Articles: intensive-care-units.
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To examine a subgroup of severely injured patients spending > or = 3 weeks in the intensive care unit (ICU) and to determine their disposition and eventual functional outcome. ⋯ Despite tremendous resource utilization, the majority of trauma patients with prolonged ICU stays can eventually return to varying degrees of functional daily living and independence, but not to preinjury levels. A subgroup of severely injured elderly patients had a significantly higher mortality rate. However, elderly survivors that entered our rehabilitation facility fared as well as the younger patients.
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To examine the functional outcome and costs of a prolonged illness requiring a stay in the surgical intensive care unit (SICU) of 7 of more days. ⋯ An acute surgical illness that results in a prolonged SICU stay has a substantial in-hospital death rate and is costly, but the functional outcome from both a physical and physiologic standpoint is compatible with a good quality of life.
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Review
Multifactorial analyses in the diagnosis of pneumonia arising in the surgical intensive care unit.
The diagnosis of ventilator-associated pneumonia in the surgical intensive care unit continues to be problematic. The majority of intensive care units use clinical criteria based on chest x-ray; fever; leukocytosis; alterations in the pulse oximeter observations; the need to alter modes and amounts of ventilatory support; and more specific microbiologic studies, such as appropriate sputum, Gram stain, and culture to identify pneumonia. Diagnosing pneumonia based on clinical criteria alone is often difficult and inaccurate, which may lead to inappropriate use and choice of antibiotics. ⋯ Furthermore, those results that return positive are often too late to dictate the need for, or direction of, therapy. Our use of a "pneumonia grid" may help identify patients likely to have a poor outcome. Until a readily available and cost-effective diagnostic study for pneumonia is developed, clinical criteria remain vital in routine practice.
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This study was designed to identify and measure the patients' perspective of the concept quality of life within the context of a high-dependency unit (HDU). Data were collected in two phases. In phase one, 55 patients were interviewed, which resulted in the concept clarification of quality of life as: physical, social, psychological and family/friends. ⋯ Post-HDU patients demonstrated improvements upon pre-admission scores in both instruments (the social domain in the quality of life index being the exception), although this only reached statistical significance P<0.05 in the overall index score and within the domains of health and family. When exploring variables of age and severity of illness (Apache 2 score, Knaus et al. 1980) it was the people who were older and physiologically compromised to an increased extent (P<0.05) who demonstrated higher levels of satisfaction with their resulting quality of life. This study has been successful in providing patients with an opportunity to participate more actively in service evaluation and has identified the need for future evaluation of HDUs to move beyond physiological measures, to incorporate the impact that illness leading to admission to an HDU has upon the patients' ability to function and their resulting quality of life.