Articles: critical-care.
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Anasth Intensivther Notfallmed · Feb 1985
Clinical Trial Controlled Clinical Trial[EEG parameters in the monitoring of ventilated intensive care patients under various sedation methods].
Visual evaluation of the EEG and spectral analysis of the background activity are useful in monitoring changes of cerebral function caused by sedatives, hypoxia and changes in state of health. Continuous slow changes of the EEG are indicative of critical situations of cerebral blood flow or metabolism. Monitoring cerebral function of 40 sedated and ventilated patients on an intensive care unit, we found typical EEG changes dependent on different regimes of sedation, amount of sedatives and patient condition. ⋯ The EEG was an aid to predicting the outcome of intensive care and to demonstrate the degree of cerebral damage. In patients with septicaemia, cerebral function was more depressed than in patients with cardiac failure. Spectral analysis and computed parameters proved to be valuable in monitoring cerebral changes caused by sedation and state of health in ventilated patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomized, prospective trial of cimetidine and ranitidine for control of intragastric pH in the critically ill.
Forty-eight critically ill patients in an intensive care unit were enrolled in a prospective study of stress ulcer prophylaxis. The H2-receptor antagonists cimetidine and ranitidine were used, patients being randomized on hospital number. Response was assessed by measuring gastric pH every 2 hours. ⋯ However, even with much lower plasma concentrations of ranitidine, similar amounts of both drugs were present in the gastric juice, suggesting a possible explanation for the greater efficacy of ranitidine. We conclude that, although ranitidine is more effective than cimetidine, neither of these drugs is adequate for stress ulcer prophylaxis. If they ae used for this purpose in the critically ill patient, regular monitoring of gastric pH is essential to allow detection of therapeutic failures.
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Medicare prospective payment by diagnosis-related groups (DRGs) has intensified the debate over the use and costs of medical technology. In this study, we examine the financial impact of DRG payment for medicare patients receiving medical intensive care. During a one-year period, payment for 446 Medicare patients receiving medical intensive care at a large teaching hospital was calculated to be +4.7 million below costs, representing an average loss per discharge of +10,567. ⋯ For this group, the average payment per discharge was projected to be +21,651 below the average per discharge cost. We conclude that the results send strong financial messages to hospitals providing medical intensive care to severely ill, elderly patients. Further exploration and research must occur to ensure hospital responses will be consistent with public policy expectations.