Articles: intensive-care-units.
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Comparative Study
Efficiency of intensive care. A comparative analysis of eight pediatric intensive care units.
To calculate overall pediatric intensive care unit (PICU) efficiency rates, 1668 patients representing 6962 patient-days were studied in eight PICUs. The contributions to inefficiency by two patient groups--low-risk monitored patients and potential early-discharge patients--were quantified using measures of daily mortality risk and therapeutic assessments. Low-risk monitored patients never received a unique PICU therapy and had daily mortality risks less than 1%. ⋯ Potential early-discharge patients constituted from 12% to 29% of the populations and the potential early-discharge days of care ranged from 5.1% to 17.2% of the total days of care. These results indicate that large disparity exists in efficiency among PICUs. Efficiency rates of greater than 0.80 seem to be a reasonable goal.
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First year mortality and hospital morbidity were studied in 4678 surviving infants liveborn at National Women's Hospital during 1980, of whom 1113 had been admitted to the neonatal intensive care unit. Of children born there, but never admitted to the neonatal unit, 8.3% were hospitalised in their first year for a mean of 6.7 days per admission or 0.8 days per child. Hospitalisation rates were increased in neonatal unit survivors, ranging from 11.6% in normal birthweight to 15.5% in very low birthweight survivors. ⋯ Deaths in normal birthweight survivors were due to congenital abnormalities. No VLBW survivor died after discharge from National Women's Hospital. Children surviving neonatal unit care in Auckland in 1980 appeared to have less continuing first year morbidity and mortality than has been reported elsewhere.
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Critical care medicine · Sep 1987
Impact of hemodynamic monitoring in a medical intensive care unit.
Previous reports have shown hemodynamic data inaccurately predicted by physical examination and x-ray findings. Although invasive hemodynamic monitoring has been shown to significantly alter the management of critically ill patients, the impact on mortality has been difficult to assess. ⋯ However, cardiac output was accurately estimated. Management was altered 34% of the time because of invasive hemodynamic assessment; however, mortality was not affected by a change in therapy.
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Am. Rev. Respir. Dis. · Sep 1987
Randomized Controlled Trial Comparative Study Clinical TrialA prospective study of lung water measurements during patient management in an intensive care unit.
We prospectively evaluated a protocol that included extravascular thermal volume (ETV) as a measure of extravascular lung water (EVLW) instead of pulmonary artery wedge pressure (Ppaw) measurements to guide the hemodynamic management of 48 critically ill patients. Patients were randomized to either a protocol management (PM), or to a routine management (RM) group. In the RM group, EVLW measurements were unknown to the primary care physicians. ⋯ Mortality for the groups as a whole was similar, but was significantly better (p less than 0.05) for PM patients with initially high EVLW and normal Ppaw (predominantly patients with sepsis or the adult respiratory distress syndrome). For both groups, patients with an initial EVLW greater than 14 ml/kg had a significantly greater mortality than did those with a lesser amount of EVLW: 13 of 15 (87%) versus 13 of 32 (41%), p less than 0.05. We conclude that management based on a protocol using EVLW measurements is safe, may hasten the resolution of pulmonary edema, and may lead to improved outcome in some critically ill patients.
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Pediatric pulmonology · Sep 1987
Performance of respirators at fast rates commonly used in neonatal intensive care units.
The effect on tidal volume and airway pressure of increasing ventilator rate (30, 60, and 120/min) was tested in six commonly used neonatal ventilators. In all six ventilators increased flow was necessary to maintain mean airway pressure at the higher rates. ⋯ This was only demonstrated in four ventilators, all incorporating nonassisted expiratory valves. These results stress the necessity for appropriately designed ventilators if fast rates are to be used routinely in clinical practice.