Articles: critical-care.
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Acta Anaesthesiol Scand · Nov 1992
Therapeutic intervention scoring system (TISS)--a method for measuring workload and calculating costs in the ICU.
The Therapeutic Intervention Scoring System (TISS) is an easily applicable method for measurement of workload in the intensive care unit (ICU). In the present study a modified TISS-scoring (mTISS) was performed daily during 1988-1989 on 2693 patients in a general ICU. Of these, 900 could be classified as 'true' ICU-patients (ICU-stay > or = 24 h or TISS > or = 20 points), whereas the rest were postoperative. ⋯ The cost of each mTISS-point was calculated. In conclusion, the present study showed that mTISS is a valuable tool when evaluating resource utilization in the ICU. Together with the proposed workload-index and calculation of costs, mTISS could be used for ICU management control.
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J Intensive Care Med · Nov 1992
Critical appraisal of therapeutic interventions in the intensive care unit: human monoclonal antibody treatment in sepsis. Journal Club of the Hamilton Regional Critical Care Group.
Using the medical literature to solve patient problems is challenging and rewarding. For intensive care physicians, this evidence-based medicine approach is more compelling when basic critical appraisal skills are developed. We highlight the important methodological points for interpreting the literature on treatment, using a cogent example from the critical care literature--monoclonal antibody therapy in sepsis. It is likely that as we move into the 1990s, growth in the number of articles on immunotherapy in the sepsis syndrome will parallel the growth of the general biomedical literature.
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To develop a conceptual path model to explain the effects of a set of personal and work-related independent variables and the dependent variables of situational stress, job stress and job motivation on job satisfaction among critical care nurses. ⋯ Thirteen variables had a significant effect on job satisfaction and explained 63% of the variance. The four most significant effects on job satisfaction were opportunities for advancement, meaningfulness of work, pay and supervision. Commitment to the career, task identity and job security had a modest effect on job satisfaction.
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J Intensive Care Med · Nov 1992
ReviewIndications, technical considerations, and strategies for renal replacement therapy in the intensive care unit.
Renal replacement therapy in the intensive care unit can vary from simple procedures to very complex technologies. I discuss the factors that contribute to the decisions regarding the selection of a specific therapy. These factors include immediate and intermediate therapeutic goals (e.g., solute removal, dehydration), hemodynamic stability and other clinical conditions, and the technical requirements obligate to specific therapies. The differences between convective and diffusive solute removal are described, as well as the rationale for choosing one over the other. This choice is particularly relevant to and dependent on the therapeutic goal. Spontaneous blood flow versus pumped blood flow is debated. Lastly, the removal of middle molecular weight molecules is discussed in the context of toxic cytokines or bacterial products.