Can intermediate care substitute for intensive care?
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Critical Care↗
Biomedical subjects
D Teres
Publications and source records attributed to D Teres.
A comparison of methods to predict mortality of intensive care unit patients.
This paper presents results of the first study explicitly designed to compare three methods for predicting hospital mortality of ICU patients: the Acute Physiology Score (APS), the Simplified Acute Physiology Score (SAPS), and the Mortality Prediction Model (MPM). With respect to sensitivity, specificity, and total correct classification rates, these methods performed comparably on a cohort of 1,997 consecutive ICU admissions. In these patients from a single hospital, the APS overestimated and the SAPS underestimated the probability of hospital mortality. The MPM probabilities most closely matched the observed outcomes. Each method holds considerable promise for assessing the severity of illness of critically ill patients. The MPM should be particularly useful for comparing ICU performance, since it is independent of ICU treatment and can be calculated at the time a patient is admitted.
Diagnosis-Related Groups↗
Enhanced bleeding with cefoxitin or moxalactam. Statistical analysis within a defined population of 1493 patients.
Most cases of beta-lactam-associated coagulopathy occur in patients with other risk factors. This study analyzed temporally related clinical bleeding events in 1493 patients who received one antibiotic for at least three days. Univariate and multivariate analyses controlled for condition variables (nutritional status, renal, hepatic, or hematologic dysfunction, intensive care unit stay) and treatment variables (use of antiplatelet agents, anticoagulants, vitamin K, antitumor chemotherapy or antiulcer therapy, steroids) that could have been associated with bleeding independently. Rates of bleeding ranged from 0% (chloramphenicol sodium succinate, vancomycin hydrochloride, erythromycin lactobionate) to 8.2% (cefoxitin) to 22.2% (moxalactam disodium). Multiple logistic regression analyses revealed that only moxalactam (odds ratio, 9.9) and cefoxitin (odds ratio, 2.1) exhibited significantly higher likelihoods of bleeding than other agents. This study statistically confirms increased risk of bleeding with moxalactam, heretofore reported only anecdotally. Cefoxitin may carry risks greater than previously believed.
Anti-Bacterial Agents↗
Applications of microcomputer spreadsheet packages as adjuncts to multiple logistic regression analysis.
This paper illustrates how a microcomputer spreadsheet package can be used by epidemiologists to facilitate the computation of multiple logistic regression (MLR) probabilities, as well as odds ratios and associated confidence intervals, given the coefficients of the MLR model. By formatting a spreadsheet, data entry is greatly simplified, and computations are accomplished without any arithmetic manipulations on the part of the user. This approach makes it feasible for clerical support staff to assist in the computation of seemingly complex expressions. The increasing availability of microcomputers in clinical and research settings suggests that numerous analytic applications are amenable to this approach, thereby decreasing reliance on mainframe computers and desk-top calculators.
Computers↗
A comparison of infections in different ICUs within the same hospital.
Infections identified between 1981 and 1983 in a hospital's medical/surgical, pediatric, neonatal, coronary care, and cardiac surgery ICUs were compared. Among 14,360 admissions, 1840 infections occurred in 1360 patients. Total infection rates ranged from 1.0% (cardiac surgery ICU) to 23.5% (medical/surgical ICU). Rates of ICU-acquired infection ranged from 0.8% (cardiac surgery ICU) to 11.2% (medical/surgical ICU), indicating that only about half of infections in the latter unit were acquired from within. Primary bacteremias comprised 14.5% of neonatal ICU infections, a rate 500% higher than in other ICUs. Meningitis and genitourinary infections were more common in pediatric and coronary care ICUs. Candida and Pseudomonas species and Klebsiella-Enterobacter-Serratia were most common in the medical/surgical ICU. Survival rate of infected patients was over 87% in pediatric and neonatal ICUs, compared with only 55.4% in the medical/surgical ICU. These differences in types and rates of infection have an important bearing on infection-control activities in the ICU, and also provide a yardstick against which similar institutions can gauge their ICU infection status.
