Articles: critical-care.
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Randomized Controlled Trial Clinical Trial
A model to compute the medical cost of patients in intensive care.
Our objective was to identify, among the information routinely collected on patients in intensive care units (ICUs), data that determine the total cost for a given patient. ⋯ Our standardised cost model is a possible approach to allow comparison of medical costs within and between ICUs.
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Intensive care medicine · Jun 1999
Randomized Controlled Trial Clinical TrialThe prognostic significance of passing a daily screen of weaning parameters.
While "weaning parameters" are commonly used to guide removal of mechanical ventilation devices, little information exists concerning their prognostic value. We evaluated whether passing weaning parameters was associated with survival. ⋯ Passing a daily screen of weaning parameters is an independent predictor of successful extubation and survival, but its prognostic value decreases over time. Time spent on mechanical ventilation after passing the daily screen presents an important opportunity to optimize liberation from the ventilator.
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Intensive care medicine · Apr 1999
Randomized Controlled Trial Clinical TrialFatty acid composition of platelet membrane lipids after administration of two different fat emulsions in critically ill patients.
To determine the effects on platelet membrane fatty acid composition following administration of two different fat emulsions. ⋯ The observed changes in fatty acid composition are in agreement with the lipid composition of the fat emulsions used. Because the C18:2n-6/C18:3n-3 ratio in both emulsions is close (approximately 9.0), the observed changes in the fatty acid composition of platelets may not be relevant for platelet function.
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Anesthesia and analgesia · Apr 1999
Randomized Controlled Trial Comparative Study Clinical TrialThe assessment of four different methods to verify tracheal tube placement in the critical care setting.
One of the most serious complications of conventional endotracheal intubation is unidentified placement of the tube in the esophagus. The aim of our study was to evaluate four different methods for immediate detection of the tube position: auscultation, capnographic determination of ETCO2, esophageal detection method (EDM) using a self-inflating bulb, and the transillumination method using a lighted stylet (Trachlight; Laerdal, Armonk, NY). Thirty-eight endotracheally intubated patients admitted to our medical intensive care unit were enrolled in the study. A second identical tube was inserted into the esophagus under laryngoscopic control. The endotracheal tube was then disconnected from the ventilator. Two blinded examiners, one experienced, the other inexperienced, determined the tube position within 30 s using one of the four methods. The order of the tubes tested and the methods used were randomized. In 130 of 152 examinations, both examiners correctly diagnosed the position of the tube. The wrong result was obtained by both examiners 4 times; only the experienced examiner was wrong 4 times, and only the inexperienced examiner was wrong 14 times. Using ETCO2, both examiners were correct in all cases. Auscultation showed an obvious relation to the examiner's experience: the experienced examiner was correct in all cases, the inexperienced examiner was correct in only 68% of cases. Using the self-inflating bulb, there were two wrong results of the experienced examiner and one wrong result of the inexperienced examiner. The transillumination technique was associated with a high error rate by both examiners (16% and 13%, respectively). Comparing all four methods showed that capnography is superior to auscultation (P = 0.0005) and to the Trachlight detection method (P = 0.0078). EDM was not statistically superior to auscultation and transillumination. Capnography was the most reliable method for rapid evaluation of tube position, followed by EDM, whereas auscultation and Trachlight did not seem to be of comparable value. Experience was a determining factor for auscultation. ⋯ To prevent unidentified esophageal intubation, a serious complication in the critical care setting, four methods for detecting tube position were tested by two examiners (one experienced, the other inexperienced) in endotracheally intubated patients after insertion of a second tube into the esophagus.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group.
To determine whether a restrictive strategy of red-cell transfusion and a liberal strategy produced equivalent results in critically ill patients, we compared the rates of death from all causes at 30 days and the severity of organ dysfunction. ⋯ A restrictive strategy of red-cell transfusion is at least as effective as and possibly superior to a liberal transfusion strategy in critically ill patients, with the possible exception of patients with acute myocardial infarction and unstable angina.