Anaesthesia
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We assessed the hourly occupancy of our intensive care unit by high dependency patients over an 8-week period using the criteria established by the Working Group on Guidelines on Admission to and Discharge from Intensive Care and High Dependency Units published by the National Health Service Executive. High dependency patients accounted for 1914 bed hours (21.6%) out of a potential available total of 8880 hours. Measurement of Therapeutic Intervention Scoring System points and Acute Physiology and Chronic Health Evaluation II scores confirmed that categorising patients according to the new guidelines produced significantly different populations of patients. ⋯ Calculating bed occupancy with different definitions for the whole of our intensive care unit population during the 8 weeks revealed a range of occupancies between 85.3% and 107.3%. We recommend the intensive care unit bed occupancy should be calculated in a standard manner nationally to allow comparison between units. We suggest that hourly occupancy be adopted as the universal method.
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We studied a group of spontaneously breathing patients anaesthetised for routine orthopaedic surgery using a circle system and isoflurane in a Komesaroff vaporiser within the circle. We observed and recorded: (1) the change in inspired isoflurane concentration caused by changing the fresh gas flow, (2) the increased respiration produced by surgical stimulus and the resulting increase in isoflurane concentration, (3) the respiratory depression produced by opioids and the consequent decrease in isoflurane concentration. We consider this regulation of anaesthetic uptake by the patient to be beneficial.
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We studied the frequency with which treatment was withdrawn in intensive care patients and the primary reason for reaching the decision. The medical records of patients having had active treatment withdrawn between August 1992 and February 1996 inclusive were reviewed. Patients were classified into an imminent death group consisting of those expected to die, a qualitative group who had treatment withdrawn on quality of life considerations and a lethal conditions group who had associated disease that precluded long-term survival. ⋯ The primary reason for treatment withdrawal was imminent death in 45% of patients, qualitative considerations in 50% and lethal conditions in 5%. The reason varied significantly depending on the patient's age. Treatment is withdrawn commonly in ICU, the primary reason being quality of life considerations as often as because death is the expected outcome.