Articles: intensive-care-units.
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The persistent differences between those who question the appropriateness of aggressive resuscitative measures for many extremely low birth weight (ELBW) infants (birth weight < 1001 g) and those who generally initiate such treatment has been a source of ongoing tension for physicians, parents, judges, and policymakers. We believe that much of this tension may be a result of the way the issue is framed. We began this study with the intuition that although many ELBW infants die, most succumb quickly. Were this true, discussions that considered only survival rates might miss the point. A more relevant statistic might be the degree to which interventions prolong dying, extend suffering, or use resources for infants who will eventually die. ⋯ Generally, when we talk of survival rates to parents, ethics committees, or policy makers, we base our predictions largely on birth weight. The data presented here suggest that predictions should be corrected by including DOL and that, when this is done, the prognostic value of birth weight rapidly diminishes. In addition, birth weight-specific mortality and day of death for nonsurvivors correlated inversely; that is more of the smaller infants died, but the doomed ones died more quickly. Consequently, medical resources allocated to nonsurvivors remained low, and independent of birth weight. This formulation lends weight both to the reasonableness of physicians in offering NICU care to ELBW infants, with unlikely prospects for survival, and of parents and surrogate decision-makers in requesting/ assenting to it.
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To prove that tracheostomy performed at the bedside in the intensive care unit is a safe, cost-effective procedure. ⋯ Bedside tracheostomy in the intensive care unit can be performed with morbidity and mortality rates comparable to operative tracheostomy. In addition, it provides a significant cost savings for the patient.
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Our purpose was to evaluate the cost and benefit of noise reduction after replacement of acoustic ceiling tile in an open ward neonatal intensive care unit (NICU). ⋯ The renovation resulted in a small decrease in the decibel level in the NICU, although this measured decrease was not perceived by observers. With a formal prerenovation noise evaluation, a more efficient ceiling tile might have been selected or the project may have been aborted or modified because of the low levels of noise already present.
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Dimens Crit Care Nurs · May 1996
Comparative StudyCharacteristics related to DNR orders for pediatric ICU patients.
Although technology exists to sustain vital functions of almost any patient, not every pulse-less patient is a candidate for resuscitation. Criteria needs to be developed to guide health care professionals in identifying DNR situations and teaching families about DNR options. The first step is to identify characteristics that are related to current DNR selection, so prescriptive criteria can be developed to aid in DNR decisions in the future. This article presents a descriptive study of characteristics associated with DNR statistics for pediatric ICU patients.
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Comparative Study
Enhanced enteral and parenteral nutrition practice and outcomes in an intensive care unit with a hospital-wide performance improvement process.
To improve patient outcomes at a 455-bed community health care facility, a performance improvement process was implemented for the delivery of enteral and parenteral nutrition in a 28-bed intensive care unit (ICU). In 1992, the study group consisted of all patients who were started on either enteral or parenteral nutrition while in the ICU during a 2-month period. These patients were followed up until discharge from the hospital or death to determine practice patterns and outcomes. ⋯ Through an interdisciplinary approach, a nutrition support decision tree and patient outcome statement were developed. In 1994, evaluation of a group meeting the same criteria as the original group indicated that the goals for nutrition support practice improvement were met in all three areas identified. Providing a systematic approach to an interdisciplinary performance improvement process, as part of an organization-wide plan, enhanced nutrition support practice in a community hospital and resulted in quality improvement and cost savings.