Critical care medicine
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Critical care medicine · Mar 1987
Clinical characteristics and resource utilization of ICU patients: implications for organization of intensive care.
We reviewed the clinical characteristics and resource utilization of 391 medical (M) and 315 surgical (S) ICU patients. In general, MICU patients had more physiologic derangement, as determined by the admission, maximal, and average acute physiology scores (APS). SICU patients had more frequent therapeutic interventions as measured by admission, maximal, and average therapeutic intervention scoring system values. ⋯ In contrast, 83% of patients with APS greater than 10 had considerable intensive interventions. These patients required mechanical ventilation, invasive monitoring, and vasoactive drugs more than twice as often as patients with lower APS scores. Consideration should be given, therefore, to the organization of ICUs according to the patient's severity of illness.
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Critical care medicine · Mar 1987
Comparative StudyComplement activation and increased alveolar-capillary permeability after major surgery and in adult respiratory distress syndrome.
The concentrations of C3a des Arg were measured in bronchoalveolar fluid (BAL) and plasma from 12 patients with adult respiratory distress syndrome (ARDS). Compared with 32 controls, all patients had increased BAL fluid levels (p less than .001), and nine of 12 had increased plasma levels (p less than .001) of this split product from the third complement component. Reduced total hemolytic activity (CH50) in serum was seen in five patients (p less than .01). ⋯ Of the 12 ARDS patients, eight had increased BAL fluid concentrations of C3a (p less than .001), and ten had increased BAL fluid levels of albumin (p less than .001) compared with the post-surgical patients. Measuring complement consumption in blood by these techniques is of limited value in ARDS due to the lack of specificity. BAL fluid albumin has a similar degree of sensitivity and specificity for ARDS as does BAL fluid C3a.(ABSTRACT TRUNCATED AT 250 WORDS)
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The adult respiratory distress syndrome (ARDS) is a syndrome of diffuse lung injury with a high mortality rate. We evaluated retrospectively 35 adult patients with ARDS. Their overall mortality rate was 69% and was related to their age (32 +/- 14 yr in survivors and 54 +/- 15 yr in nonsurvivors; p less than .001) and to the number of complications during their illness (1.4 complications in survivors, 2.6 in nonsurvivors; p less than .005). ⋯ Neither a simplified acute physiology score nor a respiratory failure severity index was significantly different between survivors and nonsurvivors on admission. The mean PEEP level on admission in survivors was 8.1 +/- 4.6 cm H2O and in nonsurvivors 3.7 +/- 3.9 cm H2O (p less than .025). We conclude that the age of the patients and superimposed multiple system organ failure are probably related with the still high mortality rate of this syndrome.
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Critical care medicine · Mar 1987
Value of a conventional approach to the diagnosis of traumatic cardiac contusion after chest injury.
We wanted to evaluate whether current screening techniques effectively determine a patient's need for hospital admission and intensive care monitoring after blunt chest trauma. Consequently, we reviewed 104 consecutive admissions for "blunt chest trauma; rule out cardiac contusion." Neither clinical findings, cardiac enzyme levels, chest x-rays, nor ECGs predicted the high-risk patients who would subsequently develop complications related to myocardial contusion. Since only 23% of the study patients developed such complications, the plurality of study patients did not require admission and monitoring. There is, therefore, a definite need to develop new, accurate screening tests for patients at risk for myocardial contusion complications.
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Critical care medicine · Mar 1987
A computer simulation program to facilitate budgeting and staffing decisions in an intensive care unit.
ICUs have unique problems in choosing their best staffing levels for direct patient care because each unit's total patient needs per shift, quantitated in acuity points, vary widely. We devised a computer program to simulate our 12-bed medical/cardiac ICU workload and staffing system. ⋯ Using the model, we considered financial concerns, quality of care issues, and staff working preferences and determined that our best staffing level would be based on 5.5 direct FTEs per shift. The stimulation analysis is straightforward, flexible, adaptable, and easy to update and use.