Abstract:
OBJECTIVES:To develop a predictive equation to estimate the frequency of blood drawing for intensive care unit (ICU) laboratory tests and to evaluate variations in ICU blood sampling practices after adjusting for patient and institutional factors. DESIGN:Prospective, inception, cohort study. SETTING:Forty-two ICUs in 40 hospitals, including 20 teaching and 17 nonteaching ICUs. PATIENTS:A consecutive sample of 17,440 ICU admissions, in which 14,043 blood samples were drawn for laboratory testing on ICU days 2 to 7. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Patient demographic, physiologic, and treatment data were obtained on ICU day 1; the type and number of blood samples for laboratory testing were recorded on ICU days 1 to 7. In the 42 ICUs, a mean of 16.2 blood samples were drawn for tests on ICU days 2 to 7, but varied between 23 samples in the teaching ICUs and 9.9 samples in nonteaching ICUs. Using only ICU day 1 patient data, we predicted the subsequent number of samples drawn on ICU day 2 (R2 = .26 across individual patients) and on ICU days 2 to 7 (R2 = .26 across individual patients). The most important determinants of the number of blood samples drawn on ICU days 2 to 7 were the ICU day 1 Acute Physiology Score and admission diagnosis. After controlling for patient variables, hospital teaching status, number of beds, and location in the East and South were significantly (p < .05) associated with increased blood sampling on ICU day 2 and on ICU days 2 to 7. More frequent use of an arterial cannula and mechanical ventilation were also associated with increased blood sampling on subsequent days. CONCLUSIONS:The ability to adjust for patient and institutional variables and to predict the number of blood samples drawn for laboratory tests can allow ICUs to compare their practices with those of other units. When integrated into a continuous quality improvement process, this information can be used to identify and focus on opportunities for improving blood conservation and reducing excessive diagnostic testing.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Zimmerman JE,Seneff MG,Sun X,Wagner DP,Knaus WAdoi
10.1097/00003246-199705000-00006subject
Has Abstractpub_date
1997-05-01 00:00:00pages
737-48issue
5eissn
0090-3493issn
1530-0293journal_volume
25pub_type
杂志文章,多中心研究abstract:OBJECTIVE:To develop definitions of infection that can be used in clinical trials in patients with sepsis. CONTEXT:Infection is a key component of the definition of sepsis, yet there is currently no agreement on the definitions that should be used to identify specific infections in patients with sepsis. Agreeing on a ...
journal_title:Critical care medicine
pub_type: 共识发展会议,杂志文章,评审
doi:10.1097/01.ccm.0000168253.91200.83
更新日期:2005-07-01 00:00:00
abstract:OBJECTIVES:Studies have shown contradicting results on the association of nursing workload and mortality. Most of these studies expressed workload as patients per nurse ratios; however, this does not take into account that some patients require more nursing time than others. Nursing time can be quantified by tools like...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004005
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVE:To determine the role of toll-like receptor 2 in cardiac dysfunction during polymicrobial sepsis. DESIGN:Controlled animal study. SETTING:University hospital research laboratory. SUBJECTS:Male C57BL/6, wild-type, toll-like receptor 2-/-. INTERVENTION:Polymicrobial peritonitis, a clinically relevant model ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181d99e67
更新日期:2010-05-01 00:00:00
abstract:OBJECTIVE:To examine the efficacy and safety of proton pump inhibitors in comparison with histamine-2 receptor antagonists for stress-related upper gastrointestinal bleeding prophylaxis among critical care patients. DATA SOURCES:PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov. STUDY SELECTION:Randomized, con...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析
doi:10.1097/CCM.0b013e3181d69ccf
更新日期:2010-04-01 00:00:00
abstract::Clonidine may be a source of serious toxicity when ingested by toddlers. We describe 11 cases of clonidine ingestion by toddlers (mean dose 0.15 mg/kg; range 0.01 to 0.57). The source of the clonidine was a grand-parent in six of 11 cases. Symptoms included altered level of consciousness (n = 11), miosis (n = 5), brad...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199010000-00014
更新日期:1990-10-01 00:00:00
abstract::Subcutaneous, transcutaneous, and conjunctival oxygen tensions (PscO2, PtcO2, and PcjO2, respectively) were measured in anesthetized dogs subjected sequentially to normoxia, hyperoxia, and hypoxia. Intravascular pressure, hemodynamic and oxygen transport variables were measured simultaneously. PtcO2 and PcjO2 closely ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198812000-00011
更新日期:1988-12-01 00:00:00
