Abstract:
OBJECTIVE:To assess the influence of private attending physician status on the withdrawal of life-sustaining interventions among patients dying within a medical intensive care unit (ICU). DESIGN:Retrospective cohort analysis. SETTING:An academic tertiary care center. PATIENTS:One hundred fifty-nine consecutive patient deaths occurring in the medical ICU during a 12-month period. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Withdrawal of life-sustaining interventions (i.e., mechanical ventilation, dialysis, and/or vasopressors), duration of mechanical ventilation, length of intensive care unit stay, medical care costs, and patient charges were recorded. Life sustaining interventions were actively withdrawn from 69 (43.4%) patients prior to death. Patients without a private attending physician were significantly more likely to undergo the withdrawal of life-sustaining interventions compared with patients having a private attending physician (odds ratio = 2.5; 95% confidence interval = 1.8, 3.6, respectively; p = .005). A correlation was found between the possession of private health insurance and private attending physician status (r2 = .39, p < .001). Multiple logistic regression analysis was subsequently used to control for demographic factors and severity of illness. Three independent predictors for the withdrawal of life-sustaining interventions were identified in this patient cohort (p < .05) having a planned therapeutic trial of life-sustaining interventions outlined in the medical record (adjusted odds ratio 9.4; 95% confidence interval = 5.6 to 15.6; p < .001); lack of a private attending physician (adjusted odds ratio = 4.4; 95% confidence interval = 2.9 to 6.5; p < .001); and the presence of clearly defined advance directives regarding patient preferences for medical care (adjusted odds ratio = 3.6; 95% confidence interval = 2.3 to 5.7; p. = .005). Patients with private attending physicians had significantly greater medical care costs and medical care charges compared with patients without a private attending physician. CONCLUSION:Among patients dying within a medical ICU, those patients without a private attending physician are more likely to undergo the active withdrawal of life-sustaining interventions.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Kollef MHdoi
10.1097/00003246-199606000-00016subject
Has Abstractpub_date
1996-06-01 00:00:00pages
968-75issue
6eissn
0090-3493issn
1530-0293journal_volume
24pub_type
杂志文章abstract::We investigated clinically the differences in respiratory work of patients imposed by three modes of one ventilator: the flow-by system, the demand valve system, and the pressure support system. Inspiratory work using flow-by and pressure support systems was reduced sufficiently when compared to the demand valve syste...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199006000-00016
更新日期:1990-06-01 00:00:00
abstract:OBJECTIVE:To examine the role of platelets, fibrin, and adhesion molecules in mediating neutrophil-endothelial cell interactions in septic shock. DESIGN:Controlled experiments using phase contrast microscopy to examine neutrophil, platelet, and endothelial cell interactions in flowing cell suspensions under simulated ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000139918.80602.57
更新日期:2004-09-01 00:00:00
abstract::A simple, safe, and effective system for umbilical artery monitoring controls continuous fluid infusion to prevent fluid overinfusion and keep the catheter from clotting. Accurate and continuous pressure measurements can be recorded simultaneously with fluid infusion. A convenient method for checking dynamic response ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198207000-00009
更新日期:1982-07-01 00:00:00
abstract:OBJECTIVE:Cortisol clearance is reduced in sepsis and may contribute to the development of impaired adrenocortical function that is thought to contribute to the pathophysiology of critical illness-related corticosteroid insufficiency. We sought to assess adrenocortical function using computer-assisted numerical modelin...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000721
更新日期:2015-03-01 00:00:00
abstract::Disseminated intravascular coagulation (DIC) is an acquired syndrome characterized by intravascular fibrin formation occurring in the course of a variety of severe diseases. In gram-negative sepsis, endotoxin is the bacterial component eliciting a cascade of tissue factor dependent hypercoagulable reactions mediated b...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-200009001-00003
更新日期:2000-09-01 00:00:00
abstract:OBJECTIVES:Lung contusion is a major risk factor for the development of acute respiratory distress syndrome. We set to determine the role of toll-like receptor 3 and the binding of double-stranded RNA in the pathogenesis of sterile injury following lung contusion. DESIGN:Toll-like receptor 3 expression was analyzed in...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001879
更新日期:2016-11-01 00:00:00
