Anaesthesia
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Multicenter Study
Acute respiratory distress syndrome: an audit of incidence and outcome in Scottish intensive care units.
This prospective audit of incidence and outcome of the acute respiratory distress syndrome was conducted as part of the national audit of intensive care practice in Scotland. All patients with acute respiratory distress syndrome in 23 adult intensive care units were identified using the diagnostic criteria defined by the American-European Consensus Conference. Daily data collection was continued until death or intensive care unit discharge. ⋯ Intensive care unit mortality for acute respiratory distress syndrome was 53.1%, with a hospital mortality of 60.9%. In our national unselected population of critically ill patients, the overall outcome is comparable with published series (Acute Physiology and Chronic Health Evaluation II standardised mortality ratio = 0.99). However, mortality from acute respiratory distress syndrome in Scotland is substantially higher than in recent other series suggesting an improvement in outcome in this condition.
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An outreach service was introduced in three surgical wards and the surgical high dependency unit in a large teaching hospital. A modified early warning score and callout algorithm were used to facilitate referrals to the team. Changes in unplanned admission rate to intensive care, length of stay, mortality rate and number of re-admissions following the introduction of outreach were sought. ⋯ These emergency patients had shorter lengths of stay (4.8 days vs. 7.4 days) and had a lower mortality (28.6% vs. 23.5%, p = 0.05). The re-admission rate also fell from 5.1% to 3.3% (p = 0.05). The outreach service had a significant impact on critical care utilisation.