Articles: critical-illness.
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Prog Cardiovasc Nurs · Jan 1994
Electrocardiographic changes in critically ill adults during intrahospital transport.
Critically ill patients are frequently transported out of the intensive care unit (ICU) for diagnostic tests and procedures. Advanced diagnostic testing and increased patient acuity have influenced the level of nursing care required during intrahospital transport. Previous studies have documented deleterious patient outcomes during intrahospital transport, but none have evaluated twelve lead electrocardiograms (ECGs). ⋯ A convenience sample of 29 critical care patients (14 cardiac, 8 neurological, 5 medical, 2 transplant) was selected from three ICUs at a university hospital. In addition to the standard, single bipolar lead monitor, patients were monitored with a portable, interpretative electrocardiograph with continuous 12 lead ST segment analysis. Results of this study indicate that cardiac events during intrahospital transport may go undetected because of current monitoring practices and the mechanics of transport.
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Intensive care medicine · Jan 1994
Comparative StudySignificance of pathologic oxygen supply dependency in critically ill patients: comparison between measured and calculated methods.
oxygen supply dependency at normal or high oxygen delivery rate has been increasingly proposed as a hallmark and a risk factor in critical illnesses. We hypothesized that as far as an adequate oxygen delivery is provided, oxygen consumption, when determined by indirect calorimetry, is not dependent on oxygen delivery in critically ill patients whereas calculated oxygen consumption is associated with artefactual correlation of oxygen consumption and delivery. ⋯ analysis of oxygen uptake, when measured by indirect calorimetry, failed to substantiate oxygen supply dependency in the vast majority of the critically ill patients irrespective of diagnosis and outcome. Mathematical coupling of shared variables accounted for the correlation between oxygen delivery and calculated oxygen consumption.
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This paper examines how decisions to limit treatment to critically ill patients under uncertainty can be made rationally. Expected utility theory offers one way of making rational decisions under uncertainty. One problem with using this approach is that we may not know the value of each option. ⋯ Critically ill patients are allowed to die because it is believed that their lives will be not worth living. It is likely that some patients are allowed to die when there is some objective chance of worthwhile future life. This paper argues that a policy of treating critically ill patients until the nature of future options can be better evaluated, in company with an offer of subsequent euthanasia where appropriate, allows a more rational and humane approach to treatment limitation decisions under uncertainty.
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Intensive care medicine · Jan 1994
Comparative StudyEvaluation of oxygen uptake and delivery in critically ill patients: a statistical reappraisal.
The evaluation of oxygen consumption (VO2) and oxygen delivery (DO2) has gained increasing importance in the monitoring of critically ill patients. They can be obtained from either direct measurements or by indirect calculations based on the Fick principle. However the choice between these two approaches remains controversial. The aim of the study was to investigate whether these 2 methods provide similar results, and if not, to define the best one in terms of reproducibility. ⋯ Our data suggested that the indirect calculation (Fick equation) and the direct measurement (indirect calorimetry, thermodilution) of both VO2 and DO2 did not provide similar results. Direct measurements are more reproducible methods and must be preferred.
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Clin Intensive Care · Jan 1994
Metabolic effects of continuous veno-venous haemofiltration in critically ill patients.
To evaluate the short-term metabolic and haemodynamic effects of continuous veno-venous haemofiltration (CVVH) in critically ill patients with acute renal failure (ARF). ⋯ CVVH does not affect metabolic rate and haemodynamic stability in critically ill patients. The lack of any effect on the metabolic rate and haemodynamic parameters in such patients may have significant clinical importance and it further attests to the suitability of CVVH for the treatment of critically ill patients.