Articles: intensive-care-units.
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A 1-month prospective quality improvement audit was performed to determine the incidence of self-extubation in the intensive care units (ICUs) at the Westchester County Medical Center (WCMC), a 625-bed tertiary care hospital with 92 intensive care beds in 11 ICUs. During the 1-month study period, there were seven unplanned extubations in six of 121 intubated patients, or one unplanned extubation for every 136 patient-ventilator days. Based on the initial review, a corrective action plan was initiated that consisted of education of nurses and house staff about the problem of unplanned extubation, daily assessment on rounds of patient risk of unplanned extubation, and careful documentation of any episodes of unplanned extubation. ⋯ Unplanned extubation can be a serious complication associated with mortality and therefore is a quality-of-care concern. However, the majority of patients with this complication did well and were discharged from the hospital. The incidence of unplanned extubation can be reduced but not eliminated by a program of education and attention to risk factors for unplanned extubation.
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Southern medical journal · Nov 1994
Frequency and outcome of infectious disease admissions to a pediatric intensive care unit.
This prospective clinical study was designed to assess patients with primary infectious disease (ID) necessitating admission to a pediatric intensive care unit (PICU), to identify morbidity and mortality risk factors, and to better define this subpopulation of critically ill children and compare them with patients who had a noninfectious disease (NID). All patients (N = 1,151) admitted to a multidisciplinary, university-affiliated, 20-bed PICU from January through December 1988 were studied. The patients were classified as having either ID or NID as the primary indication for PICU admission. ⋯ We concluded that patients admitted to our PICU with a diagnosis of infectious disease were significantly younger and had higher severity of illness scores than patients admitted with a diagnosis of noninfectious disease. The most frequent cause of death in both groups was multisystem organ failure. Patients with sepsis syndrome showed showed no significant difference in overall mortality, but their PRISM scores and mortality rate were significantly greater than those of the other ID patients.
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Noise in the operating theatre, recovery room and intensive care unit is above internationally recommended levels. The psychological and physiological effects of noise are reviewed. Equipment and conversation among the staff are major sources of noise in these areas. Equipment design, modification of nursing care procedures, and increased awareness of noise created by the staff may be effective in reducing noise pollution in these areas.
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Although only 5-10% of all hospitalized patients are treated in ICUs, they account for approximately 25% of all nosocomial infections, and the incidence of nosocomial infections in ICUs is 5-10 times higher than that observed in general hospital wards. Systemic and respiratory infections are far more common than in general wards, and most epidemics originate in ICUs. Nosocomial infections are the primary focus of most infection control programmes because they are the cause of high mortality rates in ICUs. ⋯ A simple and inexpensive way to reduce nosocomial infections in ICUs is to ensure that staff disinfect their hands after dealing with a patient. Intravascular devices, mechanical ventilation and urinary catheterization are major risk factors for nosocomial infections, and their use should be evaluated daily and discontinued as soon as clinically possible. Selective decontamination of the digestive tract and the use of standard immunoglobulin for prophylaxis are still controversial and need further investigation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Critical care services are major contributors to rising healthcare costs, with intensive care units (ICUs) consuming nearly 20 percent of the country's healthcare expenditures. This article examines ways of controlling and avoiding unnecessary ICU costs. A case study shows how a thorough examination of admission, discharge, and transfer practices and provision of the appropriate number and mix of ICU and step-down beds can significantly reduce the use of critical care resources.