Articles: critical-care.
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Journal of neurotrauma · Sep 2004
Multicenter Study Comparative StudyInaccurate early assessment of neurological severity in head injury.
Intubation, which requires sedation and myorelaxants, may lead to inaccurate neurological evaluation of severely head-injured patients. Aims of this study were to describe the early clinical evolution of traumatic brain injured (TBI) patients admitted to intensive care unit (ICU), to identify cases of over-estimated neurological severity, and to quantify the risk factors for this over-estimation. A total of 753 TBI patients consecutively admitted to ICU of three academic neurosurgical hospitals (NSH) were assessed. ⋯ The main features distinguishing MS from truly severe cases were younger age, higher Glasgow Coma Scale (GCS) score at all time points, Marshall classification of Computerized Tomographic (CT) scan mostly Diffuse Injury I and II, fewer pupillary abnormalities, and a lower frequency of hypoxia, hypotension, and extra-cranial injuries. In a certain proportion of non-surgical TBI patients, mostly intubated and sedated, neurological examination is difficult and severity can be over-estimated. Risk factors for this inaccurate evaluation can be identified, and clinical decisions should be based on further examination.
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Enferm. Infecc. Microbiol. Clin. · May 2004
Multicenter Study[Indications for antifungal treatment in intensive care unit patients].
This study investigates the indications for antifungal treatment in patients admitted to intensive care units (ICUs) in Spain and determines the frequency at which each individual drug is prescribed. ⋯ A total of 11.5% of patients included in the study were given one or more treatment courses with antifungal agents. Antifungal treatment was prescribed in proved fungal infections in only 21.1% of cases. Fluconazole was the antifungal agent most frequently used.
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Review Randomized Controlled Trial Multicenter Study Clinical Trial
[Recombinant activated Factor VII (Novo Seven) for uncontrollable hemorrhage in critically ill patients with multiple injuries].
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Am. J. Respir. Crit. Care Med. · Feb 2004
Randomized Controlled Trial Multicenter Study Clinical TrialJunior versus senior physicians for informing families of intensive care unit patients.
To compare the effectiveness of information delivered to family members of critically ill patients by junior and senior physicians, we performed a prospective randomized multicenter trial in 11 French intensive care units. Patients (n = 220) were allocated at random to having their family members receive information by only junior or only senior physicians throughout the intensive care unit stay; there were 92 and 93 evaluable cases in the junior and senior groups, respectively, with no significant differences in baseline characteristics. ⋯ Family members informed by a junior physician were more likely to feel they had not been given enough information time (additional time wanted: 3 [0-6.5] vs. 0 [0-5] minutes, p = 0.01) and to have sought additional explanations from their usual doctor (48.9 vs. 34.4%, p = 0.004). Specialty residents, if given opportunities for acquiring experience, can become proficient in communicating with families and share this task with senior physicians.
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Multicenter Study
Constipation and its implications in the critically ill patient.
Motility of the lower gut has been little studied in intensive care patients. ⋯ Constipation has implications for the critically ill.