Articles: intensive-care-units.
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Critical care medicine · Apr 1993
ReviewCivilian triage in the intensive care unit: the ritual of the last bed.
To evaluate the numerous problems that exist when there is an acute shortage of trained critical care nurses, no triage officer is available or designated, there is no cooperation among intensive care units (ICUs) or alternative sites, or there is excessive political or financial pressure applied to maintain a referral practice or to fill all the beds, or limited ability to divert ambulances to other hospitals. The Joint Commission on Accreditation of Health Care organizations now mandates a written policy: "when patient load exceeds optimal operational capacity" (1992). ⋯ It is necessary to have public disclosure of the broader issues related to high-level triage. The first issue is recognition that there are periods of time when ICU capacity is exceeded or skilled critical care nurse availability is reduced. The next issue is the decision of who is best suited to make complex and dynamic triage decisions and what kind of oversight should be provided. Other issues relate to whether there should be patient or family consent, and what to do about patients receiving marginal benefit or who are considered hopeless or unsalvageable, yet the family or surrogate decision maker (or perhaps one of the consultants) wants to continue active care in the ICU. In the conflict between individual and community rights and benefits, there should be a nonlitigious approach when a patient is harmed during these periods of high census or limited capacity. In recognition of these complex issues (including potential conflicts among ICUs, hospital administration, individual physicians, and the various medical and surgical programs feeding patients into special care units), the Society of Critical Care Medicine has organized a Task Force on the legal and ethical justification for triage.
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Critical care medicine · Apr 1993
Endocrine profiles for outcome prediction from the intensive care unit.
To evaluate the discriminating ability of various specific endocrine studies on patient outcome from the intensive care unit (ICU). ⋯ The basal cortisol and triiodothyronine concentrations obtained from blood samples collected within 48 hrs of ICU admission appear to be better discriminators of patient outcome than the APACHE II score.
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To describe the structure and organization of pediatric intensive care units (ICUs) in the United States. ⋯ Substantial diversity exists in pediatric ICU structure and organization. Determining factors associated with quality of care is important for improving outcomes.
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Critical care medicine · Mar 1993
Near drowning: is emergency department cardiopulmonary resuscitation or intensive care unit cerebral resuscitation indicated?
a) To report the neurologic outcome of a series of near-drowning victims treated with supportive management without aggressive cerebral resuscitation; and b) to identify patient characteristics that indicate prognosis and guide therapy at the scene, the Emergency Department, and in the intensive care unit (ICU). ⋯ Our results cast further doubt on the utility of aggressive forms of cerebral monitoring and resuscitation and emphasize the need for initial full resuscitation in the Emergency Department.