Articles: intensive-care-units.
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Critical care medicine · Aug 1999
Clinical Trial Controlled Clinical TrialFinancial impact of elimination of routine chest radiographs in a pediatric intensive care unit.
To determine the change in chest radiograph use if each chest radiograph requires a separate order and clinical indication. ⋯ These results demonstrate the impact of an evaluation and subsequent change in radiology ordering practice in our PICU. The change resulted in decreased variability in ordering practice, fewer chest radiographs per patient, and an accompanying cost savings to our patients and payors.
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Comparative Study
Nosocomial outbreak of gentamicin-resistant Klebsiella pneumoniae in a neonatal intensive care unit controlled by a change in antibiotic policy.
Between August and November 1997, a nosocomial outbreak caused by gentamicin-resistant Klebsiella pneumoniae occurred in the Neonatal Intensive Care Unit (NICU) of our hospital. Thirteen neonates became colonized and three of them became infected. Comparison of the isolates by amplified fragment length polymorphism (AFLP) revealed clonal similarity for isolates of eight neonates (homology > 90%). ⋯ Length of stay on the NICU was significantly longer for cases, but mean time until colonization (6.3 days) was shorter than the total stay for controls (9.5 days). No single member of the medical or nursing staff was significantly more involved with cases than with controls. The outbreak was stopped by replacing gentamicin by amikacin as the antibiotic of first choice whenever the use of an aminoglycoside antibiotic was indicated.
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Anaesth Intensive Care · Aug 1999
Comparative StudyPatient referral and transportation to a regional tertiary ICU: patient demographics, severity of illness and outcome comparison with non-transported patients.
A descriptive analysis and comparison of critically ill transported patients with non-transported patients will assist in selecting the appropriate referral and transportation process and subsequent incorporation into the critical care services of receiving hospitals. A retrospective review of transported and non-transported patients admitted to the same Intensive Care Unit was conducted. ⋯ Transported patients had a different case mix, significantly higher severity of illness measures, mortality and length of ICU stay. Observed mortality of transported patients with sepsis, gastrointestinal disease or bleeding, intracranial haemorrhage and post respiratory arrest was less than predicted whilst those with neurological disease, post cardiac arrest and overdose had a higher than predicted mortality.
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Critical care medicine · Aug 1999
Forgoing life support in western European intensive care units: the results of an ethical questionnaire.
To determine current views of European intensive care physicians regarding end-of-life decisions. ⋯ Intensive care unit admissions are frequently limited by the availability of beds across Europe, particularly in the south and in the United Kingdom, yet 73% of intensivists still admit patients with no hope of survival. When treating patients with no hope of survival, 40% of intensivists will deliberately administer large doses of drugs until death ensues. There are interesting differences between what a physician actually does and what he or she believes should be done with regard to various ethical questions. Important differences in attitudes also exist between European countries.