Crit Care Resusc
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To develop an influenza pandemic ICU triage (iPIT) protocol that excludes patients with the highest and lowest predicted mortality rates, and to determine the increase in ICU bed availability that would result. ⋯ The iPIT protocol excludes patients with the lowest and highest ICU mortality, and provides increases in ICU bed availability. Adjusting the lower SOFA score exclusion limit provides a method of escalation or de- escalation to cope with demand.
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Comparative Study
Predicting energy expenditure in sepsis: Harris-Benedict and Schofield equations versus the Weir derivation.
Given the difficulties of using indirect calorimetry in many intensive care units, clinicians routinely employ predictive equations (the Harris-Benedict equation [HBE] and Schofield equation are commonly used) to estimate energy expenditure in critically ill patients. Some extrapolate CO(2) production (V CO(2)) and O(2) consumption (V O(2)) by the Weir derivation to estimate energy expenditure. These derivative methods have not been compared with predictive equations. ⋯ In a cohort of patients with sepsis, TEE values calculated by the HBE and Schofield equation matched reasonably well with MEE values derived from the Weir equation. Correlation was better in patients with less severe sepsis (SIRS and severe sepsis and APACHE II score < 25). Our results suggest that predictive equations have sufficient validity for ongoing regular use in clinical practice.
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To compare patients admitted from the emergency department (ED) directly to a ward (EDWard), the intensive care unit (EDICU) or stepdown (high dependency) unit (EDSDU) with patients admitted via the ED, but whose admission to an ICU (EDWardICU) or SDU (EDWardSDU) was preceded by a ward stay. ⋯ Patients discharged from the ED to a general ward and subsequently to an ICU or SDU had a mortality that exceeded that of ED patients admitted directly to the ICU or SDU. Further investigations are warranted to explain this excess mortality and ascertain the extent of potential preventability.
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Epidemiology and clinical trials require valid, repeatable definitions that ideally dichotomise patients into having, or not having, a clinical condition. • Some conditions are clearly dichotomous, such as pregnancy; others such as hypertension or obesity rely on defining a threshold on an objective scale. • Defining delirium and "adequate" sedation and analgesia in the intensive care unit is more difficult, as there is no universally agreed scale that quantifies the relative importance of various diagnostic features, distinguishes features merely observed from those actively sought, quantifies severity or fluctuation over time, or accounts for the variable approaches of clinicians and the effects of assessment environment and pharmacological treatment. Definitions of delirium and adequate sedation and analgesia therefore vary by assessment method and context, making studies using different methods and personnel not necessarily comparable. • Although there is no simple solution, we suggest better awareness of these problems will be helpful. Further, we propose a simplified categorisation to facilitate clinical communication and treatment in the ICU.