Current opinion in critical care
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Curr Opin Crit Care · Oct 2009
ReviewHealth-related quality of life in critically ill patients: how to score and what is the clinical impact?
Traditionally, the assessment of critical care has focused largely on mortality. However, in the last few years, there is more attention on the quality of survival. Health-related quality of life (HRQOL) is an important issue for both patients and family. The purpose of this review is to describe HRQOL scoring in critically ill patients and to discuss the clinical impact on HRQOL. ⋯ In this article, we reviewed the methods and description of measurement instruments used in critically ill patients. The most recently used instruments to measure HRQOL, how to score HRQOL before ICU admission and the impact of critical illness on HRQOL are discussed. Assessment of HRQOL can improve the answers given by critical care physicians and nurses about the prospects of their patients. To get insights in these issues regarding the impact of ICU treatment, we should incorporate not only short-term outcomes, for example length of stay and mortality, but also HRQOL.
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Curr Opin Crit Care · Oct 2009
ReviewAerosolized antibiotics in critically ill ventilated patients.
This review will summarize recent clinical data examining the efficacy of aerosolized antimicrobial therapy in treating respiratory tract infections in mechanically ventilated patients in the ICU. ⋯ Aerosolized antibiotic therapy may provide an efficacious means of treating respiratory tract infection when targeted at mechanically ventilated patients with proximal airway infection, VAT (with or without VAP) and with highly resistant organisms.
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In this article we discuss our experiences benchmarking eight ICUs in The Netherlands. Benchmarks must be carefully designed and implemented to generate meaningful results. We define prerequisites that we have identified for successful benchmarking and discuss the development, implementation and results of ICU benchmarks that we have completed. ⋯ Benchmarking is an increasingly common activity, however it is difficult to prove that benchmarks result in improved outcomes. Concurrent with our benchmarking activities the Standardized Mortality Ratio in Dutch ICUs has decreased. We have been able to show that larger ICUs in our benchmarks generally had improved outcomes despite a higher average patient severity. Quality assurance in healthcare is maturing and benchmarks will become an increasingly useful way of comparing performance between institutions.
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Curr Opin Crit Care · Oct 2009
ReviewIs MOF an outcome parameter or a transient, adaptive state in critical illness?
The term 'multiorgan failure' (MOF) carries the negative connotation of major homeostatic breakdown and severe malfunction. However, this traditional paradigm may not be necessarily accurate. This review will investigate the rationale for no longer considering MOF to be simply a 'failed' pathophysiological state. ⋯ The concept of MOF could be revisited as a transient state of metabolic shutdown analogous to hibernation. Avoiding the detrimental effects of inappropriate and counter-adaptive iatrogenic interventions is an important cornerstone of therapeutic management.
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Prognostic models for predicting outcome after severe traumatic brain injury (TBI) may be useful in several areas. However, established risk prediction models for general critical illness show significant limitations in neurotrauma. Development of specific risk prediction models for TBI has been difficult due to the variability of injury, which predicates a large sample for construction of robust models. Previous development of prognostic models for TBI has suffered from small sample sizes, poor study design and follow up, difficulty in application to clinical practice, limited inclusion of patients from low income countries, and lack of external validation. ⋯ The outcome prediction models that have evolved from these databases are undergoing further refinement and validation, and it is likely that these advances will prove valuable in training clinicians, counselling patients' families, auditing unit performance, designing better clinical trials, and rational allocation of resources.