ISSN:0090-3493    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectivesTo develop and evaluate a model that predicts mortality risk based on admission data for infants weighing 501 to 1500 grams at birth, and to use the model to identify neonatal ICUs where the observed mortality rate differs significantly from the predicted rate.DesignValidation cohort study.SettingUniversity-based, tertiary care neonatal ICUs.PatientsSample of 3,603 infants with birth weights of 501 to 1500 grams who were born at seven National Institute of Child Health and Human Development (NICHHD) Neonatal Research Network Centers, over a 2-yr period of time.InterventionsNone.Measurements and Main ResultsBased on logistic regression analysis, admission factrs associated with mortality risk for inborn infan were: decreasing birth weight, appropriate size for gestational age, male gender, non-black race, and 1-min Apgar score of ≤3. The mortality prediction model based on these factors had a sensitivity of 0.50, a specificity of 0.92, a correct classification rate of 0.82, and an ar under the receiver operating characteristis curve of 0.82 when applied to a validation sam ple. Goodness-of-fit testing showed that then was a marginal degree of fit between the obses vations and model predictions (X2= 15.4,p= .05 The observed mortality rate for 3,603 infa at the seven centers was 24.7%, ranging from 21.8% to 27.7% at individual centers. These were no statistically significant difference between observed and predicted mortality rats at any of the centers. One center had an of served mortality rate that was 2.8% lower the predicted by the model (95% confidence inte −6.0% to 0.5%), and another center had as observed rate that was 3% higher than expects (95% confidence interval −0.3% to 6.2%).ConclusionsMortality risk for infants weiing 501 to 1500 grams can be predicted based admission factors. However, until more ace rate predictive models are developed and dated and the relationships between care p tices and outcomes are better understood, su models should not be relied on for evaluat the quality of care provided in different neo tal ICUs. (Crit Care Med 1993; 21:12–18)

ISSN:0090-3493    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectivesTo determine whether a continuous iv infusion of cimetidine, a histamine-2 (H2) receptor antagonist, is needed to prevent upper gastrointestinal (GI) hemorrhage when compared with placebo and if that usage is associated with an increased risk of nosocomial pneumonia. Due to the importance of this latter issue, data were collected to examine the occurrence rate of nosocomial pneumonia under the conditions of this study.DesignA multicenter, double-blind, placebocontrolled study.InterventionsPatients were randomized to receive cimetidine (n = 65) as an iv infusion of 50 to 100 mg/hr or placebo (n = 66).SettingIntensive care units in 20 institutions.PatientsCritically ill patients (n = 131), all of whom had at least one acute stress condition that previously had been associated with the development of upper GI hemorrhage.Measurements and Main ResultsSamples of gastric fluid from nasogastric aspirates were collected every 2 hrs for measurement of pH and were examined for the presence of blood. Upper GI hemorrhage was defined as bright red blood or persistent (continuing for >8 hrs) “coffee ground material” in the nasogastric aspirate. Baseline chest radiographs were performed and sputum specimens were collected from all patients, and those patients without clear signs of pneumonia (positive chest radiograph, positive cough, fever) at baseline were followed prospec-tively for the development of pneumonia while receiving the study medication.Cimetidine-infused patients experienced significantly (p = .009) less upper GI hemorrhage than placebo-infused patients: nine (14%) of 65 cimetidine vs. 22 (33%) of 66 placebo patients. Cimetidine patients demonstrated significantly (p = .0001) higher mean intragastric pH (5.7 vs. 3.9), and had intragastric pH values at >4.0 for a significantly (p = .0001) higher mean percentage of time (82% vs. 41%) than placebo patients. Differences in pH variables were not found between patients who had upper GI hemorrhage and those patients who did not, although there was no patient in the cimetidine group who bled with a pH < 3.5 compared with 11 such patients in the placebo group. Also, the upper GI hemorrhage rate in patients with one risk factor (23%) was similar to that rate in patients with two or more risk factors (25%). Of the 56 cimetidine-infused patients and 61 placebo-infused patients who did not have pneumonia at baseline, no cimeti-dine-infused patient developed pneumonia while four (7%) placebo-infused patients developed pneumonia.ConclusionsThe continuous iv infusion of cimetidine was highly effective in controlling

ISSN:0090-3493    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

ObjectivesTo determine whether myocardial hyporesponsiveness to administered catecholamines occurs in human sepsis and whether this phenomenon is associated with impaired β-adrenergic receptor stimulation of cyclic adenosine monophosphate.DesignProspective study.SettingMedical ICU in a university hospital.PatientsNormal human volunteers (n = 7), critically ill patients who were not septic (n = 9), septic patients not in shock (n = 16), and septic patients in shock (n = 17).Measurements and Main ResultsPulmonary artery catheter-derived hemodynamic data were obtained in patients with sepsis and septic shock. Isoproterenol and sodium fluoride-stimulated cyclic adenosine monophosphate accumulations were measured in circulating lymphocytes. The hemodynamic response to sequential infusions of dobutamine, 5 and 10 μg/ kg/min, was obtained in septic and septic shock patients. Baseline hemodynamic values for mean arterial pressure, cardiac index, left ventricular stroke work index, and oxygen delivery index at approximately 2 days after the onset of sepsis were significantly lower in septic shock patients compared with septic (nonshock) patients (p< .01,p< .05,p< .001,p< .01, respectively). Isoproterenol-and sodium fluoride-stimulated cyclic adenosine monophosphate accumulations were significantly reduced in septic shock patients compared with those accumulations observed in septic patients (p< .01 andp< .001, respectively). The heart rate response to 10 μg/ kg/min of dobutamine was significantly (p< .01) lower in septic shock patients compared with septic patients.ConclusionsIn patients with septic shock, impaired β-adrenergic receptor stimulation of cyclic adenosine monophosphate is associated with myocardial hyporesponsiveness to catecholamines, suggesting that β-adrenergic receptor dysfunction may contribute to the reduced myocardial performance observed in this shock state. (Crit Care Med 1993; 21:31–39)

ISSN:0090-3493    

出版商:OVID    

年代:1993

数据来源: OVID