Critical care medicine
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Critical care medicine · Aug 1997
ReviewCentral venous catheter replacement strategies: a systematic review of the literature.
To evaluate the effect of guidewire exchange and new-site replacement strategies on the frequency of catheter colonization and infection, catheter-related bacteremia, and mechanical complications in critically ill patients. ⋯ Guidewire exchange of central venous catheters may be associated with a greater risk of catheter-related infection but fewer mechanical complications than new-site replacement. More studies on scheduled vs. as-needed replacement strategies using both techniques are warranted. If guidewire exchange is used, meticulous aseptic technique is necessary.
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Critical care medicine · Aug 1997
Comparative StudyPreventable adverse drug events in hospitalized patients: a comparative study of intensive care and general care units.
To compare the frequency and preventability of adverse drug events and potential adverse drug events in intensive care units (ICUs) and non-ICUs. To evaluate systems factors involving the individual caregivers, care unit teams, and patients involved in each adverse drug event by comparing ICUs with non-ICUs and medical ICUs with surgical ICUs. ⋯ The rate of preventable and potential adverse drug events was twice as high in ICUs compared with non-ICUs. However, when adjusted for the number of drugs ordered, there was no greater likelihood for preventable adverse drug events and potential adverse drug events to occur in ICUs than in non-ICUs. Preventable adverse drug events and potential adverse drug events occurred in units that functioned normally and involved caregivers who were working under reasonably normal circumstances, not at the extremes of workload, stress, or a difficult environment.
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Critical care medicine · Aug 1997
Comparative StudyCan hospital discharge diagnoses be used for intensive care unit administrative and quality management functions?
To determine whether hospital discharge diagnoses can be used for intensive care unit (ICU)-related activities. ⋯ The primary discharge diagnosis often failed to reflect the reason for ICU admission, making it impossible to consistently establish the reason for ICU admission from the discharge data. The reason for ICU admission was also frequently not included among the secondary discharge diagnoses. Administrative data are therefore not useful for ICU quality management and other functions. Intensivists need to establish their own databases.
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Critical care medicine · Aug 1997
Practice guideline for arterial blood gas measurement in the intensive care unit decreases numbers and increases appropriateness of tests.
To test the hypothesis that implementation of a practice guideline for blood gas measurement would decrease numbers and increase appropriateness of tests (according to criteria in the guideline) for up to 1 yr after introduction of the guideline. ⋯ Implementation of this guideline for arterial blood gas measurement increases efficiency of test utilization without prolonging mechanical ventilation or affecting outcome.
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Procalcitonin, the precursor peptide of calcitonin, has been shown to be a serum marker of the severity and mortality of several systemic inflammatory response syndromes. This study addressed the correlation of serum procalcitonin with the course of classic (nonexertional) heatstroke. ⋯ Classic heatstroke is associated with increased concentrations of serum procalcitonin, particularly among survivors. Further studies are required to elucidate the source and action(s) of procalcitonin as well as its relationship to cytokine activation.