Critical care

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Critical care medicine is the "health care provided to a critically ill patient during a medical emergency or crisis".[1]

Monitoring

Swan-Ganz catheterization

Oxygenation

Alveolar-arterial oxygen (A-a) gradient (alveolar-arterial oxygen difference - AVO2D)

The A-a gradient is harder to calculate, but accounts for changes in ventilation as measured by the partial pressure of carbon dioxide.

PaO2/FiO2 ratio (PF ratio)

This measure is easier to calculate.

Comparative studies provide mixed recommendations regarding which measure is best.[2][3]

Preventing complications in critically ill patients

Selective gastrointestinal decontamination

Preventing gastrointestinal tract ulceration

Systematic reviews conclude that selective decontamination of the digestive tract may reduce morbidity in critically ill patients[4][5][6] although some randomized controlled trials have[7][8][9] and others have not found benefit[10].

Preventing deep venous thrombosis

Preventing healthcare-associated pneumonia

References

  1. ↑ Anonymous. Critical care. National Library of Medicine. Retrieved on 2008-01-07.
  2. ↑ Covelli HD, Nessan VJ, Tuttle WK (1983). "Oxygen derived variables in acute respiratory failure". Crit. Care Med. 11 (8): 646–9. PMID 6409506. [e]
  3. ↑ El-Khatib MF, Jamaleddine GW (2004). "A new oxygenation index for reflecting intrapulmonary shunting in patients undergoing open-heart surgery". Chest 125 (2): 592–6. PMID 14769743. [e]
  4. ↑ Chan EY, Ruest A, Meade MO, Cook DJ (2007). "Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis". BMJ 334 (7599): 889. DOI:10.1136/bmj.39136.528160.BE. PMID 17387118. Research Blogging.
  5. ↑ Silvestri L, van Saene HK, Milanese M, Gregori D, Gullo A (2007). "Selective decontamination of the digestive tract reduces bacterial bloodstream infection and mortality in critically ill patients. Systematic review of randomized, controlled trials". J. Hosp. Infect. 65 (3): 187–203. DOI:10.1016/j.jhin.2006.10.014. PMID 17244516. Research Blogging.
  6. ↑ Silvestri L, van Saene HK, Milanese M, Gregori D (2005). "Impact of selective decontamination of the digestive tract on fungal carriage and infection: systematic review of randomized controlled trials". Intensive Care Med 31 (7): 898–910. DOI:10.1007/s00134-005-2654-9. PMID 15895205. Research Blogging.
  7. ↑ de Jonge E, Schultz MJ, Spanjaard L, et al (2003). "Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial". Lancet 362 (9389): 1011–6. PMID 14522530. [e]
  8. ↑ Cockerill FR, Muller SR, Anhalt JP, et al (1992). "Prevention of infection in critically ill patients by selective decontamination of the digestive tract". Ann. Intern. Med. 117 (7): 545–53. PMID 1524328. [e]
  9. ↑ Stoutenbeek CP, van Saene HK, Little RA, Whitehead A (2007). "The effect of selective decontamination of the digestive tract on mortality in multiple trauma patients: a multicenter randomized controlled trial". Intensive Care Med 33 (2): 261–70. DOI:10.1007/s00134-006-0455-4. PMID 17146635. Research Blogging.
  10. ↑ Gastinne H, Wolff M, Delatour F, Faurisson F, Chevret S (1992). "A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. The French Study Group on Selective Decontamination of the Digestive Tract". N. Engl. J. Med. 326 (9): 594–9. PMID 1734249. [e]
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