Articles: critical-care.
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The long-term survival of elderly patients following critical illness in the United Kingdom has not previously been studied. The demographic (age, sex, diagnosis, severity of illness) and treatment details (admission type, length of treatment, prior surgery) of all critically ill patients aged over 70 years were recorded. The 1-year survival of such patients was measured and compared with that of a matched normal population. ⋯ The 1-year survival of patients aged < 85 years was 56% which was significantly better than that of patients over 85 years (27%). The survival of all critically ill elderly patients was significantly poorer than that of a matched normal population (1-year survival 93%). Logistic regression revealed that age, diagnosis and severity of illness are independent predictors of 1-year survival.
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Substantial evidence indicates that outcome of critically ill children, treated in tertiary paediatric intensive care units (PICUs) is superior to that of those treated in other settings. However, a significant number of children who require this level of care are not admitted to such a unit e.g. due to capacity constraints, reluctance of physicians of general hospitals to refer children to a tertiary centre, and transportation problems. Centralization of care, as recently proposed in the UK, is necessary in the Netherlands, as well, to improve the quality of care. This will require a controlled number of PICU beds in a restricted number of centres, adequate transport facilities and step-down or high dependency units in large general hospitals.
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Comparative Study
Follow up of elderly patients after cardiac surgery and intensive care unit admission, 1991 to 1995.
To examine the outcome of cardiac surgery and resulting intensive care admission in elderly (> or = 75 years) cardiac surgery patients at Waikato Hospital, 1991 to 1995. ⋯ Following cardiac surgery and intensive care admission at Waikato Hospital, surviving elderly patients have experienced a favourable outcome in terms of symptom control and quality of life. Mortality rates are acceptably low.
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Little is known about the extent of critical care delivered to patients in the emergency department (ED) and its impact on ED lengths of stay or patient outcomes. The purpose of this study was to characterize the timing of care for critically ill patients, both medical and surgical, in the ED. The design was a retrospective review. ⋯ The timing of these procedures indicates that they are performed when necessary for patient care regardless of ED or ICU setting. Thus, ICU care is often initiated and maintained in the ED setting. EDs must be staffed adequately with appropriately trained personnel to care for these patients.