Critical care medicine
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Critical care medicine · Feb 2001
Comparative StudyPredicting hospital mortality for patients in the intensive care unit: a comparison of artificial neural networks with logistic regression models.
Logistic regression (LR), commonly used for hospital mortality prediction, has limitations. Artificial neural networks (ANNs) have been proposed as an alternative. We compared the performance of these approaches by using stepwise reductions in sample size. ⋯ When sample size is adequate, LR and ANN models have similar performance. However, development sets of < or = 800 were generally inadequate. This is concerning, given typical sample sizes used for individual ICU mortality prediction.
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Critical care medicine · Feb 2001
ReviewEnd-of-life care in the intensive care unit: can we do better?
Everywhere we turn these days, it seems that we are confronted with a new study that reports the dissatisfaction expressed by families with the quality of care received by their loved ones who have died while in the intensive care unit. It is difficult for caregivers to accept this information, which is now commonly reported both in published studies and in the lay press. As clinicians, most of us believe that we truly care about our patients and are trying, as best we can, to act in their best interest. ⋯ For caregivers, enhancing end-of-life skills may be a matter of improved listening skills, attention to the proper environment for end-of-life discussions, and a willingness to facilitate end-of-life decision-making. Encouraging caregivers to view end-of-life skills as a lifelong educational process, identifying core competencies in end-of-life care, and training clinicians in these skills are the challenges for the future. The quality of care our patients receive at the end of life will depend on our ability to answer these difficult questions.
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To determine the risk factors for pressure ulceration in an intensive care setting, to evaluate the Braden scale as a predictor of pressure ulcer risk in critically ill patients, and to determine whether pressure ulcers are likely to occur early in the hospital stay. ⋯ Pressure ulcers may develop within the first week of hospitalization in the intensive care unit. Patients at risk have Braden scores of < or = 16 and are more likely to be underweight. These results suggest that aggressive preventive care should be focused on those patients with Braden scores of < or = 13 and/or a low body mass index at admission.
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Critical care medicine · Feb 2001
ReviewEnd-of-life care in the intensive care unit: where are we now?
A growing body of evidence and experience has effaced what were once thought to be clear distinctions between "critical illness" and "terminal illness" and has exposed the problems of postponing palliative care for intensive care patients until death is obviously imminent. Integration of palliative care as a component of comprehensive intensive care is now seen as more appropriate for all critically ill patients, including those pursuing aggressive treatments to prolong life. At present, however, data on which to base practice in this integrated model remain insufficient, and forces of the healthcare economy and other factors may constrain its application. ⋯ We also address the need for assessment tools for research and quality improvement. We discuss recent initiatives and ongoing obstacles. Finally, we identify areas for further exploration and suggest guiding principles.
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Critical care medicine · Feb 2001
Bronchoscopy with bronchoalveolar lavage via the laryngeal mask airway in high-risk hypoxemic immunosuppressed patients.
Fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) are major tools in the diagnosis of pulmonary complications in immunocompromised patients. Nevertheless, severe hypoxemia is an accepted contraindication to FOB in nonintubated patients. The purpose of this study was to evaluate the feasibility and safety of laryngeal mask airway (LMA)-supported FOB with BAL in immunosuppressed patients with suspected pneumonia and severe hypoxemia. ⋯ Application of the LMA appears to be a safe and effective alternative to intubation for accomplishing FOB with BAL in immunosuppressed patients with suspected pneumonia and severe hypoxemia.