Critical care medicine
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Critical care medicine · Jan 1997
Randomized Controlled Trial Clinical TrialOxygen delivery, oxygen consumption, and gastric intramucosal pH are not improved by a computer-controlled, closed-loop, vecuronium infusion in severe sepsis and septic shock.
To investigate the influence of the neuromuscular blocking agent vecuronium on oxygen delivery (DO2), oxygen consumption (VO2), oxygen extraction ratio, and gastric intramucosal pH in heavily sedated patients with severe sepsis or septic shock. ⋯ In these patients, vecuronium infusion achieved the targeted level of paralysis and improved respiratory compliance but did not alter intramucosal pH, VO2, DO2, or oxygen extraction ratios. With deep sedation, neuromuscular blockade in severe sepsis/septic shock does not significantly influence oxygen flux and should be abandoned as a routine method of improving tissue oxygenation in these patients.
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Critical care medicine · Jan 1997
Comparative StudyPrediction of outcome from intensive care: a prospective cohort study comparing Acute Physiology and Chronic Health Evaluation II and III prognostic systems in a United Kingdom intensive care unit.
To evaluate the ability of two prognostic systems to predict hospital mortality in adult intensive care patients. ⋯ Both predictive models demonstrated a similar degree of overall goodness-of-fit. APACHE II showed better calibration, but discrimination was better with APACHE III. Hospital mortality was higher than predicted by both models, but was underestimated to a greater degree by APACHE III. Risk estimates by both models showed considerable variation across the disease spectrum of ICU patients. Risk predictions for surgical patients and patients with gastrointestinal disease were better with APACHE II. Factors reflecting the clinical practice of an individual ICU are not accounted for by APACHE II and III. Overall, the performance of APACHE III was not superior to that of its predecessor for a cohort of United Kingdom ICU patients; for certain diagnostic categories, APACHE III performed worse than APACHE II despite an improved system of disease classification.
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Critical care medicine · Jan 1997
Quality of life after cardiac surgery complicated by multiple organ failure.
To evaluate quality of life after prolonged multiple system intensive care treatment in cardiac surgical patients. ⋯ Patients treated with prolonged multiple system intensive care after heart surgery have a poor outcome with respect to quality of life measured at least 1 yr after discharge from the ICU.
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Critical care medicine · Jan 1997
Effect of continuous venovenous hemofiltration with dialysis on lactate clearance in critically ill patients.
To evaluate the effect of continuous venovenous hemofiltration with dialysis on lactate elimination by critically ill patients. ⋯ Continuous venovenous hemofiltration with dialysis cannot mask lactate overproduction, and its blood concentration remains a reliable marker of tissue oxygenation in patients receiving this renal replacement technique.
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Critical care medicine · Jan 1997
Mortality is directly related to the duration of mechanical ventilation before the initiation of extracorporeal life support for severe respiratory failure.
To investigate the relationship between the period of mechanical ventilation before extracorporeal life support and survival in patients with respiratory failure. ⋯ In severe acute respiratory failure treated with lung rest and extracorporeal life support, a predicted 50% mortality rate was associated with 5 days of preextracorporeal life support mechanical ventilation.