Misplaced Pages

#778221

66-458: An intensive care unit (ICU) was defined by the task force of the World Federation of Societies of Intensive and Critical Care Medicine as “an organized system for the provision of care to critically ill patients that provides intensive and specialized medical and nursing care , an enhanced capacity for monitoring, and multiple modalities of physiologic organ support to sustain life during

132-450: A central venous catheter placed in one of the large central veins . In such cases a blood pump is used to drive blood flow through the filter. Native access for hemodialysis (e.g. AV fistulas or grafts) are unsuitable for CHF because the prolonged residence of the access needles required might damage such accesses. The length of time before the circuit clots and becomes unusable, often referred to as circuit life , can vary depending on

198-512: A clean environment, medical equipment, clean water, and fruits. With this work, the mortality rate decreased from 60% to 42% and then to 2.2% In response to a polio epidemic (where many patients required constant ventilation and surveillance), Bjørn Aage Ibsen established the first intensive care unit globally in Copenhagen in 1953. The first application of this idea in the United States

264-483: A hospital ward can offer) or on a 1:1 basis for patients requiring extreme intensive support and monitoring; for example, a patient on multiple vasoactive medications to keep their blood pressure high enough to perfuse tissue. The patient may require multiple machines; Examples: continuous dialysis CRRT , a intra-aortic balloon pump , ECMO . International guidelines recommend that every patient gets checked for delirium every day (usually twice or as much required) using

330-658: A hospital. Patients are admitted to the intensive care unit if their medical needs are greater than what the general hospital ward can provide. Indications for the ICU include blood pressure support for cardiovascular instability ( hypertension / hypotension ), sepsis , post-cardiac arrest syndrome or certain cardiac arrhythmias . Other ICU needs include airway or ventilator support due to respiratory compromise . The cumulative effects of multiple organ failure , more commonly referred to as multiple organ dysfunction syndrome , also requires advanced care. Patients may also be admitted to

396-526: A hospital. In 1962, in the University of Pittsburgh, the first critical care residency was established in the United States. In 1970, the Society of Critical Care Medicine was formed. Monitoring refers to various tools and technologies used to obtain information about a patient's condition. These can include tests to evaluate blood flow and gas exchange in the body, or to assess the function of organs such as

462-882: A larger facility if need be he/she may have demonstrated a significant decrease in stability. Critically ill Intensive care medicine , usually called critical care medicine , is a medical specialty that deals with seriously or critically ill patients who have, are at risk of, or are recovering from conditions that may be life-threatening. It includes providing life support , invasive monitoring techniques, resuscitation , and end-of-life care . Doctors in this specialty are often called intensive care physicians, critical care physicians, or intensivists . Intensive care relies on multidisciplinary teams composed of many different health professionals. Such teams often include doctors, nurses, physical therapists , respiratory therapists , and pharmacists , among others. They usually work together in intensive care units (ICUs) within

528-457: A patient's blood is passed through a set of tubing (a filtration circuit ) via a machine to a semipermeable membrane (the filter ) where waste products and water (collectively called ultrafiltrate ) are removed by convection . Replacement fluid is added and the blood is returned to the patient. As in dialysis , in hemofiltration one achieves movement of solutes across a semi-permeable membrane . However, solute movement with hemofiltration

594-717: A patient's breathing, provide treatments to help their breathing, evaluate for respiratory improvement, and manage mechanical ventilation parameters. They may be involved in emergency care like inserting and managing an airway, humidification of oxygen, administering diagnostic lung mechanics tests, invasive or non-invasive mechanical ventilation management, weaning the ventilator, aerosol therapy (pulmonary vasodilatory medications included), inhaled Nitric oxide therapy, arterial blood gas analysis, and providing physiotherapy. Additionally, Respiratory Therapists are commonly involved in ECMO management and many pursue certification in such therapies due to

660-604: A patient's hospitalization. Common complications in the ICU include: ICU care requires more specialized patient care; this need has led to the use of a multidisciplinary team to provide care for patients. Staffing between Intensive care units by country, hospital, unit, or institution. Critical care medicine is an increasingly important medical specialty. Physicians with training in critical care medicine are referred to as intensivists . Most medical research has demonstrated that ICU care provided by intensivists produces better outcomes and more cost-effective care. This has led

726-569: A period of life-threatening organ system insufficiency.” Patients may be referred directly from an emergency department or from a ward if they rapidly deteriorate, or immediately after surgery if the surgery is very invasive and the patient is at high risk of complications. In 1854, Florence Nightingale left for the Crimean War , where triage was used to separate seriously wounded soldiers from those with non-life-threatening conditions. Florence provided several simple but powerful interventions:

