Subject(s)
Community-Acquired Infections/diagnosis , Legionella pneumophila/isolation & purification , Legionnaires' Disease/diagnosis , Rhabdomyolysis/diagnosis , Adult , Community-Acquired Infections/complications , Community-Acquired Infections/drug therapy , Female , Humans , Legionnaires' Disease/complications , Legionnaires' Disease/drug therapy , Rhabdomyolysis/drug therapy , Rhabdomyolysis/etiology , Treatment OutcomeABSTRACT
PURPOSE: This systematic review assessed if outcomes in adult intensive care units (ICUs) are related to hospital and ICU patient volume. METHODS: A systematic search strategy was used to identify studies reporting on volume-outcome relationship in adult ICU patients till November 2010. Inclusion of articles was established through a predetermined protocol. Two reviewers assessed studies independently and data extraction was performed using standardized data extraction forms. RESULTS: A total of 254 articles were screened. Of these 25 were relevant to this study. After further evaluation a total of 13 studies including 596,259 patients across 1,068 ICUs met the inclusion criteria and were reviewed. All were observational cohort studies. Four of the studies included all admissions to ICU, five included mechanically ventilated patients, two reported on patients admitted with sepsis and one study each reported on patients admitted with medical diagnoses and post cardiac arrest patients admitted to ICU, respectively. There was a wide variability in the quantitative definition of volume and classification of hospitals and ICUs on this basis. Methodological heterogeneity amongst the studies precluded a formal meta-analysis. A trend towards favourable outcomes for high volume centres was observed in all studies. Risk-adjusted mortality rates revealed a survival advantage for a specific group of patients in high volume centres in ten studies but no significant difference in outcomes was evident in three studies. CONCLUSIONS: The results indicate that outcomes of certain subsets of ICU patients--especially those on mechanical ventilation, high-risk patients, and patients with severe sepsis--are better in high volume centres within the constraints of risk adjustments.
Subject(s)
Intensive Care Units/statistics & numerical data , Quality of Health Care , Treatment Outcome , Adult , Humans , Intensive Care Units/standards , Respiration, ArtificialABSTRACT
BACKGROUND: Acute cardiogenic pulmonary oedema (APO) occurs due to an increase in pulmonary microvascular pressure and massive transvascular fluid filtration into the lungs, causing respiratory insufficiency. OBJECTIVE: To determine whether fluid sequestration in the lungs effectively leads to contraction of the circulating blood volume, leading to relative hypovolaemia, and whether resolution of APO and fluid shift to the vascular compartment restores the circulating volume. METHODS: A retrospective analysis was conducted in the intensive care unit of a university teaching hospital, April - September 2007. It comprised a cohort of APO patients and a control group of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) with similar demographics. Patient demographics, haematocrit, haemoglobin levels, total protein and albumin levels, and arterial blood gas were analysed at presentation and after clinical resolution or at 24 hours. Fluid balance charts were reviewed. Blood, plasma and cell volume changes were calculated using haemoglobin levels and haematocrit. RESULTS: 52 patients (27 with APO; 25 with COPD) were included. Median haematocrit decreased significantly and the calculated blood and plasma volumes showed statistically significant increases after treatment in the APO group when compared with the COPD group (P < 0.001). Fluid intake and output were well balanced in both groups. CONCLUSIONS: Patients with APO are hypovolaemic at the onset relative to their state after treatment. With treatment and resolution of APO, hypovolaemia is corrected and circulating volume is restored.
