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At least 19 recordsLinked to original sources
PubMedDate not supplied

Management of patients with metastatic malignancy in the intensive care unit.

Intensive care units serve to provide temporary physiologic support to patients with reversible organ failure. However, with increasing frequency, patients with end-stage and terminal illnesses are being admitted to the intensive care unit. Indeed, in the United States, a third of all patients with terminal metastatic malignancy are admitted to the intensive care unit, and 60% of all hospital deaths occur after such an admission. In many instances, admission to an intensive care unit serves only to transform death into a prolonged, painful, and undignified process. In patients with a terminal illness, the focus should be on measures that ensure comfort, and admission to an intensive care unit should generally be avoided. Intensivists, who are charged with making the best use of limited resources, should ultimately be the individuals who determine the appropriateness of admitting such patients to the intensive care unit.

Critical Care↗
PubMed2001

[Activity registration in intensive care units].

Intensive care treatment is expensive and its capacity is limited. The population of elderly patients with greater need for intensive care increases. It has become more important to evaluate the use of intensive care resources and to compare it with the results of treatment. Diagnoses do not provide a satisfactory description of the stay in the intensive care unit. Scoring systems for severity of illness and for resource needs are therefore of great value. The Norwegian Board of Health has requested all intensive care units in Norway to describe their activities by scoring systems for severity of illness, SAPS II (Simplified Acute Physiology Score II) and for use of resources NEMS (Nine Equivalents of Nursing Manpower Use Score). The systems are generally well recognised, easy to learn and not time-consuming. Through SAPS II and NEMS it is possible to compare results of treatment and use of resources across intensive care units or against a standard.

APACHE↗
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↗
PubMed2003

Gallbladder and biliary tract disease in the intensive care unit.

Intensive care unit patients present a difficult challenge in the diagnosis and treatment of complications related to the biliary tract. Altered mental status interferes with the patient's ability to communicate symptoms and give a reliable physical examination. Laboratory data are often nonspecific in diagnosing complications of biliary tract disease because of the high incidence of cholestasis in intensive care unit patients. Likewise, routine radiographic evaluation has a marked decreased sensitivity and specificity in evaluating biliary tract disorders. Taken together, these factors often lead to a delay in diagnosis of biliary tract problems in the intensive care unit patient. Intervention in these patients is associated with high morbidity and mortality when compared to the ambulatory setting. This article reviews the clinical presentation, differential diagnosis, and management options of biliary tract complications in this complex patient population.

Biliary Tract Diseases↗
PubMed2003

Expanding intensive care medicine beyond the intensive care unit.

Intensive care medicine probably requires the artificial boundaries of an intensive care unit to nurture and legitimize the specialty. The next major step in intensive care medicine is to explore ways of optimizing the outcome of seriously ill patients by recognizing and resuscitating them at an earlier stage. Some of these ways include better education of existing staff; earlier consultation; and automatic calling by intensive care staff to abnormalities identifying at-risk patients. Some of these interventions are currently being evaluated and results should soon indicate their relative effectiveness.

Acute Disease↗
PubMed1989

[Patient flow at a medical intensive care unit].

Intensive care units have been established in all somatic hospitals in Norway over the last two decades. In order to examine the use of these units in a medical department the group of patients admitted to the unit at Haukeland hospital during a six month period was analyzed. The flow of patients is twice that found in the regular medical wards. The dominating reason for admittance is heart disease. The overall mortality of the patients in these units is high. However, it is probable that it may be possible to define groups of patients, who without reduction of medical security, could be treated in regular and less costly medical wards.

Humans↗
PubMedDate not supplied

[Factors causing stress in patients in intensive care units].

Intensive care units have been considered stress generating areas. Knowing the causes why this happens will allow us to take specific measures to prevent or minimize it. This study has been performed with the aim to identify stress raising factors, as they are perceived by intensive care patients. The study has been performed in 49 patients most of whom were being attended in postoperatory control. The valuation of the degree of stress was performed using the "Scale of Environmental Stressors in Intensive Care" by Ballard in 1981, modified and adapted to our environment, with a result of 43 items distributed in six groups; Immobilization, Isolation, Deprivation of sleep, Time-spacial disorientation, Sensorial deprivation and overestimulation, and depersonalization and loss of autocontrol. The level of stress perceived by patients was low. The factors considered as most stressing were those related to physical aspects; presence of tubes in nose and mouth, impossibility to sleep and presence of noise, whereas those less stressing referred to Nursing attention. We conclude that patients perceive ICU as a little stressing place in spite of the excessive noise, remark the presence of invasive tubes and the difficulty to sleep as the most stressing factors, and in the same way, express a high degree of satisfaction about the attention received.