SECTION 10

#1732849132779

792-643: A postgraduate residency and become certified as critical care pharmacists. Pharmacists help manage all aspects of drug therapy and may pursue additional credentialing in critical care medicine as BCCCP by the Board of Pharmaceutical Specialties. Many critical care pharmacists are a part of the multi-professional Society of Critical Care Medicine. Inclusion of pharmacist decreases drug reactions and poor outcomes for patients. Nutrition in intensive care units presents unique challenges due to changes in patient metabolism and physiology while critically ill. Critical care nutrition

858-419: A specific medical requirement or patient: Common equipment in an ICU includes mechanical ventilators to assist breathing through an endotracheal tube or a tracheostomy tube ; cardiac monitors for monitoring Cardiac condition; equipment for the constant monitoring of bodily functions; a web of intravenous lines , feeding tubes, nasogastric tubes , suction pumps, drains, and catheters , syringe pumps; and

924-418: A substantially higher cost of treatment. Before implementing continuous renal replacement therapy (CRRT), acute renal failure (ARF) in critically ill, multiple organ failure patients was managed by intermittent hemodialysis and the mortality rate was very high. Hemodialysis is effective in clearance and ultrafiltration, but it has deleterious effects on hemodynamic stability. In 1971, Lee Henderson described

990-712: A validated clinical tool. The two most widely used are the Confusion Assessment Method for the ICU (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC). There are translations of these tools in over 20 languages and they are used globally in many ICU's. Nurses are the largest group of healthcare professionals working in ICUs. There are findings which have demonstrated that nursing leadership styles have impact on ICU quality measures particularly structural and outcomes measures. In

1056-514: A wide array of drugs to treat the primary condition(s) of hospitalization. Medically induced comas , analgesics , and induced sedation are common ICU tools needed and used to reduce pain and prevent secondary infections . The available data suggests a relation between ICU volume and quality of care for mechanically ventilated patients. After adjustment for severity of illnesses, demographic variables, and characteristics of different ICUs (including staffing by intensivists), higher ICU staffing

1122-499: Is a rapidly evolving field, responding to the increasing demand for specialized care in critical settings. Training in ICM is offered through various recognized programs that equip healthcare professionals with the necessary skills to manage critically ill patients. Training Programs Feeder Specialties The feeder specialties for intensive care medicine in India include: Nurses that work in

1188-415: Is a syndrome common in intensive care and cardiac units where patients who are in unfamiliar, monotonous surroundings develop symptoms of delirium (Maxmen & Ward, 1995). This may include interpreting machine noises as human voices, seeing walls quiver, or hallucinating that someone is tapping them on the shoulder. There exists systematic reviews in which interventions of sleep promotion related outcomes in

1254-422: Is a well-established multi professional society for practitioners working in the ICU including nurses, respiratory therapists , and physicians. Intensive care physicians have some of the highest percentages of physician burnout among all medical specialties, at 48 percent. Intensive care training is provided as a fellowship and is awarded as a Sub-Specialty certificate of Critical Care (Cert. Critical Care) which

1320-561: Is awarded by the Colleges of Medicine of South Africa. Candidates are eligible to enter sub specialty training after completing specialty training in Anaesthetics, Surgery, Internal Medicine, Obstetrics and Gynaecology, Paediatrics, Cardiothoracic surgery or Neurosurgery. Training usually takes place over 2 years during which time candidates rotate through different ICU's (Medical, Surgical, Paediatric etc.) Intensive care medicine (ICM) in India

1386-406: Is governed by convection rather than by diffusion. With hemofiltration, dialysate is not used. Instead, a positive hydrostatic pressure drives water and solutes across the filter membrane from the blood compartment to the filtrate compartment, from which it is drained. Solutes, both small and large, get dragged through the membrane at a similar rate by the flow of water that has been engendered by

SECTION 20

#1732849132779

1452-463: Is infused directly into the blood line. However, dialysis solution is also run through the dialysate compartment of the dialyzer. The combination is theoretically useful because it results in good removal of both large and small molecular weight solutes. These treatments can be given intermittently, or continuously. The latter is usually done in an intensive care unit setting. There may be little difference in clinical and health economic outcome between

