plan was activated and sufficient personal and infrastructure could be mobilized.