Critical care medicine
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Critical care medicine · Aug 2000
Comparative Study Clinical TrialNoninvasive whole-body electrical bioimpedance cardiac output and invasive thermodilution cardiac output in high-risk surgical patients.
To evaluate the reliability of whole-body impedance cardiography with two electrodes on either both wrists or one wrist and one ankle for the measurement of cardiac output compared with the thermodilution method. ⋯ Agreement between whole-body impedance cardiography and thermodilution in the measurement of cardiac output was unsatisfactory. Factors that can explain these differences are differences between the populations used for calibration of nCO and the study population, the influence of changing peripheral perfusion, and the effect of a supranormal hemodynamic state on the bioimpedance signal. Whole-body impedance cardiography cannot be recommended for assessing the hemodynamic state of high-risk surgical patients as studied in this investigation.
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Critical care medicine · Aug 2000
Multicenter Study Comparative StudyComparison of the performance of two general and three specific scoring systems for meningococcal septic shock in children.
To evaluate the performance at admission to the pediatric intensive care unit (PICU) of five severity scores, two general (the Pediatric Risk of Mortality [PRISM] II and III scores) and three specific for meningococcal septic shock (Leclerc, Glasgow Meningococcal Septicemia Prognostic Score [GMSPS], and Gedde-Dahl's MOC score) in children with this condition. ⋯ The specific GMSPS and the general pediatric severity system PRISM II performed better than the other three scores, being appropriate tools to assess severity of illness at admission to the PICU in children with presumed meningococcal septic shock.
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Encephalopathy is a common complication of sepsis. This review describes the different pathologic mechanisms that may be involved in its etiology. ⋯ The most immediate and serious complication of septic encephalopathy is impaired consciousness, for which the patient may require ventilation. The etiology of septic encephalopathy involves reduced cerebral blood flow and oxygen extraction by the brain, cerebral edema, and disruption of the blood-brain barrier that may arise from the action of inflammatory mediators on the cerebrovascular endothelium, abnormal neurotransmitter composition of the reticular activating system, impaired astrocyte function, and neuronal degeneration. Currently, there is no treatment.
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Critical care medicine · Aug 2000
Discrimination of sepsis and systemic inflammatory response syndrome by determination of circulating plasma concentrations of procalcitonin, protein complement 3a, and interleukin-6.
To evaluate whether plasma concentrations of procalcitonin (PCT), interleukin-6 (IL-6), protein complement 3a (C3a), leukocyte elastase (elastase), and the C-reactive protein (CRP) determined directly after the clinical onset of sepsis or systemic inflammatory response syndrome (SIRS) discriminate between patients suffering from sepsis or SIRS and predict the outcome of these patients. ⋯ Our data show that the determination of PCT, IL-6, and C3a is more reliable to differentiate between septic and SIRS patients than the variables CRP and elastase, routinely used at the intensive care unit. The determination of PCT and C3a plasma concentrations appears to be helpful for an early assessment of septic and SIRS patients in intensive care.
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Critical care medicine · Aug 2000
End-of-life care in the pediatric intensive care unit after the forgoing of life-sustaining treatment.
To describe the attitudes and practice of clinicians in providing sedation and analgesia to dying patients as life-sustaining treatment is withdrawn. ⋯ Clinicians frequently escalate the dose of sedatives or analgesics to dying patients as life-sustaining treatment is withdrawn, citing patient-centered reasons as their principle justification. Hastening death is seen as an unintended consequence of appropriate care. A large majority of physicians and nurses agreed with patient management and were satisfied with the care provided. Care of the dying patient after the forgoing of life-sustaining treatment remains underanalyzed and needs more rigorous examination by the critical care community.