PubMed · 12163815
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Carolyn Bekes, Judy Stechert, Maria I Rudis, Richard J Brilli, Thomas G Rainey. 2002. It's time.... https://doi.org/10.1097/00003246-200208000-00040
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Critical care encompasses elements of emergency medicine, anaesthesia, intensive care, acute internal medicine, postsurgical care, trauma management, and retrieval. In metropolitan teaching hospitals these elements are often distinct, with individual specialists providing discrete services. This may not be possible in rural centres, where specialist numbers are smaller and recruitment and retention more difficult. Multidisciplinary integrated critical care, using existing resources, has developed in some rural centres as a more relevant approach in this setting. The concept of developing a specialty of integrated critical-care medicine is worthy of further exploration.
OBJECTIVE: To investigate the prognostic factors in acute respiratory distress syndrome (ARDS) patients focusing on the use of prone positioning (PP). DESIGN AND SETTING: Retrospective study conducted in an intensive care unit of a university hospital. PATIENTS: All consecutive mechanically ventilated ARDS patients surviving on day 7 after the diagnosis of ARDS. METHODS: The study included all ARDS patients who survived more than 7 days after ARDS diagnosis between January 1995 and December 2002. Demographic and respiratory variables were collected on day 1, and the management of ARDS was analyzed during the first 7 days ( n=125). We performed a univariate analysis and a stepwise logistic regression analysis comparing survivors and nonsurvivors on day 28 and at 2 and 6 months. RESULTS: Mortality rates on day 28 and at 2 and 6 months were 21.6%, 32%, and 44% respectively. A SAPS II score less than 49, McCabe score, and the use of PP introduced in the first 7 days of ARDS management appeared to be independently correlated with a decrease in mortality. CONCLUSIONS: The SAPS II score, the McCabe score, and use of PP are independently correlated with the outcome in ARDS patients.
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