Journal of critical care
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Journal of critical care · Sep 2003
Multicenter StudyInfluence of perceived functional and employment status on cardiopulmonary resuscitation directives.
Perceptions about functional and employment status before admission to the intensive care unit (ICU) may influence how patients and clinicians make decisions about cardiopulmonary resuscitation. ⋯ Functional status impairment perceived by the ICU team is associated clearly with do-not-resuscitate directives in patients unable to participate in decision making. However, the association appears much weaker in patients able to participate in decision making. PATIENTS' perceived employment status also may influence resuscitation decisions. Our results emphasize the challenges of ensuring that crucial resuscitation decisions are not affected adversely by patients' inability to participate in decisions, and by their functional and employment status.
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Journal of critical care · Sep 2003
Developing and pilot testing quality indicators in the intensive care unit.
To develop and implement a set of valid and reliable yet practical measures of intensive care units (ICU) quality of care in a cohort of ICUs and to estimate, based on current performance, the potential opportunity to improve quality. ⋯ To improve quality of care, we must measure our performance. This pilot study suggests that it is feasible to implement a broad set of ICU quality measures in a cohort of hospitals. By improving performance on these measures, we may realize reduced mortality, morbidity, and ICU length of stay.
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Journal of critical care · Sep 2003
Comparative StudyIncreased risk associated with pulmonary artery catheterization in the medical intensive care unit.
To determine whether the frequency of use of a pulmonary artery catheter (PAC) was declining over a 5-year period in a medical intensive care unit (ICU), and to assess whether mortality was higher in patients in whom a PAC was used on the day of ICU admission compared with matched controls. ⋯ PAC use on the day of admission to a medical ICU was associated with an increased risk for hospital death.
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Journal of critical care · Sep 2003
Comparative StudyHeart rate variability as early marker of multiple organ dysfunction syndrome in septic patients.
To determine whether measuring heart rate variability (HRV) in a group of septic patients without multiple organ dysfunction syndrome (MODS) made it possible to predict which of them would later develop this syndrome. ⋯ Reduction of HRV on ICU admission may be useful in identifying septic patients at risk for development of MODS.
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Journal of critical care · Sep 2003
Comparative StudyCost-effectiveness of recombinant human activated protein C and the influence of severity of illness in the treatment of patients with severe sepsis.
To evaluate the cost-effectiveness of recombinant human activated protein C (rhAPC) compared with usual therapy for patients with severe sepsis, and also to determine the influence that severity of illness exerts on cost-effectiveness. ⋯ The use of rhAPC for the treatment of patients with very severe sepsis, as determined by APACHE II score > or = 25, appears cost-effective, while treatment of patients with APACHE II score < 25 is not cost-effective.