Journal of critical care
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Journal of critical care · Dec 2003
Intensive care outflow limitation--frequency, etiology, and impact.
To assess the frequency, causes, and effect of unsuccessful discharge decisions from the ICU. ⋯ ICU outflow limitation occurs in up to 1 in 6 discharges. It can be due to medical deterioration, level of care issues or administrative problems, and may lead to inefficient use of ICU resources.
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Journal of critical care · Dec 2003
Multicenter Study Comparative StudyPrevention of venous thromboembolism in critically ill medical patients: a Franco-Canadian cross-sectional study.
Medical intensive care unit (ICU) patients are at moderate risk of venous thromboembolism (VTE) and prophylaxis against VTE is recommended. ⋯ In this binational cross-sectional observational study of medical ICU patients, we found that 92% of eligible patients received either UFH or LWMH for VTE prophylaxis. Differences in prescribing between countries include significantly greater use of LMWH in France, but use of lower doses than in Canada, and greater use of mechanical VTE prophylaxis in Canada. More randomized trials of VTE prophylaxis in critically ill medical patients would better inform practice.
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Journal of critical care · Dec 2003
Comparative StudyCost-effectiveness of drotrecogin alfa (activated) for the treatment of severe sepsis in Germany.
Drotrecogin alfa (activated) (Xigris; Eli Lilly and Company, Indianapolis, IN) significantly reduced mortality in severe sepsis in the PROWESS trial. We evaluate the cost-effectiveness of drotrecogin alfa (activated) as an adjunct to standard therapy from the German healthcare payer's perspective with respect to patients with 1) severe sepsis and 2) severe sepsis and multiple organ failure the approved European indication. Hospital resource use based on PROWESS was valued using German unit costs. ⋯ Per patient treated, drotrecogin alfa (activated) increased costs by euro;7,500, and hospital costs by euro;900 for all patients (euro;7,400 and euro;1,500 respectively for the approved indication) and survival by 0.59 life years (0.87 life years respectively for the approved indication). Thus drotrecogin alfa (activated) cost euro;14,100 (euro;17,700 discounting life years at 3%) per life year gained for all patients (euro;10,200 and euro;12,900, respectively, for the approved indication). Testing the unit cost of drotrecogin alfa (activated), pattern of resource use, and survival benefit, demonstrated that cost-effectiveness lies well within the range of other life saving interventions in Germany representing good economic value.
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Journal of critical care · Dec 2003
Do we need a systematic activation of alarm soundings for blood pressure monitoring for the safety of ICU patients?
Evaluation of a protocol of activation-deactivation of alarm soundings on noninvasive mean arterial pressure (MAP) monitoring. ⋯ In this study, a systematic activation of alarm soundings for non-invasive blood pressure monitoring seemed unnecessary for the safety of ICU patients.
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Journal of critical care · Dec 2003
Quantification of lung water by transpulmonary thermodilution in normal and edematous lung.
To analyze the accuracy of the transpulmonary thermodilution method in the determination of extravascular lung water (EVLW). ⋯ The transpulmonary thermodilution method is very accurate to detect changes in EVLW in normal lungs. In edematous lung, this method may underestimate the EVLW.