Abstract:
OBJECTIVE:To assess the intrarater and interrater reliability of electrocardiogram (ECG) interpretation in critically ill patients and to assess the effect of knowledge of cardiac troponin values on these reliability estimates. DESIGN:Prospective cohort study. SETTING:Fifteen-bed medical-surgical intensive care unit. PATIENTS:Consecutive adults admitted over a 2-month period. MEASUREMENTS AND RESULTS:All consecutive 12-lead ECGs were interpreted independently by two raters for the presence of myocardial ischemia or infarction and secondarily for specific ischemic ECG abnormalities. The ECGs were first interpreted blinded to the patient's troponin levels and reinterpreted on two separate occasions, blinded and unblinded to the troponin values. Results are reported using chance-independent agreement (phi) with associated 95% confidence intervals. For the presence of ischemia or infarction, the intrarater reliability ranged from fair to moderate (phi = 0.35 [95% confidence interval = 0.16, 0.52] and 0.59 [0.33, 0.77] for the two raters, respectively); interrater reliability was slight when blinded to troponin levels (phi = 0.18 [0.03, 0.32]) and increased to moderate when the raters were unblinded to troponin values (phi = 0.52 [0.33, 0.66], p value for the difference = .004). For specific ECG changes, the intrarater and interrater reliability were low for T-wave flattening, whereas detection of a left bundle branch block showed high reliability. CONCLUSIONS:ECG interpretation in critically ill patients for the presence of myocardial ischemia or infarction showed moderate reliability at best; however, there was high reliability for specific ECG changes. Knowledge of the patient's troponin values increased the reliability for all studied ECG changes and resulted in a statistically significant increase in the interrater reliability for diagnosing myocardial ischemia or infarction. Additional studies assessing the appropriate methods of diagnosing myocardial ischemia and infarction and assessing the reliability of these diagnostic tests in critically ill patients are required.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Lim W,Qushmaq I,Cook DJ,Devereaux PJ,Heels-Ansdell D,Crowther MA,Tkaczyk A,Meade MO,Cook RJdoi
10.1097/01.CCM.0000214679.23957.90subject
Has Abstractpub_date
2006-05-01 00:00:00pages
1338-43issue
5eissn
0090-3493issn
1530-0293journal_volume
34pub_type
杂志文章abstract:OBJECTIVE:To determine the activation of nuclear factor-[kappa]B in peripheral blood CD14+ monocyte/macrophages and CD3+, CD4+, and CD8+ T cells in children with sepsis. DESIGN:Observational study. SETTING:University hospital. PATIENTS:Twenty-six children with sepsis (nine females and 17 males, aged between 10 days ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000284502.38701.e6
更新日期:2007-10-01 00:00:00
abstract:OBJECTIVE:To compare silver-coated and uncoated central venous catheters regarding bacterial colonization. To assess the relative contribution of catheter hub and skin colonization to catheter tip colonization. DESIGN:Prospective, randomized clinical trial. SETTING:Intensive care unit in a university hospital. PATIE...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199903000-00028
更新日期:1999-03-01 00:00:00
abstract:OBJECTIVES:Biomedical ethics has assumed an increasingly important role in medicine over the past 30 yrs, and its development has served the important goal of protecting patients' rights and interests. However, medical ethics has evolved within a Western tradition, and conflict often arises when trying to apply Western...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199803000-00013
更新日期:1998-03-01 00:00:00
abstract:OBJECTIVE:To assess survival after cardiac arrest and to determine whether age is an independent determinant of late mortality or poor neurologic outcome. DESIGN:Analyses using results of Brain Resuscitation Clinical Trial I (1979 to 1984) and Brain Resuscitation Clinical Trial II (1984 to 1989), two randomized, doubl...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/00003246-199501000-00007
更新日期:1995-01-01 00:00:00
abstract:OBJECTIVES:To compare 1-year all-cause mortality and major adverse cardiovascular events in cardiac arrest survivors with and without posttraumatic stress disorder symptomatology at hospital discharge. DESIGN:Prospective, observational cohort. SETTING:ICUs at a tertiary-care center. PATIENTS:Adults with return of sp...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003713
更新日期:2019-06-01 00:00:00
abstract:OBJECTIVES:Centers for Disease Control and Prevention built up new surveillance paradigms for the patients on mechanical ventilation and the ventilator-associated events, comprising ventilator-associated conditions and infection-related ventilator-associated complications. We assess 1) the current epidemiology of venti...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000001091
更新日期:2015-09-01 00:00:00
abstract:OBJECTIVE:Clinical predictors for acute respiratory distress syndrome (ARDS) have been studied in few prospective studies. Although transfusions are common in the intensive care unit, the role of submassive transfusion in non-trauma-related ARDS has not been studied. We describe here the clinical predictors of ARDS ris...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000165566.82925.14
更新日期:2005-06-01 00:00:00
abstract:OBJECTIVES:To define the hemodynamic and gastric intramucosal PCO2 (PiCO2) changes during the first 48 hrs after burn trauma and to analyze their relationship with outcome. DESIGN:Prospective, observational study in a cohort of consecutively admitted critically ill burn patients. SETTING:Intensive care burn unit in a...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200006000-00005
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVE:To study the impact of diabetes mellitus on the relationship between glycemia and mortality in critically ill patients. DESIGN:Retrospective observational study. SETTING:Intensive care units of two university hospitals. PATIENTS:Cohort of 4946 critically ill patients including 728 patients with diabetes me...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318181039a
更新日期:2008-08-01 00:00:00
abstract:OBJECTIVES:To characterize the landscape of process of care and safety outcomes for tracheal intubation across pediatric intensive care units BACKGROUND:Procedural process of care and safety outcomes of tracheal intubation across pediatric intensive care units has not been described. We hypothesize that the novel Nati...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182746736
更新日期:2013-03-01 00:00:00
abstract:OBJECTIVES:The Accreditation Council for Graduate Medical Education recently released new standards for supervision and duty hours for residency programs. These new standards, which will affect over 100,000 residents, take effect in July 2011. In response to these new guidelines, the Society of Critical Care Medicine c...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318225776f
更新日期:2011-11-01 00:00:00
abstract:OBJECTIVE:To assess the feasibility and safety of delivering early goal-directed sedation compared with standard sedation. DESIGN:Pilot prospective, multicenter, randomized, controlled trial. SETTING:Six ICUs. PATIENTS:Critically ill adults mechanically ventilated for greater than 24 hours. INTERVENTIONS:Patients r...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/CCM.0b013e31828a437d
更新日期:2013-08-01 00:00:00
abstract::Doppler ultrasound has been used extensively in assessing adequacy of circulation. We have found it to be convenient in the identification of blood flow, particularly in hypotensive states where percutaneous radial artery cannulation of the vessel is tedious and difficult to perform. The technique is simple, atraumati...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197611000-00011
更新日期:1976-11-01 00:00:00
abstract:OBJECTIVE:To characterize the withholding or withdrawing of life support from patients with severe head injury. SETTING:San Francisco General Hospital, a city and county hospital with a Level I trauma center. DESIGN:A standardized questionnaire was used to collect data on demographics and functional outcome of severe...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199509000-00018
更新日期:1995-09-01 00:00:00
abstract:OBJECTIVE:To define the epidemiology of broad-spectrum cephalosporin-resistant gram-negative bacilli in intensive care units (ICUs) during a nonoutbreak period, including the prevalence, the risk factors for colonization, the frequency of acquisition, and the rate of infection. DESIGN:Prospective cohort study. SETTIN...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199906000-00026
更新日期:1999-06-01 00:00:00
abstract::Hypersensitivity reactions are defined as immunologically based adverse reactions to chemicals or medicinal agents. These reactions are common in the intensive care unit and can present as a simple, mildly symptomatic rash or as life-threatening anaphylactic reactions. Hypersensitivity reactions have traditionally bee...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181de0c99
更新日期:2010-06-01 00:00:00
abstract:OBJECTIVE:To present electron micrographs of lung tissue obtained from a patient exposed to high ventilatory pressures in the context of pulmonary dysfunction and pulmonary hypertension. DESIGN:Case report. SETTING:Adult intensive care unit of a university-affiliated teaching hospital. PATIENTS:A patient exposed to ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200210000-00030
更新日期:2002-10-01 00:00:00
abstract:OBJECTIVES:Low tidal volume (= tidal volume ≤ 6 mL/kg, predicted body weight) ventilation using volume control benefits patients with acute respiratory distress syndrome. Airway pressure release ventilation is an alternative to low tidal volume-volume control ventilation, but the release breaths generated are variable ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/CCM.0000000000003437
更新日期:2018-12-01 00:00:00
abstract:OBJECTIVES:The purposes of this report are to a) describe the University of Michigan experience with venoarterial or venovenous extracorporeal life support for severe pediatric pulmonary rescue therapy, and b) examine survivors and nonsurvivors for differences that might be useful for examination in future, prospective...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199208000-00008
更新日期:1992-08-01 00:00:00
abstract:OBJECTIVES:Interventions that reduce the generation or the effects of reactive oxygen species exert controversial effects in animal models of lung injury, and these could be secondary to the pro-oxidant effects of antioxidants generally by their interaction with iron. We here describe the effects of N-acetylcysteine, d...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000199069.19193.89
更新日期:2006-02-01 00:00:00
abstract:BACKGROUND:An increased risk of postoperative infection (including pneumonia) attributable to the receipt of allogeneic blood transfusion has been investigated as a possible manifestation of transfusion-related immunomodulation (TRIM) in 16 randomized controlled trials (RCTs) and approximately 40 observational studies....
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1097/01.CCM.0000214310.70642.8C
更新日期:2006-05-01 00:00:00
abstract::An emergency cricothyrotomy device was placed in 11 anesthetized dogs in order to assess airway damage and problems in placement, ventilation, and design. Posterior airway perforation without esophageal damage occurred in three animals. Submucosal hematomas or cricoid cartilage injury occurred in seven animals. As pla...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198702000-00016
更新日期:1987-02-01 00:00:00
abstract:OBJECTIVE:To determine whether four stages of weaning (acute, prewean, wean, and outcome) could be identified by using clinical instruments designed to quantify severity of illness, patient stability, or weaning readiness. The instruments used were the Acute Physiology and Chronic Health Evaluation (APACHE III), the Th...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200007000-00013
更新日期:2000-07-01 00:00:00
abstract:OBJECTIVES:High physical activity levels are associated with wide-ranging health benefits, disease prevention, and longevity. In the present study, we examined the impact of regular physical exercise on the severity of organ injury and survival probability, as well as characteristics of the systemic immune and metaboli...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31828a2ae3
更新日期:2013-10-01 00:00:00
abstract:OBJECTIVE:To assess the efficacy of bulk diffusion in maintaining oxygenation during apnea testing for brain death. DESIGN:Case series. SETTING:ICU in a primary care hospital. PATIENTS:Twenty-four consecutive patients with suspected brain death. Most patients suffered cerebral trauma from vehicular accidents. INTER...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199211000-00014
更新日期:1992-11-01 00:00:00
abstract::To determine the influence of arachidonic acid metabolites on acute lung injury induced by glass bead embolism, two groups of animals were studied before and after the pulmonary artery pressure was doubled by glass bead embolism. One group represented an untreated time control (n = 6) while the second group (n = 6) wa...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198809000-00007
更新日期:1988-09-01 00:00:00
abstract:OBJECTIVE:The aim of the present study was to characterize pulmonary surfactant properties in children undergoing cardiovascular surgery with cardiopulmonary bypass. DESIGN:Prospective clinical trial. SETTING:University hospital pediatric intensive care unit. PATIENTS:Fifty pediatric patients with congenital cardiac...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-200301000-00045
更新日期:2003-01-01 00:00:00
abstract:OBJECTIVES:To determine: a) any heart site or tissue-specific differences in the response to increased perfusion potassium concentrations, and b) the cellular site (intracellular vs. extracellular) of the effect of calcium on reversing electrocardiographic effects of hyperkalemia. DESIGN:In vitro prospective, repeated...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:
更新日期:1994-04-01 00:00:00
abstract::We describe the use of continuous negative extrathoracic pressure to treat successfully the adult respiratory distress syndrome in a 19-yr-old woman who resisted the application of positive airway pressure. Arterial hypoxemia was reversed with -26 cm H2O of extrathoracic pressure, produced by a modified Emerson iron l...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:
更新日期:1985-11-01 00:00:00
abstract::To further define cardiovascular abnormalities in patients with septic shock, serial conventional hemodynamic measurements combined with two-dimensional echocardiographic studies were performed at the bedside in 21 patients admitted for an acute episode of sepsis-related circulatory failure. Measurements obtained duri...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199010000-00001
更新日期:1990-10-01 00:00:00