Articles: critical-illness.
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Zhonghua Wai Ke Za Zhi · Jan 1995
[Evaluation of the prognosis of critically ill surgical patients by APACHE II score system].
A prospective trial was conducted in 386 critically ill surgical patients, the APACHE II score was used to quantify the severity of illness and to judge the outcome. Admission APACHE II score of these patients averaged 15.6 +/- 5.4, the mortality rates rose from 1.9% to 100% when the APACHE II score increased from 0 to 38. The score was closely correlated with the subsequent risk of hospital death for these patients (r = 0.75 P < 0.001). Critically ill surgical patients would be well served by APACHE II for quality assurance or outcome.
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J Intensive Care Med · Jan 1995
ReviewGastric tonometry: a new monitoring modality in the intensive care unit.
In many critically ill patients, systemic measures of hemodynamic and O2 transport variables may not be sufficiently sensitive to portray the complex interaction between energy requirements and energy supply in all tissues. Gastric or intestinal tonometry has been proposed as a relative noninvasive index of the adequacy of aerobic metabolism in the gut mucosa, a tissue that is particularly vulnerable to alterations in perfusion and oxygenation. The gut mucosa lacks some of the microvascular control mechanisms that allow other tissues, such as the heart, skeletal muscle, and the brain, to increase tissue perfusion during times of stress, and, just like the canary, it will display metabolic changes indicative of dysoxia earlier than those more "vital" tissues. ⋯ Increases in mucosal PCO2, or conversely, decreases in mucosal pH (pHi), are associated with the development of intestinal mucosa ischemia. The clinical utility of pHi to detect intestinal mucosal ischemia has been demonstrated in patients undergoing abdominal aortic surgery. Further, a low gastric mucosal pHi on admission to the ICU appears to be predictive of mortality and pHi-guided resuscitation may improve outcome in a subpopulation of patients admitted to the ICU with normal pHi, perhaps by preventing splanchnic ischemia and the development of a systemic oxygen deficit.
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Acta Anaesthesiol Scand Suppl · Jan 1995
ReviewQuantifying pulmonary oxygen transfer deficits in critically ill patients.
The clinical picture describing oxygen transfer deficits in literature is complicated by inconsistent terminology, and a weak perception of the influence total errors of measured and estimated values have on clinical decision-making. Clinical and analytical terminology: Terms like hypoxia, hypoxaemia and tissue hypoxia in clinical literature are often used synonymously. In present terminology, arterial hypoxia (pO2(a)) is considered to be based on measurements of oxygen tension in arterial blood. ⋯ A calculated shunt of 20-29% may be life threatening in a patient with limited cardiovascular function. A calculated shunt greater than 30% usually requires significant cardiopulmonary support. The necessity of sampling mixed-venous blood seems to be the most limiting factor for a widespread clinical use of shunt calculations.
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American family physician · Jan 1995
ReviewAnalgesia, sedation and paralysis in the intensive care unit.
Patients admitted to the intensive care unit often experience some degree of pain and frequently are anxious, confused or delirious. Relief of pain, anxiety and agitation is important for effective patient care. ⋯ Opioids are the cornerstone of analgesia, while benzodiazepines and haloperidol are commonly used for sedation and relief of agitation. When sedative agents fail to control agitation and effective ventilation of the patient is compromised, it may be appropriate to pharmacologically paralyze the patient.
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Intensive care medicine · Jan 1995
Pronounced elevation in circulating calcitonin in critical care patients is related to the severity of illness and survival.
To study circulating levels of calcitonin in critically ill patients in relation to the severity of illness and survival. ⋯ Pronounced elevations in circulating iCT were seen during the first 24 h critically ill patients. As the major part of the iCT consisted of high molecular weight CT this would not induce hypocalcemia. Rather, the elevated iCT would be regarded as a part of the metabolic responses to illness.