Journal of intensive care medicine
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J Intensive Care Med · May 2009
Decannulation following tracheostomy for prolonged mechanical ventilation.
We examined the process of decannulation following tracheostomy in patients transferred to a long-term acute care (LTAC) hospital for weaning from prolonged mechanical ventilation (PMV). ⋯ Decannulation was achieved in 35% of patients transferred to an LTAC for weaning from prolonged mechanical ventilation.
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J Intensive Care Med · Mar 2009
Meta AnalysisBrain injury and fever: hospital length of stay and cost outcomes.
Fever has been shown to be related to extended hospital stays in neurologically injured patients. We performed meta-analyses of the impact of fever on length of stay (LOS) in the Intensive Care Unit (ICU) and for total hospital length of stay, including all recent scholarship published since 1/1/1995 pertaining to thermoregulation of neurogenic fever and length of hospital stay. We also developed estimates of the financial impact on hospital costs. ⋯ For hospital LOS, g = .79, Z = 2.2, P = .0278. Mean additional ICU days = 5.7 days; mean additional hospital days = 8.5 days. We estimate that fever added an average of $17,414 in hospital cost to total hospital stays; mean $13,672 (95% Confidence Interval [CI]: $10,074, $17,270) in additional ICU costs and mean $3,742 (CI: -$1,203, $8,820) in additional routine costs.
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J Intensive Care Med · Mar 2009
Recombinant activated factor VII following pediatric cardiac surgery.
Review the use of recombinant activated Factor VII following cardiac surgery. Specifically, we sought to define our current therapeutic practice indications and outcomes to assess the impact of recombinant activated factor VII on postoperative bleeding. ⋯ Hemostasis occurred in 25 postoperative pediatric cardiac patients after recombinant activated Factor VII was given. In this setting, once conventional hemostatic therapy was optimized, recombinant activated Factor VII 180 microg/kg initially with intercostal losses greater than 10 mL/kg/h and a repeat dose after 2 hours if losses remained greater than 5 mL/kg/h was effective. No complications were found to have occurred and there was a coincidental reduction in annual returns to theatre for excessive bleeding.
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J Intensive Care Med · Mar 2009
Review of a large clinical series: intrahospital transport of critically ill patients: outcomes, timing, and patterns.
The purpose of this study was to analyze the relationship of intrahospital transport patterns with patient throughput and outcomes in an oncological intensive care unit. We retrospectively reviewed all patients admitted to a closed medical-surgical intensive care unit at a cancer center between January 1, 2004 and December 31, 2005. We compared the clinical characteristics and outcomes of patients with and without transport and analyzed all intrahospital transports in relation to intensive care unit occupancy, length of stay, and intensive care unit and hospital outcomes. ⋯ The highest transport rates and nearly half of all first transports occurred during the first 24 hours of intensive care unit admission. Transports were most common during weekdays and on afternoon and evening hours and most frequently to the computed tomography suite. Our study shows that intrahospital transport of the critically ill is a multifaceted process with important implications for intensive care unit resource analysis, workload and throughput.
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J Intensive Care Med · Mar 2009
ReviewConsiderations in caring for the critically ill older patient.
People over age 65 are the fastest growing segment of the population and account for 42% to 52% of the intensive care unit admissions in the United States. There are many physiologic changes that occur with aging which can impact on both the presentation and management of older patients with critical illness. ⋯ While outcome studies suggest that chronologic age itself is not a risk factor for poor outcomes after adjusting for severity of illness, older patients clearly have physiologic changes which need to be considered when providing critical care. This article will review important physiologic changes of aging, as well as sepsis and delirium and outcomes of older ICU patients.