Journal of critical care
-
Journal of critical care · Jun 2007
Multicenter StudyAnalysis of physiologic alterations in intensive care unit patients and their relationship with mortality.
To analyze patient physiologic alterations (events) and multiple organ failure during intensive care unit (ICU) stay and examine their relationship with ICU mortality. ⋯ Routinely gathered ICU data on physiologic variables and multiple organ failure can offer considerable complementary information not provided by usual mortality prediction systems; and their weight in daily care policy decisions may need to be revisited.
-
Journal of critical care · Jun 2007
Multicenter StudyIntensive care unit cultures and end-of-life decision making.
Prior researchers studying end-of-life decision making (EOLDM) in intensive care units (ICUs) often have collected data retrospectively and aggregated data across units. There has been little research, however, about how cultures differ among ICUs. This research was designed to study limitation of treatment decision making in real time and to evaluate similarities and differences in the cultural contexts of 4 ICUs and the relationship of those contexts to EOLDM. ⋯ As interventions to improve EOLDM are developed, it will be important to understand how they may interact with unit cultures. Attempting to develop one intervention to be used in all ICUs is unlikely to be successful.
-
Journal of critical care · Jun 2007
Multicenter Study Comparative StudyImpact of the Leapfrog Group's intensive care unit physician staffing standard.
The aim of this study was to describe hospital efforts to meet the Leapfrog Group's intensive care unit (ICU) physician staffing (IPS) standard; compare adopters and committers with resisters relative to perceived benefits, barriers and motivating factors; and examine implementation strategies. ⋯ Most hospitals-including half of those who publicly resisted the standard-made attempts to change physician staffing in their ICUs, based on the criteria outlined by the Leapfrog Group. Major barriers that need addressing are implementation costs and convincing hospital organizations and medical staff regarding the benefits of adopting the standard.
-
Journal of critical care · Jun 2007
Multicenter Study Comparative StudyBarriers to implementing the Leapfrog Group recommendations for intensivist physician staffing: a survey of intensive care unit directors.
The Leapfrog Group, representing a consortium of health care purchasers, has promoted standards for intensive care unit (ICU) staffing in nonrural areas. The purpose of this study was to examine the perception of the Leapfrog standards among ICU directors and determine the potential barriers to implementing these standards. ⋯ Numerous barriers exist to implementing the Leapfrog recommendations for intensivist staffing, not the least of which is the lack of an ICU director in many hospitals. Better strategies are needed to overcome these barriers before the widespread adoption of an intensivist care model similar to Leapfrog is feasible.
-
Journal of critical care · Jun 2007
Early evolution of arterial oxygenation in severe community-acquired pneumonia: a prospective observational study.
Acute respiratory failure requiring mechanical ventilation in severe community-acquired pneumonia has been shown to be a significant negative prognostic factor. We analyzed the early evolution of the Pao(2)/Fio(2) ratio and evaluated its clinical value as an outcome predictor. ⋯ A progressive improvement of Pao(2)/Fio(2) ratio during the first 48 hours of mechanical ventilation indicates favorable outcome. Serial measurement of this ratio should be considered in decision making for therapeutic strategy.