Abstract:
OBJECTIVE:To determine the utility of thoracic computed tomography (TCT) in the initial assessment of critically ill patients with chest injuries. DESIGN:Prospective observational study of cohorts. SETTING:Trauma intensive care unit (ICU) of a Spanish Level III hospital (US equivalent Level I). PATIENTS:Three hundred seventy-five patients with chest injuries were studied, grouped into two cohorts according to whether they underwent admission TCT (exposed cohort, group I, n = 104) or not (unexposed cohort, group II, n = 271). INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Demographic data, initial severity scores, and chest radiograph (CXR)-based diagnosis were collected in all patients as independent variables. In patients of group I, we also recorded the TCT-based diagnosis and any incidents, complications, or therapy changes resulting from the TCT. The need for and duration of mechanical ventilation, length of ICU stay, and ICU mortality were gathered in the whole sample as dependent variables. The admission data were similar in the two groups, except for a higher Injury Severity Score (ISS) and thoracic ISS in group I. TCT proved to be more sensitive than CXR in detecting pulmonary contusion, hemothorax, pneumothorax, and vertebral fractures and in identifying the faulty placement of chest drainage tubes. TCT findings induced therapy changes in approximately 30% of patients in group I. In the other dependent variables studied, there were no differences between the two groups. In the multivariate analysis, the TCT screening had no effects on the time on mechanical ventilation, length of ICU stay, or mortality. CONCLUSIONS:TCT detects more chest injuries in trauma patients than does CXR and induces therapy changes in a considerable number of patients. However, this does not translate into an improvement in clinical outcomes.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Guerrero-López F,Vázquez-Mata G,Alcázar-Romero PP,Fernández-Mondéjar E,Aguayo-Hoyos E,Linde-Valverde CMdoi
10.1097/00003246-200005000-00018subject
Has Abstractpub_date
2000-05-01 00:00:00pages
1370-5issue
5eissn
0090-3493issn
1530-0293journal_volume
28pub_type
杂志文章abstract:OBJECTIVES:There is limited evidence supporting the widespread use of α2 agonists (clonidine and dexmedetomidine) in pediatric critical care sedation. This study sought to test the association between the use of α2 agonists and enhanced sedation. DESIGN:A retrospective observational cohort study was conducted. Noninfe...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003789
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVE:The effect of levosimendan, a novel inotropic vasodilator (inodilator), on the microvascular gastric mucosal hemoglobin oxygenation (muHbo(2)) is unknown. A possible effect could thereby be selective for the splanchnic region or could primarily reflect changes in systemic oxygen transport (Do(2)) and/or oxyge...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000150653.89451.6f
更新日期:2005-01-01 00:00:00
abstract:OBJECTIVES:To test whether hospital-based physicians made different intensive care unit and life-sustaining treatment decisions for otherwise identical black and white patients with end-stage cancer and life-threatening hypoxia. DESIGN:We conducted a randomized trial of the relationship between patient race and physic...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0b013e3182186e98
更新日期:2011-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the clinical utility of right ventricular end-diastolic volume index (RVEDVI) and pulmonary artery occlusion pressure (PAOP) as measures of preload status in patients with acute respiratory failure receiving treatment with positive end-expiratory pressure. DESIGN:Prospective, cohort study. SETTI...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199811000-00017
更新日期:1998-11-01 00:00:00
abstract:OBJECTIVES:To develop a predictive equation to estimate the frequency of blood drawing for intensive care unit (ICU) laboratory tests and to evaluate variations in ICU blood sampling practices after adjusting for patient and institutional factors. DESIGN:Prospective, inception, cohort study. SETTING:Forty-two ICUs in...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/00003246-199705000-00006
更新日期:1997-05-01 00:00:00
abstract:OBJECTIVE:To examine the role of platelets, fibrin, and adhesion molecules in mediating neutrophil-endothelial cell interactions in septic shock. DESIGN:Controlled experiments using phase contrast microscopy to examine neutrophil, platelet, and endothelial cell interactions in flowing cell suspensions under simulated ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000139918.80602.57
更新日期:2004-09-01 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:OBJECTIVES:Delirium occurs in approximately 30% of critically ill patients, and the risk of dying during admission doubles in those patients. Molecular mechanisms causing delirium are largely unknown. However, critical illness and the ICU environment consistently disrupt circadian rhythms, and circadian disruptions are...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003077
更新日期:2018-06-01 00:00:00
abstract::Intralipid elimination patterns were compared in 25 healthy controls, 12 patients recovering from uncomplicated cholecystectomy, and 25 critically ill patients. The intravenous fat tolerance test revealed a similar fractional removal rate (k2) in healthy controls and critically ill patients, but k2 was increased in ch...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198605000-00009
更新日期:1986-05-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181e69f05
更新日期:2010-08-01 00:00:00
abstract:OBJECTIVE:The efficacy of noninvasive mechanical ventilation (NIMV) in improving breathing pattern and arterial blood gases (ABG) in hypercapnic patients has been well documented; however, little attention has been given to the choice of the interface and the ventilatory mode. We evaluated the effects of three types of...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-200006000-00015
