Articles: intensive-care-units.
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Intensive care medicine · Oct 1996
Antibiotic susceptibility in aerobic gram-negative bacilli isolated in intensive care units in 39 French teaching hospitals (ICU study).
Evaluation of the distribution and antibiotic susceptibility of the aerobic gram-negative bacilli (AGNB) isolated from patients in intensive care units (ICU study). ⋯ Rates of resistance in AGNB as a whole and in particular species (P. aeruginosa, Klebsiella), as well as frequency of concomitant resistance found in the French ICU study, were higher than those found in ICU studies conducted with the same methodology in Belgium, The Netherlands, and Germany, which may reflect differences in case mix.
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To evaluate the ability of the Simplified Acute Physiology Score (SAPS) to predict the occurrence of hospital-acquired infections in intensive care unit (ICU) patients, we conducted a cohort study in an eight-bed combined ICU. From January 1991 to December 1992, 690 patients were admitted in the ICU and 656 stayed at least 48 h. Patients' severity of illness was estimated within the first 24 h of the ICU stay using the SAPS. ⋯ Significantly more infections occurred in the patients with a SAPS > 10 points (20.9% vs. 5.1%, P < 0.0001). Sensitivity, specificity, positive and negative predictive values for a SAPS > 10 points were 88, 40, 21, and 95%, respectively. Our results suggest that 95% of patients at low risk for developing hospital-acquired infections could be identified on admission with the use of severity scoring systems such as SAPS < or = 10 points.
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Complications of pregnancy may necessitate admission to an Intensive Therapy Unit (ITU). All obstetric patients admitted to ITU were reviewed in order to assess whether these admissions could have been predicted and to determine the place of intensive care compared with high dependency nursing. Case notes of 122 women from a total group of 144 women admitted to an ITU of an inner-city hospital from 1989-1993 were reviewed retrospectively. ⋯ The perinatal mortality rate was 6% and there were three maternal deaths. The need for admission to ITU was unpredictable in two-thirds of the cases. Many of the women evaluated in this review were ineligible for high dependency care and required full ITU facilities, both of which will always be needed to deal with serious complications of pregnancy.
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In April 1994 at the University of California at Los Angeles Medical Center the Surgical Intensive Care Unit's (SICU's) Quality Improvement Council unanimously agreed on pain management as one of the major factors that negatively affect outcomes for their patient population. Using the FOCUS-PDCA (plan-do-check-act) model for quality improvement (QI), the council chartered a subcommittee to improve the pain management in their ICUs. ⋯ The Quality Improvement Council felt that improvements in pain management were due largely to their having provided staff with the right tools to use in assessing, documenting, and controlling pain. Gains in pain management continue to be made.
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Comparative Study
Full-cost determination of different levels of care in the intensive care unit. An activity-based costing approach.
We applied an activity-based costing methodology to determine the full cost of intensive care service at a community hospital, a university hospital and a health maintenance organisation (HMO)-affiliated hospital. A total of 5 patient care units were analysed: the intensive care unit (ICU) and surgical ICU (SICU) at the university setting, the ICU at the community setting, and the SICU and cardiac care unit at the HMO setting. ⋯ The analysis revealed a marked increase in patient-minute cost associated with mechanical ventilation. Higher costs associated with prolonged neuromuscular blockade have important economic implications with respect to selection of an appropriate neuromuscular blocking agent.