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  • Electronic Resource  (2)
  • 1995-1999  (2)
  • Key words Intensive care costs  (1)
  • Mechanical ventilation  (1)
  • Shock  (1)
  • 1
    Electronic Resource
    Electronic Resource
    Changing use of intensive care for hematological patients: (1999)
    Springer
    Intensive care medicine 25 (1999), S. 1395-1401 
    Details
    ISSN: 1432-1238
    Keywords: Key words Multiple myeloma ; Hematological patients ; Intensive care ; Bone marrow transplantation ; Mechanical ventilation ; Noninvasive mechanical ventilation ; Shock
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Intensivists generally view patients with hematological malignancies as poor candidates for intensive care. Nevertheless, hematologists have recently developed more aggressive treatment protocols capable of achieving prolonged complete remissions in many of these patients. This change mandates a reappraisal of indications for ICU admission in each type of hematological disease. Improved knowledge of the prognosis is of assistance in making treatment decisions. Patients and methods: The records of 75 myeloma patients consecutively admitted to our ICU between 1992 and 1998 were reviewed retrospectively and predictors of 30-day mortality were identified using stepwise logistic regression. Results: The median age was 56 years (37–84). Chronic health status (Knaus scale) was C or D in 39 cases. Fifty-five patients (73 %) had stage III disease and 17 had a complete or partial remission. Autologous bone marrow transplantation had been performed in 28 patients (37 %). ICU admission occurred between 1992 and 1995 in 41 patients (54.7 %), and between 1996 and 1998 in 34 patients (45.3 %). The median SAPS II and LOD scores were 60 (23–107) and 7 (0–21), respectively. Reasons for ICU admission were acute respiratory failure in 39 patients (52 %) and shock in 31 (41 %). Forty-six patients (61 %) required mechanical ventilation. Fifty patients (66 %) received vasopressors and 24 dialysis. Thirty-day mortality was 57 %. Only five parameters were independently associated with 30-day mortality in the multivariate model: female gender (OR = 5.12), mechanical ventilation (OR = 16.7) and use of vasopressor agents (OR = 5.67) were associated with a higher mortality rate, whereas disease remission (OR = 0.16) and ICU admission between 1996 and 1998 (OR = 0.09) were associated with a lower one. Conclusion: The prognosis for myeloma patients in the ICU is improving over time. This may reflect either recent therapeutic changes in hematological departments and ICUs or changes in patient selection for ICU admission. Hematologists and intensivists should work closely together to select hematological patients likely to benefit from ICU admission.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051087
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Estimation of direct cost and resource allocation in intensive care: correlation with Omega system (1998)
    Springer
    Intensive care medicine 24 (1998), S. 582-589 
    Details
    ISSN: 1432-1238
    Keywords: Key words Intensive care costs ; Omega system ; Resource allocation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: An instrument able to estimate the direct costs of stays in Intensive Care Units (ICUs) simply would be very useful for resource allocation inside a hospital, through a global budget system. The aim of this study was to propose such a tool. Design: Since 1991, a region-wide common data base has collected standard data of intensive care such as the Omega Score, Simplified Acute Physiologic Score, length of stay, length of ventilation, main diagnosis and procedures. The Omega Score, developed in France in 1986 and proved to be related to the workload, was recorded on each patient of the study. Setting: Eighteen ICUs of Assistance Publique-Hôpitaux de Paris (AP-HP) and suburbs. Patients: 1) Hundred twenty-one randomly selected ICU patients; 2) 12,000 consecutive ICU stays collected in the common data base in 1993. Measurements: 1) On the sample of 121 patients, medical expenditure and nursing time associated with interventions were measured through a prospective study. The correlation between Omega points and direct costs was calculated, and regression equations were applied to the 12,000 stays of the data base, leading to estimated costs. 2) From the analytic accounting of AP-HP, the mean direct cost per stay and per unit was calculated, and compared with the mean associated Omega score from the data base. In both methods a comparison of actual and estimated costs was made. Results: The Omega Score is strongly correlated to total direct costs, medical direct costs and nursing requirements. This correlation is observed both in the random sample of 121 stays and on the data base' stays. The discrepancy of estimated costs through Omega Score and actual costs may result from drugs, blood product underestimation and therapeutic procedures not involved in the Omega Score. Conclusions: The Omega system appears to be a simple and relevant indicator with which to estimate the direct costs of each stay, and then to organise nursing requirements and resource allocation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050619
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
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