ICU admissions after actual or planned hospital discharge

ICU admissions after actual or planned hospital discharge. Chest, vol. 136(5), Nov. 2009, p.1257-1262.

Chawla, S., et al.

http://chestjournal.chestpubs.org/content/136/5/1257.full

Unexpected ICU admissions may result from early or premature discharge from the hospital. We sought to determine the incidence, clinical characteristics, and outcomes of patients admitted to the ICU after actual or planned hospital discharge and to analyze whether the need for ICU admission was related or unrelated to the associated hospitalization.

Caring to the end?

Caring to the end? National confidential enquiry into patient outcome and death. A review of the care of patients who died in hospital within four days of admission. 2009.

Cooper, H. et al.

http://www.ncepod.org.uk/2009report2/Downloads/DAH_report.pdf

This report highlights the process of care of patients who died in acute hospitals within four days of admission. It takes a critical look at the areas where patient care might have been improved. Remediable factors have been identified in the clinical and the organisational care of these patients.

Prolonged acute mechanical ventilation: implications for hospital benchmarking

Prolonged acute mechanical ventilation: implications for hospital benchmarking. Chest, vol. 135(5), May 2009, p.1157-1162.

Zilberberg, M.D. et al.

http://chestjournal.chestpubs.org/content/135/5/1157.full

Hospital performance measures rely on aggregate outcomes. For patients receiving mechanical ventilation (MV), outcomes depend on severity of illness, hospital MV volume, and case mix. Patients requiring prolonged acute MV (PAMV) [MV for ≥ 96 h] comprise a resource-intensive group, but the impact of its volume on aggregate outcomes is unknown. We investigated whether observed outcomes differed from those predicted by APACHE (acute physiology and chronic health evaluation) IV risk adjustment and the relationship between hospital MV volume and outcomes among patients receiving PAMV.

Age, duration of mechanical ventilation and outcomes of patients who are critically ill

Age, duration of mechanical ventilation and outcomes of patients who are critically ill. Chest vol. 136(3), Sept. 2009, p. 759-764.

Feng, Y. et al.

http://www.chestjournal.org/content/136/3/759.full.pdf+html

Age and duration of mechanical ventilation (MV) are strongly associated with mortality and hospital discharge disposition. Methods: Electronic administrative records from a 425-bed community teaching hospital were obtained for 9,912 patients who were admitted to hospital ICUs between 2003 and 2008. Risk estimates of age and duration of MV for in-hospital mortality and discharge to home vs extended-care facilities (ECFs) also were obtained.
This study suggests that age and duration of MV are strongly associated with mortality
and posthospital disposition.

Effects on management and outcome of severe sepsis and septic shock patients admitted to the intensive care unit

Effects on management and outcome of severe sepsis and septic shock patients admitted to the intensive care unit after implementation of a sepsis program: a pilot study. Critical care Vol. 13(5), Sept 2009.

Girardis, M., et al.

http://ccforum.com/content/pdf/cc8029.pdf

The application in clinical practice of evidence-based guidelines for the management of patients with severe sepsis/septic shock is still poor in the emergency department, while little data are available for patients admitted to the intensive care unit (ICU). The aim of this study was to evaluate the effect of an in-hospital sepsis program on the adherence to evidence-based guidelines and outcome of patients with severe sepsis/septic shock admitted to the ICU.

Pain management within the palliative and end-of-life care experience in the ICU

Pain management within the palliative and end-of-life care experience in the ICU. Chest, May 2009, vol. 135(5), 1360-1369.

Mularski, R.A., et al.

http://www.chestjournal.org/content/135/5/1360.full.pdf+html

In the ICU where critically ill patients receive aggressive life-sustaining interventions, suffering is common and death can be expected in up to 20% of patients. High-quality pain management is a part of optimal therapy and requires knowledge and skill in pharmacologic, behavioral, social, and communication strategies grounded in the holistic palliative care approach. This contemporary review article focuses on pain management within comprehensive palliative and end-of-life care.

Terminal Withdrawal of Mechanical Ventilation at a Long-Term Acute Care Hospital

Terminal Withdrawal of Mechanical Ventilation at a Long-Term Acute Care Hospital: Comparison with a medical ICU. Chest, vol. 136(2), Aug 2009, p.465-470.

White, A.C., et al.

http://www.chestjournal.org/content/136/2/465.full.pdf+html

Long-term acute care hospitals provide care for patients who require prolonged mechanical ventilation (MV) for respiratory failure. A multicenter study found weaning to be unsuccessful in 20% of patients receiving prolonged MV despite a multidisciplinary approach to care. The decision to terminally withdraw MV from critically ill patients in whom MV is no longer considered beneficial is common in ICUs in the United States and in Europe. Updated practice guidelines are available to inform practitioners in the terminal withdrawal of MV in the ICU.

