MEDNEMO.it presenta ANESTESIA.tk - Sito Italiano di Anestesia

ABSTRACTS DI RIANIMAZIONE - GENNAIO 2004

Ultimo Aggiornamento: Gennaio 2004

1: Anaesthesia. 2004 Jan;59(1):94.

White cell count and intensive care unit outcome: rethinking the vocabulary.

Steiner M, Schuff-Werner P.

University of Rostock, D-18057 Rostock, Germany E-mail:
michael.steiner@med.uni-rostock.de

PMID: 14687112 [PubMed - in process]

2: Chest. 2003 Nov;124(5):1978-84.

Informed consent for medical procedures: local and national practices.

Manthous CA, DeGirolamo A, Haddad C, Amoateng-Adjepong Y.

Pulmonary and Critical Care Department, Bridgeport Hospital and Yale University
School of Medicine, Bridgeport, CT 06610, USA. pcmant@bpthosp.org

BACKGROUND: No studies have assessed whether clinicians obtain informed consent
for invasive medical procedures, and there are no explicit national standards to
guide the process. HYPOTHESIS: Informed consent practices are inconsistent for
commonly performed invasive medical procedures. METHODS: A simple questionnaire
was electronically mailed and/or faxed to training program directors of critical
care medicine and internal medicine departments, and to ICU directors in the
state of Connecticut. The questionnaire listed common invasive medical
procedures and asked the respondents to check those for which practitioners
routinely obtain informed consent in their hospital. RESULTS: The three samples,
national intensivists (88 respondents), Connecticut intensivists (29
respondents), and national internists (56 respondents) demonstrated
heterogeneity of consenting practices. The rate of obtaining consent for common
vascular access procedures ranged from 20 to 90%. The rates of obtaining consent
for Foley catheterization and nasogastric intubation were uniformly < 10%, and
those for endoscopic procedures were > 90%. Separate consent (beyond the general
consent to treat) was not uniformly obtained for the transfusion of blood
products (range, 74 to 93%) and common diagnostic medical procedures (eg,
thoracentesis, paracentesis, or lumbar puncture; range, 77 to 96%). Surgical
intensivists reported that the obtaining of consent for invasive procedures was
less routine compared to medical intensivists. Lower rates of consent were noted
by those respondents who used a "blanket" consent form, which was signed at the
time of hospital admission, to cover subsequent procedures. CONCLUSIONS: In this
relatively small sample, there was no uniform practice of informed consent for
commonly performed invasive medical procedures. Consent was routinely obtained
for GI endoscopy, bronchoscopy, and medical research, and was not obtained for
Foley catheterization and nasogastric intubation. The obtaining of consent for
vascular cannulation and diagnostic procedures was not routine in the ICUs of a
substantial number of respondents. Explicit standards that delineate
specifically which procedures require consent may be required to assure more
uniform practices.

PMID: 14605076 [PubMed - indexed for MEDLINE]

3: Crit Care Nurse. 2003 Dec;23(6):49-57.

Nutrition support in the intensive care unit. Adequacy, timeliness, and
outcomes.

Roberts SR, Kennerly DA, Keane D, George C.

Baylor University Medical Center, Dallas, Tex., USA.

PMID: 14692172 [PubMed - in process]

4: Crit Care Nurse. 2003 Dec;23(6):42-8.

Anaphylactoid syndrome of pregnancy. A devastating complication requiring
intensive care.

De Jong MJ, Fausett MB.

University of Kentucky School of Nursing, USA.

PMID: 14692171 [PubMed - in process]

5: Intensive Care Med. 2003 Dec 19 [Epub ahead of print].

Volume of activity and occupancy rate in intensive care units. Association with
mortality.

Lapichino G, Gattinoni L, Radrizzani D, Simini B, Bertolini G, Ferla L,
Mistraletti G, Porta F, Miranda DR.

Istituto di Anestesiologia e Rianimazione, Universita di Milano, Azienda
Ospedaliera-Polo Universitario San Paolo, Via A Di Rudini 8, 20142, Milan,
Italy.

OBJECTIVE. Mortality after many procedures is lower in centers where more
procedures are done. It is controversial whether this is true for intensive care
units, too. We examined the relationship between the volume of activity of
intensive care units (ICUs) and mortality by a measure of risk-adjusted volume
of activity specific for ICUs. DESIGN. Prospective, multicenter, observational
study. SETTING. Eighty-nine ICUs in 12 European countries. PATIENTS. During a
4-month study period, 12,615 patients were enrolled. INTERVENTIONS. Demographic
and clinical statistics, severity at admission and a score of nursing complexity
and workload were collected. RESULTS. Total volume of activity was defined as
the number of patients admitted per bed per year, high-risk volume as the number
of high-risk patients admitted per bed per year (selected combining of length of
stay and severity of illness). A multi-step risk-adjustment process was planned.
ICU volume corresponding both to overall [odds ratio (OR) 0.966] and 3,838
high-risk (OR 0.830) patients was negatively correlated with mortality. Relative
mortality decreased by 3.4 and 17.0% for every five extra patients treated per
bed per year in overall volume and high-risk volume, respectively. A direct
relationship was found between mortality and the ICU occupancy rate (OR 1.324
and 1.351, respectively). CONCLUSIONS. Intensive care patients, whatever their
level of risk, are best treated where more high-risk patients are treated.
Moreover, the higher the ICU occupancy rate, the higher is the mortality.

PMID: 14685662 [PubMed - as supplied by publisher]

6: Intensive Care Med. 2003 Dec 19 [Epub ahead of print].

The European Directive: a further blow to science in intensive care medicine in
Austria.

Druml C, Singer EA.

Ethics Committee, Medical Faculty, University of Vienna and Vienna General
Hospital, Borschkegasse 8b, 1090, Vienna, Austria.

PMID: 14685660 [PubMed - as supplied by publisher]

7: Intensive Care Med. 2003 Dec 19 [Epub ahead of print].

A waiver of consent for intensive care research?

Lemaire F.

Hopital Henri Mondor, Service de Reanimation Medical, 51 Avenue M. de Lattre de
Tassigny, CEDEX, 94010, Creteil, France.

PMID: 14685654 [PubMed - as supplied by publisher]

8: JAMA. 2003 Dec 24;290(24):3191; author reply 3191-2.

Comment on:
JAMA. 2003 Sep 3;290(9):1166-72.
JAMA. 2003 Sep 3;290(9):1208-10.Ethics consultation in the intensive care unit.

Quigley R.

Publication Types:
Comment
LetterPMID: 14693865 [PubMed - indexed for MEDLINE]

9: JAMA. 2003 Dec 24;290(24):3191; author reply 3191-2.

Comment on:
JAMA. 2003 Sep 3;290(9):1166-72.Ethics consultation in the intensive care unit.

White DB, Luce JM.

Publication Types:
Comment
LetterPMID: 14693864 [PubMed - indexed for MEDLINE]

10: Lancet. 2003 Dec 20;362(9401):2119-2120.