Articles: critical-care.
-
Intensive care medicine · Jan 1991
Short- and long-term prognosis, functional outcome following ICU for elderly.
Among 1532 ICU patients we analysed 295 elderly patients (19%) aged more than 70-years-old. We determined prospectively the immediate and subsequent one-year outcome with a study of the predictive value of their ICU admission parameters. ⋯ On ICU discharge, 216 elderly were followed at 1, 6, 12 months; the one-year cumulative mortality was 49% from ICU discharge, majority of deaths occurring over the first month. Age, previous health status and SAPS had a predictor value of one-year mortality for ICU survivors. 103 patients were alive at one year: 88% returned to home, 72% had a relatively good functional status allowing an independent life, and 82% had the same or improved functional status.
-
Intensive care medicine · Jan 1991
Outcome prediction of acute renal failure in medical intensive care.
Data acquired prospectively from 134 patients with acute renal failure requiring dialysis in a medical intensive care unit (ICU) were analysed in order to derive indicators predicting ICU-survival. Mortality in the ICU was 56.7%. ⋯ On the other hand, the total correct classification rates achieved by a standardised system for scoring ICU-patients (APACHE II) did not exceed 58.2%. It is concluded that outcome prediction by APACHE II and even by the discriminant functions is too inaccurate to become the basis for clinical decisions either concerning the initiation or the continuation of dialysis treatment in ARF.
-
Psychiatric disorders are observable in Intensive Care Unit. They belong to all the psychiatric field. Their genesis depend on various factors that often work together and are interdependent: organic, demographic, psychological, environmental, procedural, hypnic. They can be considered as risk factors influencing the development of responses to stress (theory of stress).
-
Intensive care medicine · Jan 1991
Factors influencing transcutaneous oxygen and carbon dioxide measurements in adult intensive care patients.
Transcutaneous PO2 (PtcO2) is suggested to reflect tissue oxygenation in intensive care patients, whereas transcutaneous PCO2 (PtcCO2) is advocated as a noninvasive method for assessing PaCO2. In 24 critically ill adult patients (mean Apache II score 14.2, SD 4.7) we investigated the impact of variables that are commonly thought to determine PtcO2 and PtcCO2 measurements. A linear correlation was found between PtcO2 and PaO2 (r = 0.6; p less than or equal to 0.0001) and between PtcO2 and mean arterial blood pressure (MAP; r = 0.42; p less than or equal to 0.003). ⋯ A significant linear correlation was demonstrated between PtcCO2 and PaCO2 (r = 0.76; p less than or equal to 0.0001) but not between PtcCO2 and CI, MAP and arterial base excess (BEa). Stepwise multiple regression analysis revealed an influence of PaCO2 and of CI on PtcCO2; 66% of the variability of a single PtcCO2-value could be explained by PaCO2 and CI. Our data demonstrate that transcutaneous derived gas tensions result from complex interaction between hemodynamic, respiratory and local factors, which can hardly be defined in ICU-patients.
-
How do people make sense of critical illness and the ICU? What does that experience mean to the patient? These questions are of vital importance in selecting nursing interventions that are appropriate as well as therapeutic. The study of individuals and their experiences can provide a rich and unexpected picture of what it is like to live through a critical illness. This information can increase our understanding of the needs of critically ill patients as well as how people in general make sense of their world.