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Items 1 - 9 of 9 |
One page. |
[Neuromonitoring with S-100 protein in the intensive care unit]
[Article in German]
Fries M, Bickenbach J, Beckers S, Henzler D, Rossaint R, Kuhlen R.
Klinik fur Anasthesiologie, Universitatsklinikum Aachen.
During the last years biochemical neuromonitoring with various molecules such as S-100 protein has become popular. A huge number of investigations both experimental and clinical have been undertaken to determine diagnosis and prognosis of patients with acute neurologic diseases. This article gives a review on the current knowledge, indications and limitations on the use of S-100 protein with regard to most of the acute neurological diseases an intensivist is confronted with in everyday practice.
PMID: 15322710 [PubMed - as supplied by publisher]
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[The myth of Prometheus mirrored in intensive medicine]
[Article in German]
Thiel M.
Publication Types:
PMID: 15141298 [PubMed - indexed for MEDLINE]
Comment on:
Oxygen consumption: validation of the closed-circuit PhysioFlex anaesthesia machine.
Hofland J, Tenbrinck R.
Publication Types:
PMID: 15281556 [PubMed - indexed for MEDLINE]
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Respiratory distress after intrathecal baclofen withdrawal.
Santiago-Palma J, Hord ED, Vallejo R, Trella J, Ahmed SU.
Massachusetts General Hospital Pain Center, Department of Anesthesia and Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. jsantiagopalma@hotmail.com
We present the case of a 19-yr-old woman with a history of generalized dystonia who developed sudden onset of adductor spasms of the vocal cords and increased dystonia after the interruption or intrathecal baclofen therapy. Her symptoms resolved after intrathecal baclofen was restored. In patients with dystonia receiving intrathecal baclofen therapy, the onset of dyspnea associated with increased muscle tone should prompt the investigation of baclofen withdrawal.
Publication Types:
PMID: 15281534 [PubMed - indexed for MEDLINE]
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Twenty months' routine use of a new percutaneous tracheostomy set using controlled rotating dilation.
Sengupta N, Ang KL, Prakash D, Ng V, George SJ.
Intensive Care Unit, Harefield Hospital, Royal Brompton & Harefield Hospitals NHS Trust, Middlesex, UK.
After a favorable trial period, we introduced the new percutaneous tracheostomy set, PercuTwist, in February of 2002 for our routine procedures. Over the next 20 mo, 90 procedures were performed with minimal complications. To prospectively evaluate this experience, we collected information on reasons for unit admission, operators' previous experience, the duration of prior tracheal intubation, the time needed for the procedure, the grading of the difficulty, the amount of bleeding, and the complications of the procedure. Twenty-two of 90 (24.4%) procedures were performed by senior consultants with experience; 68 of 90 (75.6%) were safely performed by intensive care residents under close bedside supervision. The mean time needed for the procedure was 13 min 7 s. In only one procedure during the entire study was any difficulty observed during the insertion process. This occurred because the initial skin incision was too small. However, no major bleeding or complications were encountered.
Publication Types:
PMID: 15281528 [PubMed - indexed for MEDLINE]
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Evidence-based management of critically ill patients: analysis and implementation.
Gropper MA.
Critical Care Medicine, 505 Parnassus Ave., Room M917, University of California-San Francisco, San Francisco, CA 94143-0624, USA. gropperm@anesthesia.ucsf.edu
A number of important clinical trials focusing on critically ill patients have been completed in the last few years. These trials have been among the first critical care clinical trials to demonstrate mortality reduction in the critically ill. As in any adaptation of evidence-based medicine, it is essential to closely examine the trials and to determine whether the demonstrated benefits can be translated to the individual patient. In addition to the primary outcome, usually survival benefit, it is also important to examine cost-effectiveness. All of the trials examined in this review were able to demonstrate mortality reduction. Most focused on patients with severe sepsis, because this population has been associated with both frequent mortality and increased hospital costs. Some of the interventions, such as small tidal volume mechanical ventilation in patients with acute lung injury or the administration of low-dose corticosteroids for patients with septic shock, are cost-effective and relatively simple to implement. Others, such as use of activated protein C in patients with severe sepsis or "tight" glycemic control in patients with hyperglycemia, require either significant pharmaceutical expenditure or, possibly, additional health care personnel. Nevertheless, the trials discussed represent significant advances in the field of critical care medicine and should at least be considered for implementation in all intensive care units.