1518-399: Is most commonly used in an intensive care unit setting, where it is either given as 8- to 12-hour treatments, so called SLEF (slow extended hemofiltration), or as CHF (continuous hemofiltration), also sometimes called continuous veno-venous hemofiltration (CVVH) or continuous renal replacement therapy (CRRT). Hemodiafiltration (SLED-F or CHDF or CVVHDF) also is widely used in this fashion. In

1584-400: Is not rigidly standardized, and types of units are dictated by the needs and available resources of each hospital. These include: Medical studies suggest a relation between ICU volume and quality of care for mechanically ventilated patients. After adjustment for severity of illness, demographic variables, and characteristics of the ICUs (including staffing by intensivists ), higher ICU volume

1650-611: Is rapidly becoming a subspecialty for dieticians who can pursue additional training and achieve certification in enteral and parenteral nutrition through the American Society for Parenteral and Enteral Nutrition (ASPEN). Respiratory therapists often work in intensive care units to monitor how well a patient is breathing. Respiratory therapists may pursue additional education and training leading to credentialing in adult critical care (ACCS) and neonatal and pediatric (NPS) specialties. Respiratory therapists have been trained to monitor

1716-575: Is variously called an eICU , virtual ICU , or tele-ICU . Remote staff typically have access to vital signs from live monitoring systems, and telectronic health records so they may have access to a broader view of a patient's medical history. Often bedside and remote staff have met in person and may rotate responsibilities. Such systems are beneficial to intensive care units in order to ensure correct procedures are being followed for patients vulnerable to deterioration, to access vital signs remotely in order to keep patients that would have to be transferred to

1782-527: The Leapfrog Group to make a primary recommendation that all ICU patients be managed or co-managed by a dedicated intensivist who is exclusively responsible for patients in one ICU. In Australia, the training in intensive care medicine is through College of Intensive Care Medicine . In Germany, the German Society of Anaesthesiology and Intensive Care Medicine is a medical association of professionals in

1848-484: The United States . The mean hospital charge was 2.5 times higher for discharges with ICU services than for those without. Hemofiltration Hemofiltration , also haemofiltration , is a renal replacement therapy which is used in the intensive care setting. It is usually used to treat acute kidney injury (AKI), but may be of benefit in multiple organ dysfunction syndrome or sepsis . During hemofiltration,

1914-630: The American neurosurgeon Walter Dandy created a three-bed unit at the Johns Hopkins Hospital . In these units, specially trained nurses cared for critically ill postoperative neurosurgical patients. The Danish anaesthesiologist Bjørn Aage Ibsen became involved in the 1952 poliomyelitis epidemic in Copenhagen , where 2722 patients developed the illness in a six-month period, with 316 of those developing some form of respiratory or airway paralysis. Some of these patients had been treated using

1980-501: The ICU for close monitoring or intensive needs following a major surgery. There are two common ICU structures: closed and open. In a closed unit, the intensivist takes on the primary role for all patients in the unit. In an open ICU, the primary physician, who may or may not be an intensivist, can differ for each patient. There is increasingly strong evidence that closed units provide better patient outcomes. Patient management in intensive care differs between countries. Open units are

2046-419: The ICU have proven impactful in the overall health of patients in the ICU. The English nurse Florence Nightingale pioneered efforts to use a separate hospital area for critically injured patients. During the Crimean War in the 1850s, she introduced the practice of moving the sickest patients to the beds directly opposite the nursing station on each ward so that they could be monitored more closely. In 1923,

Intensive care unit - Misplaced Pages Continue

2112-480: The United Kingdom in 2003–04, the average cost of funding an intensive care unit was: Some hospitals have installed teleconferencing systems that allow doctors and nurses at a central facility (either in the same building, at a central location serving several local hospitals, or in rural locations another more urban facility) to collaborate with on-site staff and speak with patients (a form of [telemedicine]). This

2178-576: The United States, the specialty requires additional fellowship training for physicians having completed their primary residency training in internal medicine, pediatrics , anesthesiology , surgery or emergency medicine . US board certification in critical care medicine is available through all five specialty boards . Intensivists with a primary training in internal medicine sometimes pursue combined fellowship training in another subspecialty such as pulmonary medicine, cardiology, infectious disease, or nephrology. The American Society of Critical Care Medicine

2244-447: The United States, the substitution fluid used in CHF or CHDF is commercially prepared, prepackaged, and sterile (or sometimes is prepared in the local hospital pharmacy), avoiding regulatory issues of on-line creation of replacement fluid from dialysis solution. With slow continuous therapies, the blood flow rates are usually in the range of 100-200 ml/min, and access is usually achieved through

