Articles: intensive-care-units.
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Multicenter Study
Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease.
To describe outcomes and identify variables associated with hospital and 1-year survival for patients admitted to an intensive care unit (ICU) with an acute exacerbation of chronic obstructive pulmonary disease (COPD). ⋯ Patients with COPD admitted to an ICU for an acute exacerbation have a substantial hospital mortality (24%). For patients aged 65 years or older, mortality doubles in 1 year from 30% to 59%. Hospital and longer-term mortality is closely associated with development of nonrespiratory organ system dysfunction; severity of the underlying respiratory function substantially influences mortality following hospital discharge. The need for mechanical ventilation at ICU admission did not influence either short- or long-term outcomes. Physicians should be aware of these relationships when making treatment decisions or evaluating new therapies.
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The restructuring of healthcare delivery systems has increased the demand for successful, low-cost, alternative approaches to providing care. The authors detail the design, implementation, and evaluation of one alternative approach for delivery of care to thoracic surgery patients. The authors describe the use of a stepdown unit for the care of patients 24 to 36 hours after cardiothoracic surgery.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 1995
[Exposure of intensive care personnel to isoflurane in long-term sedation].
Isoflurane is a suitable agent to produce sedation in the intensive care unit (ICU). However, data concerning occupational exposure to isoflurane during long-term sedation are not yet available. The purpose of this study was to evaluate occupational exposure to isoflurane in the ICU. ⋯ We conclude that an effective high flow scavenging system, a low-leakage anaesthesia machine and an airconditioning equipment without recirculation could keep occupational exposure low. The majority of the measured values was below the NIOSH recommendation (2 ppm). All values was lower than a national state recommendation (10 ppm). Under other circumstances (e.g. without scavenging system) air pollution will be higher and therefore measurements at the working place are needed.
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J Epidemiol Community Health · Dec 1995
Neonatal intensive care cots: estimating the population based requirement in Trent, UK.
To estimate the population based requirement for neonatal intensive care (NIC) cots by investigating NIC utilisation in a large population based study. ⋯ Trent RHA is reasonably representative of the greater population of England and Wales in terms of both the distribution of birth weight and of birth weight-specific neonatal mortality. Trent RHA did not seen to be underprovided for NIC cots or to be overusing these cots inappropriately. It therefore seems reasonable, if the assumptions of the analysis are borne carefully in mind, to treat these utilisation data as a rough guide to true population based need. NIC cot requirements depend critically upon the size of the served population - small populations are subject to greater random variability and require relatively more cots to ensure cot availability on an equivalent proportion of days. A neonatal unit should not therefore serve a population generating fewer than 5000 and 25 000 births per annum, the estimated population based provision which would ensure free cots on 29 out of 30 days falls gradually from 1.20 to 0.88 NIC cots per 1000 births per annum. A cooperative network of NICUs offers the opportunity to provide fewer cots per head of population while maintaining good access for most neonates referred to the service.