Articles: intensive-care-units.
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Visitation in adult critical care units is an important aspect of patient care, and thus should be incorporated into the patient's plan of care. There is no longer a question as to whether visitation should be liberalized or restricted; instead, visitation is individualized in each situation to best meet the patient's needs. One method of incorporating visitation into the care plan is by contracting with patients and family members.
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Between November 1985 and October 1989, 1413 patients were admitted to the medical intensive care unit (ICU) of our cancer hospital. Data collected at admission and during the ICU stay were analysed for: 1) medical problems and treatment modalities requiring the admission; 2) types of underlying disease; 3) mortality during intensive care; 4) nursing requirements. Of the 1413 admissions, 1220 were for solid tumors (mainly ovarian cancer, breast cancer and lung cancer) and 144 for hematological malignancies. ⋯ Overall mortality was 22%. Of 64 patients treated by artificial ventilation, 46 (72%) died during their ICU stay. 732 admissions were made in order for administration and monitoring of special treatment or new therapeutic modalities including phase I drug infusion, intraperitoneal chemotherapy, intensive (megadosage) chemotherapy, lipophilic drug containing liposomes and coadministration of platinum derivatives. Our experience emphasizes the role of ICU facilities in modern oncology for both optimal supportive care in emergency cases and the safe development of new anticancer modalities.
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To assess the effect of selective decontamination of the digestive tract on respiratory tract infections and survival of patients treated in an intensive care unit, we carried out a meta-analysis of clinical studies comparing patients treated with selective decontamination with untreated controls. From eleven trials (1489 patients), differences between observed and expected respiratory tract infections and mortality were compared, and odds ratios (ORs) calculated. Analysis was done according to study design. ⋯ By contrast, the mortality benefit was less clear. Studies with historical controls and randomised trials showed that mortality was not significantly different between treatment and control patients. The evidence from these studies is at best consistent with a very limited effect of selective decontamination of the digestive tract on survival of patients in the intensive care unit, despite a clear preventive effect on the occurrence of respiratory tract infections.