abstract:OBJECTIVES:Critically ill patients routinely receive vancomycin as empiric antibiotic therapy. A continuous infusion administration strategy may be superior to intermittent infusion by minimizing peak concentrations and variability thereby optimizing safety. We performed a systematic review and meta-analysis to investi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004326
更新日期:2020-06-01 00:00:00
abstract::Pentoxifylline has been shown to increase red blood cell malleability, thus increasing capillary blood flow in a number of disease states. The present study was undertaken to determine whether pentoxifylline might improve tissue oxygenation after anesthesia and during an operation in rats. Rats were anesthetized and d...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198702000-00001
更新日期:1987-02-01 00:00:00
abstract:OBJECTIVE:To study the epidemiology, style of management, and outcome of intensive care patients with acute renal failure requiring replacement therapy in Australia. DESIGN:Prospective epidemiologic study. SETTING:Australian adult intensive care units providing acute renal replacement therapy. PATIENTS:Adult intensi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200110000-00010
更新日期:2001-10-01 00:00:00
abstract:OBJECTIVE:To determine the relationships between plasma L-arginine concentrations and the severity of respiratory distress syndrome (RDS) or systemic blood pressure in premature infants. DESIGN:Prospective, observational study. SETTING:Neonatal intensive care, tertiary referral hospital. SUBJECTS:Fifty-three prematu...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199807000-00033
更新日期:1998-07-01 00:00:00
abstract:OBJECTIVES:To assess whether, in patients under mechanical ventilation, fluid responsiveness is predicted by the effects of short respiratory holds on cardiac index estimated by esophageal Doppler. DESIGN:Prospective, monocentric study. SETTING:Medical ICU. PATIENTS:Twenty-eight adult patients with acute circulatory...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003522
更新日期:2019-02-01 00:00:00
abstract:OBJECTIVE:Keratinocyte growth factor (KGF) is expressed primarily by fibroblasts, is important for alveolar epithelial proliferation/function, and protects against lung injury in multiple animal models. We wished to determine whether acute lung injury/acute respiratory distress syndrome (ALI/ARDS) alveolar fluid induce...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31819fc81a
更新日期:2009-05-01 00:00:00
abstract::In 179 healthy boys and girls, the relationship between body surface area (S) in dm2 and body weight (bw) in kg was investigated. The body surface was calculated from the DuBois and DuBois formula. For infants below 20 kg, the relationship followed the regression equation S=3.6kg + 9; r=0.996. For infants with bw betw...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198111000-00005
更新日期:1981-11-01 00:00:00
abstract:OBJECTIVE:To describe the long-term health-related quality of life (HRQL) of survivors of sepsis and to evaluate the reliability and validity of the medical outcomes study Short Form-36 (SF-36) in this population. STUDY DESIGN:Cross-sectional survey. SETTING:University intensive care unit. PATIENTS:Surviving patient...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200011000-00006
更新日期:2000-11-01 00:00:00
abstract::We found that altering aspirating flow rate (ASR) and sample tubing length (STL) affected the response time and capnogram of 2 different side-stream capnometers. Increased flow rate shortened rise time, transit time, and total delay time (TDT), whereas increased STL increased transit and TDTs but not rise time. Increa...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198408000-00015
更新日期:1984-08-01 00:00:00
abstract:OBJECTIVE:Sympathetic vasoconstriction regulates peripheral circulation and controls blood pressure, but sepsis is associated with hypotension. We evaluated whether apparent loss of sympathetic vasoconstrictor responsiveness relates to distended smooth muscles or to endotoxemia and/or hypoxia. DESIGN:Prospective descr...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001486
更新日期:2016-04-01 00:00:00
abstract::Standard cardiopulmonary-cerebral resuscitation fails to achieve restoration of spontaneous circulation in approximately 50% of normovolemic sudden cardiac arrests outside hospitals and in essentially all victims of penetrating truncal trauma who exsanguinate rapidly to cardiac arrest. Among cardiopulmonary-cerebral r...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-200011001-00012
更新日期:2000-11-01 00:00:00
abstract:OBJECTIVE:To assess clinician perceptions of a machine learning-based early warning system to predict severe sepsis and septic shock (Early Warning System 2.0). DESIGN:Prospective observational study. SETTING:Tertiary teaching hospital in Philadelphia, PA. PATIENTS:Non-ICU admissions November-December 2016. INTERVE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003803
更新日期:2019-11-01 00:00:00
