Library

X
feed icon rss

Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
  • 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
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 2
    Electronic Resource
    Electronic Resource
    Predictors of short-term mortality in critically ill patients with solid malignancies (2000)
    Springer
    Intensive care medicine 26 (2000), S. 1817-1823 
    Details
    ISSN: 1432-1238
    Keywords: Key words Cancer ; Intensive care unit ; Mortality ; Prognostic factors ; Mechanical ventilation ; Logistic organ dysfunction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Admission of cancer patients with serious medical complications to the ICU remains controversial primarily because of the high short-term mortality rates in these patients. However, the cancer patient population is heterogeneous regarding age, underlying conditions, and curability of their disease, suggesting that large variations may occur in the effectiveness of intensive care within this subgroup of critically ill patients.¶Objectives: To identify factors predicting 30-day mortality in patients with solid tumors admitted to a medical ICU.¶Patients and methods: We conducted a retrospective study in 120 consecutive cancer patients (excluding patients with hematological malignancies) admitted to the medical ICU of a 650-bed university hospital between January 1990 and July 1997. Medical history, physical and laboratory test findings at admission, and therapeutic interventions within the first 24 h in the ICU were recorded. The study endpoint was vital status 30 days after ICU admission. Stepwise logistic regression was used to identify independent prognostic factors.¶Results: The observed 30-day mortality rate was 58.7 % (n = 68), with most deaths (92 %) occurring in the ICU. Univariate predictors of 30-day mortality were either protective [prior surgery for the cancer (p = 0.01) and complete remission (p = 0.01)] or associated with higher mortality [Knaus scale C or D (p = 0.02), shock (p = 0.04), need for vasopressors (p = 0.0006) or for mechanical ventilation (p = 0.0001), SAPS II score greater than 36 (p = 0.0001), LOD score greater than 6 (p = 0.0001), and ODIN score 〉 2 (p = 0.0001)]. Three variables were independent predictors: previous surgery for the cancer (OR 0.20, 95 % CI 0.07–0.58), LOD score 〉 6 (OR 1.26, 95 % CI 1.09–1.44), and need for mechanical ventilation (OR 3.55, 95 % CI; 1.26–6.7). Variables previously thought to be indicative of a poor prognosis (i. e., advanced age, metastatic or progressive disease, neutropenia or bone marrow transplantation) were not predictive of outcome.¶Conclusion: When transfer to an ICU is considered an option by patients and physicians, 30-day mortality is better estimated by an evaluation of acute organ dysfunction than by the characteristics of the underlying malignancy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051350
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 3
    Electronic Resource
    Electronic Resource
    Haemodynamic study of prolonged deep accidental hypothermia (1975)
    Springer
    Intensive care medicine 1 (1975), S. 65-70 
    Details
    ISSN: 1432-1238
    Keywords: Accidental Hypothermia ; Hypovolaemia ; Cardiac insufficiency ; Isoproterenol ; Rewarming
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Right heart catheterisation was undertaken in six patients with accidental deep hypothermia. Studies were carried out before and after rapid blood volume expansion, with and without Isoproterenol infusion, and were repeated at normal body temperatures. The initial haemodynamic pattern indicated a marked hypovolemia with a simultaneous decrease of both cardiac output and ventricular filling pressures, and a decreased measured total blood volume. Rapid correction of the hypovolemia revealed cardiac insufficiency, in part due to the persisting bradycardia. Left ventricular function was depressed in patients with prolonged cold exposure and normal in patients with short exposure. These abnormalities disappeared after Isoproterenol infusion during hypothermia, and spontaneously after return to normothennia. No imbalance existed between the decreased cardiac output and oxygen uptake in hypothermia, arterio-venous oxygen difference being within normal limits.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00626428
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 4
    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
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 5
    Electronic Resource
    Electronic Resource
    Using the logistic organ dysfunction system to assess organ dysfunction in the intensive care unit (1998)
    Springer
    Intensivmedizin und Notfallmedizin 35 (1998), S. 183-192 
    Details
    ISSN: 1435-1420
    Keywords: Schlüsselwörter Multiorganversagen ; Krankheitsverlauf ; logistisches Organ-Dysfunktion-System ; Key words Multiple Organ Dysfunction ; Severity Overtime ; Logistic Organ Dysfunction System
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract For many years the multiple organ dysfunction syndrome has been on the top of medical articles about the intensive care patient. While severity scores deal with the 1st ICU day physiology, the organ dysfunction systems aim to take in account the duration type and severity of physiologic disturbances during the ICU stay. Most of the published systems have been created by a panel of experts, giving to each dysfunction a number of points, usually 1 to 4, according to the severity. Only 2 systems are different: the MODS of Marshall et al. and the Logistic Organ Dysfunction LOD system of Le Gall et al., both published recently (1995 and 1996). They differ from the others because first they were created either from a literature review (MDOS) or from a logistic regression (LOD), and secondly, because neither takes into account the therapy. Besides, the LOD system, when used on the 1st ICU day, has statistical qualities which are very promising. The LOD system is now used each consecutive day on septic patients in an European multicenter study.
    Notes: Zusammenfassung Seit vielen Jahren steht das Multiorganversagen im Mittelpunkt des Interesses in der Intensivmedizin. Während die meisten Scoring-Systeme sich hauptsächlich auf den ersten Tag der intensivmedizinischen Behandlung konzentrieren, ist es Ziel eines Scoring-Systems für das Multiorganversagen, zusätzlich Dauer, Art und Schwere der physiologischen Störungen im Verlauf des intensivmedizinischen Aufenthaltes zu berücksichtigen. Die meisten bisher publizierten Scoring-Systeme wurden durch ein Expertengremium initiiert, wobei innerhalb des Scoring-Systems jeder Dysfunktion eine bestimmte Anzahl von Punkten, meist 1 bis 4, für den entsprechenden Schweregrad zugeordnet wurden. Nur zwei Systeme benutzen bisher einen hiervon unterschiedlichen Ansatz: Das „MODS“ von Marshall et al. und das „Logistic Organ Dysfunction LOD System“ von Le Gall et al., beide in den vergangenen Jahren publiziert. Beide Systeme unterscheiden sich von anderen Scoring-Ansätzen zum einen durch die Berücksichtigung entsprechender Literaturübersichten (MDOS) oder einer logistischen Regression (LOD), zum anderen sind beide unabhängig von der jeweiligen Therapie. Für das LOD-System konnte gezeigt werden, daß eine Anwendung am ersten intensivmedizinischen Behandlungstag eine statistisch qualifizierte Vorhersage für den Patienten ermöglichte. Gegenwärtig wird dieses LOD-System an entsprechend aufeinanderfolgenden Tagen bezüglich der prognostischen Aussagekraft bei septischen Patienten im Rahmen einer europäischen Multicenter-Studie weiter untersucht.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003900050135
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
Close ⊗
This website uses cookies and the analysis tool Matomo. More information can be found here...