Critical care medicine
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Critical care medicine · Aug 2006
ReviewCentral venous pressure: A useful but not so simple measurement.
To review the clinical use of central venous pressure measurements. ⋯ If careful attention is paid to proper measurement techniques, central venous pressure can be very useful clinically. However, the physiologic or pathophysiological significance of the central venous pressure should be considered only with a corresponding measurement of cardiac output or at least a surrogate measure of cardiac output.
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Critical care medicine · Aug 2006
Accuracy of weight and height estimation in an intensive care unit: Implications for clinical practice and research.
Numerous calculations routinely used in the intensive care require the knowledge of patients' weight and height, although these measurements are not always made. Estimates by doctors or nurses are often substituted. This study sought to ascertain the accuracy of estimates of weight and height of patients made by intensive care unit (ICU) staff. ⋯ Individual estimates of weight and height are frequently inaccurate. These errors of estimation could compromise application of effective therapies, as well as contribute to a reduction in design sensitivity of clinical trials.
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Critical care medicine · Aug 2006
Randomized Controlled TrialPilot study on the effects of high cutoff hemofiltration on the need for norepinephrine in septic patients with acute renal failure.
High cutoff hemofilters are characterized by an increased effective pore size designed to facilitate the elimination of inflammatory mediators in sepsis. Clinical data on this new renal replacement modality are lacking. ⋯ In this pilot study, high cutoff hemofiltration has been shown to exert a beneficial effect on the need for norepinephrine in septic patients with acute renal failure. In addition, we demonstrate that high cutoff hemofiltration is superior to conventional hemofiltration in the elimination of IL-6 and IL-1ra from the circulating blood of septic patients.
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Critical care medicine · Aug 2006
ReviewFacts and fallacies concerning the prevention of contrast medium-induced nephropathy.
The aim of this article is to extract from recent medical literature and nephrologic practice the facts and fallacies concerning the possible prophylaxis of contrast medium-induced nephropathy. ⋯ : It is believed that prevention is actually achieved by correcting hypovolemia, dehydration, or both. Normalization of body fluids is probably the true objective to be achieved by preventive measures in all patients, not only in those at risk. Because limited data have been collected in intensive care units, at present, no firm or specific recommendations can yet be provided for the critically ill.
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Critical care medicine · Aug 2006
Long-term survival, quality of life, and quality-adjusted life-years among critically ill elderly patients.
To assess mortality, quality of life (QOL), and quality-adjusted life-years (QALYs) for critically ill elderly patients. ⋯ High age alone is not a valid reason to refuse intensive care, but the benefits perceived by intensive care seem to decrease with aging, if reflected as QALYs. However, 97% of the elderly survivors lived at home and 88% of them considered their QOL satisfactory or good after hospital discharge. Therefore, more reliable information on the outcome for the elderly is clearly needed.