Articles: critical-care.
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Critical care medicine · Sep 2002
Multicenter StudyRating the quality of intensive care units: is it a function of the intensive care unit scoring system?
Intensive care units (ICUs) use severity-adjusted mortality measures such as the standardized mortality ratio to benchmark their performance. Prognostic scoring systems such as Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score II, and Mortality Probability Model II0 permit performance-based comparisons of ICUs by adjusting for severity of disease and case mix. Whether different risk-adjustment methods agree on the identity of ICU quality outliers within a single database has not been previously investigated. The objective of this study was to determine whether the identity of ICU quality outliers depends on the ICU scoring system used to calculate the standardized mortality ratio. ⋯ APACHE II, Simplified Acute Physiology Score II, and Mortality Probability Model II0 exhibit fair to moderate agreement in identifying quality outliers. However, the finding that most ICUs in this database were judged to be high-performing units limits the usefulness of these models in their present form for benchmarking.
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Journal of critical care · Sep 2002
Multicenter StudySystemic candidiasis in intensive care units: a multicenter, matched-cohort study.
To determine the impact of systemic candidiasis on the mortality and length of hospital stay of intensive care unit (ICU) patients and the associated workload. ⋯ Systemic Candida infections increased mortality and morbidity in severely ill patients. Optimizing management of such infections is imperative.
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Journal of critical care · Sep 2002
Multicenter StudyPrevention of ventilator-associated pneumonia: current practice in Canadian intensive care units.
To evaluate the current use of strategies to prevent ventilator-associated pneumonia (VAP) and to identify interventions to target for quality-improvement initiatives. ⋯ Significant opportunities exist to improve VAP prevention practices in Canada. These strategies include decreasing the frequency of ventilator circuit changes, and increasing the use of non-invasive ventilation, subglottic secretion drainage endotracheal tubes, kinetic bed therapy, small bowel feedings, and elevation of the head of the bed.
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Intensive Crit Care Nurs · Jun 2002
Multicenter StudyAdmissions for critically ill children: where and why?
Planning services for critically ill children requires identification of overall critical care activity as well as an assessment of population needs. METHOD AND OBJECTIVES: This prospective needs assessment took a census approach to estimating population-based admission rates for paediatric critical care irrespective of where care was provided. A survey form was completed for every child in the study population for all of their admissions. ⋯ This baseline study shows a significant number of critically ill children who are never cared for in PIC units. With national changes in UK policy to regionalise care for these children, monitoring care in all locations by cause of admission remains important. While the data were collected in 1997, the findings from this study remain relevant and provide the basis for planning regional critical care services for children. Results are also relevant to other geographical areas in that measuring the use of services for critically ill children must go beyond documenting admission to ICUs for children and adults. All settings for critical care must be identified, the activity documented, and the use of services measured against existing resources. Clear clinical criteria are needed to identify children who can be cared for appropriately on high dependency units.
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Critical care medicine · Jun 2002
Multicenter StudyCost effectiveness of aggressive care for patients with nontraumatic coma.
To estimate the cost effectiveness of aggressive care for patients with nontraumatic coma. ⋯ Continuing aggressive care after day 3 of nontraumatic coma is associated with a high cost per QALY gained, especially for patients at high risk for poor outcomes. Earlier decisions to withhold life-sustaining treatments for patients with very poor prognoses may yield considerable cost savings.