Articles: critical-illness.
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Comparative Study
Comparison of APACHE II and III scoring systems for mortality prediction in critical surgical illness.
To determine whether the Acute Physiology and Chronic Health Evaluation III (APACHE III), an updated version of APACHE II that contains a larger number of postoperative patients in the normative database, offers better prediction in critical surgical illness. ⋯ In institutions or groups of patients where APACHE II underestimates mortality, APACHE III may be corrective. However, the differences are subtle and may be difficult to detect in smaller studies.
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Critical illness creates stress in patients and their families. However, families' reactions vary and suggest that having a loved one in an intensive care unit (ICU) may not be a crisis for all families. The purpose of this study was to explore and describe the meanings that families ascribe to an ICU experience. ⋯ Interviews were analyzed qualitatively and revealed five categories of meanings that the ICU experience had for families: "it could go either way," "everything is good," "going upstairs," "like living on a roller-coaster," and "there is no hope." All eight families described an initial period of uncertainty during which they were unsure whether the patient would survive. The subsequent trajectory of critical illness followed one of two paths: positive or negative. The results of this study are of interest to nurses who seek to broaden their understanding of the impact of critical illness on the family.
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Critical care medicine · Dec 1994
Variability in dobutamine pharmacokinetics in unstable critically ill surgical patients.
To delineate the variability in the pharmacokinetics of dobutamine over time in an unstable critically ill adult surgical patient population concurrently receiving therapeutic interventions to optimize oxygen delivery and consumption variables. ⋯ Dobutamine pharmacokinetics in adult critically ill patients is best described by a first-order model. Pathophysiologic factors may have an effect on the pharmacokinetics of dobutamine which appears to change over time. Both inter- and intrapatient variability in infusion rate administered and resultant serum concentrations were wide, suggesting that infusion rate should be guided by clinical end points rather than by predetermined values.