Other bulletins in this series include:

Breast Surgery

Tuesday, 28 October 2008

Year in review 2007 : Critical Care & # 8211 ; multiple organ failure and sepsis

Bibliographic export Print

James M O'Brien ; Naeem A Ali and Edward Abraham
BioMed Central PDF Abstract
Free Medical Journals . com (/1997 - / Embargo: 2 years)
UK PubMed Central (/1997 - /2008)
Page: 228 Vol/Issue: 2008 ; VOL 12 Date: 2008-07-16
ISSN Print: 1364-8535 E-ISSN: 1466-609X
Search Google: Article Author(s)

Conscious surgery: influence of the environment on patient anxiety

Conscious surgery: influence of the environment on patient anxiety
Mark Mitchell
Journal of Adv Nursing

Mobility interventions to improve outcomes in patients undergoing prolonged mechanical ventilation: a review of the literature.

Biol Res Nurs. 2008 Jul;10(1):21-33. LinkOut
Choi J, Tasota FJ, Hoffman LA. University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261, USA. jic11@pitt.edu

Survivors of critical illness often undergo an extended recovery trajectory. Reduced functional ability is one of several adverse outcomes of prolonged bed rest and mechanical ventilation during critical illness. Skeletal muscle weakness is known to be one of the major phenomena that account for reduced functional ability. Although skeletal muscle weakness is evident after prolonged mechanical ventilation (PMV), few studies have tested the benefits of various types of mobility interventions in this population. The purpose of this article is to review the published research on improving mobility outcomes in patients undergoing PMV. For this review, published studies were retrieved from MEDLINE, PubMed, CINAHL, and the Cochrane Database of Systematic Reviews from January 1990 to July 2007. A total of 10 relevant articles were selected that examined the effect of whole body physical therapy, electrical stimulation (ES), arm exercise, and inspiratory muscle training (IMT). Overall, there is support for the ability of mobility interventions to improve outcomes in patients on PMV but limited evidence of how to best accomplish this goal. Generating more data from multicenter studies and randomized controlled trials is recommended.
PMID: 18647758 [PubMed - indexed for MEDLINE]

Mobilizing patients in the intensive care unit: improving neuromuscular weakness and physical function.

1: JAMA. 2008 Oct 8;300(14):1685-90. LinkOut
Needham DM.
Division of Pulmonary and Critical Care Medicine, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland 21205, USA. dale.needham@jhmi.edu

Early mobilization of patients in the hospital and the intensive care unit has a strong historical precedent. However, in more recent times, deep sedation and bed rest have been part of routine medical care for many mechanically ventilated patients. A growing body of literature demonstrates that survivors of severe critical illness commonly have significant and prolonged neuromuscular complications that impair their physical function and quality of life after hospital discharge. Bed rest, and its associated mechanisms, may play an important role in the pathogenesis of neuromuscular weakness in critically ill patients. A new approach for managing mechanically ventilated patients includes reducing deep sedation and increasing rehabilitation therapy and mobilization soon after admission to the intensive care unit. Emerging research in this field provides preliminary evidence supporting the safety, feasibility, and potential benefits of early mobilization in critical care medicine.

PMID: 18840842 [PubMed - in process]

Improvement of the ventilator associated pneumonia rate with infection control practices in an Italian ICU.

Prospero E, Bacelli S, Barbadoro P, Nataloni S, D'Errico MM, Pelaia P.
Department of Infectious Disease and Public Health, Polytechnic University of Marche, Ancona, Italy e.prospero@univpm.it.

BACKGROUND: To assess the impact of an intervention to improve respiratory infection control practices and reduce the ventilator associated pneumonia (VAP) rate in an intensive care unit, at the request of the ICU staff.

METHODS: Design: prospective surveillance before-after study. Baseline VAP rates were determined over a 4-month period of active surveillance without an infection control program (period 1) and compared to VAP rates following implementation of an infection control program (period 2). The ICU staff requested the implementation of infection control practices. Setting: Intensive Care Unit (ICU) at a university teaching hospital in Italy. Patients: A total of 185 patients admitted to the ICU were included in the study.

RESULTS: Patients assessed during period 1 were similar to patients assessed during period 2 with regard to age, sex, origin, type of admission and mortality. Patients who were admitted during period 2 had significantly lower simplified acute physiology scores (SAPS) II and acute physiology and chronic health evaluation (APACHE) II scores than patients admitted during period 1 (P<0.05). During period 1, there were 27 cases of VAP, and the incidence rate was 36.9/1000 MV-days. During period 2, the VAP rate decreased significantly (P=0.049): there were only 17 cases of VAP, and the incidence rate was 22.5/1 000 MV-days, with a rate-ratio of 0.61.
CONCLUSION: Despite our short study period, the results appear to be encouraging and show a measurable impact on the incidence of VAP.
PMID: 18854795 [PubMed - in process]

Nurse staffing and patient mortality in intensive care units.

