Articles: intensive-care-units.
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"Do not resuscitate" (DNR) decisions were examined in a medical intensive care unit (MICU) of a 1,000-bed hospital. Seventy-one (14%) of 506 study patients were designated DNR; nine survived hospitalization. Severity of illness, age, and prior health were predictive of DNR orders; race and socioeconomic factors were not. ⋯ Documented justifications of DNR decisions included poor prognosis (59%), poor quality of life (24%), and patients' wishes (15%). There were no written justifications for the DNR decisions in 30 cases (42%). Although willingness to write DNR orders in an MICU and continued active treatment of DNR patients are both reassuring in a general sense, they raise questions about the consistency of treatment plans and goals for individual patients.
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Analgesia and sedation for patients in intensive care units (ICU) who require mechanical ventilation are most commonly provided by intermittent i.v. injections of opiates and benzodiazepines. However, the technique has a number of disadvantages. Also, in many cases these drugs are inadequate, even in large doses, and muscle relaxants may be necessary for patient respirator coordination. ⋯ In patients with multiple trauma and in patients where frequent assessment of the level of consciousness is important this technique is superior to parenteral analgesic sedative combinations. Intrathecal morphine may be indicated in patients in a compromised position. The daily analgesic requirement can be reduced by about 10-100 times by the use of epidural and intrathecal morphine respectively.
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Intensive care medicine · Jan 1985
Outcome and costs of intensive care. A follow-up study on 238 ICU-patients.
A retrospective follow-up study was performed on 238 consecutive admissions in the surgical ICU. The patients were grouped into four categories according to the therapeutic intervention scoring system: 14 in class I, 13 in class II, 81 in class III and 130 in class IV. The mortality rate during their stay in the ICU (5.4%), after discharge from the ICU (2.1%) and 2 years after discharge from the hospital (7.6%) was estimated. ⋯ Fifty-two percent of the total hospitalization costs were generated during the ICU stage which accounted for 17.5% of the hospitalization period. Sixty percent of the total financial investment was spent on the group of survivors who resumed normal work. The mean cost per survivor was $7095 or $1 per survivor per day of active life over an average span of 15 years survival after discharge from the hospital.
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The purpose of this study was to identify staff behaviors and parental coping patterns helpful to parents during their child's hospitalization in a pediatric intensive care unit. Subjects were 21 mothers and 15 fathers of 27 hospitalized children. ⋯ The staff behavior seen as most important by the largest number of parents was "being permitted to stay with their child as much as possible." In evaluating the overall findings regarding personal coping strategies, it appears that parents most frequently used problem-focused coping strategies and that these strategies were seen as most helpful. Emotion-focused coping was used by a slightly lower percentage of parents than the other categories.