Bacteria↗
A method for predicting survival and mortality of ICU patients using objectively derived weights.
Data at ICU admission and after 24 h in the ICU were collected on 755 patients, to derive multiple logistic regression models for predicting hospital mortality. The derived models contained relatively few and easily obtained variables. The weight associated with each variable was determined objectively. There were seven admission variables, none of which were treatment dependent, and seven 24-h variables reflecting treatments and patients' conditions in the ICU. Predicted outcomes using these two models were closely correlated with actual outcome. Theoretically, a predictive model would be useful to physicians for triage decisions as well as determining aggressiveness of care through discussions with families, determining utilization of ICU facilities, and objectively comparing different ICUs. This research represents an initial attempt to develop models that are not based on subjectively determined weights.
Adolescent↗
Usefulness of pulmonary artery catheterization in the ICU.
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Cardiac Catheterization↗
Treatment of hypophosphatemia.
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Drug Administration Schedule↗
Absence of generation of oxygen-containing free radicals with 4'-deoxydoxorubicin, a non-cardiotoxic anthracycline drug.
In vitro ESR studies of doxorubicin and 4'-deoxydoxorubicin have been conducted using the spin traps PBN and DMPO. Solutions prepared in the presence of atmospheric oxygen at pH = 12 exhibited a typical semiquinone signal preceded by a short-lived signal attributed to perhydroxyl radical, HO2. At physiological pH the perhydroxyl signal was observed in the doxorubicin solution but not in 4'-deoxydoxorubicin. In the absence of oxygen, at pH = 7.5, neither drug exhibited a signal. A relationship is proposed between the perhydroxyl radical and the cardiotoxicity observed in doxorubicin but not in 4'-deoxydoxorubicin.
Antineoplastic Agents↗
Two-year outcome of adult intensive care patients.
Five hundred fifty-eight patients admitted to a general/medical surgical intensive care unit were studied 2 years after hospital discharge to determine whether they were still alive, were able to perform daily activities, and had returned to work. The overall 2-year survivorship (hospital and long-term) was 63.5%. Two-year survival was considerably lower for patients with certain condition or treatment characteristics than for others. This ranged from 14% 2-year survival for patients with 48 or more hours of coma to 82.2% for patients with no condition or treatment characteristics recorded. Once a patient was discharged alive, the 2-year cumulative survival of surgical ICU patients (84.6%) was significantly better than that of medical ICU patients (76.5%). Among ICU survivors responding to a follow-up survey, 85% were able to perform daily activities, but only 66% were working. Of the 44 patients experiencing a change in ability to perform daily activities at time of follow-up compared with pre-ICU admission, functional status of 34 (77%) improved, while 10 (23%) got worse. By comparison, of the 45 patients experiencing a change in working status, only 7 patients (16%) who did not work prior to ICU admission had returned to work, whereas the remaining 38 patients (84%) who worked prior to ICU admission were not working at time of follow-up study.
Activities of Daily Living↗
Lymphocytopenia in the surgical intensive care unit patient.
Total lymphocyte counts were monitored in 328 consecutive adult patients in the intensive care unit of a large community hospital. Lymphocytopenia was common with a severe reduction in circulating lymphocytes (less than 900/mm3) present in 37% of the patients and moderate reduction (900-1500/mm3) in 38% of the patients. Mortality was 30% and 13% in these two groups, respectively. Patients undergoing high-risk elective surgery frequently had moderate lymphocytopenia even when corticosteroids were not administered. Patients having two or more clinically evident infections with severe lymphocytopenia had a 59% mortality rate. Among patients who did not manifest any clinically detectable infection, mortality associated with those having severe lymphocyte reduction was significantly greater than those with normal lymphocyte counts or moderate depletion.
Adrenal Cortex Hormones↗
A comparison of mortality and charges in two differently staffed intensive care units.
