摘要:

The potential use of prognostic indices (Pls) as instruments for assessing patient outcome has not met the expectatives associated with their development. The inaccuracy of prognosis evaluations, and the fact that they were designed for groups rather than individual patients, has limited their practical clinical use. Physicians are disappointed that the effort spent in developing these instruments has not been matched by guidance in their proper use. This paper responds to this concern by reviewing the possibilities of Pls. Outcome assessments, with their wide limitations, are still the most frequent use of Pls (although their results should be interpreted with caution). These tools are best used as managerial instruments or quality-control aids. Their effectiveness and efficiency are closely related to the information obtained from Pls. The capability of Pls to define different arms of clinical trials has opened a new field for their use as research cooperative tools. Finally, we review trends for further research.

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Outcome measures such as mortality, cost and efficacy of treatment, and length of stay in the ICU have little significance if severity of hospital illness is not accounted for. Identifying high-risk patients has promoted the concept of scoring systems. Assessment of patient prognosis depends on the ability to convene an inception cohort of subjects at a uniform point in the course of their illness. Understanding the continuum of illness, including organ dysfunction and comorbid factors that are not accounted for in general severity scores, may enhance the potential accuracy and usefulness of models.

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The papers in this section review recent developments in the diagnosis and management of patients who are critically ill due to toxic exposures. Several of the papers reviewed present techniques that offer the potential of reducing morbidity, reducing cost, or (best of all) both together. Improvements in technology often produce significant benefits in the management of patients with critical illness. A simple flutter valve device may provide similar benefits in less severely compromised patients. However, the effectiveness of technology in improving patient outcomes must be carefully evaluated in clinical studies that consider the many factors which influence the course of critical illnesses. The use of bronchoscopy to detect airway burns and the use of hyperbaric oxygen to treat carbon monoxide intoxication are applications of established technologies for which efficacy in these specific of situations has not been conclusively proven. Finally, the use of heart rate period variability to assess patients with possible tricyclic antidepressant overdoses represents an application of a technology which is still in the developmental phase. Traditional methods to assess the risk for adverse outcomes from overdoses using an index based on several clinical findings still merit evaluation.

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Inhalation injury represents an ongoing threat to patients with thermal injury. The magnitude of the disease severity is related to the multilevel insult to the pulmonary system. Asphyxiants present in inhaled smoke can compromise oxygen delivery, resulting in cell death. Also, early changes in the microcirculation of the lung parenchyma, related to polymorphonuclear cell activation and oxygen free radical production, are responsible for early pulmonary edema. Perhaps the most significant pathologic change caused by smoke inhalation is loss of the respiratory epithelium and the formation of tracheobronchial casts. The recent application of high-frequency flow interruption ventilation and intrapulmonary percussive ventilation has made the largest impact on improved survival in patients suffering from smoke inhalation.

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

This article reviews the current literature related to the medical toxicology of mushroom poisoning, paralytic shellfish poisoning, snake and scorpion envenomation, and carbon monoxide poisoning. Of the mushrooms of toxicologic concern, the most deadly are those that contain cyclopeptides. This group, typified by Amanita phalloides, may cause fulminant hepatic failure. There has been a recent trend toward the use of hepatic transplantation in patients with such failure. Paralytic shellfish poisoning is the result of toxins from phytoplankton that concentrate in shellfish during periods ofred tides. The toxins are potent neurotoxins, and death may occur, within 24 hours of ingestion, from respiratory muscle weakness. The mainstay of the treatment of venomous snake bites is antivenin. Most antivenins are crude immunoglobulin or serum preparations and are associated with a high rate of anaphylactoid reactions and serum sickness. Recent developments in the use of specific Fab fragments as antivenins are promising approaches to alleviating these complications. Scorpion envenomation is also treated with antivenin. However, scorpion venom has a direct cardiotoxic effect that may not be amenable to antivenin therapy. Dobutamine has been suggested as the inotropic agent of choice in the treatment of cardiac failure caused by scorpion venom. Carbon monoxide poisoning is a common cause of longstanding central neurotoxicity. Although studies have been done on various neuroimaging and electroencephalographic techniques, none has been found to be ideal for evaluating these neurologic effects. Recent literature suggests that carbon monoxide neurotoxicity may be prevented by hyperbaric oxygen treatment.

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Acute overdose with prescription medications and acute withdrawal syndromes are commonly encountered in the critical care setting. Life-threatening overdoses are usually the result of a suicide attempt, and tricyclic antidepressants are commonly used. Recent literature has focused on objective criteria to determine the prognosis for adverse outcomes.Electrocardiographic findings hold promise for determining patients at highest risk, but further studies are needed to determine which patients may be safely monitored outside of an intensive care unit setting without complications. Other studies have focused on the fatality rates of antidepressants and benzodiazepines when taken in overdose, and this may reflect a trend to change prescribing habits to use less-toxic medications in patients at high risk for suicide. The use of less-toxic medication may lead to fewer fatal overdoses and lessen the burden on critical care resources. A recent review of the toxicity of lithium is discussed. When supportive treatment for overdose fails, hemodialysis is often used, but a new technique known as continuous arteriovenous hemoperfusion may be an alternative therapy. Treatment of acute withdrawal syndromes in the intensive care unit is not standardized and there are no recent studies of protocols. Short-acting cross-tolerant medications should be titrated to relieve withdrawal signs.Many abused drugs do not produce physical dependence and can be treated symptomatically. Once patients have been treated for the acute overdose or withdrawal syndrome, they should be referred for long-term treatment of their underlying disease.

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID