Intensive care medicine
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Intensive care medicine · Jan 1991
Current practice regarding invasive monitoring in intensive care units in Finland. A nationwide study of the uses of arterial, pulmonary artery and central venous catheters and their effect on outcome. The Finnish Intensive Care Study Group.
As part of a nationwide evaluation of intensive care, we examined patient- and hospital-related factors which could influence the patterns of utilization of arterial cannulae and central venous and pulmonary artery catheters. We also studied the possible impact of these interventions on the short-term outcome among 14,951 consecutive ICU admissions to 25 intensive care units (75% of all ICU beds) in Finland. There was considerable variation between individual units in the use of these devices even if the differences in severity of illness were taken into account. ⋯ The factors predicting the use of invasive monitoring included extensive surgery causing a risk of cardiovascular instability, needs for mechanical ventilation, infusion of vasoactive drugs and complicated fluid therapy. Cardiovascular problems among non-operative patients increased the odds for PA catheterization but reduced them for arterial and CV cannulation. No clear-cut benefit could be found in the form of hospital mortality reduction from invasive haemodynamic monitoring, used as described in this study.
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Intensive care medicine · Jan 1991
Comparative StudyThe cost of an intensive care unit: a prospective study.
The cost of intensive care for patients admitted to the ICU were estimated. Patients suffering from severe combined acute respiratory and renal failure who required mechanical ventilation and renal replacement therapy (SCARRF-D) cost per day significantly more than non-renal patients (pounds 938 compared to pounds 653 per patient respectively) and their average length of stay in hospital is nearly 4 times as long (28.8 compared to 7.6 days respectively). Approximately 44% of the total cost was staff related (28% for the provision of nurses and 16% for the rest). Retrieving information related to cost was difficult, time consuming and labour intensive.
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Intensive care medicine · Jan 1991
Prognostic significance of early intracranial and cerebral perfusion pressures in post-cardiac arrest anoxic coma.
The prognosis of prolonged cardiac arrests is generally related to brain damage due to the cerebral anoxia. A neurological worsening leading to irreversibility is sometimes associated with an increase in intracranial pressure. We studied for 5 years the early intracranial and cerebral perfusion pressures in 84 patients with deep anoxic coma after cardiac arrest. ⋯ Moreover, none of the patients showing intracranial peak pressures over 25 mmHg survived without after-effects. It is clear that many patients suffer early periods of high intracranial pressures and low cerebral perfusion pressures leading to a bad neurological prognosis. Intracranial pressure monitoring may allow assessment of patients' neurological status and prognosis after cardiac resuscitation.
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To clarify the clinical nature of post-resuscitation hyperthermia, we reviewed the charts of 18 patients who had cardiac arrest on arrival and regained cardiovascular stability for a study period of sufficient length. Patients with trauma, burns, poisoning and cerebrovascular accidents were excluded. We analyzed the hyperthermia (above 38 degrees C) occurring in the initial 48 h after resuscitation. ⋯ The incidence of factors influencing body temperature did not differ between the brain death and prolonged coma groups. Patients achieving full recovery did not show hyperthermia. In conclusion, hyperthermia is an early indicator of brain damage after resuscitation.
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Intensive care medicine · Jan 1991
An objective method to evaluate rationing of pediatric intensive care beds.
Rationing of pediatric intensive care beds occurs when the severity of illness of patients admitted to and discharged from the PICU is inversely proportional to the number of available PICU beds. Bed rationing may also increase the proportion of patients using unique PICU therapies, thereby increasing efficiency. Consecutive PICU admissions (n = 283) were evaluated for three months for descriptive data, daily severity of illness, and daily care modalities. ⋯ Severity of illness for patients admitted when only one bed was available or discharged when there were no available beds was not higher than at other times. Therefore, we did not find evidence of rationing of pediatric intensive care by using quantitative methods. As health care funding becomes more limited, quantitative analyses such as this study differentiating the need for more PICU beds from the need for better PICU bed utilization will be beneficial.