Arch Surg Chicago
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To determine the comparative efficacy of selective decontamination of the digestive tract in critically ill surgical and medical patients, and in selected subgroups of surgical patients with pancreatitis, major burn injury, and those undergoing major elective surgery and transplantation. ⋯ Selective decontamination of the digestive tract notably reduces mortality in critically ill surgical patients, while critically ill medical patients derive no such benefit. These data suggest that the use of selective decontamination of the digestive tract should be limited to those populations in whom rates of nosocomial infection are high and in whom infection contributes notably to adverse outcome.
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The response of the United States to a perceived terrorist threat is dichotomous. The hyperbole and exaggeration often displayed by the media and general public lies in stark contrast to the relative indifference with which terrorism is regarded by the medical community. ⋯ We will then outline recommendations for modest changes in our disaster medical planning to better prepare for these threats. Special attention will be directed at the emergence of nonconventional weapon use by terrorist organizations and how this might affect the civilian medical community.
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The concept of multiple organ failure and related abnormalities was first developed in the 1970s. Multiple organ failure became evident when the support systems in intensive care units were able to keep patients alive long enough for multiple organ problems to develop in them. ⋯ These trials have had either limited success or negative results, despite considerable evidence for efficacy or protection by such agents in experimental animals and in studies of normal human volunteers. I believe a major reason for these negative results has been the use of general entry criteria for the trials rather than the treatment of specific diseases or injuries.
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A critical evaluation of monitoring in critical illness must recognize first that there are many different types of monitoring that may take place, and that each type of monitor may be evaluated appropriately by different standards. Monitoring may occur with imaging devices, analyzers that require the permanent removal of tissue or fluid for analysis, or monitors that observe physiology with either invasive or noninvasive methods without requiring an ex vivo sample.
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Nonoperative management of blunt liver and spleen injuries in hemodynamically stable, neurologically intact patients has become an accepted treatment in recent years. ⋯ Nonoperative management in patients with an altered mental status can be done safely in a monitored setting. This challenges the current criteria of excluding neurologically impaired patients with liver or spleen trauma from nonoperative management.