Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock

Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest, 2009, Vol. 136(5), p. 1237-1248.

Kumar, A., et al.

http://chestjournal.chestpubs.org/content/136/5/1237.full

To determine the impact of the initiation of inappropriate antimicrobial therapy on survival to hospital discharge of patients with septic shock.

Potential for response bias in family surveys about end-of-life care in the ICU

Potential for response bias in family surveys about end-of-life care in the ICU. Chest, 2009, Vol. 136(6), p. 1496-1502.

Kross, E.K., et al.

http://chestjournal.chestpubs.org/content/136/6/1496.full

After-death surveys are an important source of information about the quality of end-of-life care, but response rates generally are low. Our goal was to understand the potential for nonresponse bias in survey studies of family members after a patient's death in the hospital ICU by identifying differences in patient demographics and delivery of palliative care between patients whose families respond to a survey about end-of-life care and those whose families do not.

Association between ICU admission during morning rounds and mortality

Association between ICU admission during morning rounds and mortality. Chest, 2009, Vol. 136(6), p. 1489 - 1495.

Afessa, B., et al.

http://chestjournal.chestpubs.org/content/136/6/1489.full

No previous study has evaluated the association between admission to ICUs during round time and patient outcome. The objective of this study was to determine the association between round-time ICU admission and patient outcome.

The ICU 'golden hour' vs morning admissions

The ICU 'golden hour' vs morning admissions. Chest, 2009, vol. 136(6), p. 1449-1451.

Freire, AX and Yataco, JC.

http://chestjournal.chestpubs.org/content/136/6/1449.full

The authors present a robust observation from a single academic institution identifying an association between ICU admissions during morning teaching rounds and increased severity-adjusted mortality.

Weaning from ventilation: Does a care bundle approach work?

Weaning from ventilation: Does a care bundle approach work? Intensive and critical care nursing, 2008, vol. 24(3), p. 180-186

Crocker, C. and Kinnear, W.

http://www.intensivecriticalcarenursing.com/article/S0964-3397(07)00120-6/abstract

A care bundle is a small but critical set of processes that when implemented together improve outcome. One critical care network has written a weaning care bundle. This is an example of a service improvement initiative the aim of which was to improve weaning from mechanical ventilation.

End of life decisions:Nurses' perceptions, feelings and experiences

End of life decisions: Nurses' perceptions, feelings and experiences. Intensive and critical care nursing, 2008, Vol 24(4), p. 251-59

McMillen, R.E.

http://www.intensivecriticalcarenursing.com/article/S0964-3397(07)00119-X/abstract

Decisions to withdraw treatment are made on a regular basis in intensive care units. While nurses play a central role in patient care, previous studies have found that they are not always involved in withdrawal decisions.

Having the difficult conversations about the end of life

Having the difficult conversations about the end of life. BMJ 2010; 341:c4862

Barclay, S. and Maher, J.

http://www.bmj.com/content/341/bmj.c4862.full

Clinicians need to create repeated opportunities for patients to talk about their future and end of life care, guided by the patient as to timing, pace, and content of such talks, and respecting the wishes of those who do not want to discuss such matters

Achieving a good death for all

Achieving a good death for all. BMJ 2010; 341:c4861.

Ellershaw, J., et al.

http://www.bmj.com/content/341/bmj.c4861.full

A good death for all is now recognised as a priority at societal and political levels. To achieve this goal we need a fundamental shift of emphasis: to train and educate healthcare professionals, to ensure rigorous assessment of new end of life care services that aim to improve quality and choice, and to explore best use of resources.

Dying matters: let's talk about it

Dying matters: let's talk about it. BMJ 2010; 341:c4860

Seymour, J.E., et al.

http://www.bmj.com/content/341/bmj.c4860.full

As death has become less common in our daily lives, it has become harder to consider our own mortality or that of those close to us. Lack of openness about death has negative consequences for the quality of care provided to the dying and bereaved. Eradicating ignorance about what can be achieved with modern palliative care and encouraging dialogue about end of life care issues are important means of changing attitudes.

Recognising and managing key transitions in end of life care

Recognising and managing key transitions in end of life care. BMJ 2010; 341:c4863.

Boyd, K. and Murray, S.A.

http://www.bmj.com/content/341/bmj.c4863.full

Prognostic paralysis may delay a change in gear for too long. Being alert to the possibility that a patient might benefit from supportive and palliative care is central to delivering better end of life care.

Long-term cognitive impairment and functional disability among survivors of severe sepsis

Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA vol. 314(16), 2010; p. 1787-1794.

Iwashyna, T.J., et al.

http://jama.ama-assn.org/cgi/content/full/304/16/1787?etoc

Cognitive impairment and functional disability are major determinants of caregiving needs and societal health care costs. Although the incidence of severe sepsis is high and increasing, the magnitude of patients' long-term cognitive and functional limitations after sepsis is unknown. Severe sepsis in this older population was independently associated with substantial and persistent new cognitive impairment and functional disability among survivors. The magnitude of these new deficits was large, likely resulting in a pivotal downturn in patients' ability to live independently.

A 19-year-old woman with intracranial hemorrhage and diffuse pulmonary infiltrates

A 19-year-old woman with intracranial hemorrhage and diffuse pulmonary infiltrates. CHEST October 2010 vol. 138(4), p. 1014-1017.

Liu, Z., et al.

http://chestjournal.chestpubs.org/content/138/4/1014.full.pdf+html

A 19-year-old, previously healthy woman presented with a sudden onset of headache and an altered mental status. Her vital signs were stable, and physical examinations were significant only for an expressive aphasia and a defect in her visual fi eld. A head CT scan revealed a left temporoparietal intracerebral hemorrhage. While she was monitored in the ICU, her symptoms improved. About 24 h later, her headache suddenly worsened, and she quickly lost consciousness. Case Report.

