Moderate IV Fluid Resuscitation Is Associated With Decreased Sepsis Mortality.

Objectives: Significant practice variation exists in the amount of resuscitative IV fluid given to patients with sepsis. Current research suggests equipoise between a tightly restrictive or more liberal strategy but data is lacking on a wider range of resuscitation practices. We sought to examine the relationship between a wide range of fluid resuscitation practices and sepsis mortality and then identify the primary driver of this practice variation.

Higher rates of all-cause mortality and resource utilization during episodes-of-care for diabetic foot ulceration.

Aims: Our primary objective was to determine whether all-cause rates of mortality and resource utilization were higher during periods of diabetic foot ulceration. In support of this objective, a secondary objective was to develop and validate an episode-of-care model for diabetic foot ulceration.

Methods: We evaluated data from the Medicare Limited Data Set between 2013 and 2019.

Fluid administration in severe sepsis and septic shock, patterns and outcomes: an analysis of a large national database.

Purpose: The optimal strategy of fluid resuscitation in the early hours of severe sepsis and septic shock is controversial, with both an aggressive and conservative approach being recommended.

Methods: We used the 2013 Premier Hospital Discharge database to analyse the administration of fluids on the first ICU day, in 23,513 patients with severe sepsis and septic shock, who were admitted to an ICU from the emergency department. Day 1 fluid was grouped into categories 1 L wide, starting with 1-1.

Relationship Between ICU Length of Stay and Long-Term Mortality for Elderly ICU Survivors.

Objectives: To evaluate the association between length of ICU stay and 1-year mortality for elderly patients who survived to hospital discharge in the United States.

Design: Retrospective cohort study of a random sample of Medicare beneficiaries who survived to hospital discharge, with 1- and 3-year follow-up, stratified by the number of days of intensive care and with additional stratification based on receipt of mechanical ventilation.

Interventions: None.

Incidence, outcome, and attributable resource use associated with pulmonary and cardiac complications after major small and large bowel procedures.

Background: Complications increase the costs of care of surgical patients. We studied the Premier database to determine the incidence and direct medical costs related to pulmonary complications and compared it to cardiac complications in the same cohort.

Methods: We identified 45,969 discharges in patients undergoing major bowel procedures.

Intensive care unit readmission during childhood after preterm birth with respiratory failure.

Objective: To determine the incidence and risk factors for readmission to the intensive care unit (ICU) among preterm infants who required mechanical ventilation at birth.

Study Design: We studied preterm newborns (birth weight 500-1250 g) who required mechanical ventilation at birth and were enrolled in a multicenter trial of inhaled nitric oxide therapy. Patients were assessed up to 4.

Trends in the epidemiology of pediatric severe sepsis*.

Objectives: In the past decade, guidelines have been developed for the early detection and management of severe sepsis in children and neonates. However, severe sepsis continues to be a significant U.S.

Hospitalizations of children with neurologic disorders in the United States.

Objectives: Although neurologic disorders are among the most serious acute pediatric illnesses, epidemiologic data are scarce. We sought to determine the scope and outcomes of children with these disorders in the United States.

Design: Retrospective cohort study.

Epidemiology of ophthalmologic disease associated with erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis in hospitalized children in the United States.

The objective of the current study was to characterize the epidemiology and resource use of U.S. children hospitalized with ophthalmologic disease secondary to erythema multiforme (EM), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN).

Risk factors for dementia after critical illness in elderly Medicare beneficiaries.

Introduction: Hospitalization increases the risk of a subsequent diagnosis of dementia. We aimed to identify diagnoses or events during a hospitalization requiring critical care that are associated with a subsequent dementia diagnosis in the elderly.

Methods: A cohort study of a random 5% sample of Medicare beneficiaries who received intensive care in 2005 and survived to hospital discharge, with three years of follow-up (through 2008) was conducted using Medicare claims files.

A comparison of critical care research funding and the financial burden of critical illness in the United States.

Objectives: To estimate federal dollars spent on critical care research, the cost of providing critical care, and to determine whether the percentage of federal research dollars spent on critical care research is commensurate with the financial burden of critical care.

Design And Data Sources: The National Institutes of Health Computer Retrieval of Information on Scientific Projects database was queried to identify funded grants whose title or abstract contained a key word potentially related to critical care. Each grant identified was analyzed by two reviewers (three if the analysis was discordant) to subjectively determine whether it was definitely, possibly, or definitely not related to critical care.

Comparison of medical admissions to intensive care units in the United States and United Kingdom.

