Critical care medicine
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Critical care medicine · Jun 1996
Comparative StudyProspective, controlled study of the outcome of human immunodeficiency virus-1 antibody-positive children admitted to an intensive care unit.
Intensive care resources are both scarce and costly in South Africa. We set out to ascertain whether human immunodeficiency virus (HIV) status affects the spectrum of disease and the prognosis in children treated in pediatric intensive care units (ICUs). ⋯ Outcome in children with AIDS admitted to the pediatric ICU was significantly worse than the outcome in HIV-uninfected children. However, the number of AIDS patients studied was small. HIV antibody-positive children without AIDS do as well as uninfected controls. Ethics committees in resource-constrained countries may be assisted by such data when making difficult decisions on the admissions of HIV-infected patients to pediatric ICU facilities.
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Critical care medicine · Jun 1996
Comparative StudyPrivate attending physician status and the withdrawal of life-sustaining interventions in a medical intensive care unit population.
To assess the influence of private attending physician status on the withdrawal of life-sustaining interventions among patients dying within a medical intensive care unit (ICU). ⋯ Among patients dying within a medical ICU, those patients without a private attending physician are more likely to undergo the active withdrawal of life-sustaining interventions.
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Critical care medicine · Jun 1996
Myocardial dysfunction after successful resuscitation from cardiac arrest.
To investigate the functional and metabolic changes in the myocardium after successful resuscitation from cardiac arrest. ⋯ Postresuscitation myocardial dysfunction in this animal model was characterized by impaired contractile function, decreased work capability, and ventricular dilation.
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Critical care medicine · Jun 1996
Breathing measurement reduces false-negative classification of tachypneic preextubation trial failures.
There is increased awareness of imposed work of breathing contributing to apparent ventilatory dependency. This study evaluates the impact of tachypnea as an indicator of ventilatory failure during a room air-5 cm H2O continuous positive airway pressure, spontaneous breathing, preextubation trial when associated with increased imposed work of breathing. ⋯ Tachypnea as a marker of respiratory distress is sensitive, but is not sufficiently specific to be used as a criterion in preextubation trials. Reliance on tachypnea as a preextubation trial failure criterion is likely to prolong intubation and ventilatory support for a large number of patients. Patient risks, determined by the extubation failures and reintubation rate, are the same.
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Critical care medicine · Jun 1996
Selective brain cooling in infant piglets after cardiac arrest and resuscitation.
To test the hypothesis that selective brain cooling could be performed in an infant model of cardiac arrest and resuscitation without changing core temperature and to study its acute effects on regional organ blood flow, cerebral metabolism, and systemic hemodynamics. ⋯ Selective brain cooling by surface cooling can be achieved rapidly in an infant animal model of cardiac arrest and resuscitation without changing core temperature. Brain temperatures known to improve neurologic outcome can be achieved by this technique with minimal adverse effects. Because of its ease of application, selective brain cooling may prove to be an effective, inexpensive method of cerebral resuscitation during pediatric CPR.