Articles: critical-illness.
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All in-hospital interventions by the crash team of our hospital were recorded and evaluated retrospectively from 1 January 1992 to December 1994 and prospectively for 1995. The most frequent diagnosis was some type of cardiac arrest with a maximal incidence of 32.4% in 1994. Intubation was required in 58.7% of the cases in 1995. ⋯ The inappropriate overruling of the 'do not attempt resuscitation' (DNAR) policy eventually resulted in one survivor. We identified at least five cardiac arrest patients with an unacceptable delay in advanced life support. Our in-hospital critical incident registry resulted in a better policy for appropriate and timely intensive care unit referral.
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American family physician · Sep 1996
ReviewMonitoring pulmonary artery wedge pressure in medical patients.
Pulmonary artery wedge pressure is used in the diagnosis and management of critically ill patients. This measurement provides an accurate assessment of hemodynamic status, cardiac function and venous oxygen saturation. Wedge pressure monitoring has been used in the management of patients with complicated myocardial infarction, refractory heart failure, circulatory shock, pulmonary edema and other critical illnesses. ⋯ Clinical assessment or noninvasive tests, including chest radiographs and echocardiography, often provide information adequate for planning management. If therapy fails, or if noninvasive data are uncertain, pulmonary artery catheterization is appropriate. Risks and complications may be secondary to either catheter insertion or the continued presence of the catheter.
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Critical care medicine · Sep 1996
Critical illness is associated with low circulating concentrations of insulin-like growth factors-I and -II, alterations in insulin-like growth factor binding proteins, and induction of an insulin-like growth factor binding protein 3 protease.
To describe the sequential changes in the circulating concentrations of insulin-like growth factor-I, insulin-like growth factor-II, and insulin-like growth factor binding proteins in critically ill patients. To determine whether critical illness is associated with induction of a specific protease directed against insulin-like growth factor binding protein 3 and to relate these changes to outcome. ⋯ Critical illness is associated with low circulating concentrations of insulin-like growth factor-I, insulin-like growth factor-II, and insulin-like growth factor binding protein 3 and these low values are associated with induction of protease activity specifically directed against insulin-like growth factor binding protein 3. In survivors, recovery is associated with increasing insulin-like growth factor-I and insulin-like growth factor binding protein 3 concentrations and cessation of protease activity. The therapeutic effects of exogenous growth factors are likely to be influenced by these changes.
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Am. J. Respir. Crit. Care Med. · Sep 1996
ReviewEthical considerations of ensuring an informed and autonomous consent in research involving critically ill patients.
Despite several codes of research ethics, the issuance of comprehensive rules regarding informed consent by governmental agencies, and numerous writings on the subject of informed consent, many commentators still question the quality of the informed consent process in clinical research. A major concern is that investigators emphasize only the information-giving aspect of "informed" consent, whereas moral philosophy stresses a more robust concept of informed consent that incorporates the additional requirements of subject competence and voluntariness of the consent, thus ensuring that a consent is not only informed, but autonomous as well. This article aims to examine the issues involved with disclosure, competence, and voluntariness, especially those related to research involving critically ill patients. Suggestions concerning methods that can promote an informed consent process that is more respectful of autonomous decision making will also be discussed.
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Cardiologia (Rome, Italy) · Sep 1996
Randomized Controlled Trial Clinical TrialTransesophageal echocardiography in critically-ill patients using a miniaturized probe: feasibility, efficacy and indications.
Transesophageal echocardiography (TEE) with standard probes may be unsuccessful in emergencies, and in critically-ill or non collaborative patients. A miniaturized pediatric probe was used to overcome these limitations. Thirty-nine patients (age 18-87 years, height 155-184 cm, weight 45-102 kg) were studied with the pediatric probe, and 21 of them were studied using both the pediatric and adult probes in a random sequence. ⋯ Imaging projections and diagnostic accuracy in a wide range of cardiac, aortic and mediastinal diseases were similar for both the pediatric and adult probes. Patient's compliance was much improved by the pediatric probe. In conclusion, TEE by pediatric probes can be used in critically-ill adult patients when the approach with the standard probe is unfeasible or when sedation is undesirable.