Abstract:
OBJECTIVES:The mortality outcome of mechanical ventilation, a key intervention in the critically ill, has been variously reported to be determined by intensive care patient volume. We determined the volume-(mortality)-outcome relationship of mechanically ventilated patients whose records were contributed to the Australian and New Zealand Intensive Care Society Adult Patient Database. DESIGN, SETTING, AND PARTICIPANTS:Retrospective cohort study of 208,810 index patient admissions from 136 Australian and New Zealand intensive care units in the same number of hospitals over the course of 1995-2009. MEASUREMENTS AND MAIN RESULTS:The patient-volume effect on hospital mortality, overall and at the level of patient (nonsurgical, elective surgical, and emergency surgical) and intensive care unit (rural/regional, metropolitan, tertiary, and private) descriptors, was determined by random-effects logistic regression adjusting for illness severity and demographic and geographical predictors. Annualized patient volume was modeled both as a categorical (deciles) and, with calendar year, a continuous variable using fractional polynomials. The patients were of mean age of 59 yrs (SD, 19 yrs), Acute Physiology and Chronic Health Evaluation III score 66 (32), and 39.4% female, with a hospital mortality of 22.4%. Overall and at both the patient and intensive care unit descriptor levels, no progressive decline in mortality was demonstrated across the annual patient volume range (12-932). Over the whole database, mortality odds ratio for the last volume decile (801-932 patients) was 1.26 (95% confidence interval, 1.06-1.50; p = .009) compared with the first volume decile (12-101 patients). Calendar year mortality decreases were evident (odds ratio, 0.96; 95% confidence interval, 0.94-0.98; p = .0001). Using fractional polynomials, modest curvilinear mortality increases (range, 5%-8%) across the volume range were noted over the whole database for nonsurgical patients and at the tertiary intensive care unit level. CONCLUSION:No inverse volume-(mortality)-outcome relationship was apparent for ventilated patients in the Australian and New Zealand Intensive Care Society database. Mechanisms for mortality increments with patient volume were not identified but warrant further study.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Moran JL,Solomon PJ,ANZICS Centre for Outcome and Resource Evaluation of the Australian and New Zealand Intensive Care Society.doi
10.1097/CCM.0b013e318236f2afsubject
Has Abstractpub_date
2012-03-01 00:00:00pages
800-12issue
3eissn
0090-3493issn
1530-0293journal_volume
40pub_type
杂志文章,多中心研究abstract::To evaluate the effect of meconium on pulmonary surface tension properties, the mechanics of 30 excised, separated canine pulmonary lobes were studied. Meconia were blended in normal saline to produce solutions of 10% and 20%. Solutions were filtered to remove large particles and instilled endobronchially into the can...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198504000-00005
更新日期:1985-04-01 00:00:00
abstract::Checklists have been recently promulgated as a method to enhance patient safety and improve outcomes for critically ill patients. Specifically, recent work performed by researchers from the Johns Hopkins Medical Institutions has demonstrated that the addition of checklists to usual care in the intensive care unit is a...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e31819541f8
更新日期:2009-02-01 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::This study evaluated the effects of varying colloid concentrations and infusion volumes on survival and plasma volume expansion in rats subjected to an intestinal ischemic shock. Up to 10% solutions of albumin and dextran-40 in lactated Ringer's solution, infused over a 6-h period, had the same effects on hematocrit (...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198509000-00003
更新日期:1985-09-01 00:00:00
abstract:OBJECTIVE:Opioids are frequently used during mechanical ventilation for severe viral infection in infancy. Opioid receptors have immunomodulatory properties, but nothing is known about their antiviral effects. We therefore aimed to investigate the role of opioid receptors in virus-induced airway inflammation. PATIENTS...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31826767a8
更新日期:2013-01-01 00:00:00
abstract::Simple insertion of a nasogastric (NG) tube was successful in only 52 of 100 anesthetized intubated patients. After the larynx was manually pulled forward, the NG tube was successfully inserted in 33 patients. In the remaining 15 patients, the NG tube was inserted only with the aid of a finger or a laryngoscope used w...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198503000-00013
更新日期:1985-03-01 00:00:00
abstract:OBJECTIVE:To determine the influence of a selective, sterile central nervous system surgery on immune reactivity, particularly whether a decrease of monocytic human leukocyte antigen-DR expression, indicating immunodepression, occurs after neurosurgery and if this measurement is useful for identification of patients wi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199512000-00006
更新日期:1995-12-01 00:00:00
abstract:OBJECTIVES:To define the role of the intensivist in the initiation and management of patients on extracorporeal membrane oxygenation. DESIGN:Retrospective review of the literature and expert consensus. SETTING:Series of in-person meetings, conference calls, and emails from January 2018 to March 2019. SUBJECTS:A mult...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004330
更新日期:2020-06-01 00:00:00
abstract:OBJECTIVE:This study aims to explore the relationship between team-leadership skills and quality of cardiopulmonary resuscitation in an adult cardiac-arrest simulation. Factors affecting team-leadership skills were also assessed. DESIGN:Forty advanced life-support providers leading a cardiac arrest team in a standardi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182591fda
更新日期:2012-09-01 00:00:00
abstract::Sequential assessment of renal function in 50 critically ill postoperative patients was done by simultaneous determinants of osmolar, free water, creatinine and sodium clearances, and fractional excretion of sodium. The traumatic and nontraumatic critically ill surgical patients had a characteristic pattern of creatin...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198002000-00004
更新日期:1980-02-01 00:00:00
