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PubMed2002

[Risk predictors, scoring systems and prognostic models in anesthesia and intensive care. Part II. Intensive Care].

The aim of the second part of this review article was to describe common scoring systems in intensive care, and to point out their possible benefits and limitations. Intensive care medicine multipurpose scoring-systems are currently used to estimate severity of illness, mortality and the amount of treatment required. Costs (only commercial available scores e.g. Acute Physiology and Chronic Health Evaluation [APACHE] III) and time needed for calculation have to be taken into consideration. Prognostic models of the third generation (APACHE III, Simplified Acute Physiology Score [SAPS] II, Mortality Prediction Model [MPM] II) should be preferred having better prognostic performance compared to scoring systems of prior generations. Although no prospective study exists comparing these three common scoring systems, it appears that all three systems are able to provide useful information to the clinician and researcher. These scoring systems were designed to classify severity of illness or the course of diagnostic and therapeutic interventions and to perform a risk stratification for scientific studies in a standardized way. In quality management and cost control, scoring systems and predictors are used for risk adjustment and evaluation of care performance.

APACHE↗
PubMed1981

Neurosurgical admissions to the intensive care unit: intensive monitoring versus intensive therapy.

Among 624 consecutive admissions to a medical-surgical intensive care unit (ICU), we identified 289 patients admitted for concentrated nursing care and intensive monitoring of whom only 44 (15%) received active treatment before discharge. Within this group were 82 patients admitted after uncomplicated elective neurosurgery. Only 1 of these patients required active treatment before discharge. None had any major physiological abnormality detected by electronic monitoring, and no patient required readmission to the ICU or died during hospitalization. These 82 neurosurgical admissions accounted for 13% of the total admissions over the study period and 10.5% of the total number of ICU days. The admission of these patients to the ICU was prompted by the need for labor-intensive services, such as hourly neurological checks, that were not available on the regular hospital floor. For stable postoperative neurosurgical patients, improved staffing of hospital wards could lead to a reduction in the number of admissions to the ICU.

Central Nervous System Diseases↗
PubMedDate not supplied

[Cultural meaning of humanized care at intensive care units: "lots of words, little action"].

This work consists in an ethnographic study which aimed at understanding the cultural meaning attributed by nursing teams to humanized care in Intensive Care Units of the University Hospital of Goiás Federal University. Participant observations and semi-structured interviews were used for data collection with nursing teams at their workplace. Three main categories emerged from the data: humanized care--"love the other as you love yourself"; humanized care--"it's not present as it should be"; stress and suffering--"the ones who care need to be looked after". The cultural theme that emerged from the data was: the humanized care--"a lot is said about it, but little is experienced". This theme emphasize the reality of the care at the ICU that involves a nursing team with the humanization concept synthesized on the expression: "love the other as you love yourself"; but in a practical way, the caring process does not reveal this deep thought.

Brazil↗
PubMedDate not supplied

Bacteriological profile and antibiotic resistance: comparison of findings in a burn intensive care unit, other intensive care units, and the hospital services unit of a single center.

The purpose of the study was to define the bacteriological profile and antibiotic resistance patterns of a burn intensive care unit (ICU) and to compare them with the patterns from three other hospital areas in the same center (ie, cardiovascular-coronary ICU, a general ICU, and the hospital service unit). Bacterial isolates were collected prospectively from the burned patients and the patients from the other hospital areas between May 2001 and November 2003. In the burn ICU, Pseudomonas aeruginosa was the isolated pathogen most frequently (40.4%), followed by Staphylococcus aureus (29.3%) and Acinetobacter spp. (9.8%). S. aureus was the most common isolated pathogen in other hospital areas. The agents that were most effective against P. aeruginosa in the burn ICU were piperacillin/tazobactam and sulbactam/cefoperazon. We observed higher antimicrobial resistance in burn ICU than in the other hospital areas studied. In conclusion, bacteriological profile and antibiotic resistance patterns of patients in the burn ICU are significantly different from those in other ICUs and hospital units at our center. This knowledge is crucial for early treatment of infections in burned patients.

Acinetobacter↗
PubMed1992

Clinical audit in intensive care--the Meath Intensive Care Audit.

Audit is now recognised as being an essential component of clinical practice. We report on the first year of the Meath Intensive Care Audit (MICA). This audit was instituted to investigate the activity of the unit, to assess the feasibility of continuous audit in our ICU and to provide data for future development of ICU facilities. Two hundred and fifty four patients were admitted between July 1st 1990 and June 30th 1991. The mean age at admission was 58 years and the mean length of stay 5.2 days. The mean APACHE II score was 16. Thirty four patients (13.4%) died in the ICU and 17 patients died in hospital following discharge from the unit bringing the hospital mortality rate to 20%. The audit proved feasible to implement and data collection is now accepted as a routine part of our ICU work.

Cause of Death↗
PubMed2004

A content analysis of forms, guidelines, and other materials documenting end-of-life care in intensive care units.

