Integrating Palliative and Critical Care: Evaluation of a Quality-Improvement Intervention
Author(s):
Curtis , J . R . ; Treece , P . D . ; Nielsen , E . L . ; Downey , L . ; Shannon , S . E . ; Braungardt , T . ; Owens , D . ; Steinberg , K . P . ; Engelberg , R . A .
ISSUE: 2008 ; VOL 178 ; PART 3
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Page: 269-275
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Wednesday, 27 August 2008
Acquired Weakness, Handgrip Strength, and Mortality in Critically Ill Patients
Acquired Weakness, Handgrip Strength, and Mortality in Critically Ill Patients
Author(s): Ali , N . A . ; O Brien , J . M . ; Hoffmann , S . P . ; Phillips , G . ; Garland , A . ; Finley , J . C . W . ; Almoosa , K . ; Hejal , R . ; Wolf , K . M . ; Lemeshow , S .
ISSUE: 2008 ; VOL 178 ; PART 3
Access: From Free Medical Journals . com (/1997 - /Embargo: 1 year)
From Proquest NHS [Full Text] (02/2003 - /)
Page: 261-268
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Author(s): Ali , N . A . ; O Brien , J . M . ; Hoffmann , S . P . ; Phillips , G . ; Garland , A . ; Finley , J . C . W . ; Almoosa , K . ; Hejal , R . ; Wolf , K . M . ; Lemeshow , S .
ISSUE: 2008 ; VOL 178 ; PART 3
Access: From Free Medical Journals . com (/1997 - /Embargo: 1 year)
From Proquest NHS [Full Text] (02/2003 - /)
Page: 261-268
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Time course of plasma gelsolin concentrations during severe sepsis in critically ill surgical patients
Time course of plasma gelsolin concentrations during severe sepsis in critically ill surgical patients
Author(s): HaiHong Wang ; BaoLi Cheng ; QiXing Chen ; ShuiJing Wu ; Chen Lv ; GuoHao Xie ; Yue Jin and XiangMing Fang
ISSUE: 2008 ; VOL 12 (2008-06-18)
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Page: R106
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Author(s): HaiHong Wang ; BaoLi Cheng ; QiXing Chen ; ShuiJing Wu ; Chen Lv ; GuoHao Xie ; Yue Jin and XiangMing Fang
ISSUE: 2008 ; VOL 12 (2008-06-18)
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Page: R106
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Monitoring of endothelial dysfunction in critically ill patients:
Cribbs SK, Martin GS, Rojas M. Related Articles, LinkOut
Monitoring of endothelial dysfunction in critically ill patients: the role of endothelial progenitor cells.Curr Opin Crit Care. 2008 Jun;14(3):354-60. Review. PMID: 18467899 [PubMed - indexed for MEDLINE]
Monitoring of endothelial dysfunction in critically ill patients: the role of endothelial progenitor cells.Curr Opin Crit Care. 2008 Jun;14(3):354-60. Review. PMID: 18467899 [PubMed - indexed for MEDLINE]
Improving care of the sepsis patient.
Zubrow MT, Sweeney TA, Fulda GJ, Seckel MA, Ellicott AC, Mahoney DD, Fasano-Piectrazak PM, Farraj MB. Related Articles, LinkOut
Jt Comm J Qual Patient Saf. 2008 Apr;34(4):187-91. PMID: 18468354 [PubMed - indexed for MEDLINE]
Jt Comm J Qual Patient Saf. 2008 Apr;34(4):187-91. PMID: 18468354 [PubMed - indexed for MEDLINE]
Patient-related factors and circumstances surrounding decisions to forego life-sustaining treatment, including intensive care unit admission refusal.
Reignier J, Dumont R, Katsahian S, Martin-Lefevre L, Renard B, Fiancette M, Lebert C, Clementi E, Bontemps F. Related Articles, LinkOut
Patient-related factors and circumstances surrounding decisions to forego life-sustaining treatment, including intensive care unit admission refusal.
Crit Care Med. 2008 Jul;36(7):2076-83. PMID: 18552685 [PubMed - indexed for MEDLINE]
Patient-related factors and circumstances surrounding decisions to forego life-sustaining treatment, including intensive care unit admission refusal.
Crit Care Med. 2008 Jul;36(7):2076-83. PMID: 18552685 [PubMed - indexed for MEDLINE]
Lipopolysaccharide binding protein in a surgical intensive care unit: a marker of sepsis?
Sakr Y, Burgett U, Nacul FE, Reinhart K, Brunkhorst F.
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Lipopolysaccharide binding protein in a surgical intensive care unit: a marker of sepsis?
Crit Care Med. 2008 Jul;36(7):2014-22. PMID: 18552695 [PubMed - indexed for MEDLINE]
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Lipopolysaccharide binding protein in a surgical intensive care unit: a marker of sepsis?
Crit Care Med. 2008 Jul;36(7):2014-22. PMID: 18552695 [PubMed - indexed for MEDLINE]
The effect of nurse champions on compliance with Keystone Intensive Care Unit Sepsis-screening protocol.
Campbell J. Related Articles, LinkOut
The effect of nurse champions on compliance with Keystone Intensive Care Unit Sepsis-screening protocol.
Crit Care Nurs Q. 2008 Jul-Sep;31(3):251-69.
PMID: 18574373 [PubMed - indexed for MEDLINE]
The effect of nurse champions on compliance with Keystone Intensive Care Unit Sepsis-screening protocol.
Crit Care Nurs Q. 2008 Jul-Sep;31(3):251-69.
PMID: 18574373 [PubMed - indexed for MEDLINE]
Surveillance of microbial resistance in European Intensive Care Units: a first report from the Care-ICU programme for improved infection control.
Hanberger H, Arman D, Gill H, Jindrák V, Kalenic S, Kurcz A, Licker M, Naaber P, Scicluna EA, Vanis V, Walther SM.
Related Articles, LinkOut
Intensive Care Med. 2008 Aug 1; [Epub ahead of print] PMID: 18670757 [PubMed - as supplied by publisher]
Related Articles, LinkOut
Intensive Care Med. 2008 Aug 1; [Epub ahead of print] PMID: 18670757 [PubMed - as supplied by publisher]
A phenomenological study to understand the experiences of nurses with regard to brainstem death.
Ronayne C. Related Articles, LinkOut
Intensive Crit Care Nurs. 2008 Jul 24; [Epub ahead of print] PMID: 18657425 [PubMed - as supplied by publisher]
Intensive Crit Care Nurs. 2008 Jul 24; [Epub ahead of print] PMID: 18657425 [PubMed - as supplied by publisher]
Development of the 3-SET 4P questionnaire for evaluating former ICU patients' physical and psychosocial problems over time
: A pilot study.Intensive Crit Care Nurs. 2008 Aug 7; [Epub ahead of print]
Akerman E, Fridlund B, Ersson A, Granberg-Axéll A.
Related Articles, LinkOut
PMID: 18692395 [PubMed - as supplied by publisher]
Akerman E, Fridlund B, Ersson A, Granberg-Axéll A.
Related Articles, LinkOut
PMID: 18692395 [PubMed - as supplied by publisher]
Impact of 2 different levels of performance feedback on compliance with infection control process measures in 2 intensive care units.
Am J Infect Control. 2008 Aug;36(6):407-13. LinkOut
Assanasen S, Edmond M, Bearman G.
Divisions of Infectious Diseases and Quality Health Care, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA, USA. sisaa@mahidol.ac.th
BACKGROUND: Performance monitoring and feedback of infection control process measures is an important tool for improving guideline adherence. Different feedback strategies may lead to distinctive outcomes.
OBJECTIVES: Our objective was to determine the relative impact of 2 different levels of feedback on compliance in an intensive care unit (ICU) setting.
METHODS: Proportion of head of bed (HOB) elevation, hand hygiene (HH) compliance, and proportion of femoral catheter (FC) to all central venous catheter-days were observed in a medical ICU and a surgical ICU. After a 3-month baseline observation phase (phase 1; P1), we provided quarterly feedback on these process measures and major health care-associated infections (HAIs) to unit leaders from July 2004 to June 2005 (P2). From July 2005 to June 2006 (P3), feedback parameters were also provided to unit leaders and to all staff via 48 x 72-inch color posters in ICU personnel-only areas. At the end of the study, a survey was performed to assess the influence of the posters and HH observations.
RESULTS: The analysis of IC process measures included 6948 HOB elevation observations, 1576 HH opportunities, and 16,591 catheter-days. In P2, the overall compliance with HOB elevation and the proportion of FC use significantly improved from 51% to 88% (P < .001) and 13% to 7% (P < .001), respectively. No significant difference in HH compliance was observed during this phase (40% vs 47%, respectively; P = .28). Comparing P3 with P2, HH compliance significantly improved from 47% to 71% (P < .001), and there was a slight improvement in HOB elevation rate from 88% to 93% (P < .001). There was no significant change in FC use in P3. There were 53 survey respondents. Sixty percent reported that the poster information changed their practices. Nearly all respondents (92%) knew that their HH behavior was being observed; however, 61% claimed that HH compliance was not influenced by observation.
CONCLUSION: Feedback of infection control process measures and major HAIs to unit leadership significantly improved compliance with HOB elevation rate and FC use but not HH. Multilevel feedback significantly improved HH compliance and delivered a satisfactory level of compliance with HOB and FC use in both ICUs during the study period.
PMID: 18675146 [PubMed - in process]
Assanasen S, Edmond M, Bearman G.