Cho SH, Hwang JH, Kim J. Related Articles, LinkOut

Nurs Res. 2008 Sep-Oct;57(5):322-30. PMID: 18794716 [PubMed - indexed for MEDLINE]

Composite auditory evoked potential index versus bispectral index to estimate the level of sedation in paralyzed critically ill patients: a prospectiv

Lu CH, Man KM, Ou-Yang HY, Chan SM, Ho ST, Wong CS, Liaw WJ.
Related Articles, Compound (MeSH Keyword), Substance (MeSH Keyword), LinkOut

Anesth Analg. 2008 Oct;107(4):1290-4. PMID: 18806042 [PubMed - indexed for MEDLINE]

Monitoring central venous pressure: a survey of British intensive care units.

Barker C, Lake KJ, Jefferson P, Ball DR.
Related Articles, LinkOut

Anaesthesia. 2008 Oct;63(10):1150.
No abstract available.
Erratum in: Anaesthesia. 2008 Nov;63(11):1276. Barke, C [corrected to Barker, C]; Lake, A K [corrected to Lake, K J A]. PMID: 18821906 [PubMed - indexed for MEDLINE]

Comparison of the effect of ciprofloxacin and Tazocin((R)) on the incidence of meticillin-resistant Staphylococcus aureus (MRSA) in an Intensive Care

Aldeyab MA, Hughes CM, Kearney MP, Scott MG, McDowell DA, Hanley J, McMahon MA, Elshibly SM, Bailie R, McElnay JC. Related Articles, LinkOut

Int J Antimicrob Agents. 2008 Sep 16; [Epub ahead of print] PMID: 18801646 [PubMed - as supplied by publisher]

Bed occupancy and incidence of Methicillin-resistant Staphylococcus aureus infection in an intensive care unit

Howie AJ, Ridley SA. Related Articles, LinkOut

Anaesthesia. 2008 Oct;63(10):1070-3. PMID: 18821886 [PubMed - indexed for MEDLINE

Do fans spread infection in clinical areas ?

Bibliographic export Print

Body , R .
Publisher Free Medical Journals . com (/2000 - / Embargo: 1 year)
Proquest NHS (09/2003 - 11/2003)
UK PubMed Central (/2001 - 07/2005)
Page: 689 Vol/Issue: 2008 ; VOL 25 ; PART 10
ISSN Print: 1472-0205 E-ISSN: 1472-0213 Print Holdings: Yes
Search Google: Article Author(s)

Lactic acidosis not hyperlactatemia as a predictor of inhospital mortality in septic emergency patients

Bibliographic export Print

Lee , S . - W . ; Hong , Y . - S . ; Park , D . - W . ; Choi , S . - H . ; Moon , S . - W . ; Park , J . - S . ; Kim , J . - Y . ; Baek , K . - J .

Publisher Free Medical Journals . com (/2000 - / Embargo: 1 year)
Proquest NHS (09/2003 - 11/2003)
UK PubMed Central (/2001 - 07/2005)
Page: 659-665 Vol/Issue: 2008 ; VOL 25 ; PART 10
ISSN Print: 1472-0205 E-ISSN: 1472-0213 Print Holdings: Yes
Search Google: Article Author(s)

Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment

Wednesday, October 22, 2008

Extract from http://runningahospital.blogspot.com/

Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment

Alexi A. Wright, MD; Baohui Zhang, MS; Alaka Ray, MD; Jennifer W. Mack, MD, MPH; Elizabeth Trice, MD, PhD; Tracy Balboni, MD, MPH; Susan L. Mitchell, MD; Vicki A. Jackson, MD, MPH; Susan D. Block, MD; Paul K. Maciejewski, PhD; Holly G. Prigerson, PhDJAMA. 2008;300(14):1665-1673.
Talking about death can be difficult. Without evidence that end-of-life discussions improve patient outcomes, physicians must balance their desire to honor patient autonomy against a concern of inflicting psychological harm.

Objective: To determine whether end-of-life discussions with physicians are associated with fewer aggressive interventions.Design, Setting, and ParticipantsA US multisite, prospective, longitudinal cohort study of patients with advanced cancer and their informal caregivers (n = 332dyads), September 2002-February 2008. Patients were followed up from enrollment to death, a median of 4.4 months later. Bereaved caregivers' psychiatric illness and quality of life was assessed a median of 6.5 months later.

Main Outcome Measures Aggressive medical care (eg, ventilation, resuscitation) and hospice in the final week of life. Secondary outcomes included patients' mental health and caregivers' bereavement adjustment.ResultsOne hundred twenty-three of 332 (37.0%) patients reported having end-of-life discussions before baseline.... After propensity-score weighted adjustment, end-of-life discussions were associated with lower rates of ventilation... resuscitation ... ICU admission ... and earlier hospice enrollment. In adjusted analyses, more aggressive medical care was associated with worse patient quality of life ... and higher risk of major depressive disorder in bereaved caregivers ... whereas longer hospice stays were associated with better patient quality of life .... Better patient quality of life was associated with better caregiver quality of life at follow-up....

End-of-life discussions are associated with less aggressive medical care near death and earlier hospice referrals. Aggressive care is associated with worse patient quality of life and worse bereavement adjustment.

Posted by Paul Levy at 10/22/2008 08:11:00 PM 3 comments