OBJECTIVE: The purpose of this study was to determine the extent to which data entry forms, guidelines, and other materials used for documentation in intensive care units (ICUs) attend to 6 key end-of-life care (EOLC) domains: 1) patient and family-centered decision making, 2) communication, 3) continuity of care, 4) emotional and practical support, 5) symptom management and comfort care, and 6) spiritual support. A second purpose was to determine how these materials might be modified to include more EOLC content and used to trigger clinical behaviors that might improve the quality of EOLC. PARTICIPANTS: Fifteen adult ICUs-8 medical, 2 surgical, and 4 mixed ICUs from the United States, and 1 mixed ICU in Canada, all affiliated with the Critical Care End-of-Life Peer Workgroup METHODS: Physician-nurse teams in each ICU received detailed checklists to facilitate and standardize collection of requested documentation materials. Content analysis was performed on the collected documents, aimed at characterizing the types of materials in use and the extent to which EOLC content was incorporated. MEASUREMENTS AND MAIN RESULTS: The domain of symptom management and comfort care was integrated most consistently on forms and other materials across the 15 ICUs, particularly pain assessment and management. The 5 other EOLC domains of patient and family centered decision-making, communication, emotional and practical support, continuity of care, and spiritual support were not well-represented on documentation. None of the 15 ICUs supplied a comprehensive EOLC policy or EOLC critical pathway that outlined an overall, interdisciplinary, sequenced approach for the care of dying patients and their families. Nursing materials included more cues for attending to EOLC domains and were more consistently preprinted and computerized than materials used by physicians. Computerized forms concerning EOLC were uncommon. Across the 15 ICUs, there were opportunities to make EOLC- related materials more capable of triggering and documenting specific EOLC clinical behaviors. CONCLUSIONS: Inclusion of EOLC items on ICU formatted data entry forms and other materials capable of triggering and documenting clinician behaviors is limited, particularly for physicians. Standardized scales, protocols, and guidelines exist for many of the EOLC domains and should be evaluated for possible use in ICUs. Whether such materials can improve EOLC has yet to be determined.

Attitude of Health Personnel↗
PubMedDate not supplied

[The need for nursing care in intensive care units: daily patient assessment according to the nursing activities score (NAS)].

This study aimed to characterize patients admitted to ICU according to their bio-social factors and admissions and verify the daily needs for nursing care according to NAS. The sample was composed by 50 adult patients who were consecutively admitted to the ICU of a University Hospital in São Paulo city. It was concluded that most patients were older than 60 with an average of 3.5-day stay in the ICU; they came from the Emergency Room and were referred to the Semi-Intensive Care Unit. NAS average was 66.5% (+/- 9.1) with a score higher than 50.0% during their stay in the ICU.

Adult↗
PubMed2004

Clinical review: impact of emergency department care on intensive care unit costs.

Critical care is both expensive and increasing. Emergency department (ED) management of critically ill patients before intensive care unit (ICU) admission is an under-explored area of potential cost saving in the ICU. Although limited, current data suggest that ED care has a significant impact on ICU costs both positive and negative. ICU practices can also affect the ED, with a lack of ICU beds being the primary reason for ED overcrowding and ambulance diversion in the USA. Earlier application in the ED of intensive therapies such as goal-directed therapy and noninvasive ventilation may reduce ICU costs by decreasing length of stay and need for admission. Future critical care policies and health services research should include both the ED and ICU in their analyses.

Critical Illness↗
PubMedDate not supplied

Oral care in intensive care units: a literature review.

Patients in an intensive care unit (ICU) may have significant oral health needs. This article offers a review of the available literature regarding oral care for patients in the ICU. Based on this review, the author describes signs and symptoms reported as common among patients in the ICU and makes recommendations concerning their oral care. The implications of these findings are also discussed.

Critical Care↗
PubMed1997

[Cost analysis of primary care and intensive care treatment of multiple trauma patients].

Treatment costs of emergency therapy, surgery and intensive care were analysed in 20 randomly chosen, representative patients with severe multiple trauma (mean ISS 32 p). For an average stay of about 22.5 days in the ICU, the total costs were DM 106,924.36 (about $70,000), which breaks down as DM 39,635.88 (= 37%) for physicians and nurses, DM 67,289.08 (= 63%) for materials, X-rays, laboratory investigations, drugs and blood components. The whole treatment caused daily costs of DM 4,752.22, or DM 3.30 per min. The first emergency diagnostic procedures and emergency therapy take a mean of 451.9 min from admission to the beginning of the ICU treatment and itself generates costs of about DM 12,325.99. In Germany a new system of compensation by diagnosis-related group was introduced in 1996. Therefore, these data indicate that treatment of severe multiple trauma is very expensive and trauma care could be economically by damaging for smaller hospitals. We conclude that treatment of multiply injured patients (ISS > 16 p) should be concentrated in selected trauma centres and compensated by payment of a special daily amount of about DM 5,000 (about $3,500).

Adolescent↗