Humans↗
PubMed1981

Stresses and coping in ICU nursing. II. Nurse support groups on intensive care units.

Intensive care units (ICU) of hospitals are characteristically stressssful environments with high turnover of personnel. Support groups to help nurses deal with the stresses of the ICU environment have been widely recommended as a means to raise morale and increase communication, but are infrequently reported. Data on these groups are fragmentary. A review of the literature and correspondence with the authors of published papers demonstrated that most nurse support groups are open-ended groups with open membership, usually meeting for an hour a week, occasionally attended by nursing supervisors and unit physicians, and usually conducted by a liaison psychiatrist or a psychiatric consultant. Such groups are reported as positive experiences by nurses and group leaders. The small amounts of available objective evidence of the impact of support groups is positive; further research is required to arrive at a more definitive evaluation.

Adaptation, Psychological↗
PubMed2001

Role of the nephrologist in the intensive care unit.

Intensive care units (ICUs) are increasingly becoming a focal point for tension between medical specialists. In an extreme approach to this issue, some ICUs have become closed units managed by intensivists, with other specialists, such as nephrologists, having a restricted supportive role. The nephrologist, a subspecialist with broad skills in general internal medicine, has trained and appropriately can serve as the primary physician for patients with significant renal failure and end-stage renal disease in multiple hospital settings, including the ICU. Sick and complex hospitalized patients offer ample opportunity for a collaborative interaction between the nephrologist and intensivist in the ICU.

Continuity of Patient Care↗
PubMed2002

The hostile environment of the intensive care unit.

Intensive care units (ICUs) were developed for patients with special needs and include an array of technology to support medical care. However, basic lessons in ergonomics, human factors, and human performance fail to propagate in this complex medical environment. Complicated, error-prone devices are commonly used. There are too many patient data for one person to process effectively. Lighting, ambient noise, and scheduling all result in provider and patient stress. These difficult working conditions make errors more probable and are risk factors for provider burnout and negative outcomes for patients. Auditory alarms on ICU equipment, ICU syndrome, and needle sticks are discussed as examples of such problems.

Burnout, Professional↗
PubMed1990

Economic and ethical consideration in the intensive care unit.

Intensive care units (ICUs) sustain life but, in certain cases, this resource becomes a means to prolong dying, with great physical, emotional and financial impact. The cost to care for patients in the ICU is at least three times more than general ward care; thus, ICUs have become one of the largest cost centres in the hospital. Economic pressures require us to be mindful of whom the ICU treats and for how long. Health professionals working in the ICU must critically appraise the ethical basis for their behaviour and actions. In so doing, many are likely to appeal to the patient's right to self-determination and the physician's reliance on the principles of beneficence and non-maleficence as the underpinnings of morality in medicine. One approach is to examine the issues and rights pertinent to an individual case using a circular model. Decisions are based on medical facts and prognosis, a patient's right to self-determination, a patient's best interests and external factors. Health personnel would be compelled to consider all of these issues. Within this framework, prevention or resolution of moral dilemma can take place within the clinical rather than the legal forum.

Adult↗
PubMed1975

An assessment of the criteria for selection of patients for an obstetric intensive care unit.

Intensive care monitoring of the fetus during labour improves perinatal conditions in 'high-risk" Black women. If the available facilities and staff are to be used with maximal efficiency, a system of priorities is necessary. It would appear that patients with meconium staining of the liquor, with cephalopelvic disproportion, or with two or more indications for monitoring, should have priority for admission to our intensive care unit. Hypertension and antepartum haemorrhage are of less importance, but there are two other problems which need investigation. There is a group of patients in labour who arrive too late to be monitored. They have a considerable perinatal mortality and the reasons for their late arrival need to be ascertained. There is a second group of patients who begin labour before term and deliver babies with a high risk of perinatal death. These problems require further investigation.

Arrhythmias, Cardiac↗
PubMed1999

Drug resistance in intensive care units.

Intensive care units (ICUs) are generally considered epicenters of antibiotic resistance and the principal sources of outbreaks of multi-resistant bacteria. The most important risk factors are obvious, such as excessive consumption of antibiotics exerting selective pressure on bacteria, the frequent use of invasive devices and relative density of a susceptible patient population with severe underlying diseases. Infections due to antibiotic-resistant bacteria have a major impact on morbidity and health-care costs. Increased mortality is not uniformly shown for all of these organisms: Methicillin-resistant Staphylococcus aureus (MRSA) seems to cause significantly higher mortality, in contrast to vancomycin-resistant enterococci (VRE). Therefore it is essential to diminish these potential risk factors, especially by providing locally adapted guidelines for the prudent use of antibiotic therapy. A quality control of antimicrobial therapy within a hospital, and especially within the ICU, might help to minimize the selection of multidrug-resistant bacteria. The restricted use of antimicrobial agents in prophylaxis and therapy has also been shown to have at least temporal effects on local resistance patterns. New approaches to the problem of drug resistance in ICUs are badly needed.

