Current opinion in critical care
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Prognostic models for predicting outcome after severe traumatic brain injury (TBI) may be useful in several areas. However, established risk prediction models for general critical illness show significant limitations in neurotrauma. Development of specific risk prediction models for TBI has been difficult due to the variability of injury, which predicates a large sample for construction of robust models. Previous development of prognostic models for TBI has suffered from small sample sizes, poor study design and follow up, difficulty in application to clinical practice, limited inclusion of patients from low income countries, and lack of external validation. ⋯ The outcome prediction models that have evolved from these databases are undergoing further refinement and validation, and it is likely that these advances will prove valuable in training clinicians, counselling patients' families, auditing unit performance, designing better clinical trials, and rational allocation of resources.
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Severe sepsis and septic shock are among the most important causes of morbidity and mortality in patients admitted to the intensive care unit. The purpose of this review is to review current understanding of sepsis-induced cardiac dysfunction and discuss pertinent findings regarding its clinical presentation, underlying mechanisms of disease, and therapy. ⋯ Cardiac dysfunction is common in patients with severe sepsis and septic shock. Current understanding of the underlying mechanisms responsible is rapidly evolving and future novel therapeutic targets may be soon available. Present therapy for sepsis-induced cardiac dysfunction is based on treatment of underlying sepsis with antibiotics and hemodynamic support.
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Curr Opin Crit Care · Oct 2009
ReviewHealth-related quality of life in critically ill patients: how to score and what is the clinical impact?
Traditionally, the assessment of critical care has focused largely on mortality. However, in the last few years, there is more attention on the quality of survival. Health-related quality of life (HRQOL) is an important issue for both patients and family. The purpose of this review is to describe HRQOL scoring in critically ill patients and to discuss the clinical impact on HRQOL. ⋯ In this article, we reviewed the methods and description of measurement instruments used in critically ill patients. The most recently used instruments to measure HRQOL, how to score HRQOL before ICU admission and the impact of critical illness on HRQOL are discussed. Assessment of HRQOL can improve the answers given by critical care physicians and nurses about the prospects of their patients. To get insights in these issues regarding the impact of ICU treatment, we should incorporate not only short-term outcomes, for example length of stay and mortality, but also HRQOL.
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In this article we discuss our experiences benchmarking eight ICUs in The Netherlands. Benchmarks must be carefully designed and implemented to generate meaningful results. We define prerequisites that we have identified for successful benchmarking and discuss the development, implementation and results of ICU benchmarks that we have completed. ⋯ Benchmarking is an increasingly common activity, however it is difficult to prove that benchmarks result in improved outcomes. Concurrent with our benchmarking activities the Standardized Mortality Ratio in Dutch ICUs has decreased. We have been able to show that larger ICUs in our benchmarks generally had improved outcomes despite a higher average patient severity. Quality assurance in healthcare is maturing and benchmarks will become an increasingly useful way of comparing performance between institutions.