Critical care medicine
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Critical care medicine · Jan 2000
Interhospital transport of the extremely ill patient: the mobile intensive care unit.
Critically ill patients may require specialized care that is offered only at tertiary referral centers. As regionalization and specialization of critical care become more common, transportation of critically ill patients must be refined. Transportation of critically ill patients within a hospital, much less outside the hospital, is often deemed unsafe because of medical instability. We report, here, our results from 2 yrs' experience of transporting extremely ill patients with respiratory failure via a ground critical care transport service. ⋯ When a mobile intensive care unit is properly staffed and equipped and patient stabilization is performed before transfer, severely ill patients with respiratory failure can be transferred safely. For patients with respiratory failure, there may be a survival advantage in transfer to regional centers of expertise.
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To assess the prevalence of posttraumatic stress symptoms and coping patterns in severely injured accident victims; to study correlations between injury severity and psychosocial variables and the presence of posttraumatic stress symptoms; and to analyze intensive care unit (ICU) personnel's global clinical appraisals in relation to patient characteristics. ⋯ Trauma surgeons and ICU personnel should pay special attention to the strains and stressors their patients have been exposed to when recording case histories and to the level of their patients' psychosocial adaptation before the trauma.
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Critical care medicine · Jan 2000
Comparative StudyComparison of acute physiology and chronic health evaluations II and III and simplified acute physiology score II: a prospective cohort study evaluating these methods to predict outcome in a German interdisciplinary intensive care unit.
To evaluate the ability of three scoring systems to predict hospital mortality in adult patients of an interdisciplinary intensive care unit in Germany. ⋯ Our data more closely resemble those of the APACHE II database, demonstrating a higher degree of overall goodness-of-fit of APACHE II than APACHE III and SAPS II. Although discrimination was slightly better for the two new systems, calibration was good with a close fit for APACHE II only. Hospital mortality was higher than predicted for both new models but was underestimated to a greater degree by APACHE III. Both score systems demonstrated a considerable variation across the spectrum of diagnostic categories, which also differed between the two models.
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Critical care medicine · Jan 2000
Cerebrospinal fluid tumor necrosis factor-alpha, interleukin-1beta, interleukin-6, and interleukin-8 as diagnostic markers of cerebrospinal fluid infection in neurosurgical patients.
To evaluate whether cerebrospinal fluid concentrations of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-6, or IL-8 may be used as diagnostic markers for the differential diagnosis of aseptic vs. bacterial meningitis and/or ventriculitis in neurosurgical patients. ⋯ Cerebrospinal fluid IL-1beta appears to be the best biochemical marker of cerebrospinal fluid infection in neurosurgical patients.