Articles: critical-illness.
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Critical care medicine · Oct 1996
Bedside sonographic-guided versus blind nasoenteric feeding tube placement in critically ill patients.
To compare a blind manual bedside method for placing feeding tubes into the small bowel vs. a sonographic bedside technique in critically ill patients. ⋯ The sonographic bedside technique for placing feeding tubes into the small bowel in critically III patients has a success rate of 84.6% (confidence interval 71% to 98%) after the failure of the blind bedside manual method, proving that the former is significantly more successful. This sonographic technique facilitates the insertion of the tubes in patients who cannot be moved and in those patients with severe impairment of the peristaltic activity of the stomach.
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Critical care medicine · Oct 1996
Accuracy and reliability of noninvasive continuous finger blood pressure measurement in critically ill patients.
To evaluate the accuracy and reliability of noninvasive continuous finger blood pressure measurement in critically ill patients. ⋯ Our data provide a guide to the accuracy and reliability of noninvasive finger blood pressure measurements in critically ill patients. Although most test instrument measurements were reliable, in 8% of all patients large discrepancies (> 10 mm Hg) between both measurements with a duration of > 3 mins were noted. Concerning the considerable risk for arterial cannulation, our preliminary data demonstrate that the test instrument (PORTAPRES, TNO Biomedical Instrumentation Research Unit; The Netherlands) is an advance in noninvasive monitoring of critically ill patients and may be useful in most emergency clinical settings.
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Multicenter Study
The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators.
To examine the association between the use of right heart catheterization (RHC) during the first 24 hours of care in the intensive care unit (ICU) and subsequent survival, length of stay, intensity of care, and cost of care. ⋯ In this observational study of critically ill patients, after adjustment for treatment selection bias, RHC was associated with increased mortality and increased utilization of resources. The cause of this apparent lack of benefit is unclear. The results of this analysis should be confirmed in other observational studies. These findings justify reconsideration of a randomized controlled trial of RHC and may guide patient selection for such a study.
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To determine whether a relationship exists between the use of do-not-resuscitate (DNR) orders in the intensive care unit and the age of the patient after controlling for the severity of illness. ⋯ Older patients (> or = 75 years old) are significantly more likely than younger patients to have DNR orders written even after the severity of illness is controlled as a confounding variable. This association suggests age discrimination and becomes stronger as patient age increases.