Critical care medicine
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Critical care medicine · Sep 1999
Multicenter StudyInterobserver variability in data collection of the APACHE II score in teaching and community hospitals.
To examine interobserver reliability of the Acute Physiologic and Chronic Health Evaluation (APACHE) II score and identify major causes of variability in data collection. ⋯ Reliability of data collection varied widely in different components of the APACHE II probability-of-death model. Significant discrepancies in some components suggested a lack of explicit definitions and timing for consistent data collection between institutions or between data collectors. Nonetheless, variability resulting from data collection appears to be randomly distributed, so that comparisons of group means are valid.
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Critical care medicine · Sep 1999
The patient-related costs of care for sepsis patients in a United Kingdom adult general intensive care unit.
To determine the patient-related costs of care for critically ill patients with severe sepsis or early septic shock. ⋯ Patients with severe sepsis or early septic shock had a high mortality rate, spent prolonged periods of time in the ICU, and were significantly more expensive to treat than nonsepsis ICU patients.
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Critical care medicine · Sep 1999
Comparative StudyCytokine expression in severe pneumonia: a bronchoalveolar lavage study.
To assess the cytokine expression (tumor necrosis factor-alpha [TNF-alpha], interleukin [IL]-1beta, and IL-6) in severe pneumonia, both locally (in the lungs) and systemically (in blood). ⋯ The present study describes the lung and systemic inflammatory response in severe pneumonia. The lung cytokine expression seems to be independent from the lung bacterial burden in the presence of antibiotic treatment. Because of the limited sample size, we did not find a clear relationship between serum and BAL fluid cytokine levels and outcome.
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Critical care medicine · Sep 1999
Reliability and precision of a new thoracic electrical bioimpedance monitor in a lower body negative pressure model.
To evaluate the reliability and precision of measurement in a new thoracic electrical bioimpedance (TEB) monitor. ⋯ This new monitor appears to overcome many of the signal processing problems encountered with previous devices. The results clearly demonstrate that accurate and reliable measurement of bioimpedance waveforms is possible and suggest that the monitor is capable of generating precise hemodynamic data across a wide spectrum of hemodynamic alterations. However, the evidence also indicates that new algorithms may be needed to more fully explain the multiple factors affecting this waveform.
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Critical care medicine · Sep 1999
Comparative Study Clinical TrialEffects of norepinephrine plus dobutamine or norepinephrine alone on left ventricular performance of septic shock patients.
To determine the hemodynamic effects of the combination of norepinephrine-dobutamine in adult patients with septic shock. Specifically, we tested the hypothesis that norepinephrine in addition to dobutamine would improve cardiac index (CI) and stroke volume index (SVI) and increase left-ventricular afterload. ⋯ The addition of norepinephrine to treatment of patients with septic shock unresponsive to dobutamine significantly improves MAP, CI, SVI, and LVSWI. A different pattern of evolution was observed if norepinephrine was used alone in younger patients with higher CI at study entry, increases in MAP and LVSWI, and no concomitant change in CI or SVI. The use of norepinephrine in dobutamine-resistant septic shock may have some beneficial implications for the treatment of patients with inadequate myocardial performance associated with low SVR.