Current opinion in critical care
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Curr Opin Crit Care · Oct 2008
ReviewOutcome prediction in critical care: the Mortality Probability Models.
The comparison of morbidity, mortality, and length-of-stay outcomes in patients receiving critical care requires adjustment based on their presenting illness. These adjustments are made with severity-of-illness models. These models must be periodically updated to reflect current medical practices. This article will review the history of the Mortality Probability Model (MPM), discuss why and how it was recently updated, and outline examples of MPM use. ⋯ Understanding appropriate application of models such as MPM is important as transparency in healthcare drives demand for severity-adjusted outcomes data.
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Curr Opin Crit Care · Oct 2008
ReviewThromboprophylaxis in medical-surgical critically ill patients.
Although critically ill patients are at high risk of venous thromboembolism and bleeding, and thromboprophlyaxis is of proven effectivity in other settings, there remain relatively few data to assist clinicians in providing evidence-based care for medical-surgical patients in the intensive care unit. ⋯ Despite the high morbidity and mortality because of critical illness, the risk of venous thromboembolism in these patients, and adverse outcomes due to venous thromboembolism, much more methodologically rigorous data are required in the form of large, well designed randomized trials before firm recommendations about prophylaxis can be provided to this highly vulnerable population.
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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.