Articles: critical-care.
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Comparative Study
Outcome from intensive care. I. A 5-year study of 1308 patients: methodology and patient population.
During a 5-year period, from 1979 to 1983, demographic and disease-related data were collected prospectively on 1308 adult patients from 1555 admissions to a multidisciplinary intensive care unit (ICU) in a Danish university hospital. The patients were followed during the stay in ICU, the ensuing hospital stay, and up to 8 years after discharge from hospital. The male: female ratio was 1:1. ⋯ The APACHE- and TISS-systems were simultaneously applied to a representative sample of 216 consecutive admissions. The average APACHE score was 14.9 +/- 8.2 and the average TISS score 28.3 +/- 11.1 points. The ICU patients presented in this paper do not differ much from ICU patients in other outcome studies.
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Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir · Jan 1989
Review[Pulmonary complications within the scope of multiple organ failure].
The adult respiratory distress syndrome (ARDS) is the pulmonary manifestation of multiple organ failure. Respiratory distress, alveolar consolidation and hypoxemia refractory to oxygen are the result of uniform and unspecific morphological reactions of the alveolo capillary membrane. ⋯ A causal therapy for ARDS is not known. Treatment of the underlying disease, maintenance of arterial oxygenation and prevention of secondary complications are the most important therapeutic measures.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison between a conventional and a fiberoptic flow-directed thermal dilution pulmonary artery catheter in critically ill patients.
Invasive hemodynamic monitoring is frequently required in the management of patients in intensive care units. A fiberoptic flow-directed thermal dilution pulmonary artery catheter capable of continuously monitoring the mixed venous saturation, while more expensive than a conventional pulmonary artery catheter, theoretically could result in better patient care, and might be cost-effective if it resulted either in fewer blood tests being ordered or in less time in the intensive care unit. To test this hypothesis, we designed a randomized trial in our Medical Intensive Care Unit to compare a standard pulmonary artery catheter with a fiberoptic catheter. ⋯ There were no statistical differences between the groups in age, time in the intensive care unit, number of tests ordered, hours of mechanical ventilator therapy, hours of vasoactive drug therapy, or mortality rate. The only statistically significant differences between the groups were that (1) the fiberoptic catheter required a longer insertion time and (2) there were more technical problems in consistently obtaining the wedge pressure in the patients with the fiberoptic catheters. We conclude that routine substitution of a fiberoptic catheter for the standard pulmonary artery catheter is not indicated.
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Anaesthesiol Reanim · Jan 1989
Randomized Controlled Trial Clinical Trial[A clinical study of selective gut decolonization in 204 long-term ventilated intensive care patients undergoing abdominal and accident surgery].
In a randomized clinical trial the effects of selective digestive decolonization (SDD) on the frequency of pneumonia and sepsis and the rate of lethality as well as the resistance quota and colonization of bacteria were studied in 102 surgical ICU-patients requiring prolonged mechanical ventilation. These patients received non-resorbable antibiotics: 4 x 100 mg of polymyxin B, 4 x 500 mg of amphotericin B, and 4 x 80 mg of tobramycin via gastric tube. One hundred and two patients served as controls. ⋯ A secondary colonization of the oropharynx in patients of the SDD-group could not be observed. 38.8% of the patients in the control group showed potentially pathogenic microorganisms in oropharyngeal swabs. A development of resistance of pseudomonas aeruginosa against tobramycin occurred in 2.3% of the patients in the SDD-group and in 3.1% of the patients in the control group. It can be concluded that the administration of non-resorbable antimicrobials against gram-negative aerobes is an effective method for prevention of potentially fatal pneumonia and sepsis, and for the first time a significant improvement of the survival rate could be demonstrated.
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Relief of suffering is a major goal of nursing care. Nurses caring for nonverbal patients must develop specialized skills needed to assess pain and communicate their assessments to other nurses, physicians, and parents. Through collaborative efforts, pain relief for these patients can be achieved.