Critical care medicine
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Critical care medicine · Feb 2001
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialIs a low transfusion threshold safe in critically ill patients with cardiovascular diseases?
To compare a restrictive red blood cell transfusion strategy with a more liberal strategy in volume-resuscitated critically ill patients with cardiovascular disease. ⋯ A restrictive red blood cell transfusion strategy generally appears to be safe in most critically ill patients with cardiovascular disease, with the possible exception of patients with acute myocardial infarcts and unstable angina.
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Critical care medicine · Feb 2001
Randomized Controlled Trial Comparative Study Clinical TrialPlasma aluminum levels during sucralfate prophylaxis for stress ulceration in critically ill patients on continuous venovenous hemofiltration: a randomized, controlled trial.
To investigate plasma aluminum levels in critically ill patients requiring continuous venovenous hemofiltration (CVVH), while receiving sucralfate for stress ulcer prophylaxis. ⋯ The use of sucralfate for stress ulcer prophylaxis in patients requiring CVVH results in toxic elevations in plasma aluminum levels. Alternative agents should be considered for prophylaxis in these patients.
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Critical care medicine · Feb 2001
ReviewThe family conference as a focus to improve communication about end-of-life care in the intensive care unit: opportunities for improvement.
The intensive care unit (ICU) represents a hospital setting in which death and discussion about end-of-life care are common, yet these conversations are often difficult. Such difficulties arise, in part, because a family may be facing an unexpected poor prognosis associated with an acute illness or exacerbation and, in part, because the ICU orientation is one of saving lives. Understanding and improving communication about end-of-life care between clinicians and families in the ICU is an important focus for improving the quality of care in the ICU. ⋯ This article outlines specific steps that may facilitate good communication about end-of-life care in the ICU before, during, and after the conference. The article also provides direction for the future to improve physician-family and nurse-family communication about end-of-life care in the ICU and a research agenda to improve this communication. Research to examine and improve communication about end-of-life care in the ICU must proceed in conjunction with ongoing empiric efforts to improve the quality of care we provide to patients who die during or shortly after a stay in the ICU.
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Critical care medicine · Feb 2001
Self-reported symptom experience of critically ill cancer patients receiving intensive care.
To characterize the symptom experience of a cohort of intensive care unit (ICU) patients at high risk for hospital death. ⋯ Among critically ill cancer patients, multiple distressing symptoms were common in the ICU, often at significant levels of severity. Symptom assessment may suggest more effective strategies for symptom control and may direct decisions about appropriate use of ICU therapies.
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Critical care medicine · Feb 2001
The hepatosplanchnic area is not a common source of lactate in patients with severe sepsis.
To investigate the role of the splanchnic region in the hyperlactatemia of septic patients. ⋯ Splanchnic lactate release is uncommon in septic patients, even when hyperlactatemia is severe.