Articles: critical-illness.
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Our purpose was to review the medical records of 122 infants who died in our neonatal intensive care unit (NICU) to characterize decision making for the critically ill neonate near the end of life. The majority of deaths (72%) were related to some complication of prematurity. ⋯ At the time of decision making, prognosis was judged to be poor or hopeless and the burdens of treatment unacceptable for 90% of the infants. This study confirms that health care providers and families together can confront the ethical decision of whether to continue or forego life-sustaining treatment for the critically ill neonate near the end of life and, in the majority of cases, will choose to limit, withdraw, or withhold such support.
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Critical care medicine · Feb 1996
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialLorazepam and midazolam in the intensive care unit: a randomized, prospective, multicenter study of hemodynamics, oxygen transport, efficacy, and cost.
To evaluate and compare the clinical efficacy, impact on hemodynamic and oxygen transport variables, safety profiles, and cost efficiency of sedation and anxiolysis with lorazepam vs. continuous infusion of midazolam in critically ill, intensive care unit patients. ⋯ Sedation and anxiolysis with lorazepam and midazolam in critically ill patients is safe and clinically effective. Hemodynamic and oxygen transport variables are similarly affected by both drugs. The dose of midazolam required for sedation is much larger than the dose of lorazepam required for sedation, and midazolam is therefore less cost-efficient.
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Emerg. Med. Clin. North Am. · Feb 1996
ReviewTriage of critically ill patients: an overview of interventions.
The recognition of tissue hypoxia or cumulative oxygen debt is of fundamental importance for triage and resuscitation of critically ill patients during the ¿golden hour¿ in the emergency department (ED). The measurement of central venous blood oxygen saturation, plasma lactate concentration, cardiac output, systemic oxygen transport and use, and non-vital organ oxygenation and function can enhance the detection of systemic and regional hypoperfusion and tissue hypoxia. Systemic and organ-specific oxygenation indices may guide the choice of therapy to optimize resuscitation of the macrocirculation and microcirculation in critically ill ED patients.
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Comparative Study
Bedside percutaneous tracheostomy with bronchoscopic guidance in critically ill patients.
Bedside percutaneous dilational tracheostomy, a relatively new method of tracheal cannulation, provides safe and ready access to the trachea to relieve airway obstruction and tracheopulmonary secretions. The dilational technique has undergone various modifications during the past decade. Complications of this procedure are primarily related to the lack of direct visualization during tracheostomy tube placement and to poor patient selection. ⋯ Bedside percutaneous tracheostomy with bronchoscopic guidance is safe and cost-effective. Complications compare favorably with that of open tracheostomy. Major complications should be avoided with continuous bronchoscopic observation during the procedure.
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Pediatric emergency care · Feb 1996
Comparative StudyPediatric and neonatal critical care transport: a comparison of therapeutic interventions.
To compare the therapeutic interventions provided to newborn and pediatric patients by a dedicated combined neonatal pediatric critical care transport team. ⋯ Overall, newborns received more interventions, including intubation, and ventilation from the transport team than did pediatric patients. Our data suggest that combined pediatric neonatal transport teams should be prepared to intervene in a wide range of conditions from preterm respiratory distress to the multiply traumatized adolescent.