Articles: intensive-care-units.
-
To examine the limits of the effectiveness of critical care through the study of patients for whom it was ineffective. ⋯ Patients in the PIC category consumed a large portion of the resources devoted to critical care at an academic teaching hospital. We suggest a change in focus from assessment of the quality of critical care and risk-adjusted mortality to an assessment of ineffective care based on outcome and resource use and a patient's response to treatment over time.
-
More than 250,000 women will die of cancer in the United States this year, almost 10% of which are due to gynecologic malignancies. Many of these women will have received care in the intensive care unit (ICU). With important advances in medical technology and the advent of an expanded pharmacologic armamentarium, our ability to maintain life has increased greatly over the past few years. ⋯ Decisions regarding admission to an ICU, level of care, and termination of care must take into account patient and family wishes, a reasonable estimation of the reversibility of the acute disease process in question, and the natural history of the underlying disease. Many prognostic scoring systems have been devised to estimate the probability of death among adult ICU patients; however, most of these systems were developed with data from trauma patients rather than from patients with an underlying malignancy, and none are capable of predicting which patient will die. Decisions concerning level of care in the ICU will necessarily involve medical as well as ethical considerations and are best made with a team approach.
-
J Wound Ostomy Continence Nurs · Nov 1995
Clinical Trial Controlled Clinical TrialEvaluation of three types of support surfaces for preventing pressure ulcers in patients in a surgical intensive care unit.
Because critical care nurses recognize that many of their patients are at risk for pressure ulcer development, they provide them with support surfaces that can reduce this risk. Few reported studies, however, are available to help these nurses choose these surfaces wisely. This project was a new-product evaluation that compared the clinical effectiveness of three types of support surfaces: two dynamic mattress replacement surfaces and a static foam mattress replacement. ⋯ Although these three surfaces were comparable in effectiveness, they were not comparable in cost. Both dynamic mattress replacement surfaces cost approximately $2000 each, whereas the cost of the static foam mattress replacement was only $240 each. The results of this product evaluation should encourage other nurses to evaluate patient care products carefully before making recommendations.
-
Randomized Controlled Trial Multicenter Study Clinical Trial
Premature infant responses to noise reduction by earmuffs: effects on behavioral and physiologic measures.
The continuous high-intensity noise in the neonatal intensive care unit (NICU) is both stressful and harmful for the premature infant. Although some researchers have found evidence that loud noise can cause hearing loss and alter physiologic and behavioral responses, no study to date has investigated the benefits of noise reduction by the use of earmuffs. In this study earmuffs were placed over the premature infants' ears to reduce noise intensity in the NICU while physiologic and behavioral responses were measured. ⋯ When infants wore the earmuffs, they had significantly higher mean oxygen saturation levels and less fluctuation in oxygen saturation. Furthermore, these infants had less frequent behavioral state changes, spent more time in the quiet sleep state, and had longer bouts in the sleep state. It is imperative that NICUs develop aggressive antinoise policies to substantially and consistently reduce noise.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Patient outcomes for the chronically critically ill: special care unit versus intensive care unit.
The purpose of this study was to compare the effects of a low-technology environment of care and a nurse case management case delivery system (special care unit, SCU) with the traditional high-technology environment (ICU) and primary nursing care delivery system on the patient outcomes of length of stay, mortality, readmission, complications, satisfaction, and cost. A sample of 220 chronically critically ill patients were randomly assigned to either the SCU (n = 145) or the ICU (n = 75). Few significant differences were found between the two groups in length of stay, mortality, or complications. ⋯ The average total cost of delivering care was $5,000 less per patient in the SCU than in the traditional ICU. In addition, the cost to produce a survivor was $19,000 less in the SCU. Results from this 4-year clinical trial demonstrate that nurse case managers in a SCU setting can produce patient outcomes equal to or better than those in the traditional ICU care environment for long-term critically ill patients.