Articles: intensive-care-units.
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To audit all deaths in intensive care units (excepting coronary care only and neonatal intensive care units) in England to assess potential for organ procurement. ⋯ When brain stem death is a possible diagnosis tests should always be carried out for confirmation. Early referral to the transplant team or coordinator should occur in all cases of brain stem death to check contraindications to organ donation. There should be increased use of asystolic kidney donation, and patients should be routinely assessed for suitability for corneal donation. Finally, more publicity and education are necessary to promote consent.
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We consecutively and prospectively studied 219 critically ill patients to evaluate the accuracy of the physical examination in assessing ETT position and the appropriateness of taking routine chest x-ray films after intubation in the ICU. As a result of x-ray findings, 14 percent of the patients required ETT repositioning, and 5 percent had main-stem intubations. Endobronchial intubation was more common in females than in males, and frequently occurred after emergency intubations. ⋯ This study confirms the unreliability of the physical examination to assess ETT position. Chest x-ray films after intubation are indicated to verify tube position, particularly after emergency intubations. Other techniques such as use of a lighted stylet require evaluation to determine whether they are more cost-effective in verifying ETT placement in patients who have no other indication for postintubation x-ray films.
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Our purpose was to analyze hospital cost, resource utilization, and outcome by age for a large group of patients who required intensive care unit (ICU) services. Patients in the ICU (N = 6331) were stratified by age groups. Mean hospital cost per patient generally increased with age. ⋯ The current DRG hospital payment system appears to be inequitable for the patient who receives treatment in the ICU during the hospital stay. As hospital operating margins continue to decline because of federal and state DRG hospital payment systems, additional pressures may be applied for physicians, nurses, and health care professionals to cut expenses for these patients. In this effort to watch the bottom line, physicians and nurses must not sacrifice the quality of or the access to care for patients who require ICU services.
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Annals of plastic surgery · Nov 1989
Utilization of the burn unit for nonburn patients: the "wound intensive care unit".
Burn units and experienced burn nurses are valuable, expensive resources that are underutilized when the burn census is low. Burn facilities can be used to treat other conditions or injuries to provide optimum wound management or to provide overflow intensive care unit beds. We studied via a questionnaire survey the admission profiles of 120 burn units in the United States to determine frequency of utilization for nonburn injuries. ⋯ Seventy-seven burn units also accept overflow patients from other critical care units. A significant amount of nonburn wound care is being provided by burn units in the United States, with potential benefit to both the patient and the burn unit. The implications of the use of burn facilities as "wound intensive care units" are discussed.
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J Burn Care Rehabil · Nov 1989
Burns and associated nonthermal trauma: an analysis of management, outcome, and relation to the Injury Severity Score.
Nonthermal trauma in patients with burns necessitates additional considerations in management. The charts of all patients with nonthermal trauma admitted to a regional burn center from 1977 to 1987 were reviewed. The causative events and types of injury were determined. ⋯ Fracture management varied, and the only complications that occurred among the 15 of 61 patients with fractures were associated with overlying burns. The mortality rate was 20%, which is comparable to that predicted from the patients' ages and the percent of total body surface area burned. The mortality rate predicted from the Injury Severity Score is much lower, which brings into question its use for analysis of this patient population.