Articles: mortality.
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Jornal de pediatria · Nov 2002
[Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock].
The Institute of Medicine has called for the development of clinical guidelines and practice parameters to develop "best practice" and potentially improve patient outcome. ⋯ American College of Critical Care Medicine adult guide lines for hemodynamic support of septic shock have little application to the management of pediatric or neonatal septic shock. Studies are required to determine whether American College of Critical Care Medicine guidelines for hemodynamic support of pediatric and neonatal septic shock will be implemented and associated with improved outcome.
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Previous studies have suggested increased mortality among anesthesiologists. We report age-standardized mortality rates and causes of death among Finnish anesthesiologists. ⋯ The different age distributions of the anesthesiologists and other specialists caused the difference in age at death. The SR values for the anesthesiologists are clearly lower than those for other specialists. Thus, the present findings do not show increased mortality among Finnish anesthesiologists.
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The purpose of this study was to characterize the relation between smokeless tobacco use and the risk of all-cause and disease-specific mortality. Using data from the First National Health and Nutrition Examination Survey Epidemiologic Followup Study, the authors assessed the 20-year mortality experience of smokeless tobacco users. Subjects aged 45 years or more at baseline (1971-1975) were categorized as either smokeless tobacco users (n = 1,068) or non-smokeless tobacco users (n = 5,737). ⋯ The lung cancer mortality rate among combined users (smokeless tobacco and cigarettes), based on the rates for exclusive smokeless tobacco users and exclusive smokers, was higher than expected, possibly because of heavier smoking among these subjects. The mortality experience of smokeless tobacco users was not significantly greater than that of non-tobacco users and was appreciably less than that of cigarette smokers. Furthermore, combined use of smokeless tobacco and cigarettes did not increase overall mortality beyond that expected from use of the individual products.
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Semin Respir Crit Care Med · Oct 2002
Pneumonia complicating the acute respiratory distress syndrome.
Ventilator-associated pneumonia (VAP) complicating the course of acute respiratory distress syndrome (ARDS) is one of the most challenging diagnostic and treatment dilemmas in critical care medicine. The VAP incidence rate ranges from 37 to 60% in ARDS patients, significantly greater than for other causes of respiratory failure. Although the normal risk factors for VAP are the same in ARDS patients, multiple aspects of the underlying disease and its management increase the risk compared with non-ARDS patients. ⋯ The multilobar but predominantly lower lobe pattern of pneumonia in ARDS makes use of quantitative cultures of lower respiratory secretions (sampled by various techniques) very accurate to confirm the presence of pneumonia. VAP in ARDS patients is usually late-onset and therefore caused by highly antibiotic-resistant microorganisms. Somewhat surprisingly, the mortality of ARDS patients with VAP is not significantly greater than that of ARDS patients without VAP, although subsequent duration of mechanical ventilation is consistently prolonged in patients with VAP.