PubMed · 6926615
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J M Schmid. 1982. ICU design.. https://pubmed.ncbi.nlm.nih.gov/6926615/
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BACKGROUND: The timing of surgery in patients suffering from subarachnoid hemorrhage grade IV and V according to Hunt and Hess, is still controversial. Several authors advocate early surgery for patients in poor clinical condition. Improved outcome and decreased mortality rates were reported. Others exclude patients in poor condition from early aneurysm surgery. METHODS: Forty grade IV aneurysm patients were admitted to our department. After ventriculostomy and cerebral angiography, 28 of them were operated on within 72 hours. The postoperative treatment included hypertensive, hypervolemic, hemodilutional therapy (triple-H therapy) and intensive monitoring (intracerebral pressure, blood pressure, hemodynamic parameters). The mean follow-up time was 6 months. RESULTS: Out of the 28 patients who underwent early surgery, 64% were in good health, 11% in poor health, 25% died; there were no survivors in a vegetative state. Twelve patients were treated conservatively; 50% died from infarction and rebleeding, before the operation was performed. Six underwent delayed aneurysm surgery after clinical improvement. In this group, 25% had good clinical outcome. CONCLUSIONS: Our results favor an aggressive treatment of grade IV aneurysm patients by means of ventricular drainage, early surgery and triple-H therapy.
A computer program (the Audit Assistant) was developed to help physicians review the care of critically ill emergency department (ED) patients. The program is an example of a new class of decision aids that serves to remind physicians to consider possibilities, not an artificial intelligence program that actually attempts to simulate clinical reasoning. The goal of such programs is to enable physicians to reduce errors--in this case to enable reviewers to notice more of the errors in care in the cases they are reviewing. The objective of this study was to demonstrate on a small set of complex cases that the tested computer program enables the physician to perform a better quality review. The issue of what constitutes improved case review is addressed. In the first part of the study, reviewers reviewed two mock charts without using the Audit Assistant and then immediately reviewed the charts again with the assistance of the program. The reviews were compared. In the second part of the study, a second reviewer also compared the utility of the review of the first reviewer alone and the Audit Assistant output as an aid to review, using an additional mock chart. Six emergency physicians participated; each was a quality assurance director for the ED of one Cleveland area hospital. For the physicians reviewing without the Audit Assistant, 41% of critical actions were listed by three or four reviewers. For those using the Audit Assistant, 83% of critical actions were listed by three or four reviewers. All reviewers preferred the Audit Assistant-suggested list to the critical action list generated by a previous reviewer not using the Audit Assistant (P < .02). Use of the Audit Assistant improved the completeness and the consistency of physician review of mock charts of critically ill ED patients in a small series of cases. The critical actions added for review were important, as demonstrated by the preferential addition of critical actions chosen by other reviewers who were not using the computer program.
The leading cause of acute neuromuscular weakness in the developed world is Guillain-Barré syndrome (GBS). Mortality rates vary widely. This article discusses the care and management of patients with GBS, with an emphasis on those patients who require admission to an intensive care unit.