Articles: intensive-care-units.
-
Critical care medicine · Jan 1991
Randomized Controlled Trial Clinical TrialPediatric critical care cost containment: combined actuarial and clinical program.
To determine if providing patients' daily survival probabilities to physicians and nurses along with a short videotape on the measurement of survival probabilities and costs of pediatric intensive care would reduce resource use. ⋯ Reduction in pediatric intensive care resource use can occur from the combined effects of actuarial and clinical interventions.
-
Hosp Health Serv Adm · Jan 1991
ReviewIntensive care units in the triage mode: an organizational perspective.
Decisions to admit and discharge patients to and from the intensive care unit (ICU) when beds are scarce should be made in accordance with the triage principle--that is, allocate resources on the basis of the ability to benefit from intensive care. However, uncertainty over resource capacity and patient prognosis limits the ability of decision makers to use this prioritization principle and results in ICUs containing inappropriately placed patients who are denying or delaying care to patients who could benefit more. Using Jay Galbraith's "information processing" model, ICU admission and discharge decision making is described. Organizational strategies to reduce uncertainty and improve decision making are discussed, including strengthening the management role of the ICU physician director and employing prognostic instruments (e.g., mortality prediction models) to share and process information.
-
The increasing aggressivity of the modern technology connected with neonatal resuscitation had led to the recognition by paediatricians of the existence of pain in the newborn, and of the necessity to treat this condition. The neurophysiological development of the neonate is such that it allows pain perceptions even in premature infants; a number of clinical parameters have therefore been described for pain recognition in neonates. An antalgic therapeutic scheme to be used for treatment of pain in the intensive care unit is proposed.
-
This paper summarizes the experience with ligation of persistent ductus arteriosus in prematures performed in the intensive care unit during the years 1986 to 1988. Records of 35 operated prematures on artificial ventilation were analyzed retrospectively. Management and organization of the operation are described. For comparison, records were analysed of 47 prematures, also artificially ventilated, who during the years 1978 to 1986 had to be transported to an operating theatre over a distance of 3 or 10 km for the ligation.
-
Allocation of scarce and vital medical resources in intensive care units (ICUs) is one of the most actual and controversial questions within the context of medical ethics. How shall doctors decide which patients shall benefit from scarce resources such as ICU beds, ventilators, incubators, etc.? Which criteria are more acceptable from the ethical viewpoint in these triage situations: The rights of the patients? The expected benefits? The will of the patients or of their relatives? And how can medical responsibility be envisaged within this context? These are some of the questions discussed in this article having in mind the present framework of ethical and legal obligations pending upon doctors practicing in Portugal.