Rationale: The United States has seven times as many intensive care unit (ICU) beds per capita as the United Kingdom; the effect on care of critically ill patients is unknown.

Objectives: To compare medical ICU admissions in the United States and United Kingdom.

Methods: Retrospective (2002-2004) cohort study of 172,785 ICU admissions (137 United States ICUs, Project IMPACT database; 160 United Kingdom ICUs, Case Mix Program) with patients followed until initial hospital discharge.

Trends in admissions for pediatric status asthmaticus in New Jersey over a 15-year period.

Objective: Status asthmaticus accounts for a large portion of the morbidity and mortality associated with asthma, but we know little about its epidemiology. We describe here the hospitalization characteristics of children with status asthmaticus, how they changed over time, and how they differed between hospitals with and without PICUs.

Patients And Methods: We used administrative data from New Jersey that included all hospitalizations in the state from 1992, 1995, and 1999-2006.

Antipsychotic adherence, switching, and health care service utilization among Medicaid recipients with schizophrenia.

Objective: To evaluate health care resource utilization in patients with schizophrenia who continued newly prescribed antipsychotic medications, compared with those switching to different treatments.

Methods: Adults with schizophrenia in the California Medicaid (MediCal) database who initiated treatment with index medications in 1998-2001, were classified as having: 1) abandoned antipsychotic medications; 2) switched to another medication; or 3) continued with the index antipsychotic, for up to 6 months after the index date.

Results: Of 2300 patients meeting eligibility criteria, 1382 (60.

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.

Infection rate and acute organ dysfunction risk as explanations for racial differences in severe sepsis.

Context: Severe sepsis, defined as infection complicated by acute organ dysfunction, occurs more frequently and leads to more deaths in black than in white individuals. The optimal approach to minimize these disparities is unclear.

Objective: To determine the extent to which higher severe sepsis rates in black than in white patients are due to higher infection rates or to a higher risk of acute organ dysfunction.

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.

The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis.

Objective: The Surviving Sepsis Campaign (SSC or "the Campaign") developed guidelines for management of severe sepsis and septic shock. A performance improvement initiative targeted changing clinical behavior (process improvement) via bundles based on key SSC guideline recommendations on process improvement and patient outcomes.

Design And Setting: A multifaceted intervention to facilitate compliance with selected guideline recommendations in the ICU, ED, and wards of individual hospitals and regional hospital networks was implemented voluntarily in the US, Europe, and South America.

The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis.

Objective: The Surviving Sepsis Campaign (SSC or "the Campaign") developed guidelines for management of severe sepsis and septic shock. A performance improvement initiative targeted changing clinical behavior (process improvement) via bundles based on key SSC guideline recommendations.

Design And Setting: A multifaceted intervention to facilitate compliance with selected guideline recommendations in the intensive care unit, emergency department, and wards of individual hospitals and regional hospital networks was implemented voluntarily in the United States, Europe, and South America.

Clinical and economic effects of iNO in premature newborns with respiratory failure at 1 year.

Background: The long-term consequences of inhaled nitric oxide (iNO) use in premature newborns with respiratory failure are unknown. We therefore studied the clinical and economic outcomes to 1 year of corrected age after a randomized controlled trial of prophylactic iNO.

Methods: Premature newborns (gestational age View Article and Find Full Text PDF

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.

The effects of trauma center care, admission volume, and surgical volume on paralysis after traumatic spinal cord injury.

Objective: To evaluate compliance with American College of Surgeons (ACS) guidelines and whether trauma center designation, hospital traumatic spinal cord injury (TSCI) case volume or spinal surgery volume is associated with paralysis. We hypothesized a priori that trauma center care, by contrast to nontrauma center care, is associated with reduced paralysis at discharge.

Summary Background Data: Approximately 11,000 persons incur a TSCI in the United States annually.

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.

Growth of intensive care unit resource use and its estimated cost in Medicare.

Objective: The past 10-15 yrs brought significant changes in the United States healthcare system. Effects on Medicare intensive care unit use and costs are unknown. Intensive care unit costs are estimated using the Russell equation with a ratio of intensive care unit to floor cost per day, or "R value," of 3, which may no longer be valid.

Annual rates of arterial thromboembolic events in medicare neovascular age-related macular degeneration patients.

Purpose: Smoking, age, and nutrition have been associated with the development of neovascular age-related macular degeneration (AMD) and can increase the risk of arterial thromboembolic events (ATEs). This study assesses annual rates of ATEs in new-onset neovascular AMD patients compared with matched controls.

Design: Retrospective study.