Abstract：
OBJECTIVE:To assess the effect of strict guidelines and a rigorous training program on variability in scoring the revised Acute Physiology and Chronic Health Evaluation (APACHE II). DESIGN AND SETTING:Prospective survey and intervention in the surgical ICU of a university teaching hospital. MEASUREMENTS:Seven experienced intensivists and nine residents determined APACHE II scores in one set of patients before and in another set 4 months after a rigorous training program, following strict guidelines for using the APACHE II. RESULTS:APACHE II scores were 14.3+/-4.4 before the training program (n=12) and 18.9+/-2.4 after (n=11). Interobserver agreement rates increased significantly from 59.7% to 76.5% and the interobserver reliability coefficient (weighted kappa) from 0.72 to 0.85 after our training program was implemented. The changes were significantly greater in experienced intensivists than in less experienced residents, indicating that more experienced physicians profited to a greater degree from our training program. CONCLUSION:Interobserver variability in APACHE II scoring decreases markedly when strict guidelines and a regular training program are implemented, particularly among more experienced physicians. However, in our study a degree of variability (10-15%) persisted even in experienced intensivists with similar training, experience, and background, suggesting that a degree of variability is inherent in APACHE II scoring.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Polderman KH,Jorna EM,Girbes ARdoi
10.1007/s001340101012keywords:
subject
Has Abstractpub_date
2001-08-01 00:00:00pages
1365-9issue
8eissn
0342-4642issn
1432-1238journal_volume
27pub_type
临床试验,杂志文章abstract：PURPOSE:We evaluated whether oscillatory compliance (C(X5)) measured by forced oscillation technique (FOT) at 5 Hz may be useful for positive end-expiratory pressure (PEEP) optimisation. METHODS:We studied seven pigs in which lung injury was induced by broncho-alveolar lavage. The animals were ventilated in volume con...
journal_title：Intensive care medicine
pub_type： 杂志文章
doi：10.1007/s00134-011-2211-7
更新日期：2011-06-01 00:00:00
abstract：:Plasma colloid osmotic pressure (COP) has been calculated from both serum albumin concentration and plasma total protein concentration. These values have been compared to those measured directly using a membrane-transducer oncometer in a group of normal subjects, in a group of critically-ill patients with a variety of...
journal_title：Intensive care medicine
pub_type： 杂志文章
doi：10.1007/BF00254796
更新日期：1987-01-01 00:00:00
abstract：OBJECTIVE:To determine the incidence rates of hospital acquired infections (HAI) during the first 14 days after ICU discharge after treatment during ICU-stay with Selective Decontamination of the Digestive tract (SDD), Selective Oropharyngeal Decontamination (SOD) or Standard Care (SC). DESIGN:Prospective observationa...
journal_title：Intensive care medicine
pub_type： 杂志文章
doi：10.1007/s00134-009-1554-9
更新日期：2009-09-01 00:00:00
abstract：OBJECTIVE:Based on limited data, Candida sp. isolates from bronchoalveolar lavage (BAL) cultures in immunocompetent patients are thought to be contaminants rather than pathogens. The objective of this study was to determine the clinical significance of Candida sp. isolated from BAL cultures in critically ill trauma pat...
journal_title：Intensive care medicine
pub_type： 杂志文章
doi：10.1007/s00134-005-0065-6
更新日期：2006-04-01 00:00:00
abstract：OBJECTIVE:Candida spp. airway colonization could promote development of ventilator-associated pneumonia (VAP) caused by Pseudomonas aeruginosa, a potentially multidrug-resistant (MDR) bacteria, and worsen the outcome of VAP regardless of pathogen. We therefore address the question of the risk of MDR bacteria isolation ...
journal_title：Intensive care medicine
pub_type： 杂志文章
doi：10.1007/s00134-012-2584-2
更新日期：2012-08-01 00:00:00
abstract：OBJECTIVE:To evaluate the sensitivity, specificity and overall accuracy of a model based on the presence or absence of organ dysfunctions and/or infection (ODIN) to predict the outcome for intensive care unit patients. DESIGN:Prospective study. SETTING:General intensive care unit in a university teaching hospital. P...
journal_title：Intensive care medicine
pub_type： 杂志文章
doi：10.1007/BF01720528
更新日期：1993-01-01 00:00:00
abstract：:Membranous laryngotracheobronchitis is a very serious infection which affects the larynx, trachea and bronchi, requiring aggressive therapeutic measures. It has been recently rediscovered as a cause of disease in children. However, it is a very unusual complication of measles. Two infants with measles and membranous l...
journal_title：Intensive care medicine
pub_type： 杂志文章
doi：10.1007/BF00273547
更新日期：1985-01-01 00:00:00
abstract：OBJECTIVES:Critical illness increases the tendency to both coagulation and bleeding, complicating anticoagulation for continuous renal replacement therapy (CRRT). We analyzed strategies for anticoagulation in CRRT concerning implementation, efficacy and safety to provide evidence-based recommendations for clinical prac...
