Articles: intensive-care-units.
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Critical care medicine · Mar 1997
Factors explaining variability among caregivers in the intent to restrict life-support interventions in a pediatric intensive care unit.
To explore patient-related factors which influence the decisions of pediatric intensive care unit (ICU) caregivers to restrict life-support interventions. ⋯ Critically ill children and their families could face markedly different attitudes about the restriction of life-support interventions, depending on which nurses and physicians are involved in their care.
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In order to evaluate the effectiveness of an intensive care unit (ICU), the case-mix has to be considered. This was a cohort study. By using Acute Physiology and Chronic Health Evaluation scores (APACHE II score), we evaluated the case-mix and mortality rate of 282 patients who were treated in our postoperative ICU. ⋯ We used stepwise logistic regression to determine the predictors of death and found the prediction model to be -7.24 + 0.37 (APACHE II score) + 1.46 (postemergency surgery). The actual mortality for patients with APACHE II score > 15 in our ICU was higher than that predicted by the original APACHE II model. The causes of this difference might be difference in methodology, characteristics of ICU and the quality of care.
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Comparative Study
[The evaluation of autopsy in the pediatric intensive unit].
Because of concerns about the declining autopsy rate, an attempt was made to evaluate the contributions from the postmortem examination in children. ⋯ The value of the autopsy as quality assurance and to detect iatrogenics and occult genetic diseases is unquestionable. New strategies have to be designed to increase the rate of autopsies.
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To document the impact of routine daily chest radiographs on treatment decisions in a medical ICU. ⋯ Routine daily chest radiographs may be justified in critically ill patients in a medical ICU because for a large proportion of these patients management decisions are made on the basis of information obtained from the chest radiograph. This observation may be applicable only to ICUs that have a high turnover of patients who are in the unit for a short time.