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVE:Inflammation and immobility are comorbid etiological factors inducing muscle weakness in critically ill patients. This study establishes a rat model to examine the effect of inflammation and immobilization alone and in combination on muscle contraction, histology, and acetylcholine receptor regulation. DESIG...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0B013E3181659669
更新日期:2008-03-01 00:00:00
abstract:OBJECTIVE:Intrahospital transport of critically ill patients is often necessary for optimal patient care. However, transport of intensive care unit (ICU) patients within the hospital has been associated with a high rate of potentially detrimental complications. This study was designed to determine the occurrence rate o...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199510000-00009
更新日期:1995-10-01 00:00:00
abstract:OBJECTIVES:To assess the relations between anemia, serum erythropoietin (EPO), iron status, and inflammatory mediators in multiply traumatized patients. DESIGN:Prospective observational study. SETTING:Intensive care unit. PATIENTS:Twenty-three patients suffering from severe trauma (injury severity score > or =30). ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200104000-00009
更新日期:2001-04-01 00:00:00
abstract:OBJECTIVE:To evaluate the relationship between the acute inflammatory response after surgical trauma and changes in hepatic cytochrome P450 3A4 activity, compare changes in cytochrome P450 3A4 activity after procedures with varying degrees of surgical stress, and to explore the time course of any potential drug-cytokin...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000063040.24541.49
更新日期:2003-05-01 00:00:00
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
更新日期:1975-11-01 00:00:00
abstract:OBJECTIVES:To assess the impact of the percentage of fluid infused as Lactated Ringer (%LR) during the first 2 days of ICU admission in hospital mortality and occurrence of acute kidney injury. DESIGN:Retrospective cohort. SETTING:Analysis of a large public database (Multiparameter Intelligent Monitoring in Intensive...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001948
更新日期:2016-12-01 00:00:00
abstract::Ventricular fibrillation (VF) can masquerade as asystole. We report a 54-yr-old male in cardiac arrest who, on surface ECG, appeared to be in VF or asystole. A bedside intracardiac recording using a transmyocardial pacing wire showed the true rhythm to be atrial fibrillation (AF) with high grade atrioventricular block...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198704000-00013
更新日期:1987-04-01 00:00:00
abstract:OBJECTIVE:To assess the impact of sepsis classification and multidrug-resistance status on outcome in patients receiving appropriate initial antibiotic therapy. DESIGN:A retrospective cohort study. SETTING:Barnes-Jewish Hospital, a 1,250-bed teaching hospital. PATIENTS:Individuals with Enterobacteriaceae sepsis, sev...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001013
更新日期:2015-08-01 00:00:00
abstract::High-risk patients who survived general (noncardiac) surgery were observed to have cardiac index (CI) values averaging 4.5 L/min.m2, oxygen delivery (DO2) greater than 600 ml/min.m2, and oxygen consumption (VO2) 170 ml/min.m2 during the first 2 or three days postoperatively. Patients who subsequently died maintained r...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:
更新日期:1990-01-01 00:00:00
abstract:OBJECTIVES:Hepatic ischemia-reperfusion is a major clinical problem with limited treatment options. The pathophysiology of hepatic ischemia-reperfusion is characterized by mitochondrial dysfunction and cellular energy deficits. Sirtuin 1 is an energy-sensing enzyme known to modulate mitochondrial biogenesis. We hypothe...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001637
更新日期:2016-08-01 00:00:00
abstract::A system of instrumentation for continuous measurement of oxygen consumption (VO2), carbon dioxide production (VCO2) and minute ventilation (V1) in human newborns on assisted ventilation is described. VO2 and VCO2 are measured by open-circuit indirect calorimetry utilizing a Servomex OA 184 differential paramagnetic o...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198311000-00011
更新日期:1983-11-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003806
更新日期:2019-08-01 00:00:00
abstract:OBJECTIVE:Restoration of myocardial blood flow after ischemia triggers an inflammatory response involving toll-like receptors. Toll-like receptor 2 deficiency is associated with a reduced infarct size after myocardial ischemia and reperfusion. Because a marked mortality was observed in C3HeN wild-type mice, which was a...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181ef455b
更新日期:2010-10-01 00:00:00
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journal_title:Critical care medicine
pub_type: 共识发展会议,杂志文章,评审
doi:10.1097/00003246-200001000-00040
更新日期:2000-01-01 00:00:00
abstract:OBJECTIVES:Myocardial ischemia plays a central role in the development of right ventricular failure after acute pulmonary embolism. This study investigates whether pulmonary mediators act specifically on coronary tone and cardiac contractile function in acute pulmonary microembolization and whether such effects are alt...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199803000-00024
更新日期:1998-03-01 00:00:00
abstract:OBJECTIVE:This study aims to explore the relationship between team-leadership skills and quality of cardiopulmonary resuscitation in an adult cardiac-arrest simulation. Factors affecting team-leadership skills were also assessed. DESIGN:Forty advanced life-support providers leading a cardiac arrest team in a standardi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182591fda
更新日期:2012-09-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198812000-00011
更新日期:1988-12-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199407000-00011
更新日期:1994-07-01 00:00:00
abstract:OBJECTIVE:To determine factors influencing rationing decisions in a surgical ICU during a temporary nursing shortage when two to six of the unit's 16 beds were closed. DESIGN:Blinded, concurrent data collection, retrospective chart review. SETTING:Surgical ICU. PATIENTS:All patients (n = 308) for whom a surgical ICU...
journal_title:Critical care medicine
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doi:10.1097/00003246-199203000-00016
更新日期:1992-03-01 00:00:00