摘要:

ObjectiveTo assess the validity of the Pediatric Risk of Mortality (PRISM) scoring system in accurately predicting the probability of mortality in an Italian intensive care unit (ICU) sample.DesignProspective, observational, multicenter study.SettingTwenty-six Italian ICUs classified into two groups: a) ICUs specifically dedicated to treating pediatric patients; and b) adult ICUs treating children on a regular basis.PatientsConsecutive patients (n = 1,533) <15 yrs of age admitted during 1 yr.InterventionsNone.Measurements and Main ResultsTo assess the performance of the PRISM scoring system, the discrimination and calibration measures were adopted both in the whole population and in 12 preselected subgroups. A good discrimination capability of the scoring system was observed for both the whole population and subgroups (areas under the receiver operating characteristic curves were never <0.82). On the other hand, we documented an unsatisfactory calibration capability in the whole population and in most subgroups (p values of the Hosmer-Lemeshow goodness-of-fit test were <.001 in all but two subgroups).ConclusionsThe analyses suggest that the unsatisfactory calibration of PRISM can be attributed to various reasons. Among those reasons, a poor performance of the system, as well as its sensitivity to factors not connected to clinical ICU performance, seem particularly important. A special caution is needed in adopting a severity of illness scoring system to assess quality of care, particularly in contexts different from the one in which the instrument was originally developed. (Crit Care Med 1998; 26:1427-1432)

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objectiveor=to4) in critically ill children.DesignProspective sample.SettingPediatric intensive care unit in a tertiary care children's hospital.Patientsor=to24 hrs of scheduled intermittent intravenous ranitidine for stress ulcer prophylaxis were enrolled in the study. Patients with renal or hepatic dysfunction and those who received enteral nutrition through the nasogastric tube were excluded from enrollment.InterventionGastric pH was determined at the end of the ranitidine dosing interval, 1 hr after the dose, and at the midpoint between doses. All pH measurements were made from a sample of nasogastric aspirate, using pH sensitive paper. Gastric pH control with ranitidine was considered unsuccessful (poorly controlled) if the pH was <4 for any of the three measurements.Measurements and Main ResultsForty-five patients (median age 36 mos; range 2 wks to 264 mos) were included in the analysis. Eighty-two percent of the patients were mechanically ventilated, 16% were pharmacologically paralyzed, 18% required vasoactive infusions, 36% were nourished via transpyloric feeding tubes, and 7% received total parenteral nutrition.Gastric pH was poorly controlled in 36% of patients.Among these patients, the pH at the end of the dosing interval was significantly lower than the pH measured at 1 hr or at the midpoint between doses (p < .05)..05).Conclusionsor=to4. (Crit Care Med 1998; 26:1433-1436)

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo evaluate the correlation of the capillary refilling time measured in neonates with the hemodynamic parameters obtained by Doppler echocardiography.DesignProspective study.SettingNeonatal intensive care unit (ICU) in a university hospital.PatientsNeonates without congenital cardiac disease admitted to the neonatal ICU (n = 100).InterventionsNone.Measurements and Main ResultsThe clinical parameters obtained were: heart rate; blood pressure; mean airway pressure; cutaneous temperature; and capillary refilling time. The echocardiographic data included the measurement of aortic diameter, left atrial diameter, and shortening fraction. Pulsed-Doppler echocardiography was used to measure flow velocity values in the ascending aorta, in the pulmonary artery trunk, and in the patent ductus arteriosus. Cardiac index was calculated secondarily from the volumetric equation, including measured flow velocity in the ascending aorta, aortic diameter, and body weight. Shunt severity at this level was measured by analysis of the descending aortic flow. Thereafter, three groups were defined for analysis: group 1 with obliterated ductus arteriosus; group 2 with patent ductus arteriosus without a retrograde flow in the subdiaphragmatic aorta; and group 3 with patent ductus arteriosus and a retrograde flow in the subdiaphragmatic aorta. There was no correlation between the capillary refilling time and the following parameters: shortening fraction; mean airway pressure; body weight; left atrial diameter/aortic diameter ratio; blood pressure; and heart rate. In group 1, the capillary refilling time was significantly linked to cardiac index (r2= .54, p < .001). A lower correlation coefficient between capillary refilling time and cardiac index was found in groups 2 (r2= .31, p < .001) and 3 (r2= .41, p < .001).ConclusionThe capillary refilling time was significantly linked to cardiac index in neonates. (Crit Care Med 1998; 26:1437-1440)

