Measuring family satisfaction with care in the intensive care unit: the development of a questionnaire and preliminary results.

Purpose: To develop and test the feasibility of administering a questionnaire to measure family members' level of satisfaction with care provided to them and their critically ill relative.

Materials And Methods: To develop the questionnaire, existing conceptual frameworks of patient satisfaction, decision making, and quality of end-of-life care were used to identify important domains and items. We pretested the questionnaire for readability, clarity, and sensibility in 21 family members and 16 professionals.

The attributable mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients.

Objective: To estimate the mortality and length of stay in the intensive care unit (ICU) attributable to clinically important gastrointestinal bleeding in mechanically ventilated critically ill patients.

Design: Three strategies were used to estimate the mortality attributable to bleeding in two multicentre databases. The first method matched patients who bled with those who did not (matched cohort), using duration of ICU stay prior to the bleed, each of six domains of the Multiple Organ Dysfunction Score (MODS) measured 3 days prior to the bleed, APACHE II score, age, admitting diagnosis, and duration of mechanical ventilation.

In search of the magic nutraceutical: problems with current approaches.

Over the last few decades, substrates with immune-modulating properties have been identified in all groups of micro- and macronutrients. Numerous experimental studies have focused on evaluating these substances, either alone or in combination. After hundreds of experiments, no clear, consistent signal exists that any of these agents result in significant treatment benefits in critically ill patients.

Should immunonutrition become routine in critically ill patients? A systematic review of the evidence.

Context: Several nutrients have been shown to influence immunologic and inflammatory responses in humans. Whether these effects translate into an improvement in clinical outcomes in critically ill patients remains unclear.

Objective: To examine the relationship between enteral nutrition supplemented with immune-enhancing nutrients and infectious complications and mortality rates in critically ill patients.

Effect of postpyloric feeding on gastroesophageal regurgitation and pulmonary microaspiration: results of a randomized controlled trial.

Objective: To determine the extent to which postpyloric feeding reduces gastroesophageal regurgitation and pulmonary microaspiration in critically ill patients.

Design: Randomized trial.

Setting: A medical/surgical intensive care unit at a tertiary care hospital.

Capnography confirms correct feeding tube placement in intensive care unit patients.

Purpose: To test the accuracy and potential time savings of capnography as compared with a two-step radiographic method in placing feeding tubes in critically ill patients.

Methods: One hundred feeding tube placements were studied in our tertiary care intensive care unit. All placements utilized a two-step radiographic method, but capnography was added to the procedure.

Total parenteral nutrition in the surgical patient: a meta-analysis.

Objective: To examine the relationship between total parenteral nutrition(TPN) and complication and death rates in surgical patients.

Data Sources: A computer search of published research on MEDLINE, personal files and a review of relevant reference lists.

Study Selection: A review of 237 titles, abstracts or papers.

Long-term health-related quality of life in survivors of sepsis. Short Form 36: a valid and reliable measure of health-related quality of life.

Objective: To describe the long-term health-related quality of life (HRQL) of survivors of sepsis and to evaluate the reliability and validity of the medical outcomes study Short Form-36 (SF-36) in this population.

Study Design: Cross-sectional survey.

Setting: University intensive care unit.

End-of-life decision making in the seriously ill hospitalized patient: an organizing framework and results of a preliminary study.

Recent studies of patient/family satisfaction with end-of-life care suggest that improvements in communication and decision making are likely to have the greatest impact on improving the quality of end-of-life care. The apparent failure of recent studies specifically designed to improve decision making strongly suggest that there are powerful determinants of the decision making process that are not completely understood. In this paper, we present an organizing framework that describes the decision making process and breaks it into three analytic steps: information exchange, deliberation, and making the decision.

Dying in Canada: is it an institutionalized, technologically supported experience?

Although preliminary evidence shows that people generally prefer to die at home, very little is known about where Canadians die. Understanding the epidemiology of dying in Canada may illuminate opportunities to improve quality of end-of-life care and related health policy. We conducted a cross-sectional analysis of death records in Canada to determine the proportions of deaths occurring in hospitals and special care units.

Do potential patients prefer tissue plasminogen activator (TPA) over streptokinase (SK)? An evaluation of the risks and benefits of TPA from the patient's perspective.

Background: In patients with acute myocardial infarction, TPA (compared to SK), has been shown to reduce the 30-day mortality rate at the expense of an increased rate of stroke. The assumption in the literature is that were it not for cost issues, all patients presenting with a myocardial infarction would choose TPA. Our hypothesis is that, for many informed individuals, regardless of cost, the increased risk of stroke may deter them from selecting TPA over SK.

Parenteral nutrition in the critically-ill patient: more harm than good?

While many studies have reported that providing parenteral nutrition (PN) can change nutritional outcomes, there are limited data that demonstrate that PN influences clinically-important end points in critically-ill patients. The purpose of the present paper is to systematically review and critically appraise the literature to examine the relationship between PN and morbidity and mortality in the critically-ill patient. Studies comparing enteral nutrition (EN) with PN and studies comparing PN with no PN were reviewed.

Enteral and parenteral nutrition in the seriously ill, hospitalized patient: a critical review of the evidence.

Providing nutritional support has become a standard component of managing seriously ill patients. While many studies have documented that providing nutrition support can change nutritional outcomes (amino acid profile, weight gain, nitrogen balance, etc.), there are limited da ta that demonstrate that nutrition support actually influences clinicall y important endpoints.

Risk factors for clinically important upper gastrointestinal bleeding in patients requiring mechanical ventilation. Canadian Critical Care Trials Group.

Objective: To evaluate the incidence and risk factors for clinically important upper gastrointestinal bleeding in critically ill patients requiring mechanical ventilation.

Design: In duplicate, blinded adjudicators determined the presence of clinically important gastrointestinal bleeding using a priori criteria, evaluating relevant clinical, laboratory, and diagnostic data. Cox proportional hazards regression analyses were used to examine baseline and time-dependent risk factors for bleeding.

The effect of acidified enteral feeds on gastric colonization in critically ill patients: results of a multicenter randomized trial. Canadian Critical Care Trials Group.

Objective: To evaluate the effect of acidified enteral feeds on gastric colonization in critically ill patients compared with a standard feeding formula.

Design: Randomized, double-blind, multicenter trial.

Setting: Eight mixed intensive care units at tertiary care hospitals.

How advance directives affect hospital resource use. Systematic review of the literature.

Objective: To assess whether advance directives influence resource use by hospitalized patients.

Data Sources: A systematic search of computerized medical databases, reference lists from relevant articles, and personal files was conducted to identify studies examining the association between advance directives and resource use.

Study Selection: Primary studies assessing the effect of advance directives on hospital resource use were selected if they had a clear quantitative measure of hospital resource use, hospitalized patients as a study population, a control group for comparison, and a description of the advance directive being studied.

How to use articles about diagnostic technology: gastric tonometry.

Purpose: Periodic diagnostic tests and continuous and intermittent monitoring are integral to critical care medicine. The focus of this article is understanding the impact of existing diagnostic technology, as well as that of new diagnostic technology.

Data Synthesis: We use literature about gastric tonometry to illustrate eight steps for assessing the value of diagnostic technology.

How to use the results of an economic evaluation.

Background: Given the high costs of delivering care to critically ill patients, practitioners and policymakers are beginning to scrutinize the costs and outcomes associated with intensive care. Health economics is a discipline concerned with determining the best way of using resources to maximize the health of the community. This involves addressing questions such as which procedure, test, therapy, or program should be provided, and to whom, given available resources.

The clinical utility of invasive diagnostic techniques in the setting of ventilator-associated pneumonia. Canadian Critical Care Trials Group.

Objective: To evaluate the clinical utility of bronchoscopy with protected brush catheter (PBC) and BAL for patients with ventilator-associated pneumonia (VAP).

Design: Prospective cohort study.

Setting: Ten tertiary care ICUs in Canada.

The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. The Canadian Critical Trials Group.

To evaluate the attributable morbidity and mortality of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients, we conducted a prospective, matched cohort study. Patients expected to be ventilated for > 48 h were prospectively followed for the development of VAP. To determine the excess ICU stay and mortality attributable to VAP, we matched patients with VAP to patients who did not develop clinically suspected pneumonia.