[Record supplied by publisher]
PMID: 11871964
Anaesthesia 2002 Feb;57(2):183-184
PMID: 11871961
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Anaesthesia 2002 Jan;57(1):86
Publication Types:
PMID: 11848066, UI: 21836578
Anesth Analg 2002 Mar;94(3):506-11
Departments of Child Health, Anesthesiology, and the Division of Pediatric Critical Care/Pediatric Anesthesiology, University of Missouri-Columbia, Columbia, Missouri.
[Medline record in process]
In patients who are mechanically ventilated in the pediatric intensive care unit (PICU), sedative and/or analgesic medications are routinely provided and titrated to effect based on clinical assessment of the patient. The bispectral index (BIS) monitor uses a modified electroencephalogram to quantify the effects of central nervous system-acting drugs on the level of consciousness. To evaluate the usefulness of the BIS monitor to predict clinical sedation levels in the PICU, we compared BIS values with simultaneously obtained clinical sedation scores in 24 mechanically ventilated pediatric patients aged 5.7 plus minus 6.1 yr. For each sedation scale used, the BIS value correlated with increasing depth of sedation (P < 0.0001) and was independent of the drug(s) used for sedation. To differentiate adequate from inadequate sedation, a BIS value <70 had a sensitivity of 0.87--0.89 and a positive predictive value of 0.68--0.84. To differentiate adequate from excessive sedation, a BIS value <50 had a sensitivity of 0.67--0.75 and a positive predictive value of 0.07--0.52. We conclude that the BIS monitor may be a useful adjunct for the assessment of sedation in PICU patients. IMPLICATIONS: We demonstrate the usefulness of the bispectral index monitor for assessing sedation in pediatric intensive care unit patients. The bispectral index monitor correlated with clinically assessed sedation levels and was useful for differentiating adequate from inadequate sedation, which would be of value when the clinical examination is unavailable.
PMID: 11867366, UI: 21855781
Crit Care Nurse 2001 Dec;21(6):88, 87
Medical ICU, University of California David Medical Center, Sacramento, USA.
PMID: 11767767, UI: 21617904
Crit Care Nurse 2001 Dec;21(6):30-2, 34
University of Alaska, Anchorage, USA.
PMID: 11767762, UI: 21617900
J Trauma 2002 Feb;52(2):280-4
Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio, USA. cook.131@osu.edu
BACKGROUND: Echocardiography has been shown to be valuable in critically ill surgical patients. Transthoracic echocardiography (TTE) often fails to provide adequate imaging in critically ill patients, necessitating subsequent transesophageal echocardiography (TEE). The objective of this study was to determine and quantify factors associated with failure of transthoracic echocardiography (TTE) in critically ill surgical patients, and to define a cost-effective strategy for echocardiography in these patients. METHODS: Demographic and clinical data were collected retrospectively and evaluated to determine which factors were associated with failure of TTE to provide adequate imaging. In addition, models were developed to estimate costs for echocardiography in critically ill surgical patients. RESULTS: TTE has a high failure rate in critically ill surgical patients. This failure rate increases significantly in patients who gain > 10% body weight from admission weight, who are supported with > or = 15 cm H(2)O positive end-expiratory pressure, and in those with chest tubes. As a result, the use of TTE in critically ill surgical patients is not cost-effective. TEE, however, is highly effective in this group of patients, and is more cost-effective than TTE in evaluating those critically ill surgical patients requiring echocardiography. CONCLUSION: The routine use of TTE to initially evaluate all critically ill surgical patients who require echocardiography should be abandoned because it is not cost-effective. TEE appears to be the most cost-effective echocardiographic modality in the surgical intensive care unit.
PMID: 11834988, UI: 21824108
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