Articles: critical-care.
-
Critical care medicine · Jul 2003
Multicenter StudyGender-related differences in intensive care: a multiple-center cohort study of therapeutic interventions and outcome in critically ill patients.
To determine whether gender-related differences exist in the provided level of care and outcome in a large cohort of critically ill patients. ⋯ In a large cohort of critically ill patients, no differences in severity of illness-adjusted mortality rate between men and women were found. Despite a higher severity of illness in women, men received an increased level of care and underwent more invasive procedures. This different therapeutic approach in men did not translate into a better outcome.
-
Randomized Controlled Trial Multicenter Study Clinical Trial
[A study of early tracheostomy in patients undergoing prolonged mechanical ventilation].
Several complications are associated to mechanical ventilation (MV), especially if the duration of MV is prolonged: nosocomial pneumonias and sinusitis, laryngeal and tracheal complications (such as stenosis or granuloma). Pneumonias, en particular, seem to be associated to an increased mortality risk. Overall, the hospital mortality rate of patients undergoing MV for more than 7 days is 45%. Early tracheostomy could allow to reduce some of these complications; however, the actual value of this procedure has never been proven. ⋯ A decrease of mortality rate on d.28 from 45% to 32% is expected (two-sided test, alpha=0.05, B=0.80); overall, 468 patients should be included over a 3-yr period in at least 50 centers. In addition, a decrease of the incidence of pneumonias and of duration of MV during the first 28 days is expected. Secondary endpoints are mortality rate on d.60, hospital mortality, total duration of MV, infectious complications (other than pneumonias), laryngeal and tracheal complications, duration of sedation, duration of stay in intensive care unit, hospital costs, and comfort of patients.
-
Multicenter Study
Descriptive epidemiology of adult critical care transfers from the emergency department.
To describe the nature, frequency, and characteristics of adult critical care transfers originating from the emergency department (ED). ⋯ Trauma is the most common reason for transfer of the critically ill adult from the ED. A significant number of patients are transferred, however, with medical and surgical conditions and for non-clinical reasons. There continues to be problems with the quality of care that these patients receive. Emergency medicine clinicians must be actively involved in the development of regional critical care systems as a significant proportion of all critically ill adults transferred originate from the ED.
-
Enferm. Infecc. Microbiol. Clin. · Feb 2003
Multicenter Study[Treatment approach for fungal infections in critically ill patients admitted to intensive care units: results of a multicenter survey].
Two consensus conferences taking place in the United States and Spain were organized to optimize diagnosis and treatment of Candida spp. infections. Among other results, clinical scenarios in which early prescription of antifungal agents is indicated were identified. ⋯ Adherence to recommendations from the consensus conferences was high among intensive medicine specialists, with no differences according to level of training in infectious diseases.
-
Critical care medicine · Jan 2003
Multicenter StudyEarly indicators of prolonged intensive care unit stay: impact of illness severity, physician staffing, and pre-intensive care unit length of stay.
Scoring systems that predict mortality do not necessarily predict prolonged length of stay or costs in the intensive care unit (ICU). Knowledge of characteristics predicting prolonged ICU stay would be helpful, particularly if some factors could be modified. Such factors might include process of care, including active involvement of full-time ICU physicians and length of hospital stay before ICU admission. ⋯ Patients with high WHD, and thus high costs, can be identified early. Severity of illness only partially explains high WHD. Age is less important as a predictor of high WHD than presence of infection or ventilator dependency at 24 hrs. Both long ward stays before ICU admission and lack of full-time ICU physician involvement in care increase the probability of long ICU stays. These latter two factors are potentially modifiable and deserve prospective study.