abstract:OBJECTIVE:After a stay in the intensive care unit, patients risk experiencing delusional memories, memory loss, and symptoms of posttraumatic stress. Since the 1990s, diaries have been kept for intensive care unit patients to help fill in memory gaps, aid psychosocial recovery, and improve health-related quality of lif...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e31821e89c8
更新日期:2011-08-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that the lectin-like domain of tumor necrosis factor, mimicked by the TIP peptide, can improve lung function after unilateral orthotopic lung isotransplantation. Because of a lack of a specific treatment for ischemia reperfusion-mediated lung injury, accompanied by a disrupted barrier i...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181cdf725
更新日期:2010-03-01 00:00:00
abstract::A new device has been developed to estimate continuously and noninvasively cardiac output from the thoracic electrical bioimpedance (CObi). CObi was compared to cardiac output by thermodilution (COtd) in five anesthetized dogs. Blood pressure, blood volume, and blood flow were manipulated by hemorrhage and infusions o...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198603000-00013
更新日期:1986-03-01 00:00:00
abstract::By definition, the acute respiratory distress syndrome is associated with diffuse cellular infiltration and proteinaceous edema. It is generally believed that the widespread injury that characterizes acute respiratory distress syndrome is a process that is launched almost synchronously throughout the lung, caused by b...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181f20f01
更新日期:2010-10-01 00:00:00
abstract:OBJECTIVE:To explore the potential value of heart rate variability features for automated monitoring of sedation levels in mechanically ventilated ICU patients. DESIGN:Multicenter, pilot study. SETTING:Several ICUs at Massachusetts General Hospital, Boston, MA. PATIENTS:Electrocardiogram recordings from 40 mechanica...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000001708
更新日期:2016-09-01 00:00:00
abstract::Conventional wisdom suggests that the "human factor" in critical care environments is reason for inadequate medication and patient safety. "Human factors" (or human factors engineering) is also a scientific discipline and practice of improving human performance. Using decades of human factors research, this paper eval...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181dd8de2
更新日期:2010-06-01 00:00:00
abstract:OBJECTIVE:Pump-driven extracorporeal gas exchange systems have been advocated in patients suffering from severe acute respiratory distress syndrome who are at risk for life-threatening hypoxemia and/or hypercapnia. This requires extended technical and staff support. DESIGN:We report retrospectively our experience with...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000215111.85483.BD
更新日期:2006-05-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that therapeutic hypercapnia enhances the proinflammatory responses to endotoxemia in the lung and spleen of rats. DESIGN:Prospective randomized study. SETTINGS:Hospital research institute. SUBJECTS:Forty-eight adult male rats. INTERVENTIONS:Rats were randomly assigned for a 24-hr p...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31820ee1f2
更新日期:2011-06-01 00:00:00
abstract:OBJECTIVES:To assess whether sepsis-associated coagulopathy predicts hospital mortality. DESIGN:Retrospective cohort study. SETTING:One-thousand three-hundred beds urban academic medical center. PATIENTS:Six-thousand one-hundred forty-eight consecutive patients hospitalized between January 1, 2010, and December 31, ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002997
更新日期:2018-05-01 00:00:00
abstract:OBJECTIVE:To review the incidence, diagnosis, and management of septic emboli caused by vascular catheters after surgery for congenital heart disease. DESIGN:Retrospective clinical review. All patients were computer registered. Our database includes daily follow-up and every sign of infection registered. SETTING:Pedi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200003000-00039
更新日期:2000-03-01 00:00:00
abstract:OBJECTIVE:Comparison of two versions of bispectral index (BIS) derived from the electroencephalogram in mechanically ventilated and continuously sedated patients after major abdominal surgery. DESIGN:Prospective, cohort, observational, unblinded study. SETTING:Surgical intensive care unit of a university hospital. P...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/01.ccm.0000156291.04287.7f
更新日期:2005-03-01 00:00:00
abstract::As of October 1985, 37 candidates have passed the final examination in intensive care for the Diploma of Fellow of the Faculty of Anaesthetists, Royal Australasian College of Surgeons (FFARACS). In September 1984, 23 of these successful candidates responded to a questionnaire seeking information on their educational e...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198606000-00015
更新日期:1986-06-01 00:00:00
