Articles: critical-illness.
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Critical care medicine · Jul 1994
Comparative StudyReduction of morbidity in interhospital transport by specialized pediatric staff.
We prospectively compared the occurrence of morbidity during high-risk interhospital transport in two types of transport systems: specialized tertiary center-based vs. nonspecialized, referring hospital-based. ⋯ We conclude that specialized pediatric teams can reduce transport morbidity. This is the first published study to compare two models of pediatric transport using identical definitions of severity and morbidity.
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Critical care medicine · Jul 1994
ReviewDoes the formulation of enteral feeding products influence infectious morbidity and mortality rates in the critically ill patients? A critical review of the evidence.
To examine the relationship between the formulation of enteral nutrition and nosocomial infection in critical illness. ⋯ Insufficient experimental data exist to permit conclusions that enteral nutrition formulations or supplements reduce infectious morbidity and mortality rates, but results are promising enough to warrant further research.
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To determine what complications children have during interhospital transfer for intensive care, and how often these complications occur. ⋯ Most children had adverse clinical events during transfer for intensive care. A number are transported by inexperienced staff with inadequate or malfunctioning equipment. Standards for patient management and monitoring during transfer need to be established. To reduce unsatisfactory care during transfer, it is necessary to establish dedicated and specifically trained paediatric transport teams.
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Randomized Controlled Trial Clinical Trial
Elevation of systemic oxygen delivery in the treatment of critically ill patients.
Elevation of systemic oxygen delivery and consumption has been associated with an improved outcome in critically ill patients. We conducted a randomized trial to determine whether boosting oxygen delivery by infusing the inotropic agent dobutamine would improve the outcome in a diverse group of such patients. ⋯ The use of dobutamine to boost the cardiac index and systemic oxygen delivery failed to improve the outcome in this heterogeneous group of critically ill patients. Contrary to what might have been expected, our results suggest that in some cases aggressive efforts to increase oxygen consumption may have been detrimental.
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The effects of a sedative infusion of propofol on haemodynamics and oxygen transport were examined in critically ill adult patients. Ten patients receiving mechanical ventilation for treatment of septic shock and respiratory failure were given a decreasing rate propofol infusion designed to achieve and maintain a stable sedation level. ⋯ There were no significant changes in cardiac output, oxygen delivery, oxygen consumption or arterial blood lactate concentrations. Controlled propofol sedation is well tolerated in appropriately monitored and resuscitated critically ill adult patients, and appears to have no major effects on whole-body oxygen transport.