2310-540: The United States, up to 20% of hospital beds can be labelled as intensive-care beds; in the United Kingdom, intensive care usually will comprise only up to 2% of total beds. This high disparity is attributed to admission of patients in the UK only when considered the most severely ill. Intensive care is an expensive healthcare service. A recent study conducted in the United States found that hospital stays involving ICU services were 2.5 times more costly than other hospital stays. In

2376-587: The anesthetics and intensive care fields. It was established in 1955 by members of the German Society of Surgery . In the UK, doctors can only enter intensive care medicine training after completing two foundation years and core training in either emergency medicine, anaesthetics, acute medicine or core medicine. Most trainees dual train with one of these specialties; however, it has recently become possible to train purely in intensive care medicine. It has also possible to train in sub-specialties of intensive care medicine including pre-hospital emergency medicine . In

2442-414: The basis for convective transport in blood purification techniques. Subsequently, in 1974 he described hemodiafiltration combining convection and diffusion. These seminal papers represented the basis for the development of chronic hemodiafiltration by Leber and continuous arteriovenous hemofiltration (CAVH) by Peter Kramer. With his team, Peter Kramer (Died unexpectedly in 1984), had actually first reported

2508-404: The birth of continuous arteriovenous hemodiafiltration or hemodialysis (CAVHDF or CAVHD). Development of double-lumen venous catheters and peristaltic blood pumps was invented in the mid-1980s, when CVVH was proposed. The presence of a pump that generated negative pressure in part of the circuit made it necessary to add a device to detect the presence of air and a sensor to monitor the pressure in

2574-411: The blood line. In the United States, regulatory agencies have not yet approved on-line creation of substitution fluid because of concerns about its purity. For this reason, hemodiafiltration, had historically never been used in an outpatient setting in the United States. Continuous hemofiltration (CHF) was first described in a 1977 paper by Kramer et al. as a treatment for fluid overload. Hemofiltration

2640-482: The circuit, to avoid, respectively, air embolisms and circuit explosion in case of coagulation or obstruction of the venous line. Later, ultrafiltrate and replacement pumps and a heater were added to the circuit. The development of CVVH allows to increase the exchange volumes, and subsequently, the depurative efficiency. The use of counter-current dialysate flow led to further improvements and the birth of CVVHD and CVVHDF. Now Continuous renal replacement therapy has become

2706-421: The clock. At this time, Carl-Gunnar Engström had developed one of the first artificial positive-pressure volume-controlled ventilators, which eventually replaced the medical students. With the change in care, mortality during the epidemic declined from 90% to around 25%. Patients were managed in three special 35-bed areas, which aided charting medications and other management. In 1953, Ibsen set up what became

Intensive care unit - Misplaced Pages Continue

2772-722: The critical care setting are typically registered nurses. Nurses may pursue additional education and training in critical care medicine leading to certification as a CCRN by the American Association of Critical Care Nurses a standard that was begun in 1975. These certifications became more specialized to the patient population in 1997 by the American Association of Critical care Nurses, to include pediatrics, neonatal and adult. Nurse practitioners and physician assistants are other types of non-physician providers that care for patients in ICUs. These providers have fewer years of in-school training, typically receive further clinical on

2838-417: The discovery of new treatments, leading to the development of continuous veno-venous hemofiltration (CVVH), continuous veno-venous hemodialysis (CVVHD) and continuous veno-venous hemodiafiltration (CVVHDF). The low depurative efficiency was overcome by applying filters with two ports in the dialysate/filtrate compartment and through the use of counter-current dialysate flow, allowing the addition of diffusion and

2904-404: The few available negative pressure ventilators , but these devices (while helpful) were limited in number and did not protect the patient's lungs from aspiration of secretions. Ibsen changed the management directly by instituting long-term positive pressure ventilation using tracheal intubation , and he enlisted 200 medical students to manually pump oxygen and air into the patients' lungs round

2970-448: The heart and lungs. Broadly, there are two common types of monitoring in the ICU: noninvasive and invasive. Noninvasive monitoring does not require puncturing the skin and usually does not cause pain. These tools are more inexpensive, easier to perform, and faster to result. Invasive monitoring generally provides more accurate measurements, but these tests may require blood draws, puncturing

3036-520: The heart. In 1955, William Mosenthal, a surgeon at the Dartmouth-Hitchcock Medical Center also opened an early intensive care unit. In the 1960s, the importance of cardiac arrhythmias as a source of morbidity and mortality in myocardial infarctions (heart attacks) was recognized. This led to the routine use of cardiac monitoring in ICUs, especially after heart attacks. Hospitals may have various specialized ICUs that cater to

