Critical care medicine
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Critical care medicine · Jul 2004
Randomized Controlled Trial Clinical TrialExhaled tidal volume overestimation in mechanically ventilated patients with large cardiogenic oscillation.
In postcardiac surgery patients, we often noticed that monitored tidal volumes exceeded the ventilator settings. We investigated whether cardiogenic oscillation causes overestimation of tidal volume. ⋯ In mechanically ventilated patients with large cardiogenic oscillation, exhaled tidal volume is overestimated on at least one model of ventilator.
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Critical care medicine · Jul 2004
ReviewNew method of classifying infections in critically ill patients.
To develop a systematic classification describing the contribution made by infection to the outcome from sepsis. ⋯ We have described a novel approach to permit a better assessment of the contribution made by the infection to mortality in patients with sepsis or septic shock.
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Rationing critical care beds occurs daily in the hospital setting. The objective of this systematic review was to examine the impact of rationing intensive care unit beds on the process and outcomes of care. ⋯ These studies suggest that patients who are perceived not to benefit from critical care are more often refused intensive care unit admission; refusal is associated with an increased risk of hospital death. During times of decreased critical bed availability, several factors, including age, illness severity, and medical diagnosis, are used to triage patients, although their relative importance is uncertain. Critical care bed rationing requires further investigation.
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Critical care medicine · Jul 2004
Elevated body temperature independently contributes to increased length of stay in neurologic intensive care unit patients.
Elevated temperature results in worse outcome in experimental models of cerebral ischemia and brain trauma. In critically ill neurologic and neurosurgical patients, elevated body temperature is common and is associated with neurologic deterioration and poor outcome. We sought to determine whether, after controlling for age, severity of illness, and complications, elevated body temperature remained an important predictor of intensive care unit (ICU) and hospital length of stay, mortality rate, and hospital disposition in a large cohort of patients emergently admitted to a neurologic ICU. ⋯ In a large cohort of neurologic ICU patients, after we controlled for severity of illness, diagnosis, age, and complications, elevated body temperature was independently associated with a longer ICU and hospital length of stay, higher mortality rate, and worse outcome.
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Critical care medicine · Jul 2004
Family satisfaction with family conferences about end-of-life care in the intensive care unit: increased proportion of family speech is associated with increased satisfaction.
Family members of critically ill patients report dissatisfaction with family-clinician communication about withdrawing life support, yet limited data exist to guide clinicians in this communication. The hypothesis of this analysis was that increased proportion of family speech during ICU family conferences would be associated with increased family satisfaction. ⋯ This study suggests that allowing family members more opportunity to speak during conferences may improve family satisfaction. Future studies should assess the effect of interventions to increase listening by critical care clinicians on the quality of communication and the family experience.