Abstract:
OBJECTIVE:Although the development of ventilator-associated pneumonia (VAP) is assumed to increase costs of intensive care unit stay, it is unknown whether prevention of VAP by means of oropharyngeal decontamination is cost-effective. Because of wide ranges of individual patient costs, crude cost comparisons did not show significant cost reductions. DESIGN:Based on actual cost data of 181 individual patients included in a former randomized clinical trial, cost-effectiveness of prevention of VAP was determined using a decision model and univariate sensitivity analyses, and bootstrapping was used to assess the impact of variability in the various outcomes. DATA SOURCE:Published data on prevention of VAP by oropharyngeal decontamination, which resulted in a relative risk for VAP of 0.45, with a baseline rate of VAP of 29% among control patients. The mean costs of the intervention were 351 dollars per patient (32 dollars per patient per day). All other costs were derived from the hospital administrative database for all individual patients. RESULTS OF BASE-CASE ANALYSIS:Prevention of VAP led to mean total costs of 16,119 dollars and 18,268 dollars for patients without preventive measures administered. Thus, costs were saved and instances of VAP were prevented. Similar results were observed in terms of overall survival. RESULTS OF SENSITIVITY ANALYSIS:Prevention of VAP remains cost-saving if the relative risk for VAP because of intervention is <0.923, the costs of the intervention are less than 2,500 dollars, and the prevalence of VAP without intervention is >4%. Bootstrapping confirmed that, with about 80% certainty, oropharyngeal decontamination results in prevention of VAP and simultaneously saves costs. In terms of a survival benefit, the results are less evident; the results indicate that with only about 60% certainty can we confirm that oropharyngeal decontamination would result in a survival benefit and simultaneously save costs. CONCLUSIONS:This study provides strong evidence that prevention of VAP by means of oropharyngeal decontamination is cost-effective.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
van Nieuwenhoven CA,Buskens E,Bergmans DC,van Tiel FH,Ramsay G,Bonten MJdoi
10.1097/01.CCM.0000104111.61317.4Bsubject
Has Abstractpub_date
2004-01-01 00:00:00pages
126-30issue
1eissn
0090-3493issn
1530-0293journal_volume
32pub_type
杂志文章abstract:OBJECTIVE:To develop clinical practice guidelines for the use of restraining therapies to maintain physical and psychological safety of adult and pediatric patients in the intensive care unit. PARTICIPANTS:A multidisciplinary, multispecialty task force of experts in critical care practice was convened from the members...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000095463.72353.AD
更新日期:2003-11-01 00:00:00
abstract:OBJECTIVE:To determine whether implementation of Composite Resuscitation Team Training is associated with improvement in survival to discharge and code team performance after pediatric in-hospital cardiopulmonary arrest. DESIGN, SETTING, AND SUBJECTS:We conducted a prospective observational study with historical contr...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182a6439d
更新日期:2014-02-01 00:00:00
abstract:OBJECTIVE:Leucine-rich repeat and immunoglobulin domain-containing protein (LINGO)-1 is expressed in neural stem cells, and its neutralization results in sustained neuronal immaturity. Thus, targeted inhibition of LINGO-1 via RNA interference may enhance transplanted neural stem cell survival and neuronal differentiati...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001351
更新日期:2016-03-01 00:00:00
abstract:OBJECTIVE:To define changes in intramyocardial pH and PCO2 during cardiac arrest and resuscitation. DESIGN:Prospective and observational trial. SETTING:Mammalian research laboratory utilizing a porcine model of cardiac arrest. SUBJECTS:Sixteen domestic pigs. INTERVENTIONS:Ventricular fibrillation was induced by an ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199306000-00020
更新日期:1993-06-01 00:00:00
abstract::The educational objectives in use in our Pediatric ICU are described. These have importance for educational programs in critical care medicine, in particular, where patient care needs can easily overwhelm educational needs. It is important not to overlook our role as teachers in the development of proper attitudes and...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197705000-00008
更新日期:1977-05-01 00:00:00
abstract:OBJECTIVE:This report will describe the preparations for and the provision of care of two patients with Ebola virus disease in the biocontainment unit at the University of Nebraska Medical Center. DATA SOURCES:Patient medical records. STUDY SELECTION:Not applicable. DATA EXTRACTION:Not applicable. DATA SYNTHESIS:No...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000935
更新日期:2015-06-01 00:00:00
abstract:OBJECTIVE:To compare compliance and end-expiratory lung volume during reexpansion of normal and surfactant-deficient ex vivo atelectatic lungs with either gas or total liquid ventilation. DESIGN:Controlled, animal study using an ex vivo lung preparation. SETTING:A research laboratory at a university medical center. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199602000-00015
更新日期:1996-02-01 00:00:00
abstract:OBJECTIVE:To describe critical illnesses that occur commonly in patients with human immunodeficiency virus (HIV) infection. METHODS:We reviewed and summarized the literature on critical illness in HIV infection using a computerized MEDLINE search. SUMMARY:In the last 10 yrs, our perception of HIV infection and acquir...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000232491.15369.AB
更新日期:2006-09-01 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::A computer program is presented which analyzes acid-base and respiratory variables. This program's advantages include limited data input, hand-held portability, error identification, and succinct analysis statements. It is a useful adjunct to daily care of the critically ill. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198601000-00015
更新日期:1986-01-01 00:00:00
abstract:CONTEXT:The results of studies on noninvasive positive pressure ventilation (NPPV) for acute hypoxemic respiratory failure unrelated to cardiogenic pulmonary edema have been inconsistent. OBJECTIVE:To assess the effect of NPPV on the rate of endotracheal intubation, intensive care unit and hospital length of stay, and...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.ccm.0000148011.51681.e2
更新日期:2004-12-01 00:00:00
abstract:SUBJECT:After transient global cerebral ischemia, selective vulnerable brain areas show delayed neurodegeneration with characteristics of apoptosis. Recent data demonstrate potent neuroprotective effects of the application of endogenous growth hormones such as brain-derived neurotrophic factor (BDNF) after focal cerebr...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000134223.09056.fc
更新日期:2004-09-01 00:00:00
abstract:OBJECTIVE:To determine the effectiveness of increasing the preoxygenation period with 100% oxygen in the critically ill patient from 4 to 8 mins in preparation for emergency tracheal intubation. DESIGN:Nonrandomized, controlled trial. SETTING:Large, level one trauma center, tertiary care intensive care unit. PATIENT...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318192845e
更新日期:2009-01-01 00:00:00
abstract:OBJECTIVE:To assess whether clinical variables might be useful in selecting patients who will have an acute intracranial abnormality seen in head computed tomographic scans (HCT). DESIGN:Retrospective study. SETTING:Medical intensive care unit (MICU) in a tertiary teaching hospital. MEASUREMENTS:Medical records of p...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200005000-00008
更新日期:2000-05-01 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:BACKGROUND:An increased risk of postoperative infection (including pneumonia) attributable to the receipt of allogeneic blood transfusion has been investigated as a possible manifestation of transfusion-related immunomodulation (TRIM) in 16 randomized controlled trials (RCTs) and approximately 40 observational studies....