3102-509: The hydrostatic pressure. Thus convection overcomes the reduced removal rate of larger solutes (due to their slow speed of diffusion) seen in hemodialysis. Hemofiltration is sometimes used in combination with hemodialysis, when it is termed hemodiafiltration. Blood is pumped through the blood compartment of a high flux dialyzer, and a high rate of ultrafiltration is used, so there is a high rate of movement of water and solutes from blood to dialysate that must be replaced by substitution fluid that

3168-733: The intimate relationship of the heart and lungs. On-going critical care management of an ECMO patient commonly requires strict ventilator management in relation to the type of ECMO support used. In general, it is the most expensive, technologically advanced and resource-intensive area of medical care. In the United States , estimates of the 2000 expenditure for critical care medicine ranged from US$ 19–55 billion. During that year, critical care medicine accounted for 0.56% of GDP , 4.2% of national health expenditure and about 13% of hospital costs. In 2011, hospital stays with ICU services accounted for just over one-quarter of all discharges (29.9%) but nearly one-half of aggregate total hospital charges (47.5%) in

3234-461: The job education, and work as part of the team under the supervision of physicians. Critical care pharmacists work with the medical team in many aspects, but some include, monitoring serum concentrations of medication, past medication use, current medication use, and medication allergies. Their typically round with the team, but it may differ by institution. Some pharmacist after attaining their doctorate or pharmacy may pursue additional training in

3300-517: The journal Nordisk Medicin , with Tone Dahl Kvittingen from Norway. For a time in the early 1960s, it was not clear that specialized intensive care units were needed, so intensive care resources were brought to the room of the patient that needed the additional monitoring, care, and resources. It became rapidly evident, however, that a fixed location where intensive care resources and dedicated personnel were available provided better care than ad hoc provision of intensive care services spread throughout

3366-428: The mainstay of management of renal failure for multiple organ failure patients in the ICU. Information technology and precision medicine have recently furthered the evolution of CRRT, providing the possibility of collecting data in large databases and evaluating policies and practice patterns. The application of artificial intelligence and enhanced human intelligence programs to the analysis of big data has further moved

SECTION 50

#1732849132779

3432-449: The medication used to keep blood from clotting. Heparin and regional citrate are often used, though heparin carries a higher risk of bleeding. However, a comprehensive analysis of audit data from intensive care units in the UK revealed that, compared with heparin, citrate-based drugs were not associated with fewer deaths among patients with acute kidney injury after 90 days of treatment. Citrate-based drugs were, however, associated with

3498-435: The most common structure in the United States, but closed units are often found at large academic centers. Intermediate structures that fall between open and closed units also exist. Intensive care is usually provided in a specialized unit of a hospital called the intensive care unit (ICU) or critical care unit (CCU). Many hospitals also have designated intensive care areas for certain specialities of medicine. The naming

3564-597: The patient’s femoral artery and vein and could be rapidly established in critically ill patients. Kramer explained that this could be done continuously, avoiding the volume shifts and other problems of intermittent hemodialysis. For those in the audience who cared for patients with anuric ARF, this was an epiphany of thunderbolt proportions. He used a hollow fiber “haemofilter” that originally designed as an alternative to HD for chronic renal failure and produced 300-600 ml/hour of ultrafiltrate by convection. The simple, pumpless system made use of temporary dialysis catheters sited in

3630-620: The patient’s femoral artery and vein and could be rapidly established in critically ill patients. Using an isotonic salt solution for fluid replacement, continuous arteriovenous hemofiltration (CAVH) was soon extended to the management of ARF. In 1982, Kramer presented his experience with its use in more than 150 intensive care patients at a meeting of the American Society for Artificial Internal Organs(ASAIO). Before that, Henderson et al and Knopp, had studied hemofiltration in animals and as an alternative to dialysis in chronic renal failure, but it

3696-986: The skin, and can be painful or uncomfortable. Intensive care usually takes a system-by-system approach to treatment. In alphabetical order, the key systems considered in the intensive care setting are: airway management and anaesthesia , cardiovascular system , central nervous system , endocrine system , gastro-intestinal tract (and nutritional condition), hematology , integumentary system , microbiology (including sepsis status), renal (and metabolic), and respiratory system . A wide array of drugs including but not limited to: inotropes such as Norepinephrine , sedatives such as Propofol , analgesics such as Fentanyl , neuromuscular blocking agents such as Rocuronium and Cisatracurium as well as broad spectrum antibiotics . Interventions such as early mobilization or exercises to improve muscle strength are sometimes suggested. Intensive care units are associated with increased risk of various complications that may lengthen

