Critical care medicine
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When used to prolong life without achieving a benefit meaningful to the patient, critical care is often considered "futile." Although futile treatment is acknowledged as a misuse of resources by many, no study has evaluated its opportunity cost, that is, how it affects care for others. Our objective was to evaluate delays in care when futile treatment is provided. ⋯ Futile critical care was associated with delays in care to other patients.
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Critical care medicine · Sep 2014
The Association of Spiritual Care Providers' Activities With Family Members' Satisfaction With Care After a Death in the ICU.
Spiritual distress is common in the ICU, and spiritual care providers are often called upon to provide care for patients and their families. Our goal was to evaluate the activities spiritual care providers' conduct to support patients and families and whether those activities are associated with family satisfaction with ICU care. ⋯ Spiritual care providers engage in a variety of activities with families of ICU patients; several are associated with increased family satisfaction with ICU care in general and decision-making in the ICU specifically. These findings provide insight into spiritual care provider activities and provide guidance for interventions to improve spiritual care delivered to families of critically ill patients.
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Critical care medicine · Sep 2014
Epidemiology of Death in the PICU at Five U.S. Teaching Hospitals.
To determine the epidemiology of death in PICUs at 5 geographically diverse teaching hospitals across the United States. ⋯ The mode of death in the PICU is proportionally similar to that reported over the past two decades, while the mortality rate has nearly halved. Death is largely characterized by two fairly distinct profiles that are associated with whether death occurs within or beyond 1-week length of stay. Decisions not to resuscitate are often made in the absence of a formal do-not-resuscitate order. These data have implications for future quality improvement initiatives, especially around palliative care, end-of-life decision making, and organ donation.
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Critical care medicine · Sep 2014
Relationship Between ICU Bed Availability, ICU Readmission, and Cardiac Arrest in the General Wards.
The decision to admit a patient to the ICU is complex, reflecting patient factors and available resources. Previous work has shown that ICU census does not impact mortality of patients admitted to the ICU. However, the effect of ICU bed availability on patients outside the ICU is unknown. We sought to determine the association between ICU bed availability, ICU readmissions, and ward cardiac arrests. ⋯ Reduced ICU bed availability is associated with increased rates of ICU readmission and ward cardiac arrest. This suggests that systemic factors are associated with patient outcomes, and flexible critical care resources may be needed when demand is high.
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Critical care medicine · Sep 2014
Editorial CommentFrom storm to suppression in sepsis: are bands the link?*.