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Breast Surgery

Monday, 14 October 2013

Prognosis and ICU outcome of systematic vasculitis

Prognosis and ICU outcome of systematic vasculitis. BMC Anesthesiology 2013, 13:27

Befort, P., et al.


Systemic vasculitis may cause life threatening complications requiring admission to an intensive care unit (ICU). The aim of this study was to evaluate outcomes of systemic vasculitis patients admitted to the ICU and to identify prognosis factors.

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

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.


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. 

Resuscitation fluids

Resuscitation fluids. NEJM, Oct 2013, 369: 1243-51

Myburgh, J.A. and  Mythen, M.G.


Fluid resuscitation with colloid and crystalloid solutions is a ubiquitous intervention in acute medicine. The selection and use of resuscitation fluids is based on physiological principles, but clinical practice is determined largely by clinician preference with marked regional variation. No ideal resuscitation fluid exists. There is emerging evidence that the type and dose of resuscitation fluid may affect patient-centered outcomes.

Long-term cognitive impairment after critical illness

Long-term cognitive impairment after critical illness. NEJM, Oct 2013, 369: 1306-16

Pandharipande, P.P., et al.


Survivors of critical illness often have a prolonged and disabling form of cognitive impairment that remains inadequately characterized. We enrolled adults with respiratory failure or shock in the medical or surgical intensive care unit (ICU), evaluated them for in-hospital delirium, and assessed global cognition and executive function 3 and 12 months after discharge.

Intensivists at night

Intensivists at night: putting resources in the right place. Critical care, October 2013, 17: 1008

Levy, M.M.

[no online link available]

During the past 50 years, caring for the critically ill has become increasingly complex and the need for an intensivist has become more evident. Management by intensivists has become a quality indicator for many ICUs. Numerous small studies have demonstrated the beneficial effect of intensivists on outcomes in the critically ill, and some clinicians have advanced the argument that a night-time intensivist is essential for the care of critically ill patients. In response, many institutions have hired full-time intensivists for both day and night coverage in the ICU. Two recent studies have been conducted that make a compelling argument for redirecting funding of night-time intensivists to areas of greater need in health care. In a retrospective analysis of a large database that involved more than 65,000 patients, no benefit of night-time intensivists could be found in ICUs where care is managed by intensivists during the day. Only in ICUs where management by intensivists is not mandated could a beneficial impact on mortality be found. The second study, a randomized controlled trial, evaluated the effect of night-time intensivists on length of stay, mortality, and other outcomes and was a negative trial. In this methodologically rigorous trial, there was no difference in outcomes between the intensivist and control group, which consisted of in-house resident coverage at night with availability by telephone of fellows and intensivists. These two robust studies clearly suggest that night-time intensivists do not improve mortality in ICUs managed by intensivists during the day. Though possibly beneficial in low-intensity environments, the widespread drive to add night-time intensivist coverage may have been premature.