A Randomized Trial of Dental Brushing for Prevening Ventilator-Associated Pneumonia

A Randomized Trial of Dental Brushing for Preventing Ventilator-Associated Pneumonia. Chest, vol. 136(2), Aug. 2009, p. 433-499.

Pobo, A., et al.

http://www.chestjournal.org/content/136/2/433.full.pdf+html

Poor oral hygiene is associated with respiratory pathogen colonization and secondary
lung infection. The impact of adding electric toothbrushing to oral care in order to reduce
ventilator-associated pneumonia (VAP) incidence is unknown. The study design was a prospective, simple-blind, randomized trial of adult patients intubated for > 48 h. Controlling for exposure to antibiotic treatment, patients were randomized to oral care every 8 h with 0.12% chlorhexidine digluconate (standard group) or standard oral care plus electric toothbrushing (toothbrush group). VAP was documented by quantitative respiratory cultures. Mechanical ventilation duration, hospital ICU length of stay, antibiotic use, and hospital ICU mortality were secondary end points.

Experiences of intensive care nurses assessing sedation/agitation in critically ill patients

Experiences of intensive care nurses assessing sedation/agitation in critically ill patients. Nursing in critical care, vol. 13(4), 2008. [journal article]

Weir, S. and O'Neill, A.

http://www3.interscience.wiley.com/cgi-bin/fulltext/119878662/PDFSTART

Patients admitted to the intensive care unit (ICU) will more often than not require sedative and analgesic drugs to enable them to tolerate the invasive procedures and therapies caused as a result of their underlying condition and/or necessary medical interventions. This article reports a study exploring the perceptions and experiences of intensive care nurses using a sedation/agitation scoring (SAS) tool to assess and manage sedation and agitation amongst critically ill patients.

Withdrawal of mechanical ventilation in anticipation of death in the intensive care unit. New England Journal of Medicine, vol. 349(12), Sept. 2003. [journal article]

Cook, D., et al.

http://content.nejm.org/cgi/reprint/349/12/1123.pdf

In critically ill patients who are receiving mechanical ventilation, the factors associated with physicians’ decisions to withdraw ventilation in anticipation of death are unclear. The objective of this study was to examine the clinical determinants that were associated with the withdrawal of mechanical ventilation.

Non-invasive ventilation: don't push too hard

Non-invasive ventilation: don't push too hard. New england journal of medicine, Vol. 350(24), June 2004. [journal article]

Truwit, J.D. and Bernard, G.R.

http://content.nejm.org/cgi/reprint/350/24/2512.pdf

Noninvasive mechanical ventilation has been used increasingly over the past decade in an effort to avoid endotracheal intubation and to accelerate the discontinuation of mechanical ventilation. Noninvasive ventilation as adjunctive therapy can be applied before intubation or after extubation. The literature indicates that in both settings, outcomes in patients with chronic obstructive pulmonary disease (COPD) or cardiogenic pulmonary edema are successful.

Hydrocortisone therapy for patients with septic shock

Hydrocortisone therapy for patients with septic shock. New england journal of medicine, Vol 358 (2), January 2008 [journal article]

Sprung, C.L., et al.

http://content.nejm.org/cgi/reprint/358/2/111.pdf


Hydrocortisone is widely used in patients with septic shock, even though a survival benefit has been reported only in patients who remained hypotensive after fluid and vasopressor resuscitation and whose plasma cortisol levels did not rise appropriately after the administration of corticotropin.

Determinants of weaning success in patients with prolonged mechanical ventilation

Determinants of weaning success in patients with prolonged mechanical ventilation. Critical care 13(3), June 2009 [journal article]

Carlucci, A., et al.

http://ccforum.com/content/13/3/R97

Physiological determinants of weaning success and failure are usually studied in ventilator-supported patients, comparing those who failed a trial of spontaneous breathing with those who tolerated such a trial and were successfully extubated. A major limitation of these studies was that the two groups may be not comparable, concerning the severity of the underlying disease and the presence of comorbidities. In this physiological study, we assessed the determinants
of weaning success in patients acting as their own control, once they are eventually liberated from the ventilator.

Ventilator-associated pneumonia in patients undergoing major heart surgery

Ventilator-associated pneumonia in patients undergoing major heart surgery: an incidence study in Europe. Critical Care 13(3), June 2009. [journal article]

Hortal, J., Munoz, P., Cuerpo, G., Litvan, H., Rosseel, P.M., Bouza, E.

http://ccforum.com/content/13/3/R80

Critical Care

Mechanical ventilation during experimental sepsis increases deposition of advanced glycation end products and myocardial inflammation
Kneyber MC, Gazendam RP, Niessen HW, Kuiper J, Dos Santos CC, Slutsky AS, Plotz FB Critical Care 2009, 13:R87 (9 June 2009)
[Abstract] [Provisional PDF] [PubMed]