Articles: intensive-care-units.
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To examine structural and organizational characteristics at two ICUs with marked differences in risk-adjusted survival. ⋯ The methods used in this study can identify organizational problems and potential means for improvement. The best practices and suggestions for improvement at these units provide examples of methods for improving ICU management.
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The most important epidemiological, aetiological and diagnostic problems related to nosocomial pneumonia in the intensive care unit and its significance are reviewed. Areas of uncertainty are identified, as are methods for improving our understanding of this complex condition.
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Neuromuscular blocking agents (NMBAs) are commonly prescribed as adjunct therapy for many critically ill patients. Controversy exists regarding the appropriate long-term use of these agents, particularly since there are severe potential clinical consequences. The expanded use of NMBAs has had a significant effect on the cost of ICU care. ⋯ This article reviews some of the indicative economic issues surrounding the use of sedatives, analgesics, and NMBAs in the critical care arena. Understanding the pharmacokinetic and pharmacodynamic differences of these agents can aid in drug selection and route of administration. Appropriate drug selection can influence the pharmacoeconomics of these agents in the ICU.
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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.