Critical care medicine
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Critical care medicine · Oct 1996
Economic impact of prolonged motor weakness complicating neuromuscular blockade in the intensive care unit.
We compared a case-series of ten patients who developed prolonged neuromuscular weakness after continuous, nondepolarizing, neuromuscular blockade with a group of controls without neuromuscular weakness to determine the economic impact of the neuromuscular weakness. ⋯ The development of motor weakness was associated with an increase in ICU and hospital stays, continued mechanical ventilation, and disproportionate healthcare expenditures in excess of $66,000 per patient. A prospective evaluation of the true prevalence of neuromuscular weakness after neuromuscular blockade and of the costs to the healthcare system is needed.
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Critical care medicine · Oct 1996
Comparative StudyA comparison of venovenous and venoarterial extracorporeal membrane oxygenation in the treatment of neonatal respiratory failure.
To compare the efficacy of venovenous to venoarterial bypass in an unselected cohort of infants with refractory cardiorespiratory failure. ⋯ We conclude that venovenous ECMO using a double-lumen venovenous catheter can provide results comparable with venoarterial bypass without the need for carotid artery ligation in an unselected population of neonatal ECMO candidates. In our experience, reported contraindications to venovenous ECMO did not prove to be valid.
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Critical care medicine · Oct 1996
Starling resistor effects on pulmonary artery occlusion pressure in endotoxin shock provide inaccuracies in left ventricular compliance assessments.
Assessment of left ventricular preload and left ventricular compliance changes in septic shock using pulmonary artery occlusion pressure (PAOP) presumes that this pressure accurately reflects left heart filling pressure. We tested the hypothesis that Starling resistor forces render PAOP inaccurate as an index of left heart filling pressure, resulting in misleading assessments of left ventricular compliance changes. ⋯ The dissociation between PAOP and left atrial pressure, while left ventricular and -diastolic diameter (preload volume) decreased, and changes in pulmonary venous resistance, are strong evidence for Starling resistor forces (venocompression) rather than active venoconstriction. These data indicate that PAOP overestimates left atrial pressure during endotoxin shock, making it an inaccurate index of left ventricular preload. This overestimation can cause misleading assessments of left ventricular compliance.
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Critical care medicine · Oct 1996
Decreasing catheter-related infection and hospital costs by continuous quality improvement.
a) To reduce the rate of catheter-related infection, using improved skin preparation and catheters impregnated with silver sulfadiazine and chlorhexidine; b) to decrease the number of unnecessary guidewire exchanges of existing catheters by substituting suspected catheter-related sepsis for fever alone as an indication to change an indwelling catheter; and c) to decrease the hospital costs associated with guidewire exchanges and new catheter insertions. ⋯ Catheters impregnated with silver sulfadiazine and chlorhexidine had a smaller proportion of catheter-related infection compared with unprotected catheters. Fever alone as an indication for guidewire exchange resu
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Critical care medicine · Oct 1996
How to keep up with the critical care literature and avoid being buried alive.
To provide practical suggestions for accessing, utilizing, and storing the rapidly expanding literature on critical care. ⋯ Efficient access, appraisal, and application of the literature on intensive care are basic skills for intensivists, who have adopted a variety of resourceful and pragmatic methods for "keeping up."