Current opinion in critical care
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Curr Opin Crit Care · Oct 2008
ReviewHemodynamic monitoring by echocardiography in the ICU: the role of the new echo techniques.
The present review will discuss the usefulness of ultrasound in the ICU in assessing hemodynamic instability in various critical care conditions. We will discuss how to interpret echocardiographic findings in critically ill patients including the physiological consequences of mechanical ventilation. ⋯ Echocardiography is now an unavoidable tool in assessing hemodynamic instability in the ICU. Echocardiography is complementary to a pulmonary artery catheter in the management of critical care patients. Echocardiography training is crucial to help its widespread use in all ICUs.
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To describe the background to, rationale for, and structure and performance of the Intensive Care National Audit & Research Centre risk prediction model. ⋯ The Intensive Care National Audit & Research Centre model performs well in comparison with preexisting models when evaluated in independent validation data from UK critical care units. The use of interactions between the physiology score and diagnostic category produces better fit within individual diagnostic groups. The elimination of model exclusion criteria, for example age less than 16 years, means that the model compares the observed and expected outcomes for all patients admitted to a critical care unit providing a fairer method for comparative audit.
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To critically examine the mortality rates of septic shock over the last 25 years to determine if significant improvements have been accomplished. ⋯ Survival rates for patients in septic shock have gradually improved in critical care units worldwide over the last 25 years. Further improvement will be predicated on the discovery of new therapies to disrupt the underlying pathophysiology of sepsis and the development of improved rapid, diagnostic testing and immune monitoring of individual patients.
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Patients with acute pulmonary edema are often treated with noninvasive ventilation (NIV). There are essentially two modalities used in this setting: continuous positive airway pressure and bilevel pressure support ventilation. The clinical impact of these techniques and the subset of patients who can benefit from their application have not been definitely established. ⋯ Although in acute pulmonary edema NIV is more effective in improving respiratory distress than conventional oxygen therapy and reduces the necessity of intubation, the subset of patients who can best benefit from these techniques in terms of mortality still warrant further investigation.
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Curr Opin Crit Care · Oct 2008
ReviewCan outcome prediction data change patient outcomes and organizational outcomes?
Intensive care medicine consumes a high share of healthcare costs, and there is growing pressure to use the scarce resources efficiently. Accordingly, organizational issues and quality management have become an important focus of interest in recent years. Here, we will review current concepts of how outcome data can be used to identify areas requiring action. ⋯ Outcome assessment models provide an important framework for benchmarking. They may help the individual ICU to spot appropriate fields of action, plan and initiate quality improvement projects, and monitor the consequences of such activity.