Current opinion in critical care
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Curr Opin Crit Care · Oct 2008
ReviewThromboprophylaxis in medical-surgical critically ill patients.
Although critically ill patients are at high risk of venous thromboembolism and bleeding, and thromboprophlyaxis is of proven effectivity in other settings, there remain relatively few data to assist clinicians in providing evidence-based care for medical-surgical patients in the intensive care unit. ⋯ Despite the high morbidity and mortality because of critical illness, the risk of venous thromboembolism in these patients, and adverse outcomes due to venous thromboembolism, much more methodologically rigorous data are required in the form of large, well designed randomized trials before firm recommendations about prophylaxis can be provided to this highly vulnerable population.
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To describe the background to, rationale for, and structure and performance of the Intensive Care National Audit & Research Centre risk prediction model. ⋯ The Intensive Care National Audit & Research Centre model performs well in comparison with preexisting models when evaluated in independent validation data from UK critical care units. The use of interactions between the physiology score and diagnostic category produces better fit within individual diagnostic groups. The elimination of model exclusion criteria, for example age less than 16 years, means that the model compares the observed and expected outcomes for all patients admitted to a critical care unit providing a fairer method for comparative audit.
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Patients with acute pulmonary edema are often treated with noninvasive ventilation (NIV). There are essentially two modalities used in this setting: continuous positive airway pressure and bilevel pressure support ventilation. The clinical impact of these techniques and the subset of patients who can benefit from their application have not been definitely established. ⋯ Although in acute pulmonary edema NIV is more effective in improving respiratory distress than conventional oxygen therapy and reduces the necessity of intubation, the subset of patients who can best benefit from these techniques in terms of mortality still warrant further investigation.
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Curr Opin Crit Care · Oct 2008
ReviewCan outcome prediction data change patient outcomes and organizational outcomes?
Intensive care medicine consumes a high share of healthcare costs, and there is growing pressure to use the scarce resources efficiently. Accordingly, organizational issues and quality management have become an important focus of interest in recent years. Here, we will review current concepts of how outcome data can be used to identify areas requiring action. ⋯ Outcome assessment models provide an important framework for benchmarking. They may help the individual ICU to spot appropriate fields of action, plan and initiate quality improvement projects, and monitor the consequences of such activity.
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B-type natriuretic peptides are quantitative markers of heart failure (and/or cardiac stress) that summarize the extent of systolic and diastolic left ventricular dysfunction, valvular dysfunction, and right ventricular dysfunction. Based on the observation that heart failure is common albeit difficult to diagnose in the ICU, several studies have begun to evaluate the potential use of B-type natriuretic peptides in various ICU settings. ⋯ Although previous studies were small, they highlight the potential of using B-type natriuretic peptides as a noninvasive easily available tool to quantify cardiac stress.