Annals of the American Thoracic Society
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Editorial Comment
The importance of rigorous evaluation of quality measurement programs.
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Randomized Controlled Trial Multicenter Study
The influence of hospitalization or intensive care unit admission on declines in health-related quality of life.
Survivors of critical illness report impaired health-related quality of life (HRQoL) after hospital discharge, but the degree to which these impairments are attributable to critical illness is unknown. ⋯ Prehospital HRQoL is a significant determinant of HRQoL after hospitalization or ICU admission. Hospitalization is associated with increased risk of impairment in HRQoL after discharge, yet the overall magnitude of this reduction is small and similar between non-ICU hospitalized and critically ill patients.
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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.