Critical care medicine
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Critical care medicine · Aug 1998
Multicenter Study Comparative Study Clinical TrialA multicenter evaluation of a new continuous cardiac output pulmonary artery catheter system.
To validate a new system of continuous cardiac output monitoring. ⋯ This continuous cardiac output system provides a reliable estimate of cardiac output for clinical use if applied in conditions similar to this study. The combination of a continuous measure of cardiac output with other continuous physiologic monitoring (arterial and mixed venous oxygen saturation, oxygen consumption, etc.) may provide important information that no single parameter could achieve.
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Critical care medicine · Aug 1998
Multicenter Study Comparative StudyEvaluation of acute physiology and chronic health evaluation III predictions of hospital mortality in an independent database.
To assess the accuracy and validity of Acute Physiology and Chronic Health Evaluation (APACHE) III hospital mortality predictions in an independent sample of U.S. intensive care unit (ICU) admissions. ⋯ APACHE III accurately predicted aggregate hospital mortality in an independent sample of U.S. ICU admissions. Further improvements in calibration can be achieved by more precise disease labeling, improved acquisition and weighting of neurologic abnormalities, adjustments that reflect changes in treatment outcomes over time, and a larger national database.
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Critical care medicine · Aug 1998
Multicenter Study Comparative StudyPediatric risk of mortality: an assessment of its performance in a sample of 26 Italian intensive care units.
To assess the validity of the Pediatric Risk of Mortality (PRISM) scoring system in accurately predicting the probability of mortality in an Italian intensive care unit (ICU) sample. ⋯ The analyses suggest that the unsatisfactory calibration of PRISM can be attributed to various reasons. Among those reasons, a poor performance of the system, as well as its sensitivity to factors not connected to clinical ICU performance, seem particularly important. A special caution is needed in adopting a severity of illness scoring system to assess quality of care, particularly in contexts different from the one in which the instrument was originally developed.
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Critical care medicine · Aug 1998
Multicenter Study Comparative StudyOutcome of intensive care patients in a group of British intensive care units.
To identify priorities for intensive care unit (ICU) intervention and research. ⋯ Early identification of patients at risk, both before admission and after discharge from the ICU, may allow treatment to decrease mortality. Research and resources may be best directed at patients who die, despite a relatively low predicted mortality. Although these patients are a small percentage of the low-risk admissions, they constitute a large number of ICU deaths. Many patients die after discharge from ICU and this mortality may be decreased by minimizing inappropriate early discharge to the ward, by the provision of high-dependency and step-down units, and by continuing advice and follow-up by the ICU team after the patient has been discharged. Intervention before ICU admission and support of patients after discharge from the ICU should be part of the effort to decrease mortality for ICU patients. Inadequate provision of resources for critically ill patients may result in excess intensive care mortality that is not detected with ICU outcome prediction methods.