Navigation Links
Acute lung injury patients one-third less likely to die in 'closed' model ICUs
Date:9/28/2007

Patients with acute lung injury (ALI) are nearly one-third less likely to die if they are treated at ICUs that require board-certified critical care physicians to oversee patient care, as compared to patients treated at ICUs that allow any attending physician to oversee admission and case management.

ALI is an inflammatory disorder of the lung often seen in patients with pneumonia or sepsis. Mortality rates are high -- about 40 percent -- and worsen with age and co-morbidities. Treatment generally involves addressing the underlying condition and providing protective low tidal volume mechanical ventilation and supportive therapy.

ICUs that require patient transfer to an intensivist run team or mandate a co-attending intensivist are associated with reduced mortality in patients with ALI, wrote Miriam Treggiari, M.D., M.P.H., of the Harborview Medical Center at the University of Washington, who led the study that appears in the first issue for October of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

The study is the first to use data from a population-based prospective cohort of patients to evaluate outcomes of different ICU organizational models. As part of the National Institutes of Health funded King County Lung Injury Project, all patients in Seattle area ICUs receiving mechanical ventilation were screened for ALI, between April 1999 and July 2000. Detailed data on co-morbidities, length of hospital stay and discharge information was collected. Questionnaires were sent to both the medical directors and/or attending physicians of the ICUs and the nurse managers to assess the organizational model and structure of the ICUs. The final study group included 1,075 patients in 22 ICUs across 16 hospitals.

Two-thirds of the patients were treated at closed ICUsunits that require cases to be managed by board-certified critical care physicians or that mandate intensivists to co-manage on all patients. The remaining third received care at open ICUs, where cases could be managed by any attending physicians with admitting privileges, and pulmonary consultations were optional. According to the American College of Chest Physicians, only 25 percent of ICUs nationwide follow the closed model.

There were no significant differences in the degree of illness between patients who were cared for in closed versus open ICUs as measured by Acute Physiological and Chronic Health Evaluation III (APACHE III) scores, but patients at closed ICUs were younger and more likely to be male.

Patients cared for in a closed ICU had statistically significantly lower mortality than patients cared for in open ICUs, the researchers reported. Interestingly, the effect remained significant after adjusting for a number of variables in the analysis. While 77 percent of patients in closed ICUs were seen by a pulmonary consultant, consults alone did not have a significant effect on mortality. Similarly, adjusting for nurse-to-patient ratio and hospital volume of mechanically ventilated patients had no effect on mortality. Of patients treated in open ICUs, 45 percent died; in closed ICUs there was 35 percent mortality.

The investigators noted that because of the small sample size of hospitals and the date of the data collection, it would be difficult to extrapolate their results to a general trend among ICUs in the United States. Noting that the use of low tidal volume mechanical ventilation differed between closed and open ICUs, the researchers remarked that other unrecognized differences in patient care could exist, but that their results add support for the positive effect of a closed ICU model on patient outcome.

These findings add to the evidence of the important role of intensivist staffing in caring for critically ill patients, and support the recommendations to implement closed-model ICUs in the United States, said Dr. Treggiari. Further studies will need to investigate if the beneficial effects of closed ICU derive from higher degree of staffing that could facilitate earlier recognition of critical/deteriorating conditions or greater expertise in the specific management aspects of critical care patients.


'/>"/>

Contact: Keely Savoie
ksavoie@thoracic.org
212-315-8620
American Thoracic Society
Source:Eurekalert

Related medicine news :

1. Acute Measles Supresses HIV Replication
2. Severe Acute respiratory Syndrome (SARS)
3. WHO Travel Advice to prevent spread of "Severe Acute Respiratory Syndrome (SARS)
4. Acute Pancreatitis On The Rise Due To Alcohol Consumption
5. Promised Drug Doesnt Help Acute Heart Failure
6. Atrial fibrillation predicts for acute ischaemic stroke
7. Antibiotics for acute uncomplicated lower respiratory tract infection
8. Handwashing prevents diarrhea and acute lower respiratory infections
9. Gene Fusion Test to screen children’s with Acute Lymphoblastic Leukemi
10. Protective regimen for acute Graft-versus-host disease
11. Acute Toxicity Of Nano-Scale Zinc Powder: Severe Renal Damage And Anemia
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:5/26/2016)... Chicago, Illinois (PRWEB) , ... May 26, 2016 , ... ... relationship with women’s basketball as a partner for the Tamika Catchings Legacy Tour ... , As the industry leader in hardwood basketball surfaces in all forms and levels ...
(Date:5/26/2016)... ... 2016 , ... There are nearly 14.5 million people living with and beyond ... Sunday, June 5, 2016, communities around the world will gather to recognize these cancer ... Cancer Survivors Day® is an annual worldwide Celebration of Life that is held on ...
(Date:5/26/2016)... ... May 26, 2016 , ... An April Gallup survey ... , The 550 employees of Sun Health Senior Living (SHSL) may not ... reduces their doctor and prescription copays for the year, while holding the line on ...
(Date:5/26/2016)... ... May 26, 2016 , ... Eating Recovery Center, ... is opening a brand new child and adolescent residential treatment center on June ... with even more specialized eating disorder treatment and access to life-saving care. , ...
(Date:5/26/2016)... York, NY (PRWEB) , ... May 26, 2016 ... ... researcher, founder of Mehling Orthopedics and chief medical officer of Blue Horizon International ... Disease and Regeneration. The conference was held during May 5-6, 2016 in Chicago, ...
Breaking Medicine News(10 mins):
(Date:5/25/2016)... IRVINE, Calif. , May 25, 2016 /PRNewswire/ ... of testing for their new reference materials that ... workflows from sample collection to analyses. The rapid ... the demand for researchers to have standard methods ... data being generated. Biases inherently exist at every ...
(Date:5/25/2016)... According to market research "Global ... Demand Forecast to 2022 - Industry Insights by Type ... by P&S Market Research, the global insulin delivery device ... it is expected to grow at a CAGR of ... segment is expected to witness the fastest growth at ...
(Date:5/25/2016)... , May 25, 2016  Granger Diagnostics today announced ... for wounds and infections. This test ensures discovery ... select viruses. The test requires only a simple swab ... David G. Bostwick , MD, Chief ... facilitate wound healing: "We are excited to make ...
Breaking Medicine Technology: