Critical care medicine
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Critical care medicine · Nov 1975
Comparative StudyThe therapeutic intervention scoring system. An application to acutely ill cancer patients.
The Therapeutic Intervention Scoring System (TISS) has been introduced (Cullen DJ, Civetta JM, Briggs BA, et al: Therapeutic intervention scoring system: A method for quantitative comparison of patient care. Crit Care Med 2:57-60, 1974) at the Massachusetts General Hospital as a means of quantifying the medical and nursing care required by critically ill patients. The method has been instituted in the Intensive Care Unit of Memorial Cancer Center to evaluate its applicability to patients who develop life-threatening complications of their disease or its treatment. ⋯ This average compares closely with that of postcardiac surgery patients (31.8 points), the group that required the most care of all patients in the initial study. The results indicate the usefulness of this sytem in evaluating severity of illness, predicting survival, and assessing cost benefits. It has proven to be a simple and accurate method of assessment when simple and accurate method of assessment when applied to this patient population, but certain modifications seem warranted and have been suggested herein.
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Nine variables were studied in 56 patients to analyze hemodynamic patterns of critically ill and shock patients. The variables were central venous pressure, mean arterial pressure, heart rate, cardiac index, left ventricular stroke work, strok index, total peripheral resistance, arteriovenous oxygen difference, and oxygen consumption. We observed six patterns; three with low cardiac index (hypodynamic) and three with high cardiac index (hyperdynamic). ⋯ Group IID: High cardiac index and increased arteriovenous oxygen difference in patients with sepsis and stable hemodynamic conditions. Groups IIE and IIF: Increased cardiac index and normal or increased arteriovenous oxygen difference in septic patients, who were hemodymamically unstable or in shock. These hemodynamic observations were found to be useful for understanding physiological compensations, for deciding on therapy, and in evaluating the effectiveness of therapy.