The Use of Intensive Care: New Research Initiatives and Their Implications for National Health Policy

Knaus, William A.; Draper, Elizabeth A.; Wagner, Douglas P.

doi:10.2307/3349873

Cited by 23 publications

(3 citation statements)

References 29 publications

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“…Fue difícil tipificar a la UCI de acuerdo a la clasificación internacional (1), compartimos la opinión de Galloso (2) quien afirma que nuestra Unidad podría corresponder al denominado Nivel III, que se caracteriza por presentar un médico director a tiempo parcial, estar principalmente manejada por residentes y tener una tasa enfermera/cama baja (3,4).…”

Section: Materials Y Metodosunclassified

Ventilación Mecánica en la UCI del Departamento de Medicina del Hospital Cayetano Heredia.

Castro¹,

Piñeiro²,

Carcelén³

2013

Rev Med Hered

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SUMMARYWe report all the complications observed during ventilatory support in 65 patients at the ICU-Medicine Department, Hospital Cayetano Heredia between 1983-85. The most frequent complications were related to the airway care. We had 12 orotracheal intubation in the right bronchus, 11 burst cuft, 8 self extubation and 7 accidental decannulation. In technical complications: 9 plug disconnection, 7 deactivated alarm, 4 ventilator failure and 2 break electric cable. We also had 24 atelectasis, 8 cannula disconnection, 7 leak on the pressure circuit and 4 tension pneumothorax. Complications were fatal in 4 patients: 2 tension pneumothorax, 1 blockage by secretions and 1 unnoticed disconnection. The weanning process was successful in 21 (32%) patients which were discharged in good conditions from the hospital. The complications referred above were due to the recent openning of the Unit, unnexperienced nurses, lack of chest physical therapist, poor resources, limited budget and precarious technical support at our Intensive Care Unit.

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Section: Materials Y Metodosunclassified

Ventilación Mecánica en la UCI del Departamento de Medicina del Hospital Cayetano Heredia.

Castro¹,

Piñeiro²,

Carcelén³

2013

Rev Med Hered

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“…New research accumulated during the decade which examined the benefits of intensive care, and, of particular importance for cost containment, began to focus on the costs of achieving those benefits. Knaus, Draper, and Wagner (26) reviewed studies that tried to identify two groups of patients -those so healthy that they do not need the close monitoring available in intensive care and those so sick from terminal illnesses that the benefits of intensive care are questionable; they concluded that current methods allow such patients to be identified with reasonable accuracy and thus could support more selective admission of patients to intensive care. A Consensus Development Conference sponsored by the National Institutes of Health recommended more research aimed at predicting outcomes for patients admitted to intensive care (68).…”

Section: Treatment Technologiesmentioning

confidence: 99%

Medical Technology in The United States: The Last Decade

Russell

Sisk²

1988

Int J Technol Assess Health Care

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This paper reviews the evolution of U.S. policy toward medical technology in areas such as cost containment, regulation of devices and drugs, and third party reimbursement. In addition the authors chronicle the diffusion of major medical technologies, procedures, and organizational innovations in the United States. Finally, the article provides tentative observations on the effect of recent policy changes and concludes with some recommendations for the future.

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“…Many patients with respiratory failure resulting from trauma, illness, and as a consequence of surgery receive temporary mechanical support that sustains life until normal breathing is restored. The expansion of mechanical ventilation parallels the exponential growth of intensive care in the United States and it is probable that out of a total of more than 6 6 ,0 0 0 adult intensive care unit beds, a large number receive some kind o f mechanical respiratory assistance (Knaus, Draper, and Wagner 1983). Thus, Drinker s "tinkering" in the Harvard machine shop back in the late 1920s initiated a process that culminated in one of the essential practices of modern-day critical care medicine.…”

Section: Role Of the Iron Lung In The Evolution Of Respirators And Rementioning

confidence: 99%

The Iron Lung: Halfway Technology or Necessary Step?

Maxwell¹

1986

The Milbank Quarterly

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The iron lung is often used to epitomize the costly halfway technologies of modern-day medicine that fail to cure and only prolong a seriously compromised existence. Historical evidence indicates that the iron lung was not a costly instrument of last resort; instead, it was a lifesaving device that played a critical role in the evolution of modern respirators and respiratory care. Contrary to the prevailing views of the biomedical research community, the creation of new devices and instruments is often as important a source of technical change in medicine as are advances in the biological sciences.

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The Use of Intensive Care: New Research Initiatives and Their Implications for National Health Policy

Cited by 23 publications

References 29 publications

Ventilación Mecánica en la UCI del Departamento de Medicina del Hospital Cayetano Heredia.

Ventilación Mecánica en la UCI del Departamento de Medicina del Hospital Cayetano Heredia.

Medical Technology in The United States: The Last Decade

The Iron Lung: Halfway Technology or Necessary Step?

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