We have studied the temporal relationship for the same micro-organisms between gastric colonization and both nasopharyngeal colonization and major clinical infections in 100 consecutive, long-stay, intensive care patients. 67% of patients developed positive gastric cultures, mainly with aerobic Gram-negative bacilli and C. albicans; 33% developed positive nasopharyngeal cultures with similar organisms, but in only 8% was the same organism previously cultured from the stomach; 48% of patients developed infections, mainly respiratory, but commonly with different organisms. The presence of a positive gastric culture was not associated with gastric pH, bleeding, severity of illness, or mortality. The results fail to confirm that an ascending migration of organisms from the stomach is.frequent or that there is a relationship between gastric colonization and clinical infections. Firm therapeutic recommendation in these areas may be premature.
VAD (for Ventilation m v i s e r ) is an expert system that is intended to assist in the management of mechanical ventilation for critically ill patients. The system continuously interprets patient data collected from standard ICU equipment to offer staff advice on the patient's status, unexpected ventilation "events" and the appropriateness of current ventilator therapy. VAD's encoded medical expertise IS provided by clinical and nursing specialists in intensive care.It has been implemented as a custom expert tool written in 'C' and run in real time on an IBM-AT compatible computer. VAD is currently being "tuned" and evaluated in closely regulated clinical trials within the ICU.
BACKGROUND
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