Articles: intensive-care-units.
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Am. Rev. Respir. Dis. · Aug 1989
Multicenter Study Clinical TrialPrognosis with mechanical ventilation: the influence of disease, severity of disease, age, and chronic health status on survival from an acute illness.
This report presents a model for relating readily available clinical and physiologic measurements to prognosis from mechanical ventilation. Using data from 571 acutely ill, ventilated patients admitted to the intensive care units of 12 hospitals, it illustrates the relationship between the disease, the initiating respiratory failure, the acute severity of the disease, and the patient's age and chronic health status and the patient's probability of survival. ⋯ After 3 days of ICU treatment, estimates for hospital mortality increased to 97% (39 patients). We believe that such estimates, when available from a larger number of patients and combined with additional information on the patient's desires, expectations, preillness quality of life, and prognosis for long-term survival, can be helpful in decisions to withhold and withdraw mechanical ventilation.
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Am. Rev. Respir. Dis. · Aug 1989
ReviewIntensive care unit survival of patients with systemic illness.
Many patients with systemic illness are admitted to intensive care units (ICUs) and placed on life support. This occurs in patient populations even when the projected mortality rate might be as high as 80 to 90%. Patients with systemic illness often are life-support-dependent in ICUs as chronically critically ill patients for many weeks. ⋯ Numerous studies have identified that chronologic age is associated with increased mortality rates. However, a better assessment would be biologic age, which would take into account both chronologic age and health status. ICU survival of patients with cancer, hematologic neoplasms, renal failure, liver failure, AIDS, and burns is reviewed.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
Impact of a comprehensive supportive care team on management of hopelessly ill patients with multiple organ failure.
We developed a supportive care team for hopelessly ill patients in an urban emergency/trauma hospital. The team includes a clinical nurse specialist and a faculty physician as well as a chaplain and social worker. The supportive care team provides an alternative to intensive care or conventional ward management of hopelessly ill patients and concentrates on the physical and psychosocial comfort needs of patients and their families. ⋯ Additionally, there were 50 percent fewer therapeutic interventions provided by the supportive care team vs intensive care or conventional ward treatment of multiple organ failure patients. We describe the methods that the supportive care team uses in an attempt to meet the physical and psychosocial comfort needs of hopelessly ill multiple organ failure patients and their families. This multidisciplinary approach to the care of the hopelessly ill may have applications in other institutions facing the ethical, medical, and administrative challenges raised by these patients.
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Pregnancy-associated admissions to the Intensive Care Unit during the first 5 years of a newly established teaching hospital obstetric unit are reviewed. There were 23 such admissions; in the same period, 21,983 deliveries occurred. ⋯ Most patients required admission for less than 48 hours. Two patients died during the period of study.
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Patients receiving intraspinal opiates should be monitored in the intensive care unit for at least 24 hours to prevent potentially lethal outcomes. These include respiratory depression caused by sequestration of the morphine in the cerebrospinal fluid and migration of epidural catheters in the subarachnoid or intravascular space. At this time, most hospitals are not equipped or staffed adequately to guarantee the safety of these patients outside the intensive care unit.