Critical care medicine
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Critical care medicine · Sep 1994
Use of daily Acute Physiology and Chronic Health Evaluation (APACHE) II scores to predict individual patient survival rate.
To evaluate the use of daily Acute Physiology and Chronic Health Evaluation (APACHE) II scoring in the prediction of individual mortality rates for intensive care unit (ICU) patients. ⋯ Admission or daily APACHE II scores do not predict individual patient mortality. The adjustments needed in the algorithm that was used to avoid a false prediction of death render sensitivity so low that it would be impractical to limit therapy on this basis alone.
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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.