Journal of critical care
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Journal of critical care · Jun 2005
Case ReportsTreatment of severe coagulopathy after gunshot injury to the head using recombinant activated factor VII.
Patients with severe penetrating head injury often have a coagulopathy that is difficult to correct. In this report, we describe 3 such patients who were treated with activated factor VII (FVIIa) to stop ongoing hemorrhage that was refractory to conventional treatment. ⋯ In patients with a severe head injury and coagulopathy, use of FVIIa may help in correction of coagulopathy and decrease transfusion requirements. In patients where ongoing bleeding precludes the declaration of brain death, the use of this agent might help in achieving hemodynamic stability and preserve the possibility of organ donation. The ethical implications of using FVIIa in this situation are discussed.
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In the past 2 decades, societal spending on health care has become an international concern. The United States currently spends more than 1.6 trillion dollars per year on health care--approximately 15% of the gross domestic product. ⋯ Economic evaluation can aid policy makers and health care professionals in comparing the relative and incremental value of disparate and expensive therapies and also inform decisions about which interventions provide good value for the health care dollar. In this review, we will highlight landmark publications over the past decades that have helped to shape the field of economic evaluations for critical care medicine.
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Journal of critical care · Mar 2005
ReviewA systematic review of the Charlson comorbidity index using Canadian administrative databases: a perspective on risk adjustment in critical care research.
The Charlson index is commonly used for risk adjustment in critical care health services research. However, the literature supporting this methodology has not been thoroughly explored. We systematically reviewed the literature related to administrative database adaptations of the Charlson index. ⋯ Time and cost barriers prevent widespread use of physiology-based risk adjustment in population-based research. The decreased predictive ability of the Charlson index must be weighed against the advantages of using this instrument for population-based research. Future research should focus on updating the Charlson index for recent changes in the prognosis of comorbid diseases and introduction of International Statistical Classification of Diseases, 10th Revision coding of discharge abstracts.
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Journal of critical care · Mar 2005
When critical illness becomes chronic: informational needs of patients and families.
A large and growing group of intensive care unit survivors are "chronically critically ill," with ongoing respiratory failure and poor outcomes for postdischarge survival and functional recovery. In this qualitative study, we investigated what information is relevant and important for clinician-patient/family communication when critical illness becomes chronic, as indicated by tracheotomy for prolonged mechanical ventilation. ⋯ Given poor outcomes for most patients and high costs and burdens of treatment, effective communication is essential when critical illness enters a chronic phase. Our findings provide a framework for such communication and a basis for further research.