The incidence of major morbidity in critically ill patients managed with pulmonary artery catheters: A meta-analysis

Иванов, Р. А.; Allen, J. R.; Calvin, James E.

doi:10.1097/00003246-200003000-00002

Cited by 118 publications

(42 citation statements)

References 21 publications

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“…Ivanov and coworkers [57] found in their meta-analysis a significant reduction in morbidity when the hemodynamic resuscitation of critically ill patients was guided by the pulmonary artery catheter. Kern and Shoemaker [58] re-viewed the impact of hemodynamic optimization, directed to supranormal values, in high-risk patients.…”

Section: Endpoints For the Resuscitationmentioning

confidence: 99%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year. It has been calculated by the World Health Organization that in 2002 there occurred 1.6 million violent deaths [1] and 1.2 million deaths from traffic injury [2], for a combined mortality of 48 deaths per 100,000 population per year.Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals [3]. These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant. Errors in the ICU management of trauma patients were studied by Duke and colleagues [9]. They reported 165 ICU trauma deaths. Two hundred fifty-eight errors occurred in 81 patients (52%), and 134 of them contributed to death in 52 patients (34%). ICU errors were classified as management errors (82%), diagnostic (9%), technique (5%), and system inadequacies (4%). Davis and colleagues [10] identified critical care errors in 30% of 125 trauma deaths with errors. These errors contributed to 48% of all preventable deaths.The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions [9,10].It is imperative for the general surgeon who takes care of trauma patients to know how to deal with these critical aspects, to reduce preventable morbidity and mortality. In the next segment, the situations in which the participation of the surgeon is crucial, during the initial phases of reanimation and stabilization of the critically traumatized patient will be discussed. Airway and ventilation managementAirway and respiratory management errors are the most common of those identified by several authors [9][10][11] The cardinal manifestation is a sudden or a rapidly progressing desaturation, frequently accompanied by tachycardia and arrhytmias, and occasionally by agitation. Hypertension announces the cardiovascular collapse, and bradicardia appears immediately after the total collapse [12]. The symptoms should not be attributed to agitation when it is present, and other possible causes must be ruled out before. Diagnosing the complication involves a directed physical examination, the analysis of the airway pressures and ventilator volumes, chest radiographs, and sometimes the measurement of arterial blood gases (ABG), and the urinary bladder pressure ( Table 1).The emergency conditions in which the access to the airways must be gained, the displacement to diagnosis areas or operating room and the agitation, often present, make the critical...

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Section: Endpoints For the Resuscitationmentioning

confidence: 99%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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“…Thermodilution (TD) method, which is currently accepted as the most reliable method, is associated with some complications, including arrhythmias, vascular injury, infections and systematic errors related to the hemodynamic state and the level of experience of the intensive care professional (ANOV et al, 2000;YANG et al, 2013).…”

Section: A Adequada Monitoração Do íNdice Cardíaco (Ic) Em Pacientes mentioning

confidence: 99%

Cardiac index by thermodilution or transthoracic echocardiography in dogs at different hemodynamic states

et al. 2016

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“…In order to increase the DO 2 all these variables can be altered as described earlier [9][10][11][12] . The first step consists in CO Pw15-18mmHg; CO> 4.5l/m 2 [13][14][15] .…”

Section: Monitoring Devicesmentioning

confidence: 99%

“…As a matter of fact, PAC is the only diagnostic tool that was extensively studied with regards to its usefulness and patient safety [14,57,58] . To our knowledge in the available literature no other device was subjected to patient safety screening; the information is limited to technical characteristics and eventual indications for use [59] .…”

Section: Monitoring Devicesmentioning

confidence: 99%

Diagnostic tools and therapeutic end-points in critical care medicine: Limitations and concepts

Severino

Marum²,

Marcelino

2014

JNEP

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In Intensive Care Medicine (ICM) the presence of multiple high tech devices is common in order to perform multiple medical and non-medical procedures. The authors intend to perform a critical appraisal on the basic and practical/clinical approach to monitoring devices, analyzing the evidence support regarding clinical effects, end-points, and patient safety. All data that provides a diagnosis or a characterization of the patient's status will be considered diagnostic information whereas, variables that could be achieved by medical interventions will be considered therapeutic end-points. In any healthcare setting a careful approach to the patient is needed, namely in ICM one must consider the patient's clinical condition and choose adequate diagnostic tools and devices. Not all variables and devices currently on the market are suitable for each patient, nor proved useful in the setting under study. Also, all patients are different and must be approached differently according to established clinical end-points, translating into more holistic caregiving. ICM requires a personalized approach towards the patient, consequently, submitting diagnostic tools and monitoring devices to greater scrutiny in order to obtain greater patient benefit.

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The incidence of major morbidity in critically ill patients managed with pulmonary artery catheters: A meta-analysis

Abstract: Meta-analysis of RCTs included in this study shows that there is a statistically significant reduction in morbidity using PA catheter-guided strategies.

Cited by 118 publications

References 21 publications

Critical Care Issues in the Early Management of Severe Trauma

Critical Care Issues in the Early Management of Severe Trauma

Cardiac index by thermodilution or transthoracic echocardiography in dogs at different hemodynamic states

Diagnostic tools and therapeutic end-points in critical care medicine: Limitations and concepts

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