Articles: critical-care.
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Comparative Study
Outcome from critical care in the "oldest old" trauma patients.
This study evaluated the "oldest old" Intensive Care Unit (ICU) trauma patients, defined as patients of age 75 and over, to determine the relationships between age, injury magnitude, physiologic severity of illness, and outcome in this group, compared with younger trauma patients. Of 1,039 consecutive Surgical ICU (SICU) patients with complete data, 45 were in the Oldest group, 54 were in the Elderly group (ages 65 to 74), and 940 were in the Younger group (age < 65). Age, sex, and type of trauma (penetrating versus blunt) did not predict outcome. ⋯ When patients were stratified by ISS, there was a statistically significant difference in day 1 SAPS among age groups for most ISS categories, with higher SAPS associated with advancing age. The oldest old fare worse with trauma because their injury is more severe (higher ISS) and because their physiologic response to a given level of injury is exaggerated (higher SAPS). However, once the oldest old are stratified by SAPS, their outcome parallels that of their younger trauma cohorts.(ABSTRACT TRUNCATED AT 250 WORDS)
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Constraint of nurses by healthcare organizations, from actions the nurses believe are appropriate, may lead to moral distress. ⋯ Although the mean scores showed somewhat low levels of moral distress, the range of responses revealed that some nurses experienced high levels of moral distress with the issues. Research is needed on conditions organizations must provide to support the moral integrity of critical care nurses.
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Comparative Study
Clinical and financial outcomes of lateral rotation low air-loss therapy in patients in the intensive care unit.
To determine the clinical impact and cost-effectiveness of two lateral rotation low air-loss therapy beds and their supporting protocols in the treatment of critically ill patients. ⋯ In this study, patients treated by a prevention protocol with the Restcue beds (Support Systems International, Inc., Charleston, S.C.) had better clinical and financial outcomes than patients treated on Biodyne beds (Kinetic Concepts, Inc., San Antonio, Texas) with a more restricted, cost-conscious protocol aimed primarily at patients who have or who are at a higher risk for severe pneumonia, presence of septic shock, or adult respiratory distress syndrome.