Critical care medicine
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Critical care medicine · Aug 1998
Multicenter Study Comparative StudyEvaluation of acute physiology and chronic health evaluation III predictions of hospital mortality in an independent database.
To assess the accuracy and validity of Acute Physiology and Chronic Health Evaluation (APACHE) III hospital mortality predictions in an independent sample of U.S. intensive care unit (ICU) admissions. ⋯ APACHE III accurately predicted aggregate hospital mortality in an independent sample of U.S. ICU admissions. Further improvements in calibration can be achieved by more precise disease labeling, improved acquisition and weighting of neurologic abnormalities, adjustments that reflect changes in treatment outcomes over time, and a larger national database.
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Critical care medicine · Aug 1998
Meta Analysis Comparative StudyTunneling short-term central venous catheters to prevent catheter-related infection: a meta-analysis of randomized, controlled trials.
To evaluate the efficacy of tunneling short-term central venous catheters to prevent catheter-related infections. ⋯ Tunneling decreases central venous catheter-related infections. However, current evidence does not support routine tunneling until its efficacy is evaluated at different placement sites and relative to other interventions.
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Critical care medicine · Aug 1998
Multicenter Study Comparative StudyPediatric risk of mortality: an assessment of its performance in a sample of 26 Italian intensive care units.
To assess the validity of the Pediatric Risk of Mortality (PRISM) scoring system in accurately predicting the probability of mortality in an Italian intensive care unit (ICU) sample. ⋯ The analyses suggest that the unsatisfactory calibration of PRISM can be attributed to various reasons. Among those reasons, a poor performance of the system, as well as its sensitivity to factors not connected to clinical ICU performance, seem particularly important. A special caution is needed in adopting a severity of illness scoring system to assess quality of care, particularly in contexts different from the one in which the instrument was originally developed.
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Critical care medicine · Aug 1998
Multicenter Study Comparative StudyOutcome of intensive care patients in a group of British intensive care units.
To identify priorities for intensive care unit (ICU) intervention and research. ⋯ Early identification of patients at risk, both before admission and after discharge from the ICU, may allow treatment to decrease mortality. Research and resources may be best directed at patients who die, despite a relatively low predicted mortality. Although these patients are a small percentage of the low-risk admissions, they constitute a large number of ICU deaths. Many patients die after discharge from ICU and this mortality may be decreased by minimizing inappropriate early discharge to the ward, by the provision of high-dependency and step-down units, and by continuing advice and follow-up by the ICU team after the patient has been discharged. Intervention before ICU admission and support of patients after discharge from the ICU should be part of the effort to decrease mortality for ICU patients. Inadequate provision of resources for critically ill patients may result in excess intensive care mortality that is not detected with ICU outcome prediction methods.
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Critical care medicine · Aug 1998
Comparative StudyImportance of the sampling site for measurement of mixed venous oxygen saturation in shock.
To determine if oxyhemoglobin saturation in blood samples taken from the superior vena cava or right atrium can be substituted for oxyhemoglobin saturation in blood taken from the proximal pulmonary artery (SVO2) in patients in shock. ⋯ These wide range differences and confidence limits would lead to large errors if superior vena cava or right atrial oxyhemoglobin saturations were substituted for true mixed venous blood in oxygen transport or pulmonary venous admixture calculations, or if clinical decision making was based on individual results. In patients in shock in whom clinical decisions may be based on the value of mixed venous oxyhemoglobin, oxyhemoglobin saturation is only reliably measured in samples taken from the pulmonary artery.