All patients entering the two differently staffed adult intensive care units (ICUs) of Baystate Medical Center were studied for a three-month period. In one unit, patients were cared for by medical and surgical resident teams specifically assigned to the ICU, who were supervised by private and teaching ICU attending physicians; patients admitted to the other ICU were cared for entirely by private physicians. Significantly lower hospital mortality rates were observed in the resident-staffed ICU for three categories of patients. Median charges for the two groups of ICU patients were either the same or higher for the resident-staffed ICU when controlling for levels of condition and treatment variables.
Adult↗
Shock after phenothiazine administration in a pregnant patient with a pheochromocytoma. A case report and literature review.
A pregnant patient with undiagnosed bilateral pheochromocytoma developed shock and pulmonary edema subsequent to the administration of a phenothiazine. The patient had developed a paradoxic hypertensive response to hydralazine. A high index of suspicion is required for diagnosing a pheochromocytoma that mimics toxemia of pregnancy. There is an urgent need for prompt plasma expansion for the pregnant patient in shock, even when pulmonary edema is present.
Adrenal Gland Neoplasms↗
Predicting mortality of intensive care unit patients. The importance of coma.
Five hundred fifty-eight patients from two general medical/surgical ICUs were studied with respect to the relationship of mortality and length of stay to 18 treatment and condition variables. Two multiple logistic regression models were developed to estimate the probability of mortality. One was a model incorporating main effects only; the other allowed for the interaction of pairs of variables. For ICU mortality, the best predictive variables using the main effects model were coma, cardiopulmonary resuscitation (CPR) in the ICU, and shock. With the interactive model, the variables selected were shock plus coma, and CPR in the ICU.
Coma↗
Hospital charges and long-term survival of ICU versus non-ICU patients.
Hospital charges and long-term (2 yr) survival were evaluated for 558 ICU and 124 non-ICU patients from a large community hospital. Although the ICU patients represented only 9.5% of total hospital admissions, they incurred nearly 30% of the total hospital charges and had a median hospital charge of greater than four times the non-ICU comparison group. For the ICU patients, the overall in-hospital mortality rate was 17.3% and the overall 2-yr mortality rate was 35.6%, whereas the non-ICU group rates were 3.4 and 14.8% respectively. Given a patient was discharged alive from the hospital, the proportion surviving an additional 2 yr was strikingly similar for the two groups (83.3% of ICU patients and 89.1% of non-ICU patients). Because of excess mortality for ICU patients, discharged from a community hospital was not significantly greater than for non-ICU patients, the long-term outlook for discharged patients after receiving intensive care is not as bleak as is generally assumed.
Adult↗
Experimental diffuse alveolar damage in baboons.
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Animals↗
Prevention of doxorubicin-induced skin ulcers in the rat and pig with dimethyl sulfoxide (DMSO).
Ten potential agents were tested in the Sprague-Dawley rat, using the method of Rudolph et al, which produces skin ulcers with 0.4 mg of doxorubicin intradermally. One antidote, dimethyl sulfoxide (100%, 0.6 ml for 7 days), prevented ulcer formation not only at the local site but also at the doxorubicin control injection site. Similar ulcers were produced in the Yorkshire pig with 2.0 mg of intradermal doxorubicin injection. These ulcers were prevented at both local and distant control sites with dimethyl sulfoxide given for 7 days.
Animals↗
Synergistic effect of acute renal failure and respiratory failure in the surgical intensive care unit.
A retrospective evaluation of the effect of renal and respiratory failure on mortality in our surgical intensive care unit was undertaken. The coexistence of combined renal and respiratory failure had a synergistic adverse effect on survival. Combined pulmonary and kidney failure appeared to develop simultaneously. A subset of patients with severe prerenal azotemia but without uremia had the highest mortality. These results are not consistent with the simple combination of single systems failure but rather suggest that renal and respiratory failure are makers of a generalized underlying defect.
Acute Kidney Injury↗