Abstract:
OBJECTIVES:To establish Department of Veterans Affairs' intensive care unit (ICU) costs from a database and to use this information to validate the Russell equation, the most commonly used method of calculating ICU costs. To compare and trend Department of Veterans Affairs' and nationwide (USA) ICU and healthcare costs. DESIGN:Comparison study. SETTING:Database analysis of Department of Veterans Affairs' and nationwide ICUs over a 6-yr period (1986-1992), with biennial evaluations. MAIN MEASURES:Costs and bed occupancies of Department of Veterans Affairs' and nationwide hospitals and ICUs, as well as United States national health expenditures and gross domestic product. RESULTS:Fifty percent to Department of Veterans Affairs' ICU funds were used for nurse and physician salaries. Department of Veterans Affairs' ICU direct and indirect cost ratios have remained constant (2:1). The Russell equation is valid, providing that the "inpatient only" cost variable is used. ICU costs were consistently lower in the Department of Veterans Affairs' than nationwide, as compared by the Russell equation. A smaller fraction of the hospital budget was allocated to the ICU in the Department of Veterans Affairs than in nationwide institutions. Despite an increasing nationwide ICU patient workload, the percentage of ICU fund allocations has not increased. Health care in the United States increases at a rate greater than the increase in gross domestic product. Healthcare delivery costs are increasing at a greater rate nationwide than in the Department of Veterans Affairs. The percentage increase in ICU cost per day, both in the Department of Veterans Affairs and nationwide, was less than the increase in healthcare costs. The percent of the gross domestic product, national health expenditure, and hospital cost used by the ICU has increased minimally during the course of this study. CONCLUSIONS:The Department of Veterans Affairs has the only national ICU line item cost database available. For the Russell equation calculation to be accurate, inpatient only costs should be used. Until customized Health Care Financing Administration analyses become available, nationwide ICU costs are best determined by the Russell equation. Department of Veterans Affairs' ICUs have a consistent cost advantage over nationwide ICUs. Increases in United States healthcare delivery costs continue to exceed the increase in gross domestic product. Cost containment is already occurring in critical care.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Halpern NA,Bettes L,Greenstein Rsubject
Has Abstractpub_date
1994-12-01 00:00:00pages
2001-7issue
12eissn
0090-3493issn
1530-0293journal_volume
22pub_type
杂志文章abstract:OBJECTIVES:The potential advantages of lowering core temperature during sepsis are to lower energy requirement and to activate various cell-protecting pathways. We experimentally investigated whether postconditioning temperature modifications influence survival duration during experimental sepsis. DESIGN:A prospective...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000240231.76837.DC
更新日期:2006-10-01 00:00:00
abstract:RATIONALE:Despite recent advances in critical care and ventilator management, acute lung injury and acute respiratory distress syndrome continue to cause significant morbidity and mortality. Granulocyte-macrophage colony stimulating factor may be beneficial for patients with acute respiratory distress syndrome. OBJECT...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0b013e31822d7bf0
更新日期:2012-01-01 00:00:00
abstract:OBJECTIVE:The aim of this study is to test the hypothesis that recruitment maneuvers (RMs) might act differently in models of pulmonary (p) and extrapulmonary (exp) acute lung injury (ALI) with similar transpulmonary pressure changes. DESIGN:Prospective, randomized, controlled experimental study. SETTING:University r...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181760e5d
更新日期:2008-06-01 00:00:00
abstract:OBJECTIVES:To determine whether mean arterial blood pressure excursions below the lower limit of cerebral blood flow autoregulation during cardiopulmonary bypass are associated with acute kidney injury after surgery. SETTING:Tertiary care medical center. PATIENTS:Four hundred ten patients undergoing cardiac surgery w...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31826ab3a1
更新日期:2013-02-01 00:00:00
abstract:OBJECTIVE:Unplanned readmission of hospitalized patients to an intensive care unit (ICU) is associated with a worse outcome, but our ability to identify who is likely to deteriorate after ICU dismissal is limited. The objective of this study is to develop and validate a numerical index, named the Stability and Workload...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0B013E318164E3B0