Divisions of Infectious Diseases and Quality Health Care, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA, USA. sisaa@mahidol.ac.th
BACKGROUND: Performance monitoring and feedback of infection control process measures is an important tool for improving guideline adherence. Different feedback strategies may lead to distinctive outcomes.
OBJECTIVES: Our objective was to determine the relative impact of 2 different levels of feedback on compliance in an intensive care unit (ICU) setting.
METHODS: Proportion of head of bed (HOB) elevation, hand hygiene (HH) compliance, and proportion of femoral catheter (FC) to all central venous catheter-days were observed in a medical ICU and a surgical ICU. After a 3-month baseline observation phase (phase 1; P1), we provided quarterly feedback on these process measures and major health care-associated infections (HAIs) to unit leaders from July 2004 to June 2005 (P2). From July 2005 to June 2006 (P3), feedback parameters were also provided to unit leaders and to all staff via 48 x 72-inch color posters in ICU personnel-only areas. At the end of the study, a survey was performed to assess the influence of the posters and HH observations.
RESULTS: The analysis of IC process measures included 6948 HOB elevation observations, 1576 HH opportunities, and 16,591 catheter-days. In P2, the overall compliance with HOB elevation and the proportion of FC use significantly improved from 51% to 88% (P < .001) and 13% to 7% (P < .001), respectively. No significant difference in HH compliance was observed during this phase (40% vs 47%, respectively; P = .28). Comparing P3 with P2, HH compliance significantly improved from 47% to 71% (P < .001), and there was a slight improvement in HOB elevation rate from 88% to 93% (P < .001). There was no significant change in FC use in P3. There were 53 survey respondents. Sixty percent reported that the poster information changed their practices. Nearly all respondents (92%) knew that their HH behavior was being observed; however, 61% claimed that HH compliance was not influenced by observation.
CONCLUSION: Feedback of infection control process measures and major HAIs to unit leadership significantly improved compliance with HOB elevation rate and FC use but not HH. Multilevel feedback significantly improved HH compliance and delivered a satisfactory level of compliance with HOB and FC use in both ICUs during the study period.
PMID: 18675146 [PubMed - in process]
Examining the association between chest tube-related factors and the risk of developing healthcare-associated infections in the ICU of a community hos
Intensive Crit Care Nurs. 2008 Aug 5; [Epub ahead of print] LinkOut
Oldfield MM, El-Masri MM, Fox-Wasylyshyn SM.
Hotel-Dieu Grace Hospital, Windsor, ON, Canada.
OBJECTIVES: The study examined the association between chest tube-related factors and the risk for developing healthcare-associated infections (HAI).
RESEARCH METHODOLOGY: A case-control retrospective chart review was performed on 120 intensive care patients. Eligible patients were 18 years of age or older, had been in the intensive care unit (ICU) for 48h or more, and had one or more chest tubes.
SETTING: A 20-bed medical-surgical intensive care unit (ICU) of a community hospital in south-western Ontario, Canada. MAIN OUTCOME MEASURES: Documented diagnosis of hospital-acquired pneumonia or bloodstream infection.
RESULTS: The variable chest tube days was the only chest tube-related factor that was independently associated with HAI (OR=5.78; p=0.013). Mechanical ventilation (OR=4.88; p=0.002) and outcome length of stay (OR=0.72; p
PMID: 18693112 [PubMed - as supplied by publisher]
Oldfield MM, El-Masri MM, Fox-Wasylyshyn SM.
Hotel-Dieu Grace Hospital, Windsor, ON, Canada.
OBJECTIVES: The study examined the association between chest tube-related factors and the risk for developing healthcare-associated infections (HAI).
RESEARCH METHODOLOGY: A case-control retrospective chart review was performed on 120 intensive care patients. Eligible patients were 18 years of age or older, had been in the intensive care unit (ICU) for 48h or more, and had one or more chest tubes.
SETTING: A 20-bed medical-surgical intensive care unit (ICU) of a community hospital in south-western Ontario, Canada. MAIN OUTCOME MEASURES: Documented diagnosis of hospital-acquired pneumonia or bloodstream infection.
RESULTS: The variable chest tube days was the only chest tube-related factor that was independently associated with HAI (OR=5.78; p=0.013). Mechanical ventilation (OR=4.88; p=0.002) and outcome length of stay (OR=0.72; p
PMID: 18693112 [PubMed - as supplied by publisher]
Therapeutic positioning of the multiply-injured trauma patient in ICU.
Br J Nurs. 2008 May 22-Jun 11;17(10):638-42. LinkOut
Christie RJ.
Adult Intensive Care Unit, The Royal London Hospital, Whitechapel Road, London.
