Critical care medicine
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Critical care medicine · Feb 2013
A model to create an efficient and equitable admission policy for patients arriving to the cardiothoracic ICU.
To develop queuing and simulation-based models to understand the relationship between ICU bed availability and operating room schedule to maximize the use of critical care resources and minimize case cancellation while providing equity to patients and surgeons. ⋯ Queuing theory and computer simulation can be used to model case flow through a cardiothoracic operating room and ICU. A dynamic admission policy that looks at current waiting time and expected ICU length of stay allows for increased equity between patients with only minimum losses of efficiency. This dynamic admission policy would seem to be a superior in maximizing case-flow. These results may be generalized to other surgical ICUs.
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Critical care medicine · Feb 2013
Impact of an intensivist-led multidisciplinary extended rapid response team on hospital-wide cardiopulmonary arrests and mortality.
The effectiveness of rapid response teams remains controversial. However, many studied rapid response teams were not intensivist-led, had limited involvement beyond the initial activations, and did not provide post-ICU follow-up. The objective of this study was to examine the impact of implementing an intensivist-led multidisciplinary extended rapid response team on hospital-wide cardiopulmonary arrests and mortality. ⋯ The implementation of rapid response team was effective in reducing cardiopulmonary arrests and total hospital mortality for ward patients, improving the outcomes of patients who needed ICU admission and reduced readmissions and mortality of patients who were discharged from the ICU.
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Critical care medicine · Feb 2013
Size variation between contralateral infraclavicular axillary veins within individual patients-implications for subclavian venous central line insertion.
Vein size and use of dynamic ultrasound guidance have been shown to be directly related to a reduction in insertion failure and complication rates during subclavian vein catheterization. We hypothesized that contralateral infraclavicular axillary vein sizes are significantly different within the same patient. We also aimed to demonstrate the relationship of subject's anthropomorphic indices with vein size and contralateral vein size difference. ⋯ Contralateral infraclavicular axillary vein sizes within the same patient are significantly different in the adult surgical population and bear no clear relation to patient hand dominance. The magnitude of contralateral difference or absolute ipsilateral infraclavicular axillary vein size cannot be predicted by a subject's anthropomorphic indices. All patients in whom subclavian central line insertion is planned should have both sides examined by ultrasound to determine which side has the largest vessel.