Critical care medicine
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Critical care medicine · Oct 2008
Editorial CommentNoninvasive ventilation: trying to minimize harm?
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Critical care medicine · Oct 2008
Review Comparative StudyVariation in critical care services across North America and Western Europe.
Critical care represents a large percentage of healthcare spending in developed countries. Yet, little is known regarding international variation in critical care services. We sought to understand differences in critical care delivery by comparing data on the distribution of services in eight countries. ⋯ Absolute critical care services vary dramatically between countries with wide differences in both numbers of beds and volume of admissions. The number of intensive care unit beds per capita is not strongly correlated with overall health expenditure, but does correlate strongly with mortality. These findings demonstrate the need for critical care data from all countries, as they are essential for interpretation of studies, and policy decisions regarding critical care services.
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Critical care medicine · Oct 2008
Comparative StudyComparison of community and referral intensive care unit patients in a tertiary medical center: evidence for referral bias in the critically ill.
To determine the existence of referral bias in the critically ill by comparing the clinical and epidemiologic characteristics of community (Olmsted County, MN residents) and referral (non-Olmsted County residents) patients admitted to the intensive care unit. ⋯ Patients who resided outside of our local community and who had medical admissions to the intensive care unit were more severely ill, had greater mortality rates, and had longer length of stay compared with community patients. Our findings support the existence of referral bias in critically ill medical patients at our tertiary medical center.
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Critical care medicine · Oct 2008
Fetal outcomes of critically ill pregnant women admitted to the intensive care unit for nonobstetric causes.
The outcome of the fetus in critically ill mothers has been briefly reported as a part of descriptive studies focusing on maternal risk factors for admission to the intensive care unit. We evaluated the risk factors for adverse fetal outcomes in critically ill pregnant women admitted to the intensive care unit for nonobstetrical reasons. ⋯ Nonobstetrical critical illness in pregnant women significantly affects fetal and neonatal outcomes. Maternal shock, maternal requirement of allogenic blood product transfusion and lower gestational age were associated with an increased risk of fetal loss.
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Critical care medicine · Oct 2008
Intensive care unit hypoglycemia predicts depression during early recovery from acute lung injury.
To evaluate the association between intensive care unit blood glucose levels and depression after acute lung injury. ⋯ Hypoglycemia in the intensive care unit is associated with an increased risk of positive screening for depression during early recovery from acute lung injury. Baseline depressive symptoms, morbid obesity, and intensive care unit benzodiazepine dose were also associated with postacute lung injury depressive symptoms. These findings warrant increased glucose monitoring for intensive care unit patients at risk for hypoglycemia and further research on how patient and intensive care unit management factors may contribute to postintensive care unit depression.