Critically-ill patients who have sustained multiple traumatic injuries have complex, and often conflicting, physiological needs. These have profound implications on the way in which nursing staff approach the physical positioning of these patients to minimize the risks of further physiological injury and damage, maintain homeostasis and promote optimum recovery. This article reviews and discusses the evidence base underpinning therapeutic positioning of the multiply-injured trauma patient within the intensive-care unit (ICU), focusing on patients with a known or suspected unstable spinal injury, pelvic injury, traumatic brain injury, chest injury, or multiple limb fractures. Included are guidelines on the therapeutic positioning of the multiply-injured trauma patient within the ICU, based on the current available evidence and also drawn from practical experience within the author's own place of work. There is also a brief discussion of how such guidelines may be introduced into clinical practice.
PMID: 18563003 [PubMed - indexed for MEDLINE]
Christie RJ.
Adult Intensive Care Unit, The Royal London Hospital, Whitechapel Road, London.
Critically-ill patients who have sustained multiple traumatic injuries have complex, and often conflicting, physiological needs. These have profound implications on the way in which nursing staff approach the physical positioning of these patients to minimize the risks of further physiological injury and damage, maintain homeostasis and promote optimum recovery. This article reviews and discusses the evidence base underpinning therapeutic positioning of the multiply-injured trauma patient within the intensive-care unit (ICU), focusing on patients with a known or suspected unstable spinal injury, pelvic injury, traumatic brain injury, chest injury, or multiple limb fractures. Included are guidelines on the therapeutic positioning of the multiply-injured trauma patient within the ICU, based on the current available evidence and also drawn from practical experience within the author's own place of work. There is also a brief discussion of how such guidelines may be introduced into clinical practice.
PMID: 18563003 [PubMed - indexed for MEDLINE]
The impact of continuous lateral rotation therapy in overall clinical and financial outcomes of critically ill patients.
Crit Care Nurs Q. 2008 Jul-Sep;31(3):270-9. LinkOut
Swadener-Culpepper L, Skaggs RL, Vangilder CA.
The Medical Center of Central Georgia, Macon, GA, USA. culpepper.leslie@mccg.org
BACKGROUND: Significant pulmonary complications are prevalent in intubated and mechanically ventilated patients.
OBJECTIVES: This study was conducted to determine the impact of continuous lateral rotation therapy (CLRT) on patients considered to be at high risk for pulmonary complications. Overall study objectives included hospital length of stay, critical care length of stay, ventilator days, and cost to treat. METHODS: Patients at risk for pulmonary complications as defined by Pao2/Fio2 ratio <> 50% for more than 1 hour, positive end-expiratory pressure > or = 8, or a Predicus score of > or = 5 were compared with a historical comparison group that met the high-risk criteria given above and did not receive CLRT. Patients who received CLRT were separated into 2 groups, early CLRT group (began therapy within 48 hours, n = 49) or late CLRT group (n = 46).
RESULTS: The early CLRT group had a reduction in critical care LOS, (P = .04) as compared with the non-CLRT group. Total hospital costs were reduced (P = .01) in the early intervention group compared to the late intervention group, as well as ICU LOS (P = .02). Nonsignificant trends were seen in reduced ventilator days and hospital LOS. Reintubation rates and readmissions to critical care were also lower in the early intervention group. CONCLUSIONS: Continuous lateral rotation therapy, when introduced early in course of treatment of high-risk patients, reduces critical care LOS and cost to treat.
PMID: 18574374 [PubMed - indexed for MEDLINE]
Swadener-Culpepper L, Skaggs RL, Vangilder CA.
The Medical Center of Central Georgia, Macon, GA, USA. culpepper.leslie@mccg.org
BACKGROUND: Significant pulmonary complications are prevalent in intubated and mechanically ventilated patients.
OBJECTIVES: This study was conducted to determine the impact of continuous lateral rotation therapy (CLRT) on patients considered to be at high risk for pulmonary complications. Overall study objectives included hospital length of stay, critical care length of stay, ventilator days, and cost to treat. METHODS: Patients at risk for pulmonary complications as defined by Pao2/Fio2 ratio <> 50% for more than 1 hour, positive end-expiratory pressure > or = 8, or a Predicus score of > or = 5 were compared with a historical comparison group that met the high-risk criteria given above and did not receive CLRT. Patients who received CLRT were separated into 2 groups, early CLRT group (began therapy within 48 hours, n = 49) or late CLRT group (n = 46).
RESULTS: The early CLRT group had a reduction in critical care LOS, (P = .04) as compared with the non-CLRT group. Total hospital costs were reduced (P = .01) in the early intervention group compared to the late intervention group, as well as ICU LOS (P = .02). Nonsignificant trends were seen in reduced ventilator days and hospital LOS. Reintubation rates and readmissions to critical care were also lower in the early intervention group. CONCLUSIONS: Continuous lateral rotation therapy, when introduced early in course of treatment of high-risk patients, reduces critical care LOS and cost to treat.
PMID: 18574374 [PubMed - indexed for MEDLINE]
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