Articles: critical-care.
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Injured patients whose treatment included the use of radiologic catheter techniques were reviewed to determine the clinical utility of radiologic intervention. In the past 4 years, 51 patients have undergone 53 radiologic procedures, predominantly angiographic hemostasis. ⋯ Twenty-eight of the 31 patients with shock or with life-threatening hemorrhage or sepsis, treated by the radiologist, were salvaged. Based on our results, we believe that a radiologist, knowledgeable about trauma and expert in catheter techniques, plays a vital role in improving patient survival and should be integrated into the trauma team approach.
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The records of 40 patients with cancer and 684 patients without cancer admitted to a medical critical care unit were reviewed for the purpose of comparing survival. Patients with cancer had a higher mortality (55%, 22/40) than the patients without cancer (17%, 118/864). Patients with cancer and respiratory failure had a higher mortality (75%, 18/24) than patients without cancer but with respiratory failure (25%, 66/273) and a higher mortality than patients with cancer but without respiratory failure (25%, 4/16). ⋯ Patients with cancer but without respiratory failure had a mortality of 25% (4/16). All eight patients with cancer admitted to the hospital because of life-threatening metabolic disturbances survived. In deciding whether to apply critical care techniques to a patient with cancer, the physician should consider the specific nature of the life-threatening illness.
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Experimental and clinical aspects of fluid management problems are reviewed; clinical and physiological criteria for efficacy of various plasma expanders are evaluated. Reduced extracellular water is considered the primary defect of shock by those favoring the use of crystalloids, but hypovolemia is regarded as primary by those favoring the use of colloids. ⋯ In general, colloids improved hemodynamic and oxygen transport, while sodium-rich crystalloids increased arterial pressure and peripheral resistance, but not flow and oxygen transport. Indications for various agents and protocols (clinical algorithms) for resuscitation and critical illness are proposed.