journal_title：Intensive care medicine
pub_type： 杂志文章,meta分析,评审
doi：10.1007/s00134-005-0044-y
更新日期：2006-02-01 00:00:00
abstract：OBJECTIVE:1) To compare saline gastric tonometry monitoring with air tonometry (Tonocap) in a group of general ICU patients. 2) An in vitro investigation of the performance of other fluids used in gastric tonometry and to assess the effects of variation of temperature and carbon dioxide concentration within the range e...
journal_title：Intensive care medicine
pub_type： 临床试验,杂志文章
doi：10.1007/s001340050665
更新日期：1998-08-01 00:00:00
abstract：:Risk of critical illness is determined both by genetic and environmental influences, particularly those relating to infectious and cardiovascular diseases. Physiologically-based scoring systems cannot measure prior risk because they do not quantify physiological reserve independently of the acute illness. Genetic prof...
journal_title：Intensive care medicine
pub_type： 杂志文章,评审
doi：10.1007/s001340051120
更新日期：2000-01-01 00:00:00
abstract：:During a 3-year period, a clinical diagnosis of invasive candidosis was made in 8 out of 2054 consecutive surgical intensive care unit (ICU) patients. These patients were retrospectively matched with 16 control patients who underwent similar surgical procedures and had a similar clinical course except for negative Can...
journal_title：Intensive care medicine
pub_type： 杂志文章
doi：10.1007/s001340100891
更新日期：2001-05-01 00:00:00
abstract：OBJECTIVE:The aim of the study was to investigate the effect of lung volume changes on end-expiratory lung impedance change (ELIC) in mechanically ventilated patients, since we hypothesized that ELIC may be a suitable parameter to monitor lung volume change at the bedside. DESIGN:Clinical trial on patients requiring m...
journal_title：Intensive care medicine
pub_type： 临床试验,杂志文章
doi：10.1007/s00134-002-1555-4
更新日期：2003-01-01 00:00:00
abstract：PURPOSE:Severe acute pancreatitis (SAP) remains a life-threatening disease with classic etiology of systemic inflammatory response and mortality between 30 and 50 %. The aim of the present study is to compare two different treatment strategies of goal-directed hemodynamic management and evaluate their impact on surviva...
journal_title：Intensive care medicine
pub_type： 杂志文章
doi：10.1007/s00134-012-2775-x
更新日期：2013-04-01 00:00:00
abstract：OBJECTIVE:To investigate the theoretical interactions between ventilator settings, tracheal gas insufflation (TGI), and alveolar ventilation. DESIGN:We derived differential equations governing compartmental volume changes in a one-compartment model of TGI-assisted ventilation and equations governing gas dilution in th...
journal_title：Intensive care medicine
pub_type： 杂志文章
doi：10.1007/BF01699238
更新日期：1996-10-01 00:00:00
abstract：:Dynamic vectorcardiography (VCG) is increasingly employed for ischaemia monitoring with the use of a computerized method for recording and on-line analysis by the calculation of trend parameters. To elucidate how well the derived electrocardiogram (dECG), calculated from the VCG, compares with the simultaneously regis...
journal_title：Intensive care medicine
pub_type： 临床试验,杂志文章
doi：10.1007/s001340050455
更新日期：1997-10-01 00:00:00
abstract：:We report a fatal case of a child presenting Reye's syndrome associated with a variety of arrhythmias and ischemia-like ST-T ECG changes. At autopsy, fatty infiltration and patchy myocytolysis were detected in sections of the heart. This case report emphasizes cardiac involvement in Reye's syndrome and the possible me...
journal_title：Intensive care medicine
pub_type： 杂志文章
doi：10.1007/BF01728333
更新日期：1996-01-01 00:00:00
abstract：OBJECTIVE:Aspiration of dead space (ASPIDS) improves carbon dioxide (CO2) elimination by replacing dead space air rich in CO2 with fresh gas during expiration. The hypothesis was that ASPIDS allows normocapnia to be maintained at low tidal volumes (VT). DESIGN:Prospective study. SETTING:Adult intensive care unit in a...
journal_title：Intensive care medicine
pub_type： 杂志文章
doi：10.1007/s001340050929
更新日期：1999-07-01 00:00:00
abstract：BACKGROUND:Vasopressors are administered to critically ill patients with vasodilatory shock not responsive to volume resuscitation, and less often in cardiogenic shock, and hypovolemic shock. OBJECTIVES:The objectives are to review safety and efficacy of vasopressors, pathophysiology, agents that decrease vasopressor ...
journal_title：Intensive care medicine
pub_type： 杂志文章,评审
doi：10.1007/s00134-019-05801-z
更新日期：2019-11-01 00:00:00
abstract：OBJECTIVE:Oxygen consumption (VO2) obtained from respiratory gases by indirect calorimetry (VO2,IC) with a metabolic monitor integrated in a ventilator were to be compared to VO2 obtained by the Fick principle (VO2,Fick) in septic patients following an increase in oxygen delivery (DO2) induced by positive inotropic sup...
