Résumé
In order to evaluate the effectiveness of an intensive care unit (ICU), the case-mix has to be considered. This was a cohort study. By using Acute Physiology and Chronic Health Evaluation scores (APACHE II score), we evaluated the case-mix and mortality rate of 282 patients who were treated in our postoperative ICU. The overall mortality rate was 10.6 per cent. Higher Acute physiology scores and emergency surgery in the presence of chronic health status were related to higher mortality, but age was not. However, the original APACHE II model could not precisely predict the mortality of Thai patients. We used stepwise logistic regression to determine the predictors of death and found the prediction model to be -7.24 + 0.37 (APACHE II score) + 1.46 (postemergency surgery). The actual mortality for patients with APACHE II score > 15 in our ICU was higher than that predicted by the original APACHE II model. The causes of this difference might be difference in methodology, characteristics of ICU and the quality of care.
Sujets)
Indice APACHE , Adulte , Sujet âgé , Études de cohortes , Groupes homogènes de malades , Mortalité hospitalière , Humains , Unités de soins intensifs/normes , Adulte d'âge moyen , , Soins postopératoires/normes , Analyse de régression , ThaïlandeRésumé
We conclude that the intravenous PCA method is a cost-effective technique. Although the PCA device is expensive, the cost-effectiveness analysis should give explicit figures for physicians and the hospital administrators to decide whether they should use the PCA instead of the conventional method.
Sujets)
Adolescent , Adulte , Sujet âgé , Analgésie autocontrôlée/économie , Analgésiques morphiniques/administration et posologie , Analyse de variance , Analyse coût-bénéfice , Calendrier d'administration des médicaments , Femelle , Humains , Injections musculaires , Injections veineuses , Mâle , Adulte d'âge moyen , Morphine/administration et posologie , Douleur postopératoire/traitement médicamenteux , Études prospectivesRésumé
We conclude that the intravenous PCA method is acceptable, easy to use, does not depend on the patients' level of education, and is safe for Thai patients. The average pain scores at 48 hours postoperation of the PCA group was significantly lower than for the conventional and the I.M. groups. Satisfaction was quite difficult to assess. Thai culture might influence how much pain is accepted and the patients had not experienced other techniques, so they could not make a comparison. The amount of morphine used by the PCA group was intermediate between that used by the other two groups.