Intensive care medicine
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Intensive care medicine · Feb 2015
The association between ICU level of care and mortality in the Netherlands.
The relationship between the number of patients admitted to an intensive care unit (ICU) volume and mortality is currently the subject of debate. After implementation of a national guideline in 2006, all Dutch ICUs have been classified into three levels based on ICU size, patient volume, ventilation days, and staffing. The goal of this study is to investigate the association between ICU level and mortality of ICU patients in the Netherlands. ⋯ We demonstrated that ICU level was not associated with significant differences in the case-mix adjusted in-hospital and long-term mortality of ICU patients. This finding is in contrast with some earlier studies suggesting a volume-outcome relationship. Our results may be explained by the successful implementation of nationwide mandatory quality requirements and adequate staffing in all three levels of ICUs over the last years.
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Intensive care medicine · Feb 2015
Multicenter StudyDamage control resuscitation using blood component therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage.
To determine the effectiveness of blood component therapy in the correction of trauma-induced coagulopathy during hemorrhage. ⋯ Damage control resuscitation with standard doses of blood components did not consistently correct trauma-induced coagulopathy during hemorrhage. There is an important opportunity to improve TIC management during damage control resuscitation.
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Intensive care medicine · Feb 2015
Applying mean systemic filling pressure to assess the response to fluid boluses in cardiac post-surgical patients.
To evaluate an analogue of mean systemic filling pressure (P(msa)) and derived variables to quantitatively assess the effectiveness of volume expansion in increasing cardiac output. ⋯ Using an algorithm to derive a mean systemic filling pressure analogue, cardiac power and dynamic measures of the venous return pressure gradient relative to the mean systemic filling pressure provided an assessment of the efficiency of volume expansion in post-surgical cardiac patients.