更新日期:2008-03-01 00:00:00
abstract:BACKGROUND:Noncuffed, percutaneously inserted central venous catheters (CVCs) are widely used and cause at least 250,000 bloodstream infections (BSIs) in U.S. hospitals each year. We report a prospective study to determine whether inflammation at the insertion site is predictive of CVC-related BSI. METHODS:Percutaneou...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200212000-00003
更新日期:2002-12-01 00:00:00
abstract:OBJECTIVE:Procalcitonin, the precursor peptide of calcitonin, has been shown to be a serum marker of the severity and mortality of several systemic inflammatory response syndromes. This study addressed the correlation of serum procalcitonin with the course of classic (nonexertional) heatstroke. DESIGN:Serum samples we...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199708000-00024
更新日期:1997-08-01 00:00:00
abstract:OBJECTIVE:To assess the possible benefits of sympatholytics on uncontrolled hemorrhage in unanesthetized rats. DESIGN:A randomized laboratory study using rats to test the effects of sympatholytics on uncontrolled hemorrhage. SETTING:Research laboratory. SUBJECTS:Forty female Sprague-Dawley rats, randomly assigned in...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199909000-00025
更新日期:1999-09-01 00:00:00
abstract:OBJECTIVE:Initial success with chimeric antigen receptor-modified T cell therapy for relapsed/refractory acute lymphoblastic leukemia is leading to expanded use through multicenter trials. Cytokine release syndrome, the most severe toxicity, presents a novel critical illness syndrome with limited data regarding diagnos...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002053
更新日期:2017-02-01 00:00:00
abstract:OBJECTIVES:To evaluate the impact of an emergency department mechanical ventilation protocol on clinical outcomes and adherence to lung-protective ventilation in patients with acute respiratory distress syndrome. DESIGN:Quasi-experimental, before-after trial. SETTING:Emergency department and ICUs of an academic cente...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002268
更新日期:2017-04-01 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:OBJECTIVES:Survivors of critical illness in early life are at risk of long-term-memory and attention impairments. However, their neurobiologic substrates remain largely unknown. DESIGN:A prospective follow-up study. SETTING:Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands. PATIENTS:Thirty-eight scho...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002553
更新日期:2017-10-01 00:00:00
abstract:OBJECTIVE:To determine the association of pulmonary artery catheter (PAC) use with in-hospital mortality. DESIGN:Prospective, observational study. SETTING:The medical intensive care units (MICU) of two teaching hospitals. METHODS:The study included 751 adults who were admitted to the MICU, excluding those who stayed...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200106000-00010
更新日期:2001-06-01 00:00:00
abstract:OBJECTIVES:To evaluate the association between length of ICU stay and 1-year mortality for elderly patients who survived to hospital discharge in the United States. DESIGN:Retrospective cohort study of a random sample of Medicare beneficiaries who survived to hospital discharge, with 1- and 3-year follow-up, stratifie...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001480
更新日期:2016-04-01 00:00:00
abstract::Varying concentrations of lipopolysaccharide (LPS) and mannan suspensions were mixed with either saline or plasma from normal volunteers, heated to 100 degrees C for 10 min, and then subjected to the limulus amebocyte lysate test (LAL). A positive LAL in saline required minimum LPS and mannan concentrations of 10(-11)...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198512000-00016
更新日期:1985-12-01 00:00:00
abstract::A commercially available gas-chromatograph (Sentorr Gas Analyzer, Ohio Medical Products, Madison, WI) was tested, featuring continuous measurement of in vivo PaO2 and PaCO2 by means of a thin, heparin-coated catheter, inserted through an indwelling arterial line. Gas tensions are displayed every 4 min. The probes had ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198007000-00011
更新日期:1980-07-01 00:00:00