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1097/01.CCM.0000214310.70642.8C
更新日期:2006-05-01 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:OBJECTIVE:To compare the results of cardiac output measurements obtained by lithium dilution and thermodilution. DESIGN:Case series, observational study. SETTING:High-dependency postoperative unit and intensive care unit of a teaching hospital. PATIENTS:Forty patients were studied. Thirty-four patients had undergoin...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-199711000-00015
更新日期:1997-11-01 00:00:00
abstract:OBJECTIVES:Patients requiring admission to an ICU may subsequently experience cognitive decline. Our objective was to investigate longitudinal cognitive trajectories in older adults hospitalized in ICUs. We hypothesized that individuals hospitalized for critical illness develop greater cognitive decline compared with t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003829
更新日期:2019-08-01 00:00:00
abstract:OBJECTIVE:To compare the effects of continuous negative extrathoracic pressure (CNEP) and positive end-expiratory pressure (PEEP) at the same level of transpulmonary pressure. DESIGN:Prospective analysis. SETTING:Medical intensive care unit of a university hospital. PATIENTS:Nine consecutive acute lung injury patien...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199806000-00021
更新日期:1998-06-01 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::Capnography is a valuable tool in the management of cardiac arrest, since end-tidal CO2 (PetCO2) correlates well with cardiac output and there are no other suitable noninvasive ways to measure this important variable during resuscitation. Animal studies also suggest that PetCO2 correlates well with the likelihood of r...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199004000-00002
更新日期:1990-04-01 00:00:00
abstract:OBJECTIVES:Despite having dysregulated iron metabolism, critically ill patients may receive exogenous iron for the treatment of anemia. Iron is associated with increased tissue apoptosis and may facilitate bacterial growth. We hypothesized that exogenous iron administration given after the onset of sepsis would lead to...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000124878.02614.4c
更新日期:2004-05-01 00:00:00
abstract:OBJECTIVE:To assess the effects of dopexamine on splanchnic blood flow and splanchnic oxygen uptake in septic patients. DESIGN:A prospective, controlled trial. SETTING:A ten-bed intensive care unit (ICU) in a university hospital. PATIENTS:Twelve patients with severe sepsis (according to the criteria of the 1992 Amer...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-199910000-00015
更新日期:1999-10-01 00:00:00
abstract:OBJECTIVES:Delirium occurs in approximately 30% of critically ill patients, and the risk of dying during admission doubles in those patients. Molecular mechanisms causing delirium are largely unknown. However, critical illness and the ICU environment consistently disrupt circadian rhythms, and circadian disruptions are...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003077
更新日期:2018-06-01 00:00:00
abstract:OBJECTIVES:Increases in exhaled nitric oxide have been demonstrated to originate from the lungs of rats after septic lung injury. The aim of this study was to investigate whether treatment with the nitric oxide synthase inhibitor N-nitro-L-arginine methyl ester (L-NAME) would prevent lipopolysaccharide (LPS)-induced in...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199802000-00033
更新日期:1998-02-01 00:00:00
abstract::High-risk patients who survived general (noncardiac) surgery were observed to have cardiac index (CI) values averaging 4.5 L/min.m2, oxygen delivery (DO2) greater than 600 ml/min.m2, and oxygen consumption (VO2) 170 ml/min.m2 during the first 2 or three days postoperatively. Patients who subsequently died maintained r...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:
更新日期:1990-01-01 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:OBJECTIVES:To evaluate the use of multifrequency bioelectrical impedance analysis to predict creatinine/urea clearance based on 24 hours urine collection. A practical formula was developed, and its performance was compared with that of established formulas such as Cockcroft-Gault, Modification of Diet in Renal Disease,...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004033
更新日期:2019-12-01 00:00:00
abstract:OBJECTIVE:To determine the pharmacokinetics of fentanyl when used as a long-term continuous infusion for sedation/analgesia in mechanically ventilated critically ill infants and children. DESIGN:Prospective, case series. SETTING:A university hospital pediatric intensive care unit (ICU). PATIENTS:Nineteen mechanicall...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199307000-00012
更新日期:1993-07-01 00:00:00