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Breast Surgery

Thursday 26 September 2013

Implementing delirium screening in the ICU

Implementing delirium screening in the ICU: Secrets to success.  Critical care medicine, Sept 2013, Vol. 41(9), p.2196-2208.

Brummel, N.E. et al.

http://journals.lww.com/ccmjournal/Abstract/2013/09000/Implementing_Delirium_Screening_in_the_ICU__.15.aspx

To review delirium screening tools available for use in the adult ICU and PICU, to review evidence-based delirium screening implementation, and to discuss common pitfalls encountered during delirium screening in the ICU.

The pain, agitation and delirium care bundle

The pain, agitation and delirium care bundle: Synergistic benefits of implementing the 2013 pain, agitation and delirium guidelines in an integrated and interdisciplinary fashion. Critical care medicine, Sept 2013, Vol. 41(9), p.S99-115

Barr, J. and  Pandharipande, P.P.

http://journals.lww.com/ccmjournal/Abstract/2013/09001/The_Pain,_Agitation,_and_Delirium_Care_Bundle__.9.aspx

In 2013, the American College of Critical Care Medicine published a revised version of the pain, agitation, and delirium guidelines. The guidelines included an ICU pain, agitation, and delirium care bundle designed to facilitate implementation of the pain, agitation, and delirium guidelines.

Body temperature patterns as a predictor of hospital-acquired sepsis in afebrile adult intensive care unit patients : a case-control study

Body temperature patterns as a predictor of hospital-acquired sepsis in afebrile adult intensive care unit patients: A case-control study.  Critical care, Sept 2013, 17: R200

Drewry, A.M., et al.

http://ccforum.com/content/pdf/cc12894.pdf

Early treatment of sepsis improves survival, but early diagnosis of hospital-acquired sepsis, especially in critically ill patients, is challenging. Evidence suggests that subtle changes in body temperature patterns may be an early indicator of sepsis, but data is limited. The aim of this study was to examine whether abnormal body temperature patterns, as identified by visual examination, could predict the subsequent diagnosis of sepsis in afebrile critically ill patients.

Skeletal muscle predicts ventilator-free days, ICU-free days and mortality in elderly ICU patients

Skeletal muscle predicts ventilator-free days, ICU-free days and mortality in elderly ICU patients. Critical care, Sept 2013, 17: R206

Mosiey, L.L., et al.

http://ccforum.com/content/pdf/cc12901.pdf

As the population ages, the number of injured elderly is increasing. We sought to determine if 
low skeletal muscle mass adversely affected outcome in elderly patients following trauma.

Developing an early screening instrument for predicting psychological morbidity after critical illness

Developing an early screening instrument for predicting psychological morbidity after critical illness. Critical care, Sept 2013, 17: R210 

Schandl, A., et al.

http://ccforum.com/content/pdf/cc13018.pdf

Guidelines recommend follow-up for patients after intensive care unit (ICU) stay. Methods for identifying patients with psychological problems after intensive care would be of value, to optimize treatment and to improve adequate resource allocation in ICU followup of ICU survivors. The aim of the study was to develop a predictive screening instrument – for use at ICU discharge – to identify patients at risk for post-traumatic stress, anxiety or depression.

A prospective longitudinal multicentre study of health related qualify of life in ICU survivors with COPD

A prospective longitudinal multicentre study of health related quality of life of ICU survivors with COPD. Critical care, Sept 2013, 17:R211

Berkius, J., et al.

http://ccforum.com/content/pdf/cc13019.pdf

Mortality amongst COPD patients treated on the ICU is high. Health-related quality of life (HRQL) after intensive care is a relevant concern for COPD patients, their families and providers of health care. Still, there are few HRQL studies after intensive care of this patient group. Our hypothesis was that HRQL of COPD patients treated on the ICU declines rapidly with time.

Severe sepsis and septic shock

Severe sepsis and septic shock.  N Engl J Med 2013; 369: p.840-851

Angus, D.C. and van der Poll, T.

http://www.nejm.org/doi/full/10.1056/NEJMra1208623?af=R&rss=currentIssue

Sepsis is one of the oldest and most elusive syndromes in medicine. Hippocrates claimed that sepsis (σήψις) was the process by which flesh rots, swamps generate foul airs, and wounds fester.Galen later considered sepsis a laudable event, necessary for wound healing. With the confirmation of germ theory by Semmelweis, Pasteur, and others, sepsis was recast as a systemic infection, often described as “blood poisoning,” and assumed to be the result of the host's invasion by pathogenic organisms that then spread in the bloodstream. However, with the advent of modern antibiotics, germ theory did not fully explain the pathogenesis of sepsis: many patients with sepsis died despite successful eradication of the inciting pathogen.