abstract:OBJECTIVE:To evaluate the use of enriched thioglycolate as a transport medium of protected specimen brush samples, in particular its value in direct examination of respiratory specimens and in guiding initial antibiotic prescription. DESIGN:Prospective, randomized, pilot study. SETTING:Medical-surgical teaching inten...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-200202000-00008
更新日期:2002-02-01 00:00:00
abstract::A 77-yr-old white man recovering from aortobiiliac bypass surgery suffered a sudden stroke within 30 min after carotid sinus massage was performed in an attempt to treat supraventricular tachycardia. Even though carotid digital subtraction angiography and angiograms were negative for carotid artery disease, we believe...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198510000-00022
更新日期:1985-10-01 00:00:00
abstract::Seizures in the neonatal period are usually concomitants of serious neurological disease. The convulsive phenomena take certain distinctive and often subtle forms because of the status of the neuroanatomical and neurophysiological development of the neonatal brain. The predominant etiological process is hypoxic-ischem...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197701000-00008
更新日期:1977-01-01 00:00:00
abstract:OBJECTIVE:To evaluate the prevalence and magnitude of weakness in patients receiving chronic mechanical ventilation and the impact of providing aggressive whole-body rehabilitation on conventional weaning variables, muscle strength, and overall functional status. DESIGN:Retrospective analysis of 49 consecutive patient...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000181730.02238.9b
更新日期:2005-10-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that PaCO2 levels generated during permissive hypercapnia may enhance arterial oxygenation, when ventilation is maintained. DESIGN:Prospective study. SETTING:Research laboratory in a hospital. SUBJECTS:One group of eight mongrel dogs (four male; four female). INTERVENTIONS:The dogs ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199811000-00030
更新日期:1998-11-01 00:00:00
abstract:OBJECTIVE:To examine the ways in which healthcare professionals work together in the ICU setting, through a consideration of the contextual, organizational, processual, and relational factors that impact their interprofessional collaboration. DESIGN:Data from over 350 hours of ethnographic observation and 35 semistruc...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001136
更新日期:2015-09-01 00:00:00
abstract:OBJECTIVE:To provide a conceptual and clinical review of the physiology of the venous system as it is relates to cardiac function in health and disease. DATA:An integration of venous and cardiac physiology under normal conditions, critical illness, and resuscitation. SUMMARY:The usual teaching of cardiac physiology f...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182772ab6
更新日期:2013-01-01 00:00:00
abstract:OBJECTIVE:To assess whether the provision of computerized physiologic trend data could improve outcome in newborn infants requiring intensive care. DESIGN:Randomized, controlled trial, with subsidiary questionnaire studies. SETTING:Tertiary neonatal intensive care unit with 12 intensive care cots. PATIENTS:All infan...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199812000-00040
更新日期:1998-12-01 00:00:00
abstract::This study evaluates the recall of 100 patients after ICU admission. There was a wide spectrum of race, religion, occupation, and educational levels. The more common diagnoses included asthma, pneumonia, trauma, and adult respiratory distress syndrome. The average Acute Physiology and Chronic Health Evaluation (APACHE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199009000-00012
更新日期:1990-09-01 00:00:00
abstract:OBJECTIVES:A recent post hoc analysis suggested that driving pressure may be more important than traditional ventilatory variables in determining outcome in mechanically ventilated patients with acute respiratory distress syndrome. We conducted a systematic review and meta-analysis to summarize the risk of mortality fo...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析
doi:10.1097/CCM.0000000000002838
更新日期:2018-02-01 00:00:00
abstract::This report documents the validity of clinical measurements of oxygen consumption (VO2) and carbon dioxide production (VCO2) made with a new metabolic gas monitor (MGM) suitable for use in critically ill patients receiving mechanical ventilatory support. Paired samples of inspired and expired gases were obtained, and ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198710000-00012
更新日期:1987-10-01 00:00:00
abstract::An emergency cricothyrotomy device was placed in 11 anesthetized dogs in order to assess airway damage and problems in placement, ventilation, and design. Posterior airway perforation without esophageal damage occurred in three animals. Submucosal hematomas or cricoid cartilage injury occurred in seven animals. As pla...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198702000-00016
更新日期:1987-02-01 00:00:00