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Adult ICUs (adult + icu)

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Medical Sciences100%

Selected Abstracts

Immediate and 5-year cumulative outcome after paediatric intensive care in Sweden

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2008
N. GULLBERG
Background: Little has been reported about intensive care of children in Sweden. The aims of this study are to (I) assess the number of admissions, types of diagnoses and length-of-stay (LOS) for all Swedish children admitted to intensive care during the years 1998,2001, and compare paediatric intensive care units (PICUs) with other intensive care units (adult ICUs) (II) assess immediate (ICU) and cumulative 5-year mortality and (III) determine the actual consumption of paediatric intensive care for the defined age group in Sweden. Methods: Children between 6 months and 16 years of age admitted to intensive care in Sweden were included in a national multicentre, ambidirectional cohort study. In PICUs, data were also collected for infants aged 1,6 months. Survival data were retrieved from the National Files of Registration, 5 years after admission. Results: Eight-thousand sixty-three admissions for a total of 6661 patients were identified, corresponding to an admission rate of 1.59/1000 children per year. Median LOS was 1 day. ICU mortality was 2.1% and cumulative 5-year mortality rate was 5.6%. Forty-four per cent of all admissions were to a PICU. Conclusions: This study has shown that Sweden has a low immediate ICU mortality, similar in adult ICU and PICU. Patients discharged alive from an ICU had a 20-fold increased mortality risk, compared with a control cohort for the 5-year period. Less than half of the paediatric patients admitted for intensive care in Sweden were cared for in a PICU. Studies are needed to evaluate whether a centralization of paediatric intensive care in Sweden would be beneficial to the paediatric population. [source]

Nurses' and physicians' viewpoints regarding children visiting/not visiting adult ICUs

NURSING IN CRITICAL CARE, Issue 2 2007
Susanne Knutsson
Abstract Allowing children to visit adult intensive care units (ICUs) has been an area of controversy. There is a lack of recent research dealing with visits by children and physicians' views and whether differences exist between the views held by nurses and physicians regarding visits by children. The aim of this study was to describe and compare reasons given by nurses and physicians for restricting visits by children to a relative hospitalized in an adult ICU. This was a quantitative, descriptive multicentre study. Nurses and physicians (n= 291) at 72 general adult ICUs participated, each completing a questionnaire. A majority of the nurses and physicians were positive to children visiting patients in ICU, but they also imposed restrictions. The most common reasons were: severity of the patient's injury (50%); the environment was frightening for the child (50%); the infection risk for the child (36%) and the patient (56%). Children <7 years were restricted more than those >7 years. Nurses were more positive than physicians to visits by younger children. Physicians were more positive to visits if the patient was tired and critically ill/injured or was a friend/cousin. More physicians refused visits due to the fact that children are too noisy for the staff. Risks of negative effects on the children's health by visiting patients were also stated. Nurses and physicians still restrict children's visits to adult ICUs for a number of reasons, and nurses' and physicians' views on children visiting differ and so also the views within each professional group. The differences in views show that the dynamics are complicated and this could be attributed to a lack of a common view of care, which prevents family-centred care that includes children from being practised. [source]

Modelling survival in acute severe illness: Cox versus accelerated failure time models

JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2008
John L. Moran MBBS FRACP FJFICM MD
Abstract Background, The Cox model has been the mainstay of survival analysis in the critically ill and time-dependent covariates have infrequently been incorporated into survival analysis. Objectives, To model 28-day survival of patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), and compare the utility of Cox and accelerated failure time (AFT) models. Methods, Prospective cohort study of 168 adult patients enrolled at diagnosis of ALI in 21 adult ICUs in three Australian States with measurement of survival time, censored at 28 days. Model performance was assessed as goodness-of-fit [GOF, cross-products of quantiles of risk and time intervals (P , 0.1), Cox model] and explained variation (,R2', Cox and ATF). Results, Over a 2-month study period (October,November 1999), 168 patients with ALI were identified, with a mean (SD) age of 61.5 (18) years and 30% female. Peak mortality hazard occurred at days 7,8 after onset of ALI/ARDS. In the Cox model, increasing age and female gender, plus interaction, were associated with an increased mortality hazard. Time-varying effects were established for patient severity-of-illness score (decreasing hazard over time) and multiple-organ-dysfunction score (increasing hazard over time). The Cox model was well specified (GOF, P > 0.34) and R2 = 0.546, 95% CI: 0.390, 0.781. Both log-normal (R2 = 0.451, 95% CI: 0.321, 0.695) and log-logistic (R2 0.470, 95% CI: 0.346, 0.714) AFT models identified the same predictors as the Cox model, but did not demonstrate convincingly superior overall fit. Conclusions, Time dependence of predictors of survival in ALI/ARDS exists and must be appropriately modelled. The Cox model with time-varying covariates remains a flexible model in survival analysis of patients with acute severe illness. [source]

Immediate and 5-year cumulative outcome after paediatric intensive care in Sweden

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2008
N. GULLBERG
Background: Little has been reported about intensive care of children in Sweden. The aims of this study are to (I) assess the number of admissions, types of diagnoses and length-of-stay (LOS) for all Swedish children admitted to intensive care during the years 1998,2001, and compare paediatric intensive care units (PICUs) with other intensive care units (adult ICUs) (II) assess immediate (ICU) and cumulative 5-year mortality and (III) determine the actual consumption of paediatric intensive care for the defined age group in Sweden. Methods: Children between 6 months and 16 years of age admitted to intensive care in Sweden were included in a national multicentre, ambidirectional cohort study. In PICUs, data were also collected for infants aged 1,6 months. Survival data were retrieved from the National Files of Registration, 5 years after admission. Results: Eight-thousand sixty-three admissions for a total of 6661 patients were identified, corresponding to an admission rate of 1.59/1000 children per year. Median LOS was 1 day. ICU mortality was 2.1% and cumulative 5-year mortality rate was 5.6%. Forty-four per cent of all admissions were to a PICU. Conclusions: This study has shown that Sweden has a low immediate ICU mortality, similar in adult ICU and PICU. Patients discharged alive from an ICU had a 20-fold increased mortality risk, compared with a control cohort for the 5-year period. Less than half of the paediatric patients admitted for intensive care in Sweden were cared for in a PICU. Studies are needed to evaluate whether a centralization of paediatric intensive care in Sweden would be beneficial to the paediatric population. [source]

Nurses' and physicians' viewpoints regarding children visiting/not visiting adult ICUs

NURSING IN CRITICAL CARE, Issue 2 2007
Susanne Knutsson
Abstract Allowing children to visit adult intensive care units (ICUs) has been an area of controversy. There is a lack of recent research dealing with visits by children and physicians' views and whether differences exist between the views held by nurses and physicians regarding visits by children. The aim of this study was to describe and compare reasons given by nurses and physicians for restricting visits by children to a relative hospitalized in an adult ICU. This was a quantitative, descriptive multicentre study. Nurses and physicians (n= 291) at 72 general adult ICUs participated, each completing a questionnaire. A majority of the nurses and physicians were positive to children visiting patients in ICU, but they also imposed restrictions. The most common reasons were: severity of the patient's injury (50%); the environment was frightening for the child (50%); the infection risk for the child (36%) and the patient (56%). Children <7 years were restricted more than those >7 years. Nurses were more positive than physicians to visits by younger children. Physicians were more positive to visits if the patient was tired and critically ill/injured or was a friend/cousin. More physicians refused visits due to the fact that children are too noisy for the staff. Risks of negative effects on the children's health by visiting patients were also stated. Nurses and physicians still restrict children's visits to adult ICUs for a number of reasons, and nurses' and physicians' views on children visiting differ and so also the views within each professional group. The differences in views show that the dynamics are complicated and this could be attributed to a lack of a common view of care, which prevents family-centred care that includes children from being practised. [source]