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo evaluate the usefulness of transthoracic electrical bioimpedance in sedated and paralyzed patients with acute lung injury during mechanical ventilation with and without early application of positive end-expiratory pressure (PEEP).DesignProspective, repeated-measures study.SettingUniversity-affiliated intensive care center.PatientsTen patients with acute lung injury.InterventionsSimultaneous, three-paired cardiac output (CO) measurements by transthoracic electrical bioimpedance (TEB) and thermodilution (TD) were made at 0 and 15 cm H2O of PEEP.Measurements and Main ResultsThe average of the TD-CO measurements was 7.22 +/- 2.12 (SD) L/min during 0 cm H2O of positive end-expiratory pressure (ZEEP), and 6.91 +/- 1.72 L/min during PEEP (NS). The average of the TEB-CO measurements was 4.48 +/- 1.37 L/min during ZEEP, and 6.03 +/- 2.03 L/min during PEEP (p < .05). For each level of PEEP, bias and precision between methods were calculated. Bias calculations between TD-CO and TEB-CO ranged from -1.54 +/- 7.02 L/min at ZEEP to -2.52 +/- 4.28 L/min at PEEP, and -2.47 +/- 6.09 L/min for mixed data at ZEEP and PEEP. There was no significant correlation between the percent change with PEEP in TEB-CO and TD-CO (r2= .05, NS).ConclusionsIn patients with acute lung injury: a) the agreement between TEB-CO and TD-CO measurements is poor; b) agreement is not clinically improved by application of PEEP; and c) TEB cannot monitor trends in CO. (Crit Care Med 1998; 26:1441-1445)

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo systematically investigate the reproducibility and reliability of a newly developed, less invasive approach of estimating blood volume (BV), using indocyanine green (ICG) measured with pulse-spectrophotometry.DesignProspective, clinical study.SettingSurgical unit at a university hospital.PatientsTwenty-two patients undergoing general anesthesia for elective surgery and seven healthy volunteers.InterventionsCatheters were inserted into the forearm veins of healthy volunteers for the administration of ICG and blood sampling for the measurement of hemoglobin concentration.Measurements and Main ResultsThe distribution volumes of ICG in seven healthy volunteers were estimated repetitively following three or four consecutive intravenous administrations at 30-min intervals. A low intrasubject coefficient of variation of 3.94 +/- 2.03 (SEM) % and a reasonable intersubject coefficient of variation of 13.3 +/- 5.52% (in mL/kg) for the BV measurements were obtained. In addition, ICG was administered to 22 patients, first under general anesthesia by a bolus, and then by a bolus with a constant-rate infusion. The ICG blood concentration was noninvasively measured with pulse-spectrophotometry. The blood concentration time courses following both bolus and constant-rate infusion were well fitted by the one-compartment model, indicating that the distribution equilibrium of ICG is instantaneous. The distribution volumes estimated following bolus injection correlate closely with the distribution volume estimated based on constant-rate infusion administration (r2= .90).ConclusionsThe BV estimation with a bolus injection of ICG and pulse-spectrophotometry is reliable, as reflected by the reproducible BVs estimated in the same subject. The integrated pulse-spectrophotometry monitoring system offers a less invasive and useful tool for bedside estimation of BV. (Crit Care Med 1998; 26:1446-1451)

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo evaluate the efficacy of tunneling short-term central venous catheters to prevent catheter-related infections.Data SourcesMEDLINE, EMBASE, conference proceedings, citation review of relevant primary and review articles, personal files, and contact with expert informants.Study SelectionFrom a pool of 225 randomized, controlled trials of venous and arterial catheter management, we identified 12 relevant trials and included seven of these trials in the analysis.Data ExtractionIn duplicate, independently, we abstracted data on the population, intervention, outcomes, and methodologic quality.Data SynthesisTunneling decreased bacterial colonization of the catheter by 39% (relative risk of 0.61; 95% confidence interval [CI] of 0.39 to 0.95) and decreased catheter-related sepsis with bacteriologic confirmation by 44% (relative risk of 0.56; 95% CI of 0.31 to 1) in comparison with standard placement. The majority of the benefit in the decreased rate of catheter-sepsis came from one trial at the internal jugular site (relative risk of 0.30, 95% CI of 0.10 to 0.89) and the reduction in risk was not significant when the data from five subclavian catheter trials were pooled (relative risk of 0.71, 95% CI of 0.36 to 1.43). Tunneling was not associated with increased risk of mechanical complications from placement or technical difficulties during placement. However, this outcome was not rigorously evaluated.ConclusionsTunneling decreases central venous catheter-related infections. However, current evidence does not support routine tunneling until its efficacy is evaluated at different placement sites and relative to other interventions. (Crit Care Med 1998;26:1452-1457)

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID