Sensitivity of routine intensive care unit surveillance for detecting myocardial ischemia.

Abstract:

OBJECTIVE:To assess the effectiveness of routine intensive care unit surveillance compared with frequent 12-lead electrocardiogram monitoring for detecting electrocardiogram evidence suggestive of prolonged myocardial ischemia in vascular surgery patients. DESIGN:Prospective cohort trial. SETTING:Intensive care unit. PARTICIPANTS:We studied 149 patients undergoing elective infrainguinal or aortic vascular surgery who were admitted to the intensive care unit postoperatively. INTERVENTIONS:Patients were simultaneously monitored with a 10-electrode/12-lead electrocardiogram obtained every 2 mins (criterion standard) and routine intensive care unit surveillance that included standard monitoring (five-electrode/two-lead electrocardiogram with ST segment trends and routine 12-lead electrocardiogram) and clinical assessment for detecting myocardial ischemia. The results of the criterion standard were not available to the caregivers. MEASUREMENTS AND MAIN RESULTS:We measured the ability of routine intensive care unit surveillance to detect the first 20 mins of electrocardiogram evidence suggestive of myocardial ischemia, defined as ST segment depression or elevation of >/=1 mm in two consecutive leads, during the first postoperative day. Seventeen patients (11%) had electrocardiogram evidence suggestive of prolonged myocardial ischemia, the majority of which occurred in leads V2-V4. The sensitivity of routine intensive care unit surveillance for detecting the first episode of electrocardiogram evidence suggestive of prolonged myocardial ischemia in a patient was 12% (95% confidence interval, 7-17%), and the specificity was 98% (95% confidence interval, 95-100%) with a positive predictive value of 40% (95% confidence interval, 32-48%), a negative predictive value of 90% (95% confidence interval, 85-94%), a positive likelihood ratio of 6, and a negative likelihood ratio of 1. The sensitivity of routine intensive care unit surveillance for detecting all episodes was 3% (95% confidence interval, 2-3%) and the specificity 99% (95% confidence interval, 99-100%) per 20-min monitoring interval, with a positive predictive value of 17% (95% confidence interval, 16-18%), negative predictive value of 95% (95% confidence interval, 95-96%), positive likelihood ratio of 3, and negative likelihood ratio of 1. CONCLUSIONS:Routine intensive care unit surveillance has low sensitivity for detecting electrocardiogram evidence suggestive of prolonged myocardial ischemia compared with frequent 12-lead electrocardiograms. Because detecting electrocardiogram evidence suggestive of prolonged postoperative myocardial ischemia is important, physicians should consider alternative strategies to detect myocardial ischemia.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Martinez EA,Kim LJ,Faraday N,Rosenfeld B,Bass EB,Perler BA,Williams GM,Dorman T,Pronovost PJ

doi

10.1097/01.CCM.0000084857.87446.DD

subject

Has Abstract

pub_date

2003-09-01 00:00:00

pages

2302-8

issue

9

eissn

0090-3493

issn

1530-0293

journal_volume

31

pub_type

杂志文章
  • Interprofessional Shared Decision-Making in the ICU: A Systematic Review and Recommendations From an Expert Panel.

    abstract:OBJECTIVES:There is growing recognition that high-quality care for patients and families in the ICU requires exemplary interprofessional collaboration and communication. One important aspect is how the ICU team makes complex decisions. However, no recommendations have been published on interprofessional shared decision...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000003870

    authors: Michalsen A,Long AC,DeKeyser Ganz F,White DB,Jensen HI,Metaxa V,Hartog CS,Latour JM,Truog RD,Kesecioglu J,Mahn AR,Curtis JR

    更新日期:2019-09-01 00:00:00

  • N-acetylcysteine is effective for prevention but not for treatment of folic acid-induced acute kidney injury in mice.

    abstract:OBJECTIVES:There is controversy regarding the benefits of N-acetylcysteine in acute kidney injury. This study was to compare three commonly used regimens and explore which regimen is best for the protection of acute kidney injury. DESIGN:Prospective experimental study. SETTING:University research laboratory. INTERVE...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e31822575fc

    authors: Wang HZ,Peng ZY,Wen XY,Rimmelé T,Bishop JV,Kellum JA

    更新日期:2011-11-01 00:00:00

  • Comparison of multiple organ dysfunction scores in the prediction of hospital mortality in the critically ill.

    abstract:OBJECTIVE:To compare the scales and predictive power for hospital mortality of three recent multiple organ dysfunction scores. DESIGN:Prospective, observational, validation cohort study. SETTING:A ten-bed medical-surgical intensive care unit in a Finnish tertiary care hospital. PATIENTS:Among the 591 consecutive pat...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200208000-00005

    authors: Pettilä V,Pettilä M,Sarna S,Voutilainen P,Takkunen O

    更新日期:2002-08-01 00:00:00

  • Rehabilitation interventions for postintensive care syndrome: a systematic review.

    abstract:OBJECTIVE:An increasing number of ICU patients survive and develop mental, cognitive, or physical impairments. Various interventions support recovery from this postintensive care syndrome. Physicians in charge of post-ICU patients need to know which interventions are effective. DATA SOURCES:Systematic literature searc...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/CCM.0000000000000148

    authors: Mehlhorn J,Freytag A,Schmidt K,Brunkhorst FM,Graf J,Troitzsch U,Schlattmann P,Wensing M,Gensichen J

    更新日期:2014-05-01 00:00:00

  • Education of trainees in the intensive care unit.

    abstract::The focus on improving education in critical care medicine must begin early in medical school training and further be promoted during residency if there is to be an increase in intensivists in the hospital workforce. This is "critical" to healthcare reform movements that are endorsing full-time critical care coverage ...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/01.CCM.0000252917.25301.18

    authors: Croley WC,Rothenberg DM

    更新日期:2007-02-01 00:00:00

  • Effect of continuous lateral rotational therapy on the prevalence of ventilator-associated pneumonia in patients requiring long-term ventilatory care.

    abstract:OBJECTIVE:To evaluate the role of continuous lateral rotational therapy on the development of ventilator-associated pneumonia in patients requiring long-term mechanical ventilation. DESIGN:Prospective control study. SETTING:Chronic ventilator unit in tertiary care hospital. METHODS:Thirty-seven patients requiring lo...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200209000-00006

    authors: Kirschenbaum L,Azzi E,Sfeir T,Tietjen P,Astiz M

    更新日期:2002-09-01 00:00:00

  • Catecholamines: study of interspecies variation.

    abstract::In the last three decades, numerous articles on plasma catecholamine concentrations in various settings have been published in the medical literature. Despite this abundance of information, no summary article has analyzed the species variations in circulating catecholamine concentrations. In this paper, the plasma cat...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:

    authors: Hart BB,Stanford GG,Ziegler MG,Lake CR,Chernow B

    更新日期:1989-11-01 00:00:00

  • Effect of different cycling-off criteria and positive end-expiratory pressure during pressure support ventilation in patients with chronic obstructive pulmonary disease.

    abstract:OBJECTIVE:During pressure support ventilation, ventilator inspiration ends when inspiratory flow drops to a given percentage of the peak inspiratory flow cycling-off criteria. This study evaluated the effect of two different cycling-off criteria on breathing pattern, respiratory effort, and gas exchange in patients wit...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.CCM.0000287594.80110.34

    authors: Chiumello D,Polli F,Tallarini F,Chierichetti M,Motta G,Azzari S,Colombo R,Rech R,Pelosi P,Raimondi F,Gattinoni L

    更新日期:2007-11-01 00:00:00

  • A Quasi-Experimental, Before-After Trial Examining the Impact of an Emergency Department Mechanical Ventilator Protocol on Clinical Outcomes and Lung-Protective Ventilation in Acute Respiratory Distress Syndrome.

    abstract:OBJECTIVES:To evaluate the impact of an emergency department mechanical ventilation protocol on clinical outcomes and adherence to lung-protective ventilation in patients with acute respiratory distress syndrome. DESIGN:Quasi-experimental, before-after trial. SETTING:Emergency department and ICUs of an academic cente...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000002268

    authors: Fuller BM,Ferguson IT,Mohr NM,Drewry AM,Palmer C,Wessman BT,Ablordeppey E,Keeperman J,Stephens RJ,Briscoe CC,Kolomiets AA,Hotchkiss RS,Kollef MH

    更新日期:2017-04-01 00:00:00

  • Comparative effects of early versus delayed use of norepinephrine in resuscitated endotoxic shock.

    abstract:OBJECTIVE:To assess hemodynamic, tissue oxygenation, and tissue perfusion changes by comparing traditional therapy (fluid resuscitation followed by vasopressor treatment) and alternative therapy (early vasopressor treatment) in a hyperkinetic and sedated model of endotoxic shock. DESIGN:Prospective controlled experime...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.CCM.0000269028.28521.08

    authors: Sennoun N,Montemont C,Gibot S,Lacolley P,Levy B

    更新日期:2007-07-01 00:00:00

  • Perioperative diabetic and hyperglycemic management issues.

    abstract:OBJECTIVE AND DESIGN:To review and discuss selected literature, expert opinion, and conventional care of the hyperglycemic perioperative or critically ill patient. MAIN POINTS:Diabetes mellitus, the most commonly encountered perioperative endocrinopathy, continues to increase dramatically in prevalence. Diabetes is th...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/01.ccm.0000115623.52021.c0

    authors: Coursin DB,Connery LE,Ketzler JT

    更新日期:2004-04-01 00:00:00

  • Critical care problems of the newborn: insensible water loss in small premature infants.

    abstract::During the control period in this study, small premature infants, 1500 g in birth weight, had insensible water loss (IWL) of 2.28 g/kg/hr (equivlaent to 54 ml/kg/day), which is considerably higher than in full term infants. Under phototherapy, there was a significant increase in IWL (3.14 g/kg/hr) associated with incr...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-197511000-00006

    authors: Yeh TF,Vidyasagar D,Pildes RS

    更新日期:1975-11-01 00:00:00

  • Neutrophil accumulation is reduced during partial liquid ventilation.

    abstract:OBJECTIVE:This study evaluates the ability of perflubron to inhibit pulmonary neutrophil accumulation during partial liquid ventilation (PLV) in the setting of acute lung injury. DESIGN:Randomized, controlled, nonblinded study. SETTING:Research laboratory at a university. SUBJECTS:Male, Sprague-Dawley rats (n = 120,...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199810000-00028

    authors: Colton DM,Till GO,Johnson KJ,Dean SB,Bartlett RH,Hirschl RB

    更新日期:1998-10-01 00:00:00

  • Pulse oximetry in sickle cell anemia.

    abstract:OBJECTIVES:To determine whether pulse oximetry is accurate and if it correlates with arterial blood gas saturation in pediatric patients with sickle cell anemia. DESIGN:Prospective, comparative study using a convenience sample of patients with sickle cell anemia who had simultaneous arterial blood gas sampling and pul...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200109000-00025

    authors: Fitzgerald RK,Johnson A

    更新日期:2001-09-01 00:00:00

  • Optimal release time during airway pressure release ventilation in neonatal sheep.

    abstract:OBJECTIVE:To systematically investigate the effect of altering release time during airway pressure release ventilation in a neonatal animal model before and after oleic acid-induced acute lung injury. DESIGN:Prospective, nonrandomized, controlled study with repeated measures. SETTING:University research laboratory. ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199403000-00020

    authors: Martin LD,Wetzel RC

    更新日期:1994-03-01 00:00:00

  • Inhaled nitric oxide: technical aspects of administration and monitoring.

    abstract:OBJECTIVES:Clinical applications of inhaled nitric oxide (NO) therapy resulted in the development of delivery systems and monitoring devices applicable to routine clinical care. This article presents the various components necessary for an adequate clinical use of inhaled NO, and discusses the NO gas mixture cylinders,...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/00003246-199804000-00033

    authors: Francoe M,Troncy E,Blaise G

    更新日期:1998-04-01 00:00:00

  • Value of human factors to medication and patient safety in the intensive care unit.

    abstract::Conventional wisdom suggests that the "human factor" in critical care environments is reason for inadequate medication and patient safety. "Human factors" (or human factors engineering) is also a scientific discipline and practice of improving human performance. Using decades of human factors research, this paper eval...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e3181dd8de2

    authors: Scanlon MC,Karsh BT

    更新日期:2010-06-01 00:00:00

  • Foreign-body pneumonitis associated with tracheostomy.

    abstract::Foreign-body aspiration in adults is usually associated with asphyxiation after aspiration of food particles. The present report documents a case of foreign-body aspiration that resulted from poor tracheostomy care in an alcoholic patient, and caused fulminant pneumonitis. ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198408000-00020

    authors: Brischetto MJ,Malouf J,Taylor RW

    更新日期:1984-08-01 00:00:00

  • Pressure-flow relationships of the pulmonary circulation during endotoxin infusion in intact dogs.

    abstract:BACKGROUND AND METHODS:We aimed to characterize the effects of an endotoxin insult (Escherichia coli 0127:B8) on the relationships between pulmonary vascular pressure and flow in intact dogs. To achieve this goal, multipoint plots of total pressure gradient, arterial pressure gradient, and venous pressure gradient vs. ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199207000-00018

    authors: D'Orio V,Fatemi M,Marnette JM,Mendes P,Saad G,Martinez C,Marcelle R

    更新日期:1992-07-01 00:00:00

  • Somatosensory and brainstem auditory evoked potentials in cardiac arrest patients treated with hypothermia.

    abstract:OBJECTIVE:To evaluate the prognostic value of short-latency median nerve somatosensory evoked potentials and brainstem auditory evoked potentials in outcome prediction for comatose cardiac arrest patients treated with hypothermia. DESIGN:Prospective, randomized, controlled trial of mild hypothermia after out-of-hospit...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/01.ccm.0000171536.63641.d9

    authors: Tiainen M,Kovala TT,Takkunen OS,Roine RO

    更新日期:2005-08-01 00:00:00

  • Report on the development of a procedure to prevent placement of feeding tubes into the lungs using end-tidal CO2 measurements.

    abstract:OBJECTIVE:To determine the accuracy of a technique using capnography to prevent inadvertent placement of small-bore feeding tubes and Salem sump tubes into the lungs. SETTING:Twelve-bed medical intensive care unit (MICU) in a 557-bed teaching hospital. PATIENTS:A total of 25 ventilated adult MICU patients were studie...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章

    doi:10.1097/00003246-200105000-00004

    authors: Burns SM,Carpenter R,Truwit JD

    更新日期:2001-05-01 00:00:00

  • Effects of inhaled nitric oxide in a rat model of Pseudomonas aeruginosa pneumonia.

    abstract:OBJECTIVE:Antimicrobial effects of nitric oxide (NO) have been demonstrated in vitro against a variety of infectious pathogens, yet in vivo evidence of a potential therapeutic role for exogenous NO as an antimicrobial agent is limited. Thus, we assessed the effects of inhaled NO on pulmonary infection, leukocyte infilt...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200007000-00035

    authors: Webert KE,Vanderzwan J,Duggan M,Scott JA,McCormack DG,Lewis JF,Mehta S

    更新日期:2000-07-01 00:00:00

  • Development and validation of a printed information brochure for families of chronically critically ill patients.

    abstract:OBJECTIVE:Families and other surrogate decisionmakers for chronically critically ill patients often lack information about patient prognosis or options for care. This study describes an approach to develop and validate a printed information brochure about chronic critical illness aimed at improving comprehension of the...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e31822d7901

    authors: Carson SS,Vu M,Danis M,Camhi SL,Scheunemann LP,Cox CE,Hanson LC,Nelson JE

    更新日期:2012-01-01 00:00:00

  • Assessment of limb muscle strength in critically ill patients: a systematic review.

    abstract:OBJECTIVES:To determine the reliability of volitional and nonvolitional limb muscle strength assessment in critically ill patients and to provide guidelines for the implementation of limb muscle strength assessment this population. DATA SOURCES:The following computerized bibliographic databases were searched with MeSH...

    journal_title:Critical care medicine

    pub_type: 杂志文章,meta分析,评审

    doi:10.1097/CCM.0000000000000030

    authors: Vanpee G,Hermans G,Segers J,Gosselink R

    更新日期:2014-03-01 00:00:00

  • Written information that relatives of adult intensive care unit patients would like to receive--a comparison to published recommendations and opinion of staff members.

    abstract:OBJECTIVE:Information booklets have not been assessed by the families of intensive care unit (ICU) patients. This study explored the information that the relatives of adult ICU patients wanted to find in the information booklets. DESIGN:Multicenter survey. SETTING:Twenty-three French ICUs. SUBJECTS:One close relativ...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1097/CCM.0b013e3181a03063

    authors: Soltner C,Lassalle V,Galienne-Bouygues S,Pottecher J,Floccard B,Delapierre L,Jungfer F,Sargentini C,Alberti C,Beydon L,Lifrea Group.

    更新日期:2009-07-01 00:00:00

  • Selective decontamination of the digestive tract: impact on cytokine release and mucosal damage after hemorrhagic shock.

    abstract:OBJECTIVE:To determine if selective decontamination of the digestive tract (SDD) influences the proinflammatory immune response of the gut after hemorrhage. DESIGN:Random assignment to either unmanipulated control after 7 days of SDD or conventional rat chow, or hemorrhagic shock group after the same time of conventio...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200206000-00030

    authors: Kahlke V,Fändrich F,Brötzmann K,Zabel P,Schröder J

    更新日期:2002-06-01 00:00:00

  • Therapeutic hypercapnia enhances the inflammatory response to endotoxin in the lung of spontaneously breathing rats.

    abstract:OBJECTIVE:To test the hypothesis that therapeutic hypercapnia enhances the proinflammatory responses to endotoxemia in the lung and spleen of rats. DESIGN:Prospective randomized study. SETTINGS:Hospital research institute. SUBJECTS:Forty-eight adult male rats. INTERVENTIONS:Rats were randomly assigned for a 24-hr p...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e31820ee1f2

    authors: Norozian FM,Leoncio M,Torbati D,Meyer K,Raszynski A,Totapally BR

    更新日期:2011-06-01 00:00:00

  • Complexity modeling: identify instability early.

    abstract::Biological systems are innately complex, display nonlinear behavior, and respond to both disease and its treatment in similar complex ways. Complex systems display self-organization and predictive behavior along a range of possible states, often referred to as chaotic behavior, and can be both characterized and quanti...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e3181f24484

    authors: Pinsky MR

    更新日期:2010-10-01 00:00:00

  • Neurobiologic Correlates of Attention and Memory Deficits Following Critical Illness in Early Life.

    abstract:OBJECTIVES:Survivors of critical illness in early life are at risk of long-term-memory and attention impairments. However, their neurobiologic substrates remain largely unknown. DESIGN:A prospective follow-up study. SETTING:Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands. PATIENTS:Thirty-eight scho...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000002553

    authors: Schiller RM,IJsselstijn H,Madderom MJ,Rietman AB,Smits M,van Heijst AFJ,Tibboel D,White T,Muetzel RL

    更新日期:2017-10-01 00:00:00

  • Effects of N-acetylcysteine plus deferoxamine in lipopolysaccharide-induced acute lung injury in the rat.

    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

    authors: Ritter C,da Cunha AA,Echer IC,Andrades M,Reinke A,Lucchiari N,Rocha J,Streck EL,Menna-Barreto S,Moreira JC,Dal-Pizzol F

    更新日期:2006-02-01 00:00:00