The effect on survival of critically ill and injured patients of an ICU teaching service organized about a computer-based physiologic CARE system.

Management of the critically ill or injured surgical patient requires the organization and integration of clinical, biochemical, and physiologic data to facilitate the continuity and consistency of physician decision-making. To study the influence of these factors on improving survival, the implementation of a system of metabolically and physiologically oriented ICU care, structured around a surgical teaching service, was monitored over 6 years. Key to the organization of patient care and resident teaching was the staged introduction into the ICU of a computer-based Clinical Assessment, Research, and Education (CARE) system. In its present configuration it permits interactive entry of clinical information, fluid intake and output data, biochemical, immunologic, and metabolic profiles, as related to the cardiorespiratory physiologic data. The patient's cardiovascular and metabolic abnormalities can then be compared over time to prototype patterns obtained from previously studied patients. From this physiologic state time-course trajectory, the physician can infer pathophysiologic mechanisms and make the appropriate therapeutic decisions. The phased implementation of the CARE principles into a teaching ICU surgical service has been associated with a reduction of noncardiac surgical mortality from 18.8 to 10.5% from 1973 through 1978. Trauma mortality was reduced from 25 to 7.5%, and in surgical patients with complications of gastrointestinal disease, mortality dropped from 19.7 to 8.3%. The probability that the reduction in noncardiac surgical ICU mortality was a Linear Logistic function of the increase in CARE cardiovascular physiologic studies was significant at p