Annals of the American Thoracic Society
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Rationale: Many studies of critical illness outcomes have been restricted to short-term outcomes, selected diagnoses, and patients in one or a few Intensive Care Units (ICUs). Objective: Evaluate a range of relevant outcomes in a population-based cohort of patients admitted to ICUs. Methods: Among all adult residents of the Canadian province of Manitoba admitted to ICUs over a nine year period we assessed ICU, hospital, 30 day and 180 day mortality rates; ICU and hospital lengths-of-stay; post-hospital utilization of hospital care, ICU care, outpatient physician care, medications, and home care; and post-hospital residence location. ⋯ Conclusions: Post-hospital medical resource use among ICU survivors is substantial, though similar to that after non-ICU hospitalization. While the fraction of survivors unable to live independently was small, a larger fraction required home care services. Identifying post-hospital supports needed by ICU survivors can be useful for policy-makers and others responsible for healthcare planning.
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Multicenter Study
Factors associated with swallowing assessment after oral endotracheal intubation and mechanical ventilation for acute lung injury.
Endotracheal intubation is associated with postextubation swallowing dysfunction, but no guidelines exist for postextubation swallowing assessments. ⋯ In this multisite prospective study, female sex, intubation duration, and hospital site were associated with postextubation swallowing assessment. These results demonstrate variability in practice patterns between institutions and highlight the need to determine the appropriate timing and indications for swallowing assessment and to more fully understand swallowing dysfunction after intubation.
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Neurocognitive impairments are associated with reduced quality of life and may adversely affect medical compliance, but their prevalence after lung transplantation has not been extensively studied. ⋯ Neurocognitive impairments are prevalent among lung transplant candidates and appear to worsen in some patients after transplant. Delirium during hospitalization is associated with worse neurocognitive function after transplant among patients without cystic fibrosis.
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Randomized Controlled Trial Multicenter Study
"Do not resuscitate" decisions in acute respiratory distress syndrome. A secondary analysis of clinical trial data.
Factors and outcomes associated with end-of-life decision-making among patients during clinical trials in the intensive care unit are unclear. ⋯ The vast majority of deaths among clinical trial patients with ARDS were preceded by a DNR order. Unlike other studies of end-of-life decision-making in the intensive care unit, nearly all patients who became DNR died. The impact of variation of practice in end-of-life decision-making during clinical trials warrants further study.