abstract:OBJECTIVES:To characterize the landscape of process of care and safety outcomes for tracheal intubation across pediatric intensive care units BACKGROUND:Procedural process of care and safety outcomes of tracheal intubation across pediatric intensive care units has not been described. We hypothesize that the novel Nati...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182746736
更新日期:2013-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the prognostic value of short-latency median nerve somatosensory evoked potentials and brainstem auditory evoked potentials in outcome prediction for comatose cardiac arrest patients treated with hypothermia. DESIGN:Prospective, randomized, controlled trial of mild hypothermia after out-of-hospit...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/01.ccm.0000171536.63641.d9
更新日期:2005-08-01 00:00:00
abstract:BACKGROUND:Although survival is traditionally modeled using Cox proportional hazards modeling, this approach may be inappropriate in sepsis, in which the proportional hazards assumption does not hold. Newer, more flexible models, such as Gray's model, may be more appropriate. OBJECTIVES:To construct and compare Gray's...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.ccm.0000114819.37569.4b
更新日期:2004-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the frequency and clinical correlates of ultrafilterable hypomagnesemia in neonates admitted to the neonatal intensive care unit (ICU). DESIGN:Prospective, observational study. SETTING:Massachusetts General Hospital and Mount Auburn Hospital. PATIENTS:A total of 117 patients (84 neonatal ICU pa...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199405000-00017
更新日期:1994-05-01 00:00:00
abstract:OBJECTIVE:To evaluate the comparative efficacy of enteral cisapride, metoclopramide, erythromycin, and placebo for promoting gastric emptying in critically ill patients with intolerance to gastric enteral nutrition (EN). DESIGN:A randomized, crossover study. SETTING:Adult medical intensive care unit at a university-a...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-200002000-00025
更新日期:2000-02-01 00:00:00
abstract:BACKGROUND AND METHODS:Twelve adult male albino rabbits were assigned alternately to normotensive and hypotensive groups to assess the effect of hypovolemic shock on spontaneous correction of dilutional coagulopathy. All animals underwent dilutional exchange transfusion with 200 mL of rabbit RBCs and 5% human albumin. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199102000-00022
更新日期:1991-02-01 00:00:00
abstract:OBJECTIVES:To review the immunologic role of the cytokines and the specific role that tumor necrosis factor (TNF) plays in response to infection. The influence of bacterial lipopolysaccharide on TNF, the cytokine cascade, and resultant pathologies are also reviewed. DATA SOURCES:A MEDLINE search of the international E...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:
更新日期:1993-10-01 00:00:00
abstract:OBJECTIVE:To determine the accuracy of a technique using capnography to prevent inadvertent placement of small-bore feeding tubes and Salem sump tubes into the lungs. SETTING:Twelve-bed medical intensive care unit (MICU) in a 557-bed teaching hospital. PATIENTS:A total of 25 ventilated adult MICU patients were studie...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-200105000-00004
更新日期:2001-05-01 00:00:00
abstract:OBJECTIVES:Streptococcus pneumoniae is the most common causative pathogen in community-acquired pneumonia. In patients, thrombocytopenia is correlated with an adverse outcome of pneumonia. Platelets can modulate the host response to infection in several ways, that is, by facilitating clot formation, production of antim...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000853
更新日期:2015-03-01 00:00:00
abstract::To understand better the incidence and meaning of hyperamylasemia in the intensive care setting, cellulose acetate membrane electrophoresis was used to measure the isoenzymes of serum amylase in 192 patients with a variety of critical illnesses. Seventy of these patients had elevated serum amylase levels, but none had...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198507000-00003
更新日期:1985-07-01 00:00:00
abstract:OBJECTIVE:Cocaine, which first made its appearance >1,000 yrs ago, is now widely used throughout the world. The physiologic responses to cocaine may cause severe pathologic effects. This review highlights the many critical care challenges resulting from these effects. DESIGN:Historical vignettes, epidemiologic factors...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000063258.68159.71
更新日期:2003-06-01 00:00:00
abstract:OBJECTIVE:To determine the frequency and effects of weaning-related myocardial ischemia on weaning outcomes in patients with coronary artery disease. DESIGN:Prospective cohort study. SETTING:Medical and cardiac intensive care units of a 300-bed teaching community hospital. MEASUREMENTS AND MAIN RESULTS:Three-lead ST...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-199910000-00005
更新日期:1999-10-01 00:00:00