Critical care medicine
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Critical care medicine · Dec 1997
A prospective evaluation of the use of femoral venous catheters in critically ill adults.
To determine the rate of complications following the use of femoral catheters in adults. ⋯ Based on the data from this study, we conclude that femoral vein catheterization with a polyurethane catheter is associated with an 8.5% frequency rate of femoral vein thrombosis. Thrombosis in the popliteal vein or posterior tibial vein is higher (25.7%), but is homolateral to the catheter with only a 2.8% frequency rate. Infectious complications are low and similar to those of other central venous routes. Given the acceptable rate of clinically important complications, femoral venous catheterization offers an attractive alternate site of insertion to the jugular and subclavian veins for central venous access in the critically ill.
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Critical care medicine · Dec 1997
Early bloodstream infection after cardiopulmonary bypass: frequency rate, risk factors, and implications.
To determine the incidence, predisposing factors, and outcome of early bloodstream infection after cardiopulmonary bypass. ⋯ Early bloodstream infection after cardiac surgery is uncommon and involves predominantly Gram-negative bacteria. The risk factors associated with bloodstream infection were preoperative morbidity and more complex surgery. Bloodstream infection was associated with a significantly adverse impact on outcome after cardiac surgery.
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Critical care medicine · Dec 1997
Comparative StudyComparison of two different pulse oximeters in monitoring preterm infants.
The aim of the study was to test the reliability and variation in the readings of two widely used pulse oximeters in preterm infants. ⋯ We recommend that all neonatal units adopt a policy of using different saturation alarm limits for these two instruments. We further recommend that other pulse oximeters be tested by a methodology similar to the one we present in this paper, before their use in monitoring oxygenation in preterm infants.
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Critical care medicine · Dec 1997
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialProtocol-guided diuretic management: comparison of furosemide by continuous infusion and intermittent bolus.
To evaluate the safety and relative effectiveness of two diuretic protocols in the intensive care unit (ICU). ⋯ Protocol-guided diuretic management, with individualized titration of dosage to defined physiologic endpoints can be readily and safely implemented in the ICU. Both continuous and bolus diuretic regimens appear equally effective in achieving negative fluid balance. Larger studies with a randomized control arm are needed before these protocols can be recommended as routine practice.
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Critical care medicine · Dec 1997
Comparative StudyCirculating complement proteins in multiple trauma patients--correlation with injury severity, development of sepsis, and outcome.
To investigate protein complement 3a (C3a) and protein complement 3 (C3) plasma levels in trauma patients directly after the injury, in relation to the patients' outcome, the development of sepsis, or the injury severity, as determined by either the Polytrauma Score (PTS), the Injury Severity Score (ISS), or the Trauma and Injury Severity Score (TRISS). ⋯ Complement activation occurs immediately after the injury. The degree of activation is a hallmark for the outcome of a patient. Determination of C3a concentrations, at the scene of the accident, may prove helpful to assess the severity of the injury and to determine the prognosis. The amount of C3a and the C3a/C3 ratio may be useful as additional parameters to the existing trauma scoring systems, such as, PTS, ISS, and TRISS.