Critical care medicine
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Critical care medicine · Sep 1994
Multicenter StudyImproving intensive care unit discharge decisions: supplementing physician judgment with predictions of next day risk for life support.
To develop predictive equations, estimating the probability that an individual intensive care unit (ICU) patient will receive life support within the next 24 hrs. ⋯ Accurate, objective predictions of next day risk for life support can be developed, using readily available patient information. Supplementing physician judgment with these objective risk assessments deserves evaluation for the role of these assessments in enhancing patient safety and improving ICU resource utilization.
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Critical care medicine · Sep 1994
Multicenter StudyA method for assessing the clinical performance and cost-effectiveness of intensive care units: a multicenter inception cohort study.
To present an approach for assessing intensive care unit (ICU) performance which takes into account both economic and clinical performance while adjusting for severity of illness. To present a graphic display which permits comparisons among a group of hospitals. ⋯ Cross-indexing of clinical and economic ICU performance is easy to calculate. It has potential as a research and evaluation tool used by physicians, hospital administrators, payers, and others.
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Critical care medicine · Sep 1994
Early, routine paralysis for intracranial pressure control in severe head injury: is it necessary?
To investigate the efficacy of early, routine use of neuromuscular blocking agents for intracranial pressure management in patients with severe head injury. ⋯ Our findings suggest that early, routine, long-term use of neuromuscular blocking agents in patients with severe head injuries to manage intracranial pressure does not improve overall outcome and may actually be detrimental because of the prolongation of their ICU stay and the increased frequency of extracranial complications associated with pharmacologic paralysis. We suggest that routine early management of the head-injured patient in the ICU should be accomplished using sedation alone and that neuromuscular blockade should be generally reserved for patients with intracranial hypertension who require escalation of treatment intensity.
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To determine the applicability of the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system in predicting outcome in a subgroup of critically ill obstetrical patients. ⋯ Obstetrical patients requiring intensive care in our ICU had a better outcome than predicted, as expressed by a low mortality ratio. Various explanations that may be applicable to any subgroup of critically ill patients with a different mortality ratio are presented. The subgroup itself may be uniquely different, similar to our obstetrical patients with their physiologic changes of pregnancy. Another explanation may relate to an improvement in care of the subgroup and therefore a better outcome.
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Critical care medicine · Sep 1994
Multicenter StudyDaily prognostic estimates for critically ill adults in intensive care units: results from a prospective, multicenter, inception cohort analysis.
To develop daily prognostic estimates for individual patients treated in adult intensive care units (ICU). ⋯ Equations using initial and repeated physiologic measurements provide a high degree of explanatory power for subsequent hospital mortality rate. These daily prognostic estimates deserve evaluation for their potential role in improving the process and outcome from clinical decision-making.