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 clarify the prognosis for eventual recovery of kidney function in patients who experience prolonged dialysis dependence after acute renal failure (ARF).DesignRetrospective, chart review.SettingInpatients of a large, referral-based hospital.PatientsTwenty-six consecutive survivors of ARF who required >4 wk of dialysis support.ResultsAll 26 patients were critically ill and developed ARF during treatment in an ICU. The clinical course of these patients was characterized by multiple episodes of renal ischemia or nephrotoxin exposure during dialysis dependence. However, despite multiple renal insults and prolonged dialysis support (mean duration 8.4 ± 0.7 wk), 23 (88%) of the 26 patients recovered sufficient kidney function to discontinue dialysis. Preexisting renal impairment was associated with a greater risk of irreversible renal failure, and, in patients able to discontinue dialysis, renal recovery was often incomplete.ConclusionDespite some renal damage, most critically ill patients who survive ARF requiring prolonged dialysis support recover life-sustaining kidney function. (Crit Care Med 1991; 19:8)

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveTo determine if providing patients' daily survival probabilities to physicians and nurses along with a short videotape on the measurement of survival probabilities and costs of pediatric intensive care would reduce resource use.DesignProspective, randomized, controlled trial.SettingPediatric ICU.PatientsMedical patients in a prospective control period (n = 113), an intervention period (n = 226), and a follow-up control period (n = 97).InterventionsThe survival probabilities of 50% of the patients in the intervention period were displayed at the bedside and the staff viewed a short videotape on the measurement of survival probabilities and costs of pediatric intensive care.Measurements and Main ResultsDaily survival probabilities and resource use were evaluated each day. Resource use, adjusted for severity of illness, was evaluated using analysis of covariance. Compared with the prospective control group, reductions in the daily use of blood gases (p< .01), hematology tests (p< .001), hourly vital signs (p< .001), and hourly neurologic vital signs (p< .001) resulting in a composite reduction in daily laboratory and imaging charges from 759 ± 22 to 622 ± 18 (p< .01) were observed in the patient group receiving the survival probabilities and whose physicians also viewed the videotape. Equivalent reductions in resource use also occurred in a simultaneous control group (patients did not receive survival probabilities but healthcare workers did view the videotape) and in a follow-up control group.ConclusionReduction in pediatric intensive care resource use can occur from the combined effects of actuarial and clinical interventions. (Crit Care Med 1991; 19:12)

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveTo evaluate the clinical characteristics of increased extravascular lung water (EVLW) in patients with low pulmonary artery occlusion pressure (PAOP) in the early phase of acute myocardial infarction.DesignConsecutive sample for descriptions of the clinical features of medical disorders.SettingA general medicine group practice in a university hospital.PatientsSixteen patients with low PAOP (>18 mm Hg) on the initial measurement obtained within 12 hr of chest pain onset.Measurements and Main ResultsEVLW was measured by the thermal indocyanine green dye double-indicator dilution method. QRS score was obtained on hospital day 7 from the Selvester's QRS Scoring System. Eleven (69%) patients had increased EVLW >7 mL/kg despite low PAOP. EVLW had no significant correlation with PAOP and the difference between plasma colloid osmotic pressure and PAOP, but did have a significant correlation with pulmonary vascular resistance index (r2= .31,p< .05), and QRS score (r2= .45,p< .005).ConclusionLarger infarcts led to increased EVLW even with low PAOP, and the accumulation of increased EVLW around the small arterioles might have led to increased pulmonary vascular resistance. (Crit Care Med 1991; 19:21)

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveTo derive performance characteristics for the Glasgow Meningococcal Septicemia Prognostic Score (GMSPS).DesignRetrospective case-note study.SettingTwo children's hospitals with Regional Intensive Care Unit.PatientsOne hundred twenty-three children with proven meningococcal septicemia (some with concurrent meningitis) from January 1, 1977 to December 31, 1986.Measurements and Main ResultsAll 14 children who died after arrival scored ≥8 either on admission (n = 8) or afterward (n = 6). Of 109 survivors, five scored ≥8 (two were postictal at the time of scoring). A GMSPS of ≥10 at or after admission predicted death with sensitivity 100%, specificity 98%, and positive predictive value of 88%; for GMSPS of both ≥8 or 9, the values were 100%, 95%, and 74%, respectively.ConclusionThe GMSPS is a rapid clinical score that performs well in identifying children with poor prognosis who might benefit from early intensive care. It should be studied prospectively and compared with other scoring systems. (Crit Care Med 1991; 19:26)

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveTo compare cardiopulmonary function during spontaneous breathing with three continuous-flow breathing circuits. The major difference between these circuits was the degree of flow resistance offered by the exhalation valve.DesignRandomized crossover trial.PatientsTwelve infants <12 months of age recovering from respiratory failure of variable etiology. Only patients weighing 3 to 10 kg were studied.InterventionsThe patients were connected to each respiratory circuit in a random sequence, with 15 min allowed for equilibration before assessment of cardiopulmonary function. Airway pressure (Paw) and FIO2were maintained unchanged.Measurements and Main ResultsVentilation, gas exchange, or circulatory function were not altered significantly by changing the breathing circuit. However, Paw and esophageal pressure fluctuations were altered and were largest during breathing with the circuit that had an exhalation valve with high-flow resistance. The Paw fluctuation recorded while the patient was breathing with the flow-resistor circuit increased with weight and exceeded 2 cm H2O in all patients weighing >4.5 kg. Paw fluctuation could be decreased by >2 cm H2O in ten of 12 patients by using the threshold-resistor circuit.ConclusionThe results indicate a need for evaluating the characteristics of respiratory circuits used for spontaneous breathing in infants and children, to avoid unnecessary equipment-related increase in respiratory work. (Crit Care Med 1991; 19:31)

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID