Articles: intensive-care-units.
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This observational study examined whether specific characteristics of 1168 patients admitted to a general intensive therapy unit had changed over 4 years. The patients' age, diagnosis, severity of illness on admission (APACHE score), duration of management and outcome were recorded prospectively. The risk of hospital mortality was calculated using the APACHE score modified by the appropriate coefficient for presenting diagnosis. ⋯ There was a significant reduction in duration of admission with 70% of patients being admitted for < or = 3 days in 1988-89 while a similar proportion were admitted for a week in 1985-86. Approximately 40% of patients in each year were admitted with a risk of hospital mortality of < or = 10%; such patients received only a short period of intensive care and had a low mortality in the intensive therapy unit. A group of patients with a low predicted (and actual) mortality rate was identified; such patients may be more appropriately managed on a high dependency unit.
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The emergence of specialized oncology practices such as bone marrow transplantation has resulted in a higher incidence of critical complications and complex needs, which has led many oncology units to develop new strategies to care for the patients in the oncology unit. Designated oncology intensive care unit (ICU) beds and a dedicated trained staff is one method of delivery; other institutions transfer patients to existing ICUs, and some have equipped the entire oncology unit for critical care interventions. It is necessary to evaluate key issues when providing critical care to patients with cancer.
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Pediatric critical care resource use in the United States is rapidly expanding despite low occupancy rates and organizational and leadership characteristics that suggest inefficient resource use in pediatric ICUs (PICUs). Studies confirm widespread inefficiencies. Use of PICU resources relates directly to severity of illness, and as a result mortality rates are directly related to efficiency rates. ⋯ Pediatric studies have focused more on efficiency evaluated on each day of ICU stay according to therapies used and severity of illness. If institutions are functioning in a very inefficient manner, a re-evaluation of admission and discharge criteria, as well as other hospital services, may be required to develop more efficient use of the PICU. The solution generally involves reducing the number of patients who are "too healthy to benefit." One intervention that has been successful in reducing resource use by these patients is a risk assessment program that contributes actual mortality risk information.(ABSTRACT TRUNCATED AT 250 WORDS)
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Critical care medicine · Aug 1994
Brain death in pediatric intensive care unit patients: incidence, primary diagnosis, and the clinical occurrence of Turner's triad.
To determine the incidence and characteristics of children with brain death in the pediatric intensive care unit (ICU), and to assess the incidence of the clinical triad (Turner's triad) of central diabetes insipidus, low glucose demand, and low CO2 production. ⋯ Our series of brain-dead patients in the pediatric ICU showed a 0.9% incidence of brain death. The most common primary diagnosis was trauma, a finding that is similar to other series. We also demonstrated that the clinical triad (Turner's triad) is present in this patient population, although only 12% of study patients demonstrated all three features.
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AACN Clin Issues Crit Care Nurs · Aug 1994
Visitation in the pediatric intensive care unit: controversy and compromise.
Much controversy has arisen in the last few decades regarding parental and family visitation in the intensive care setting. The greatest needs of parents while their child is in an intensive care unit include: to be near their child, to receive honest information, and to believe their child is receiving the best care possible. ⋯ To provide family-centered care in the pediatric intensive care unit, the family must be involved in their child's care from the day of admission. As health-care providers, the goal is to empower the family to be able to advocate and care for their child throughout and beyond the life crisis of a pediatric intensive care unit admission.