journal_title：Intensive care medicine
pub_type： 临床试验,杂志文章
doi：10.1007/s001340000635
更新日期：2000-12-01 00:00:00
abstract：OBJECTIVE:There is still a lack of knowledge on the age-dependent relation between a reduction in cerebral perfusion pressure (CPP) and compromised brain perfusion leading to excessive transmitter release and brain damage cascades. The hypothesis is that an age-dependent lower threshold of cerebral blood flow (CBF) aut...
journal_title：Intensive care medicine
pub_type： 杂志文章
doi：10.1007/s00134-010-1846-0
更新日期：2010-06-01 00:00:00
abstract：:A 29-year-old woman was admitted to the Rouen University Hospital for attempted suicide by ingestion of a carbamate insecticide (Temik G, containing 10% aldicarb). Cardio-respiratory arrest occurred at the second hour and acute necrotic hemorrhagic pancreatitis on the second day. Further evolution was uneventful, and ...
journal_title：Intensive care medicine
pub_type： 杂志文章
doi：10.1007/BF02425057
更新日期：1994-01-01 00:00:00
abstract：PURPOSE:Neutrophil gelatinase-associated lipocalin (NGAL) is a promising biomarker for acute kidney injury (AKI). We evaluated the diagnostic and prognostic accuracies of plasma NGAL (pNGAL) for contrast-induced AKI (CI-AKI) in critically ill patients. METHODS:In a prospective observational study in two adult intensiv...
journal_title：Intensive care medicine
pub_type： 杂志文章
doi：10.1007/s00134-013-2826-y
更新日期：2013-05-01 00:00:00
abstract：PURPOSE:Little evidence of increased thrombotic risk is available in COVID-19 patients. Our purpose was to assess thrombotic risk in severe forms of SARS-CoV-2 infection. METHODS:All patients referred to 4 intensive care units (ICUs) from two centers of a French tertiary hospital for acute respiratory distress syndrom...
journal_title：Intensive care medicine
pub_type： 杂志文章,多中心研究
doi：10.1007/s00134-020-06062-x
更新日期：2020-06-01 00:00:00
abstract：OBJECTIVE:Inhalation of high concentrations of nitric oxide (NO) has been shown to improve gas exchange and to reduce pulmonary vascular resistance in individuals with ischemia-reperfusion injury following orthotopic lung transplantation. We assessed the cardiopulmonary effects of low doses of NO in early allograft dys...
journal_title：Intensive care medicine
pub_type： 临床试验,杂志文章
doi：10.1007/s001340050741
更新日期：1998-11-01 00:00:00
abstract：OBJECTIVES:To measure the extent of dilution of helium-oxygen (heliox) by room air when given via high concentration reservoir mask to spontaneously breathing subjects. Substantial dilution of heliox by room air under these circumstances might alter its physical properties sufficiently to negate any potential clinical ...
journal_title：Intensive care medicine
pub_type： 杂志文章,随机对照试验
doi：10.1007/s00134-008-1064-1
更新日期：2008-08-01 00:00:00
abstract：OBJECTIVE:To test the feasibility of the transcardiac conductance (TCC) method for continuous, on-line measurement of absolute left ventricular (LV) volume and to validate the method by comparison with biplane angiography. DESIGN AND SETTING:Prospective clinical feasibility and validation study in a cardiac catheteriz...
journal_title：Intensive care medicine
pub_type： 临床试验,杂志文章
doi：10.1007/s00134-004-2300-y
更新日期：2004-07-01 00:00:00
abstract：PURPOSE:Because non-invasive mechanical ventilation (NIV) is increasingly used, new devices, both ventilators and interfaces, have been continuously proposed for clinical use in recent years. To provide the clinicians with valuable information about ventilators and interfaces for NIV, several bench studies evaluating a...
journal_title：Intensive care medicine
pub_type： 杂志文章
doi：10.1007/s00134-011-2416-9
更新日期：2012-01-01 00:00:00
abstract：:In the first study 6 patients with raised intracranial pressure due to brain oedema following head injury were given dihydroergotamine because of low perfusion pressure. The intracranial pressure fell simultaneously with the increase in arterial pressure. The intracranial pressure fell from 24 +/- 2 mmHg by a maximum ...
journal_title：Intensive care medicine
pub_type： 杂志文章
doi：10.1007/BF00273564
更新日期：1989-01-01 00:00:00
abstract：:Diagnosis and treatment of infection is a common procedure in the clinical management of patients in the ICU. Infection in the ICU is an important area for study, but requires well-defined and proven diagnostic criteria. The diagnosis of infection, like any diagnosis, is based on probability, and diagnostic criteria a...
journal_title：Intensive care medicine
pub_type： 杂志文章,评审
doi：10.1007/BF01713977
更新日期：1994-11-01 00:00:00
abstract：:The effect of plasma exchange (PE) was evaluated in 4 patients with rhabdomyolysis. A single 21 PE produced a transient fall of creatinine phosphokinase and did not prevent renal failure. Theoretically PE would need to be performed very frequently to remove toxins in appropriate amounts. Since renal failure in myoglob...
journal_title：Intensive care medicine
pub_type： 杂志文章
doi：10.1007/BF00273565
更新日期：1989-01-01 00:00:00