3762-447: The two in the context of acute kidney failure. Either of these treatments can be given in outpatient dialysis units, three or more times a week, usually 3–5 hours per treatment. IHDF is used almost exclusively, with only a few centers using IHF. With both IHF or IHDF, the substitution fluid is prepared on-line from dialysis solution by running dialysis solution through a set of two membranes to purify it before infusing it directly into

3828-754: The use of CAVH in Vicenza was extended for the first time to a neonate with the application of specific minifilters . Two years later, CAVH began to be used to treat septic patients, burn patients and patients after transplantation and cardiac surgery, even with regional citrate anticoagulation. In 1986, the term continuous renal replacement therapy was applied to all these continuous approaches. The technology and terminology were expanded to include slow continuous ultrafiltration for fluid removal without replacement, continuous arteriovenous hemodialysis (CAVHD), and continuous arteriovenous hemodiafiltration. Meanwhile, clinical and technical limitations of CAVH spurred new research and

3894-664: The use of continuous hemofiltration in Germany in 1977. Peter Kramer in ASAIO presented a paper describing the use of arteriovenous hemofiltration in the management of ARF. Kramer tried that as a mean of managing diuretic-resistant fluid overload. Kramer described his experience of attaching a microporous hemofilter to the femoral artery and vein, and flowing blood through it at around 100 ml/minuets Liters of plasma filtrate poured out. He replaced it with an infusion of electrolyte solution. Kramer explained that this could be done continuously, avoiding

3960-433: The volume shifts and other problems of intermittent hemodialysis. For those in the audience who cared for patients with anuric ARF, this was an epiphany of thunderbolt proportions. He used a hollow fiber “haemofilter” that originally designed as an alternative to HD for chronic renal failure and produced 300-600 ml/hour of ultrafiltrate by convection. The simple, pumpless system made use of temporary dialysis catheters sited in

4026-508: The world's first intensive care unit in a converted student nurse classroom in Copenhagen Municipal Hospital . He provided one of the first accounts of the management of tetanus using neuromuscular-blocking drugs and controlled ventilation. The following year, Ibsen was elected head of the department of anaesthesiology at that institution. He jointly authored the first known account of intensive care management principles in

SECTION 60

#1732849132779

4092-480: Was developed in several centers for managing ARF in critically ill patients with multiple organ failure. In 1986, it has been reported that CAVH improve the patient survival from 9% to 38% with full nutrition in ARF. Moreover, a workshop presented at ASAIO in 1988 summarized the development and role of continuous hemofiltration. Since late 1980s, continuous renal replacement therapy (CRRT) has been studied extensively. In 1982,

4158-457: Was in 1951 by Dwight Harken . Harken's concept of intensive care has been adopted worldwide and has improved the chance of survival for patients. He opened the first intensive care unit in 1951. In the 1960s, he developed the first device to help the heart pump. He also implanted artificial aortic and mitral valves. He continued to pioneer in surgical procedures for operating on the heart. He established and worked in several organizations related to

4224-496: Was really Peter Kramer’s report in ASAIO meeting in 1982 that stimulated many of nephrologists and intensivists to undertake the serious evaluation of CAVH in ARF in the ICU. At first, in CAVH, the prescribed ultrafiltration rate was achieved manually by arranging the filtrate bag at the right height, thereby changing the negative pressure caused by the filtrate column. The replacement fluid was also regulated manually. Few years later, CAVH

4290-489: Was significantly associated with lower ICU and hospital mortality rates . A ratio of 2 patients to 1 nurse is recommended for a medical ICU, which contrasts to the ratio of 4:1 or 5:1 typically seen on medical floors. This varies from country to country, though; e.g., in Australia and the United Kingdom, most ICUs are staffed on a 2:1 basis (for high-dependency patients who require closer monitoring or more intensive treatment than

4356-485: Was significantly associated with lower ICU and hospital mortality rates. For example, adjusted ICU mortality (for a patient at average predicted risk for ICU death) was 21.2% in hospitals with 87 to 150 mechanically ventilated patients annually, and 14.5% in hospitals with 401 to 617 mechanically ventilated patients annually. Hospitals with intermediate numbers of patients had outcomes between these extremes. ICU delirium , formerly and inaccurately referred to as ICU psychosis,

#778221