Critical care medicine
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Critical care medicine · Jan 2008
Multicenter Study Comparative StudyDiagnostic bronchoscopy in hematology and oncology patients with acute respiratory failure: prospective multicenter data.
To describe the diagnostic yields of test strategies with and without fiberoptic bronchoscopy and bronchoalveolar lavage (FO-BAL), as well as outcomes, in cancer patients with acute respiratory failure (ARF). ⋯ In critically ill cancer patients with ARF, a diagnostic strategy that does not include FO-BAL may be as effective as FO-BAL without exposing the patients to respiratory status deterioration.
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Recent guidelines by the Heart Failure Society of America have recommended consideration for use of nitroprusside, nitroglycerin, or nesiritide in addition to diuretics to achieve hemodynamic and symptomatic improvement. This article reviews the results of previous studies evaluating the pharmacologic and clinical effects and safety profiles of these drugs in patients with heart failure.
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Critical care medicine · Jan 2008
Clinicians' evaluation and management of mental health, substance abuse, and chronic pain conditions in the intensive care unit.
The purpose of this study was to describe clinicians' evaluation and management of co-existing mental health, substance abuse (MHSA), and chronic pain (CP) conditions in patients with prolonged critical illness. Little is known about the evaluation and management of these conditions in the intensive care unit, and practice guidelines do not address management in the context of critical illness, optimal sedation/analgesia, or ventilator weaning. ⋯ The explicit evaluation and management of MHSA and CP conditions was highly variable and inconsistent across cases. Findings suggest that MHSA and CP conditions require monitoring and management similar to that required for other chronic conditions. Multidisciplinary, individual-level, and system-level responses are warranted to address the complex interplay of barriers, consequences, and context.
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Critical care medicine · Jan 2008
Prehospital neurologic deterioration in patients with intracerebral hemorrhage.
Early neurologic deterioration has been studied in patients with intracerebral hemorrhage during hospitalization, but rates and factors associated with prehospital neurologic deterioration (PND) are unknown. We sought to determine the prevalence of PND among patients with intracerebral hemorrhage during Emergency Medical Services transportation to the hospital. ⋯ PND occurs in nearly one fifth of patients with intracerebral hemorrhage. Higher diastolic blood pressure at the scene, intraventricular extension, and radiologically evident herniation seem to be associated with PND. Prospective studies are needed to evaluate the efficacy of Emergency Medical Services interventions to reduce this early clinical deterioration.
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Critical care medicine · Jan 2008
Identifying potentially shockable rhythms without interrupting cardiopulmonary resuscitation.
Current versions of automated external defibrillators (AEDs) mandate interruptions of chest compression for rhythm analyses because of artifacts produced by chest compressions. Interruption of chest compressions reduces likelihood of successful resuscitation by as much as 50%. We sought a method to identify a shockable rhythm without interrupting chest compressions during cardiopulmonary resuscitation (CPR). ⋯ The algorithm fulfilled the potential lifesaving advantages of allowing for uninterrupted chest compression, avoiding pauses for automated rhythm analyses before prompting delivery of an electrical shock.