Publication Types:
PMID: 15271740 [PubMed - indexed for MEDLINE]
Pitfalls of adverse event reporting in paediatric cardiac intensive care.
Ricci M, Goldman AP, de Leval MR, Cohen GA, Devaney F, Carthey J.
Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK. mricci@med.miami.edu
AIMS: To evaluate the pitfalls of incident reporting in a complex medical environment. METHODS: Retrospective review of 211 incident reports in a paediatric cardiac intensive care unit (CICU). Two adverse event reporting databases were compared: database A (DA), the hospital's official reporting system, is non-anonymous and reports are predominantly made by nurses; database B (DB) is anonymous and reports are submitted by a CICU consultant who collects data from daily ward rounds. Both databases classify adverse events into incident type (drug errors, ventilation, cannulae/indwelling lines, chest drains, blood transfusion, equipment, operational) and severity (0 = no, 1 = minor, 2 = major, 3 = life threatening consequences). RESULTS: Between 1 April 1998 and 31 July 2001 there were 211 adverse events involving 178 patients (11.87%), among 1500 patients admitted to CICU. A total of 112 incidents were reported in DA, 143 in DB, and 44 in both. In isolation, both databases gave an unrepresentative picture of the true frequency and severity of adverse events. Under-reporting was especially notable for less severe events (grade 0, or near misses) CONCLUSION: Incident reporting in the medical field is highly variable, and is heavily influenced by profession of the reporters as well as anonymity. When adverse event reporting is based predominantly on the observations of a single professional group, the data are grossly inaccurate.
PMID: 15321866 [PubMed - indexed for MEDLINE]
[Procalcitonin in pediatric resuscitation]
[Article in French]
Leclerc F, d'Herbomez M.
Service de reanimation pediatrique, hopital Jeanne-de-Flandre, CHU de Lille, 59037 Lille cedex, France. fleclerc@chru-lille.fr
PMID: 15158844 [PubMed - indexed for MEDLINE]
 
National questionnaire survey on what influences doctors' decisions about admission to intensive care.
Escher M, Perneger TV, Chevrolet JC.
Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, CH-1211 Geneva 14, Switzerland. monica.escher@hcuge.ch
OBJECTIVE: To determine what influences doctors' decisions about admission of patients to intensive care. DESIGN: National questionnaire survey using eight clinical vignettes involving hypothetical patients. SETTING: Switzerland. PARTICIPANTS: 402 Swiss doctors specialising in intensive care. MAIN OUTCOME MEASURES: Rating of factors influencing decisions on admission and response to eight hypothetical clinical scenarios. RESULTS: Of 381 doctors agreeing to participate, 232 (61%) returned questionnaires. Most rated as important or very important the prognosis of the underlying disease (82%) and of the acute illness (81%) and the patients' wishes (71%). Few considered important the socioeconomic circumstances of the patient (2%), religious beliefs (3%), and emotional state (6%). In the vignettes, underlying disease (cancer versus non-cancerous disease) was not associated with admission to intensive care, but four other factors were: patients' wishes (odds ratio 3.0, 95% confidence interval 2.0 to 4.6), "upbeat" personality (2.9, 1.9 to 4.4), younger age (1.5, 1.1 to 2.2), and a greater number of beds available in intensive care (1.8, 1.2 to 2.5). CONCLUSIONS: Doctors' decisions to admit patients to intensive care are influenced by patients' wishes and ethically problematic non-medical factors such as a patient's personality or availability of beds. Patients with cancer are not discriminated against.
PMID: 15321898 [PubMed - indexed for MEDLINE]
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