Critical care medicine
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Given the high costs of delivering care to critically ill patients, practitioners and policymakers are beginning to scrutinize the costs and outcomes associated with intensive care. Health economics is a discipline concerned with determining the best way of using resources to maximize the health of the community. This involves addressing questions such as which procedure, test, therapy, or program should be provided, and to whom, given available resources. ⋯ Economic evaluations use analytic techniques to systematically consider all possible costs and consequences of clinical actions. Although they should never form the sole basis for clinical decisions for individual patients, economic evaluations offer potentially useful information at different levels of decision-making.
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Critical care medicine · Jun 1999
Colonization with broad-spectrum cephalosporin-resistant gram-negative bacilli in intensive care units during a nonoutbreak period: prevalence, risk factors, and rate of infection.
To define the epidemiology of broad-spectrum cephalosporin-resistant gram-negative bacilli in intensive care units (ICUs) during a nonoutbreak period, including the prevalence, the risk factors for colonization, the frequency of acquisition, and the rate of infection. ⋯ Colonization with CAZ-RGN was common and was usually not recognized by clinical cultures. Most patients colonized or infected with CAZ-RGN had positive surveillance cultures at the time of admission to the surgical ICU, suggesting that acquisition frequently occurred in other wards and institutions. Patients exposed to first-generation cephalosporins, as well as broad-spectrum cephalosporins/penicillins, were at high risk of colonization with CAZ-RGN. Empirical treatment of nosocomial gram-negative infections with broad-spectrum cephalosporins, especially in the critically ill patient, should be reconsidered.
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To assess physician decision-making in triage for intensive care and how judgments impact on patient survival. ⋯ Physicians triage patients to intensive care based on the number of beds available, the admission diagnosis, severity of disease, age, and operative status. Admitting patients to intensive care is associated with a lower mortality rate, especially in patients with APACHE scores of 11 to 20.
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Critical care medicine · Jun 1999
Comparative StudyAccuracy of methemoglobin measurements: comparison of six different commercial devices and one manual method.
During nitric oxide inhalation, methemoglobinemia needs to be monitored. We compared six commercially available instruments and one manual method for methemoglobin measurements. In addition, we studied whether and to what degree methylene blue interferes with methemoglobin measurements. ⋯ With some limitations, all commercial instruments that were tested performed adequately for the monitoring of methemoglobinemia. Methylene blue interferes with the methemoglobin measurements in a dose-dependent manner.
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Critical care medicine · Jun 1999
Unilateral do-not-attempt-resuscitation orders and ethics consultation: a case series.
To describe the role of an ethics consultation service in unilaterally withholding cardiopulmonary resuscitation. ⋯ The process of ethics consultation is useful in resolving disagreements over withholding cardiopulmonary resuscitation and other treatment and can frequently result in a consensus. Hospital policies that permit unilateral treatment limitation should be based on a model that is process-based and that encourages interdisciplinary participation in decision-making, such as that recently proposed by the Houston Task Force.