abstract::Computerized gamma scintigraphy revealed a significant (p less than 0.001) rising lung:heart radioactivity ratio, which has been called "slope of injury" or "slope index", with both 99mTechnetium-tagged human serum albumin (99mTc-HSA) and 99mTechnetium-tagged red blood cells (99Tc-RBC) after 0.05 or 0.2 ml/kg iv oleic...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198201000-00008
更新日期:1982-01-01 00:00:00
abstract:OBJECTIVES:To determine how many multicenter, randomized controlled trials have been published that assess mortality as a primary outcome in the adult intensive care unit population, and to evaluate their methodologic quality. DATA SOURCE:A sensitive search strategy for randomized controlled trials was conducted in th...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e318168ea3e
更新日期:2008-04-01 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::The effect of halothane on electrodes covered with polypropylene and FEP teflon membranes, used for monitoring transcutaneous oxygen tension, was compared in vitro and in patients anesthetized with halothane. In vitro experiments with halothane showed a false increase in PO2 measured by the electrode covered with poly...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198308000-00006
更新日期:1983-08-01 00:00:00
abstract:OBJECTIVES:Racial/ethnic differences in palliative care resource use after stroke have been recognized, but it is unclear whether patient or hospital characteristics drive this disparity. We sought to determine whether palliative care use after intracerebral hemorrhage and ischemic stroke differs between hospitals serv...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002762
更新日期:2017-12-01 00:00:00
abstract::In a prospective randomized trial in patients with a history of preoperative pulmonary hypertension who were undergoing surgery for valvular replacement or annuloplasty, the effects of ketanserin (KET) (12 patients) and sodium nitroprusside (SNP) (14 patients) on the systemic and pulmonary circulation and pulmonary sh...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-198907000-00003
更新日期:1989-07-01 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 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:To determine whether contemporary β-lactam anti-infective dosing recommendations in critically ill children achieve concentrations associated with maximal anti-infective activity. The secondary objective was to describe the microbiological and clinical outcomes associated with β-lactam therapeutic drug manag...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002817
更新日期:2018-02-01 00:00:00
abstract:OBJECTIVE:Hypoxemic reperfusion attenuates brain injury secondary to severe cerebral ischemia, myocardial, and intestinal injury occurring in intestinal postischemic shock, and offers hemodynamic stabilization and attenuation of inflammatory response when applied in the resuscitation from hemorrhagic shock. In this stu...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31819b81ec
更新日期:2009-03-01 00:00:00
abstract:OBJECTIVE:We tested whether mild hypothermia impacts on circulatory and respiratory dysfunction during experimental endotoxemia. DESIGN:Randomized controlled prospective experimental study. SETTING:Large animal facility, Medical University of Graz, Austria. SUBJECTS:Thirteen anesthetized and mechanically ventilated ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31829791da
更新日期:2013-12-01 00:00:00
abstract:OBJECTIVE:To examine the frequency of obtaining Institutional Review Board (IRB) approval and informed consent in critical care research. DATA SOURCES AND DATA EXTRACTION:One-year retrospective review of original critical care research in humans published in seven journals, including American Journal of Respiratory an...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199809000-00035
更新日期:1998-09-01 00:00:00
abstract:OBJECTIVE:The efficacy of noninvasive mechanical ventilation (NIMV) in improving breathing pattern and arterial blood gases (ABG) in hypercapnic patients has been well documented; however, little attention has been given to the choice of the interface and the ventilatory mode. We evaluated the effects of three types of...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-200006000-00015
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVE:To describe and identify factors associated with mortality rate and quality of life 1 yr after prolonged mechanical ventilation. DESIGN:Prospective, observational cohort study with patient recruitment over 26 months and follow-up for 1 yr. SETTING:Intensive care units at a tertiary care university hospital....
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000098029.65347.F9
更新日期:2004-01-01 00:00:00