Medical Intensive Care: Indications, Interventions, and Outcomes

Abstract

To evaluate current practices regarding intensive-care units (ICU's), we collected data on 2693 consecutive admissions to a medical ICU during a two-year period and studied indications for admission, specific interventions, costs, and outcomes. The need for noninvasive monitoring rather than immediate major interventions prompted 77 per cent of the admissions. Only 10 per cent of monitored patients had subsequent indications for major interventions. The 23 per cent who required immediate interventions accounted for disproportionate shares of total charges (37 per cent) and deaths during hospitalization (58 per cent). Demographic and diagnostic data indicate that the aged and chronically ill have become the principal consumers of intensive care. Overall mortality during hospitalization was 10 per cent; cumulative mortality during follow-up study (mean duration, 15 months) was 25 per cent. We conclude that identification of sensitive predictors of complications and specific predictors of mortality can lead to more efficient and effective ICU practices.

Diffuse alveolar haemorrhage: factors associated with in-hospital and long-term mortality

“…Age .60 yrs was associated with mortality in discharged patients. This finding was in agreement with the study of THIBAULT et al [35], who found that age had a greater effect on long-term mortality in a large nonselected population of patients admitted to the ICU. Dependence on haemodialysis was also a risk factor for long-term mortality.…”

Prognostic scores in cirrhotic patients admitted to a gastroenterology intensive care unit

“…This is particularly relevant in cirrhotic patients, owing to the exponential increase in the incidence of this condition and the limited ICU resources (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) Our study assessed, to our knowledge for the first time, the accuracy of prognostic scores in cirrhotic patients admitted to a GICU. In our series, all the tested scores displayed good discrimination and calibration.…”

“…The incidence of liver cirrhosis is increasing exponentially and cirrhotic patients admitted to ICUs have high mortality rates and a high rate of consumption of resources (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Furthermore, a significant percentage (36.7%) of the total cost of ICU care for cirrhotic patients is spent on those who do not survive (11,16,19).…”

“…Furthermore, a significant percentage (36.7%) of the total cost of ICU care for cirrhotic patients is spent on those who do not survive (11,16,19). Additionally, it must be borne in mind that ICUs are a very limited health resource (10,11,18). Thus, predictive models could be very important decision-making tools in this setting.…”

Long term prognosis and quality of life following intensive care for life-threatening complications of haematological malignancy

“…: 86 ± 13.9). One patient took early Intensive care clinicians are frequently faced with ethical dilemmas concerning the appropriate extent of medical intervention for critically ill patients whose prognosis is poor (Thibault et al, 1980;Wanzer et al, 1984). Not only can intensive care be mentally and physically distressing for patients, relatives and staff but it is also expensive, especially for non-survivors (Cullen et al, 1976;Detsky et al, 1981;Turnbull et al, 1979).…”