Journal of critical care
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Journal of critical care · Jun 2006
Hypernatremia in the neurologic intensive care unit: how high is too high?
Hypernatremia is associated with increased mortality in hospitalized patients and in medical/surgical intensive care units. This relationship has not been studied in neurologic/neurosurgical intensive care units (NNICUs), where hypernatremia is often a component of treatment of cerebral edema. We performed a retrospective analysis of prospectively collected data in patients admitted to the NNICU over a 6.5-year period. ⋯ Other factors independently associated with mortality were age, mechanical ventilation, initial Acute Physiology and Chronic Health Evaluation II probability of death or low admission Glasgow Coma Scale score, and a diagnosis of cerebrovascular disease. In conclusion, hypernatremia is common in the NNICU, more so in patients treated with mannitol. In this population, severe (but not mild or moderate) hypernatremia is independently associated with increased mortality.
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Journal of critical care · Jun 2006
Multicenter StudyDevelopment and implementation of a high-quality clinical database: the Australian and New Zealand Intensive Care Society Adult Patient Database.
To describe the development of a binational intensive care database. ⋯ A high-quality ICU database has successfully been implemented in Australia and New Zealand and is now used as a routine quality assurance and peer review tool. Similar developments may be both possible and desirable in other countries.
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Journal of critical care · Jun 2006
Comparative StudyAdjustment of intensive care unit outcomes for severity of illness and comorbidity scores.
Comparison of outcomes among intensive care units (ICUs) requires adjustment for patient variables. Severity of illness scores are associated with hospital mortality, but administrative databases rarely include the elements of these scores. However, these databases include the elements of comorbidity scores. The purpose of this study was to compare the value of these scores as adjustment variables in statistical models of hospital mortality and hospital and ICU length of stay after adjustment for other covariates. ⋯ The value of APACHE II and comorbidity scores as adjustment variables depends on the outcome and population of interest.
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Journal of critical care · Jun 2006
Blood glucose on day of intensive care unit admission as a surrogate of subsequent glucose control in intensive care.
The aim of the study was to test whether the mean of the highest and lowest glucose values on day 1 (Glu(1)) is a useful surrogate marker of mean blood glucose during the totality of intensive care unit (ICU) stay (Glu(tot)). ⋯ Glu(1) was a good predictor of Glu(tot) across all study hospitals. This observation makes it possible to use Glu(1) as a surrogate of glucose control during ICU stay and opens the door to understanding ICU glucose control across the whole of Australia and New Zealand.
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Journal of critical care · Jun 2006
Comparative StudyEconomic evaluation in critical care medicine.
Scarce resources are a reality in all health care systems. There is a constant challenge to maximize health benefits within the resources available. This is particularly relevant when caring for critically ill patients, given the resource-intensive technologies and medicines used and the highly specialized professionals required. ⋯ This article illustrates how the basic principles of health economics can be applied to health care decision making through the use of economic evaluation. We demonstrate how economic evaluation can link medical outcomes, quality of life, and costs in a common index, even for therapies for different medical conditions and with different health outcomes. This article highlights the need for randomized clinical trials and economic evaluations of therapies in critical care medicine for which the effect of the therapy on health outcomes and/or costs are unknown.