ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveTo compare outcomes from pediatric intensive care in hospitals with different levels of resources.DesignProspective, blinded comparison of outcome and careSettingTertiary (n = 3) and nontertiary (n = 71) hospitals in Oregon and southwestern Washington.PatientsAll critically ill children admitted with respiratory failure and head trauma for 6 months.Measurements and Main ResultsSeverity of illness adjusted mortality rates were determined using admission day, physiologic profiles (Pediatric Risk of Mortality score) and care modalities were assessed daily. The crude mortality rate of the tertiary patients was four times higher than for the nontertiary patients (23.4% vs. 6.0%,p< .0001). In the tertiary patients, the numbers of outcomes were accurately predicted by physiologic profiles (observed: 30 deaths and 98 survivors; predicted: 29.3 deaths and 98.7 survivors, z = −.25,p> A). However, for the nontertiary patients, the number of the deaths were significantly different than predicted (observed: 20 deaths and 315 survivors; predicted: 14.4 deaths and 320.6 survivors, z = −2.08,p< .05). The odds ratios of dying in a nontertiary vs. a tertiary facility were about 1.1,2.3, and 8 (p< .05) for mortality risk groups of <5%, 5% to 30%, and >30%. Patients in tertiary facilities received more (p< .05) invasive (e.g., arterial catheters) and complex (e.g., mechanical ventilation) care, whereas patients in nontertiary facilities received more (p< .05) labor-intensive care (e.g., hourly vital signs).ConclusionsCare of the most seriously ill children in tertiary pediatric ICUs could improve their chances of survival. (Crit Care Med 1991; 19:150)

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveTo define infection rates in patients with Pediatric Risk of Mortality (PRISM) scores > and <10 on admission to the pediatric ICU (PICU).DesignDescriptive.SettingAn 18-bed PICU admitting patients of all ages except nonsurgical neonates; within a 585-bed tertiary care pediatric hospital.PatientsPatients admitted to the PICU from July 1987 to February 1988 inclusive. Of 685 admitted, 480 were followed for >72 hr.MethodsThe baseline state of the patients on admission was determined by a designated intensivist using the PRISM score. Other variables included age, length of stay, and hospital day of onset of infection. Infections were identified by a designated intensivist who undertook prospective daily bedside observation, chart, radiographic, and laboratory review.Measurements and Main ResultsEqual portions of patients had PRISM scores < and >10. Significantly more infections occurred in the high PRISM population (10.8% vs. 3.4%,p< .001). This association held through age, service, and length of stay. Sensitivity, specificity, positive and negative predictive values of a PRISM score >10 were 75%, 53%, 11%, and 97%, respectively. Bacteremias accounted for 36% of infections, skin/eye/drain site 22%, respiratory 16%, wound 15%, and urine 9%. The most prevalent organisms were coagulase-negative staphylococci (32%),Pseudomonas aeruginosa(23%),Candida sp. (20%), andS. aureus(9%).ConclusionsA PRISM score >10 on PICU admission characterizes a population within the PICU at increased risk of infection. However, 93% of patients did not develop infection and thus, a negative predictive value of 97% yields little additional information. (Crit Care Med 1991; 19:160)

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveTo compare the effectiveness of a new method of closed-loop (automatic) control of BP with usual manual control.DesignWithin-subject crossover trial.SettingGeneral and open heart ICUs in a university teaching hospital.PatientsConvenience sample of 74 seriously ill patients aged 17 to 88 yr. Twenty had hypertension: postoperative (n = 7), neurologic damage (n = 6), miscellaneous (n = 7), and were prescribed nitroprusside (n = 11) or nitroglycerin (n = 9). Fifty-four had hypotension: septic (n = 33), other (n = 21), and were prescribed norepinephrine (n = 30), dopamine (n = 11), epinephrine (n = 8), or dobutamine (n = 5). An additional 21 trials were omitted from analysis because of technical (n = 7), clinical (n = 1), or drug-related problems (n = 13).InterventionClosed-loop and manual drug administrations 1-hr were studied during periods in each patient. The target and observed mean arterial pressure (MAP) and drug infusion rate were recorded electronically every 30 sec.Main Outcome MeasurementsTime taken to achieve initial control (min); fidelity of control (the integral of size and duration of error from target MAP ±10% in mm Hg-hr/hr); and average drug dose administered (ug/min as % maximum possible per drug).ResultsCompared with manual control, closed-loop achieved faster initial control (log-rankX1= 5.04,p< .05) and greater fidelity (mean 1.37 vs. 2.36; F = 7.15,p< .01). There was no difference in average drug dose administered. There was uniformity in the efficacy advantage of closed-loop drug administration across drugs and patient classifications.ConclusionThe new closed-loop system is more effective than the usual manual control in managing acute BP disturbances in the seriously ill patient. (Crit Care Med 1991; 19:166)

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveTo assess the usefulness of the telescoping plugged catheter in the diagnosis of nosocomial pneumonia.DesignProspective study.PatientsA total of 103 ventilated patients with suspected pneumonia were prospectively studied over 20 months.ResultsThe quantitative cultures of the protected brush specimen detected pulmonary bacterial infection (>103cfu/mL) in 49 (47.5%) patients. Subsequent follow-up confirmed pneumonia in 41 patients; in only one patient was a positive protected brush specimen culture established as a false-positive result. There were 54 patients with <103cfu/mL and the diagnosis was excluded in 36 of them. We identified eight patients with false-negative protected brush specimen cultures. The results obtained by this technique allowed us to modify treatment in 49 (47.5%) patients.ConclusionsThe telescoping plugged catheter demonstrated significant bacterial infection in a relatively small proportion of patients in whom bacterial lung infection was suspected. This technique can be safely performed and is a sensitive and specific method to establish the cause of pneumonia, thus allowing specific treatment and the avoidance of inappropriate antibiotic therapy. (Crit Care Med 1991; 19:171)

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID