Articles: intensive-care-units.
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The cost-effectiveness of the Intensive Care Unit after three decades of development has yet to be demonstrated. Accurate ICU resource allocation is limited by our inability to measure cost-effectiveness. ⋯ Methodology to examine long-term outcome and quality of life after intensive care is still in its infancy. Measurement of ICU cost is limited by a lack of cost-accounting models that not only reflect true cost but that are clinically applicable.
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Critical care medicine · Feb 1994
Fiberoptic bronchoscopy in the intensive care unit--a prospective study of 147 procedures in 107 patients.
To determine the value and safety of fiberoptic bronchoscopy in an intensive care unit (ICU). ⋯ Fiberoptic bronchoscopy in the ICU is safe, contributes valuable diagnostic information, and is useful for therapeutic purposes.
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Critical care medicine · Feb 1994
Changing patterns of terminal care management in an intensive care unit.
To empirically describe changes in terminal care management behavior over time with the advent of natural death acts and public dialogue and institutional policy regarding terminal care. ⋯ There is now an increasing probability that impending death will be acknowledged by a formal terminal care decision. Such decisions may become even more frequent with the dialogue generated by the Patient Self Determination Act and the advent of decisions based on physiologic futility.
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In this paper we present a detailed analysis of the use of the APACHE II (acute physiological and chronic health evaluation) scoring system on all of the patients admitted to the general intensive care unit at the Bristol Royal Infirmary over a 20-month period. The 6-month survival of 691 adult medical and surgical patients following intensive care was recorded and this data was analysed with admission and daily APACHE II scores using a relational database. ⋯ We also demonstrate that the best day one scores are approximately 50% less than the admission score, irrespective of outcome, indicating the benefit of intensive care. By contrast, however, the scores on day one have either not improved or have worsened since admission, reflecting the importance of the pre-morbid health status of the patient in determining outcome from intensive care.
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There are now two validated time points for predicting hospital mortality of ICU patients--at admission and at 24 hours. The best purposes include evaluation of high clinical performance ICUs and for patients being enrolled in clinical trials. For the latter purpose, the model must be calibrated in the individual hospital to ensure that the model is applicable. ⋯ The mathematical link between physiology score and estimation of hospital mortality is established only for the time point of 24 hours after ICU admission. Calibration and discrimination of the admission and 24-hour models also must be performed within each hospital in which individual probabilities are presented to families. It may be possible to customize a probability model such as MPM to achieve a high level of calibration at the individual hospital level.