Articles: intensive-care-units.
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Conventional haemodialysis is not available on all intensive care units (ICUs) and there are relatively few renally trained nurses able to run haemodialysis machines. Continuous arteriovenous haemodialysis provides effective renal replacement therapy for critically ill patients in the ICU. Unlike continuous arteriovenous haemofiltration it provides sufficient control over electrolyte, solute and water balance to obviate the need for additional treatment with intermittent conventional haemodialysis.
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J Burn Care Rehabil · May 1990
Post-traumatic stress disorder in hospitalized patients with burn injuries.
The degree to which patients hospitalized for a major burn displayed symptoms of post-traumatic stress disorder or met the full criteria for this disorder was assessed during the course of hospitalization. Fifty-four consecutive patients were screened weekly for symptoms of post-traumatic stress disorder. ⋯ Post-traumatic stress disorder was found to be related to patients' total body surface area burn, length of hospital stay, sex (female patients), and lack of responsibility for the injury. The results suggest that although post-traumatic stress disorder in patients with burn injuries generally resolves without interventions other than standard hospital care, it might be preventable if patients who are at risk for developing it receive appropriate psychologic treatment soon after the injury.
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Critical care medicine · May 1990
Age, chronic disease, sepsis, organ system failure, and mortality in a medical intensive care unit.
We retrospectively studied relations between age, pre-existing chronic disease, sepsis, organ system failure, and mortality in 487 patients from a medical ICU. Single organ system failure (SOSF) occurred in 136 (28%) and multiple (greater than or equal to 2) organ system failure (MOSF) in 187 (38%) patients. Cardiovascular and pulmonary failure predominated. ⋯ Advancing age and prior chronic disease may diminish physiologic reserve and predispose to sepsis and MOSF. Although sepsis is a major risk factor for MOSF, a nonspecific host response to critical illness may contribute to the syndrome in 35% of patients. Advancing age, chronic disease, and the number of failing organs, particularly failure of cardiovascular, pulmonary, renal, and neurologic systems, are major determinants of overall mortality, but sepsis is not an independent contributor.
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A patient acuity classification is required by the Joint Commission on Accreditation of Healthcare Organizations, and this is vital in providing safe, cost-effective nursing care. The Workload Management System for Nurses (WMSN), which is based on direct and indirect nursing care research, prospectively classifies patients on the basis of direct care requirements and then establishes staffing levels on the basis of both direct care and indirect care workloads. Application of the Department of Defense WMSN to the military burn research center is feasible and has provided data for objective staffing adjustments and validated staffing requirements. In addition, several other quality assurance implications have been realized as a result of implementation of the system.
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Physiological stability index (PSI) is a score proposed to evaluate the severity of different diseases in pediatric intensive care units (PICU) by giving scores to the deterioration of 34 measurable physiological variables. In order to validate PSI, it was prospectively applied to 132 patients who entered our PICU. A significant difference (p less than 0.001) was found between the average score of those patients who survived (means: 6.1) versus those who did not (means: 21); No difference was found between theoretical mortality rates obtained by logistic regression analysis and those obtained according to PSI score ranks even thought direct hemodynamic measurements like cardiac output and capillary (wedge) pulmonary pressure were not considered in this study. In conclusion, the PSI is a useful method to measure the severity of illness in pediatric intensive care and to compare results among PICU.