Critical care: the impact of organization and management on outcomes.

Purpose Of Review: The organization and management of ICUs are key components that can affect delivery and outcome of critical care.

Recent Findings: At the healthcare system level, the provision of critical care services and the presence of a regionalized system of critical care delivery may improve optimal matching of patient severity with level of care and is associated with improved patient outcomes. In hospitals, rapid response teams and step-down beds affect admission and discharge criteria to and from the ICU, although the influence on outcome is unclear.

The epidemiology of mechanical ventilation use in the United States.

Objective: Few contemporary population-based data exist about the incidence, patient characteristics, and outcomes of mechanical ventilation in acute care hospitals. We sought to describe the epidemiology of mechanical ventilation use in the United States.

Design: Retrospective cohort study using year 2005 hospital discharge records from six states.

Dexmedetomidine in the care of critically ill patients from 2001 to 2007: an observational cohort study.

Background: Dexmedetomidine is a novel sedative agent that causes anxiolysis without respiratory depression in critically ill patients. We sought to examine patient and hospital variation in dexmedetomidine use and adoption patterns of dexmedetomidine over time.

Methods: We performed a retrospective cohort study of all patients who received intravenous infusion sedation in 174 intensive care units contributing data to Project IMPACT from 2001 through 2007.

High frequency oscillation in patients with acute lung injury and acute respiratory distress syndrome (ARDS): systematic review and meta-analysis.

Objective: To determine clinical and physiological effects of high frequency oscillation compared with conventional ventilation in patients with acute lung injury/acute respiratory distress syndrome (ARDS).

Design: Systematic review and meta-analysis.

Data Sources: Electronic databases to March 2010, conference proceedings, bibliographies, and primary investigators.

The puzzle of long-term morbidity after critical illness.

Data continue to emerge demonstrating the poor quality of life of ICU survivors in the months and years following critical illness. In this issue of Critical Care, Cuthbertson and colleagues present new data on quality of life from a cohort of ICU survivors who were followed for 5 years. They found that survivors had poor physical quality of life and low quality adjusted life-years in comparison to age-adjusted norms, describing the long-term impact of critical illness as similar to a co-morbidity.

Three-year outcomes for Medicare beneficiaries who survive intensive care.

Context: Although hospital mortality has decreased over time in the United States for patients who receive intensive care, little is known about subsequent outcomes for those discharged alive.

Objective: To assess 3-year outcomes for Medicare beneficiaries who survive intensive care.

Design, Setting, And Patients: A matched, retrospective cohort study was conducted using a 5% sample of Medicare beneficiaries older than 65 years.

Use of intensive care services during terminal hospitalizations in England and the United States.

Rationale: Despite broad concern regarding the provision and cost of health care at the end of life, country-specific patterns of care have rarely been compared.

Objectives: To assess the use of hospital and intensive care services during terminal hospitalizations in England and the United States, two populations with similar socioeconomic backgrounds and life expectancies.

Methods: Retrospective cohort study over a 1-year period (2001) using national (England) Hospital Episode Statistics, and regional (seven U.

Use of intravenous infusion sedation among mechanically ventilated patients in the United States.

Objectives: Many studies compare the efficacy of different forms of intravenous infusion sedation for critically ill patients, but little is known about the actual use of these medications. We sought to describe current use of intravenous infusion sedation in mechanically ventilated patients in U.S.

Variation in critical care services across North America and Western Europe.

Objective: Critical care represents a large percentage of healthcare spending in developed countries. Yet, little is known regarding international variation in critical care services. We sought to understand differences in critical care delivery by comparing data on the distribution of services in eight countries.

Potential value of regionalized intensive care for mechanically ventilated medical patients.

Rationale: Regionalization has been proposed as a method to improve outcomes for medical patients receiving mechanical ventilation in the intensive care unit.

Objectives: To determine the number of patients who would be affected by regionalization and the potential mortality reduction under a regionalized system of care.

Methods: We performed a retrospective cohort study with Monte Carlo simulation, using 2001 state discharge data from eight states representing 42% of the U.

International comparisons in critical care: a necessity and challenge.

Purpose Of Review: Understanding variation in critical care resources, and delivery of care between countries will allow for improved disaster planning, evaluation of research findings, and assessment of the utility of critical care itself. This review describes the available data for international comparisons and the many factors that need to be addressed for an appropriate interpretation of results.

Recent Findings: Recent studies on subgroups of critical care patients include data from many different countries.

Methods to adjust for bias and confounding in critical care health services research involving observational data.

Observational data are often used for research in critical care. Unlike randomized controlled trials, where randomization theoretically balances confounding factors, studies involving observational data pose the challenge of how to adjust appropriately for the bias and confounding that are inherent when comparing two or more groups of patients. This paper first highlights the potential sources of bias and confounding in critical care research and then reviews the statistical techniques available (matching, stratification, multivariable adjustment, propensity scores, and instrumental variables) to adjust for confounders.

Health services research in critical care using administrative data.

The aim of health services research is to provide unbiased, scientific evidence to influence health services policy at all levels. Secondary analysis of administrative data can be employed for the purpose of evaluating questions relevant to health services research in the field of critical care. This article provides an overview of the topic and specifically reviews the key components to evaluating and performing research in critical care using administrative data, including how to evaluate the quality of administrative data itself, and also how to evaluate the quality of studies that employ administrative data.

High-frequency ventilation versus conventional ventilation for the treatment of acute lung injury and acute respiratory distress syndrome: a systematic review and cochrane analysis.

In this review, we examine outcomes from using high-frequency ventilation compared with conventional ventilation as therapy for acute lung injury and acute respiratory distress syndrome in children and adults. We conducted a systematic search of the literature based on the guidelines of the Cochrane Collaboration. Two trials met the inclusion criteria; one recruited children (n = 58), and the other recruited adults (n = 148).

End-of-life decisions: a cohort study of the withdrawal of all active treatment in intensive care units in the United Kingdom.

Objective: To describe the epidemiology of active treatment withdrawal in a nationally representative cohort of intensive care units (ICUs) focusing on between-unit differences.

Design And Setting: Cohort study in 127 adult general ICUs in England, Wales and Northern Ireland, 1995 to 2001.

Patients: 118,199 adult admissions to ICUs.

Impact of exclusion criteria on case mix, outcome, and length of stay for the severity of disease scoring methods in common use in critical care.

Objective: To identify the exclusion criteria for the major severity of disease scoring methods in critical care and to investigate the impact of the exclusion criteria on the case mix, outcomes and length of stay for admissions to intensive care units (ICUs) in England, Wales and Northern Ireland.

Design: Cohort study-analysis of prospectively collected data.

Setting: 127 adult, general (mixed medical/surgical) ICUs in England, Wales and Northern Ireland.

Hospital mortality associated with day and time of admission to intensive care units.

Objective: To investigate whether hospital mortality of patients was associated with the day of the week or time of admission to intensive care units (ICUs).

Design: Cohort study.

Setting: One hundred two adult, general (mixed medical/surgical) ICUs in England, Wales and Northern Ireland.