Anti-Bacterial Agents↗
PubMed1997

Assessing antibacterial pharmacoeconomics in the intensive care unit.

Intensive care units (ICUs) represent areas of high use of antibacterials and other pharmacy goods and services. Many institutions view their ICUs as a target for drug-use surveillance and cost-containment programmes. Economic assessment of antibacterial interventions in the ICU should include all direct costs and patient outcomes. Nonetheless, many of these institutions focus their efforts at reducing antibacterial costs without considering the consequences of these actions. It is possible that devoting more resources to antibacterials can have an overall positive economic impact if more appropriate antibacterial use reduces length of stay, decreases bacterial resistance or lowers frequency of adverse complications. Two consequences of antibacterial use which can result in substantial economic burdens to institutions are drug-induced complications (toxicities and adverse events) and the development of antibacterial-resistant organisms. These events are logical targets for performing pharmacoeconomic studies to evaluate appropriate and inappropriate antibacterial use. Either of these problems can increase length of stay, which is the single most important variable influencing the overall cost of patient care. The primary goal of patient care is to hasten patients' clinical improvement. This will result in decreased antibacterial acquisition costs, decreased lengths of ICU and hospital stays, and ultimately decreased consumption of hospital resources. These can be accomplished by using strategies to guide antibacterial use in order to reduce failures, adverse events, toxicity and antimicrobial resistance.

Anti-Infective Agents↗
PubMed2004

[Quality assurance in intensive care medicine. SARI-surveillance on antibiotic use and bacterial resistance in intensive care units].

Intensive care units (ICUs) are high risk areas for emergence and spread of multiresistant bacterial pathogens. In Germany, there are no representative epidemiological data on antibiotic resistance, prophylactic or therapeutic use of antibiotics in ICUs, or on the correlation between antibiotic use and emergence of resistance. Supported by the German Ministry of Science and Education, project SARI (Surveillance on antibiotic use and bacterial resistance in ICUs) started in 02/2000 and now includes data on antibiotic use and resistance rates in 35 medical, surgical and interdisciplinary ICUs. To date (2/2000-12/2002), a total of 939 participant months, 339,461 patient days and 452,282 defined daily doses (DDD) have been covered with a mean antibiotic usage density (AD) of 1,332 DDDs/1,000 patient days and resistance data on 31,189 isolates from ICUs. The design of the project and first results of SARI are presented. The epidemiological data of SARI form a basis for improved antibiotic and infection control management in ICUs (http://www.sari-antibiotika.de).

Anti-Bacterial Agents↗
PubMed2005

Respiratory nosocomial infections in the medical intensive care unit.

Intensive care unit (ICU)-acquired lower respiratory tract infections include acute tracheobronchitis and hospital-acquired and ventilator-associated pneumonia (VAP). Nosocomial pneumonia is the second most common hospital-acquired infection and the leading cause of death in hospital-acquired infections. The mortality rate in VAP ranges from 24% to 76% in several studies. ICU ventilated patients with VAP have a 2- to 10-fold higher risk of death than patients without it. Early oropharyngeal colonization is pivotal in the etiopathogenesis of VAP. The knowledge of risk factors for VAP is important in developing effective preventive programs. Once the physician decides to treat a suspected episode of ICU-acquired pneumonia, some issues should be kept on mind: first, the adequacy of the initial empiric antibiotic therapy; second, the modification of initial inadequate therapy according to microbiological results; third, the benefit of combination therapy; and finally, the duration of the antimicrobial treatment. Additionally, a protocolized work-up to identify the causes of non-response to treatment is mandatory. All these issues are discussed in depth in this article.

Community-Acquired Infections↗
PubMed1999

Workforce dilemmas: a comparison of staffing in a generalist and a specialist intensive care unit.

Intensive care units are arguably one of the most costly resources a hospital has to maintain in terms of nursing staff, skills and technology. Given that the Government's agenda on quality remains one of obtaining cost-effective healthcare, it is imperative that nursing managers consider the implications of the new policy shift for how they currently provide services. The purpose in this paper is to compare the different staffing levels adopted by managers in generalized and neurosurgical intensive care in an acute hospital trust. The dilemmas facing managers making staffing decisions without any definitive guidelines for resourcing these specialized units are examined.

Cost-Benefit Analysis↗