Articles: intensive-care-units.
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Ann Acad Med Singap · May 1998
Impact on quality of patient care and procedure use in the medical intensive care unit (MICU) following reorganisation.
We conducted this retrospective, cohort study to evaluate the quality of patient care and procedure use in the medical care unit (MICU) following reorganisation and staffing by an intensivist. Consecutive admissions to an adult MICU in a university affiliated hospital during two 3-month periods, August to October 1993 (Period 1, n = 112) and January to March 1994 (Period 2, n = 127) were analysed. In Period 1, the MICU was run under the open system in which patient care was provided by the individual attending physicians. ⋯ Reorganisation of the MICU in Period 2 resulted in reduced length of MICU stay for survivors. Hence, we believe that coverage by a dedicated ICU team and active respiratory care by a respiratory therapist during office hours were beneficial for the care of the critically ill. There was also a noticeable increase in the use of invasive monitoring.
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Ann Acad Med Singap · May 1998
APACHE II and SAPS II are poorly calibrated in a Hong Kong intensive care unit.
This study seeks to determine if the Acute Physiology and Chronic Health Evaluation II (APACHE II) and the new Simplified Acute Physiology Score (SAPS II) model predictions are well calibrated in our adult Intensive Care Unit (ICU) patient population. 1064 successive ICU discharges were enrolled with 222 deaths at hospital discharge. APACHE II predicted 287.44 deaths, thus giving an APACHE II standardised mortality ratio (SMR) of 0.77 (95% confidence interval +/- 0.07). ⋯ The area under the Receiver Operating Characteristic plot for SAPS II risk of death was 0.87 (95% confidence interval +/- 0.028) while that for APACHE II risk of death was 0.88 (95% confidence interval +/- 0.026). Although the APACHE II and SAPS II models provide good discriminatory performance this study finds the APACHE II and SAPS II models to be poorly calibrated in that they over-predict mortality in our ICU population.
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The spectrum of neuromuscular disorders among intensive care unit (ICU) patients has shifted toward disorders acquired within the ICU and away from "traditional" neuromuscular disorders that lead to ICU admission. We sought to assess this spectrum by determining the causes and relative frequencies of neuromuscular disorders that led to electromyography (EMG) examinations in our ICU population. Ninety-two patients were studied over a 4 1/2-year period. ⋯ Thirty-nine (42%) developed acute myopathy (consistent with critical illness myopathy in most), and 13% developed acute axonal sensorimotor polyneuropathy (mainly critical illness polyneuropathy). Patients with acute myopathy and acute axonal sensorimotor polyneuropathy had similar functional outcomes. We conclude that among patients who underwent EMG in our ICU population, acute myopathy is three times as common as acute axonal polyneuropathy, and the outcomes from acute myopathy and acute axonal polyneuropathy may be similar.
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Am. J. Respir. Crit. Care Med. · May 1998
A "closed" medical intensive care unit (MICU) improves resource utilization when compared with an "open" MICU.
We hypothesized that a "closed" intensive care unit (ICU) was more efficient that an "open" one. ICU admissions were retrospectively analyzed before and after ICU closure at one hospital; prospective analysis in that ICU with an open ICU nearby was done. Illness severity was gauged by the Mortality Prediction Model (MPM0). ⋯ Days on MV were lower when "closed" (prospective 2.3 versus 8.5 d, p < 0.0005; retrospective 3.3 versus 6.4 d, p < 0.05). Pooled data revealed the following: MV predicted ICU LOS; ICU organization and MPM0 predicted days on MV; MV and ICU organization predicted hospital LOS; mortality predictors were open ICU (odds ratio [OR] 1.5, p < 0.04), MPM0 (OR 1.16 for MPM0 increase 0.1, p < 0.002), and MV (OR 2.43, p < 0.0001). We conclude that patient care is more efficient with a closed ICU, and that mortality is not adversely affected.