Articles: critical-illness.
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Multicenter Study Clinical Trial
The SUPPORT prognostic model. Objective estimates of survival for seriously ill hospitalized adults. Study to understand prognoses and preferences for outcomes and risks of treatments.
To develop and validate a prognostic model that estimates survival over a 180-day period for seriously ill hospitalized adults (phase I of SUPPORT [Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments]) and to compare this model's predictions with those of an existing prognostic system and with physicians' independent estimates (SUPPORT phase II). ⋯ A limited amount of readily available clinical information can provide a foundation for long-term survival estimates that are as accurate as physicians' estimates. The best survival estimates combine an objective prognosis with a physician's clinical estimate.
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Control Clin Trials · Feb 1995
Randomized Controlled Trial Multicenter Study Clinical TrialThe SvO2 study: general design and results of the feasibility phase of a multicenter, randomized trial of three different hemodynamic approaches and two monitoring techniques in the treatment of critically ill patients. The SvO2 Collaborative Group.
Although the attainment of normal hemodynamic values has always been assumed to be the therapeutic target for critically ill patients, recent studies reported increased values in oxygen transport variables in survivors of high-risk surgery. It has been supposed that the higher values observed in survivors might indicate a physiological compensation for the increased metabolic requirements due to disease. ⋯ Two different monitoring systems are used to maintain the target: conventional Swan-Ganz catheter with scheduled samples of mixed venous O2 saturation, and optical catheter with continuous SvO2 evaluation. The aim of the study is to answer three questions regarding the hypothesis reported above: (1) Are results in postoperative patients applicable to other pathological groups? (2) Does continuous monitoring of SvO2 provide advantages over conventional hemodynamic monitoring? (3) Is a normal SvO2 rather than a supranormal CI a good and predictable therapeutic goal? We report herein the protocol of the study and the results of the pilot phase, which was conducted in 98 critically ill patients enrolled by 56 participating centers to evaluate the safety and feasibility of the proposed trial.
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Critical care medicine · Feb 1995
Relationship between blood lactate concentrations and ionized calcium, glucose, and acid-base status in critically ill and noncritically ill patients.
To determine the relationships between circulating blood lactate concentrations and several biochemical variables including ionized calcium, glucose, pH, and acid-base status in critically ill and noncritically ill patients. ⋯ a) There is neither a statistically significant nor clinically relevant relationship between whole blood lactate concentrations and ionized calcium concentrations when studying patients with or without hyperlactatemia. b) Although there is a statistically significant correlation between circulating lactate concentrations and blood glucose concentrations, arterial pH or arterial base deficit, such associations do not appear to be clinically important.
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Paediatric anaesthesia · Jan 1995
A survey of interhospital transport of the critically ill child in the United Kingdom.
Nineteen paediatric intensive care units were surveyed by questionnaire to provide information on the number of interhospital transfers, the experience of personal accompanying the critically ill child and the equipment available to maintain intensive care during transfer. Replies were received from 17 units. ⋯ Most respondents believed that existing arrangements for transfer were unsatisfactory, but only four units said that transfer may be prevented or delayed by lack of facilities. We believe that any plan to centralize paediatric intensive care in the UK should also include the means by which to transfer the patient without increasing the risk to the patient.
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Comparative Study
Comparison of APACHE II and III scoring systems for mortality prediction in critical surgical illness.
To determine whether the Acute Physiology and Chronic Health Evaluation III (APACHE III), an updated version of APACHE II that contains a larger number of postoperative patients in the normative database, offers better prediction in critical surgical illness. ⋯ In institutions or groups of patients where APACHE II underestimates mortality, APACHE III may be corrective. However, the differences are subtle and may be difficult to detect in smaller studies.