abstract:OBJECTIVES:To assess the relations between anemia, serum erythropoietin (EPO), iron status, and inflammatory mediators in multiply traumatized patients. DESIGN:Prospective observational study. SETTING:Intensive care unit. PATIENTS:Twenty-three patients suffering from severe trauma (injury severity score > or =30). ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200104000-00009
更新日期:2001-04-01 00:00:00
abstract::A new quantitative method for measuring the prognosis and severity of illness in terms of probability of survival was developed from 224 studies in an index population of 220 critically ill surgical patients. Patients were selected preoperatively to eliminate pre-existing cardiac disease, cirrhosis, nutritional debili...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198502000-00007
更新日期:1985-02-01 00:00:00
abstract:OBJECTIVES:The main objective of the study was to determine the prevalence of venous thromboembolism events in patients infected with severe acute respiratory syndrome coronavirus 2 requiring venovenous extracorporeal membrane oxygenation. The secondary objective was to compare venous thromboembolism events and coagula...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004504
更新日期:2020-10-01 00:00:00
abstract:OBJECTIVES:To investigate the frequency, types, and implications of complications during intensive care in patients after status epilepticus has been successfully terminated. DESIGN:Retrospective study. SETTING:ICUs at a Swiss tertiary academic medical care center. PATIENTS:Data were collected from the digital patie...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004642
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVES:Hyponatremia occurs in up to 30% of patients with pneumonia and is associated with increased morbidity and mortality. The prevalence of hyponatremia associated with coronavirus disease 2019 and the impact on outcome is unknown. We aimed to identify the prevalence, predictors, and impact on outcome of mild, m...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000004605
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVES:To evaluate the internal consistency, validity, responsiveness, and minimal important difference of the Functional Status Score for the ICU, a physical function measure designed for the ICU. DESIGN:Clinimetric analysis. SETTINGS:Five international datasets from the United States, Australia, and Brazil. PA...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001949
更新日期:2016-12-01 00:00:00
abstract:OBJECTIVES:High physical activity levels are associated with wide-ranging health benefits, disease prevention, and longevity. In the present study, we examined the impact of regular physical exercise on the severity of organ injury and survival probability, as well as characteristics of the systemic immune and metaboli...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31828a2ae3
更新日期:2013-10-01 00:00:00
abstract:OBJECTIVE:To compare the outcomes and the short- and long-term complications of percutaneous translaryngeal tracheostomy (TLT) and surgical tracheostomy (ST). DESIGN:Prospective, randomized clinical trial with 1-yr double-blind follow-up. SETTING:A general intensive care unit of a university hospital. PATIENTS:A tot...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2005-05-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199002000-00010
更新日期:1990-02-01 00:00:00
abstract::Cardiac arrest is most commonly encountered as the end result of severe derangements in metabolic homeostasis. These derangements may include toxic, ischemic, or electrophysiological causes of circulatory and/or respiratory arrests. Occasionally, mechanical obstruction or impediment to circulation may cause cardiac ar...
journal_title:Critical care medicine
pub_type: 杂志文章
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journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199209000-00023
更新日期:1992-09-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-199605000-00026
更新日期:1996-05-01 00:00:00
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pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181a930f7
更新日期:2009-09-01 00:00:00
abstract::Calcium chloride is administered frequently to critically ill patients to improve cardiac output and BP. However, Ca has been implicated in the pathophysiology of shock and ischemic disorders. To test the hypothesis that Ca may be deleterious to shock outcome, we studied the effects of CaCl and Ca chelator (EGTA) infu...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198909000-00012
更新日期:1989-09-01 00:00:00
abstract:OBJECTIVE:Using a modification of the Bohr equation, single-breath carbon dioxide capnography is a noninvasive technology for calculating physiologic dead space (V(D)/V(T)). The objective of this study was to identify a minimal V(D)/V(T) value for predicting successful extubation from mechanical ventilation in pediatri...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-200006000-00059
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVE:Chronic diabetes mellitus (DM) is a known cause of multisystem injury. The effect of DM in acute critical illness may also be detrimental, but is not specifically known. We hypothesized that the preexisting diagnosis of DM is an independent risk factor for mortality in critically ill patients. DESIGN:Paralle...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181b9eaa5
更新日期:2010-01-01 00:00:00
abstract::The hospital records of 7 patients with severe bronchopulmonary dysplasia (BPD) were reviewed. All patients were ventilator dependent for prolonged periods (mean duration intermittent mandatory ventilation (IMV) 14.3 +/- 3.5 months) but eventually were successfully weaned from mechanical ventilation and sent home. The...
journal_title:Critical care medicine
pub_type: 杂志文章
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更新日期:1981-12-01 00:00:00
abstract::To further define cardiovascular abnormalities in patients with septic shock, serial conventional hemodynamic measurements combined with two-dimensional echocardiographic studies were performed at the bedside in 21 patients admitted for an acute episode of sepsis-related circulatory failure. Measurements obtained duri...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199010000-00001
更新日期:1990-10-01 00:00:00
abstract::The use of epidural opioids for postoperative analgesia has been associated with respiratory depression. This report demonstrates the ability of nalbuphine to rapidly reverse the respiratory depression caused by epidural sufentanil while maintaining postoperative pain relief. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198904000-00017
更新日期:1989-04-01 00:00:00