Critical care medicine
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Critical care medicine · Apr 2002
Impact of a pediatric clinical pharmacist in the pediatric intensive care unit.
To study the impact of a clinical pharmacist in a pediatric intensive care unit. The goals of the study were to determine the type and quantity of patient care interventions recommended by a clinical pharmacist and to specifically examine cost savings (or loss) that resulted from clinical pharmacist recommendations. ⋯ We conclude that a clinical pharmacist is an important and cost-effective member of the pediatric intensive care unit team.
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The Utstein-style template defines core and supplementary data for reporting out-of-hospital cardiac arrest information. The primary outcome statistic of the Utstein template is survival to hospital discharge (SHD). The SHD statistic is dependent on Utstein-defined out-of-hospital variables and multiple in-hospital variables that are undefined and uncontrolled. ⋯ This requirement for large study populations has resulted in recent studies that report results by using end points proximate to SHD when assessing the effect of individual interventions. It is logical that success of a specific intervention should be determined by the ability of the intervention to accomplish its purpose rather than the ability to improve SHD that is dependent on multiple variables. Furthermore, because in-hospital care is not standardized and uncontrolled variables exist, the primary Utstein end point of SHD should be reconsidered when evaluating cardiac arrest interventions.
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Critical care medicine · Apr 2002
Sex-related differences in the presentation and outcome of out-of-hospital cardiopulmonary arrest: a multiyear, prospective, population-based study.
To examine whether previously observed sex-related differences in coronary artery disease syndromes also apply to patients with out-of-hospital sudden cardiac arrest, a probable subset of patients with coronary artery disease who are easy to recognize and are treated in a standardized fashion. ⋯ In cases of out-of-hospital sudden cardiac arrest, women have significantly better resuscitation rates than men, especially when controlling for age, particularly among women with non-ventricular fibrillation/ventricular tachycardia presentations. Additional studies are required to validate these observations, not only for long-term survival and external validity, but also for other potential genetic factors and potential discrepancies with other studies.
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Critical care medicine · Apr 2002
Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury.
To define optimal cerebral perfusion pressure (CPPOPT) in individual head-injured patients using continuous monitoring of cerebrovascular pressure reactivity. To test the hypothesis that patients with poor outcome were managed at a cerebral perfusion pressure (CPP) differing more from their CPPOPT than were patients with good outcome. ⋯ CPPOPT could be identified in a majority of patients. Patients with a mean CPP close to CPPOPT were more likely to have a favorable outcome than those whose mean CPP was more different from CPPOPT. We propose use of the criterion of minimal achievable PRx to guide future trials of CPP oriented treatment in head injured patients.
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Critical care medicine · Apr 2002
Energy attenuator for pediatric application of an automated external defibrillator.
Although automatic external defibrillators (AEDs) are extensively deployed to rapidly treat sudden cardiac arrest in adults, their applicability for children is presently limited. It is desirable to extend the indications for this lifesaving equipment to all ages, even though AED application to children will be rare compared with adults. It is imperative that the inherent simplicity of present adult AED operation not be compromised to extend its use to include children. ⋯ When used with the AED, the delivered energy would be reduced within the electrodes, and only a portion of the energy output by the AED would be delivered to the pediatric patient. These electrodes could be used in conjunction with currently deployed AEDs with electrocardiographic analysis algorithms appropriate for children. This eliminates the need for a separate AED specifically for children or the purchase of a new AED with pediatric capability to replace previously deployed models.