Alcohol-use disorder in the critically ill patient

Alcohol-use disorder in the critically ill patient. CHEST October 2010 vol. 138(4), p. 994-1003.

de Wit, M., et al.

http://chestjournal.chestpubs.org/content/138/4/994.full

This review discusses the development and progression of critical illness in patients with AUDs. AUDs are linked to not only a higher likelihood of community-acquired pneumonia and sepsis but also a higher severity of illness and higher rates of nosocomial pneumonia and sepsis. The management of sedation in patients with AUDs may be particularly challenging because of the increased need for sedatives and opioids and the difficulty in diagnosing withdrawal syndrome. The health-care provider also must be watchful for the development of dangerous agitation and violence, as these problems are not uncommonly seen in hospital ICUs.

Less obvious predictors of post-ICU informal caregiver burden

Less obvious predictors of post-ICU informal caregiver burden. CHEST October 2010 Vol. 138(4), p. 1024.

Kulkarni, H.S.

http://chestjournal.chestpubs.org/content/138/4/1024.1.full.pdf+html

Follow up to the study by Van Pelt et al on the effect of critical illness felt by patients' families.

One year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation

One year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation. Annals of internal medicine, vol. 153(3), p. 167-175

Unroe, M. et al.

http://www.annals.org/content/153/3/167.abstract

Growing numbers of critically ill patients receive prolonged mechanical ventilation. Little is known about the patterns of care as patients transition from acute care hospitals to postacute care facilities or about the associated resource utilization.

Survivorship will be the defining challenge of critical care in the 21st century

Survivorship will be the defining challenge of critical care in the 21st century. Annals of internal medicine, August 3, 2010 vol. 153(3), p. 204-205.

Iwashyna, T.J.

http://www.annals.org/content/153/3/204.short?rss=1

Distracted by the high mortality rate of critical illness, we tend to overlook the essential fact that most patients survive the intensive care unit (ICU). Every year, millions of patients are discharged from the ICU to face the challenges of critical illness survivorship—the complex burdens and legacies of surviving a potentially fatal disease, often after harsh and painful treatment.

Decrease in long-term survival for hospitalized patients with community-acquired pneumonia

Decrease in long-term survival for hospitalized patients with community-acquired pneumonia. CHEST August 2010 vol. 138 (2), p. 279-283

Bordon, J., et al.

http://chestjournal.chestpubs.org/content/138/2/279.abstract

The association of hospitalization because of community-acquired pneumonia (CAP) and long-term survival has not been fully examined. This study measured the long-term survival of hospitalized patients with CAP adjusted for the effects of comorbidities.

Predictors of time to death after terminal withdrawal of mechanical ventilation in the ICU

Predictors of Time to Death After Terminal Withdrawal of Mechanical Ventilation in the ICU.
CHEST August 2010 vol. 138 (2), p. 289-297

Cooke, C.R., et al.

http://chestjournal.chestpubs.org/content/138/2/289.short?rss=1

Little information exists about the expected time to death after terminal withdrawal of mechanical ventilation. This study seeks to determine the independent predictors of time to death after withdrawal of mechanical ventilation.

Outcomes of patients ventilated with synchronized intermittent mandatory ventilation with pressure support

Outcomes of patients ventilated with synchronized intermittent mandatory ventilation with pressure support. CHEST, June 2010 Vol. 137(6), p. 1265-1277.

Ortiz, G., et al.

http://chestjournal.chestpubs.org/content/137/6/1265.short?rss=1

Few data are available regarding the benefits of one mode over another for ventilatory support. We set out to compare clinical outcomes of patients receiving synchronized intermittent mandatory ventilation with pressure support (SIMV-PS) compared with assist-control (A/C) ventilation as their primary mode of ventilatory support.

Effects of ear plugs and eye masks on nocturnal sleep, melatonin and cortisol in a simulated ICU environment

Effects of ear plugs and eye masks on nocturnal sleep, melatonin and cortisol in a simulated ICU environment. Critical Care vol. 14 (2), Apr 2010, p.

Hu, R. et al.

http://ccforum.com/content/14/2/R66

Environmental stimulus, especially noise and light, is thought to disrupt sleep in patients in the ICU. This study aimed to determine the physiological and psychological effects of ICU noise and light, and of earplugs and eye masks, used in these conditions in healthy subjects.

The effect of multidisciplinary care teams on intensive care unit mortality

The effect of multidisciplinary care teams on intensive care unit mortality. Archives of Internal Medicine, 2010; Vol. 170(4), pages 369-376.

Kim, M.M. et al.

http://archinte.ama-assn.org/cgi/content/full/170/4/369?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=Michelle%2BM.%2BKim&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

Critically ill patients are medically complex and may benefit from a multidisciplinary approach to care. Daily rounds by a multidisciplinary team are associated with lower mortality among medical ICU patients. The survival benefit of intensivist physician staffing is in part explained by the presence of multidisciplinary teams in high-intensity physician-staffed ICUs.

Hypoglycemia in the critically ill: how low is too low?

Hypoglycemia in the critically ill: how low is too low? Mayo clinic proceedings, March 2010, Vol. 85(3), p. 215-216.

Krinsley, J.S.

http://www.mayoclinicproceedings.com/content/85/3/215.full

Tight glycemic control in critically ill patients became a therapeutic paradigm after the 2001 publication of a landmark single-center interventional trial in Leuven, Belgium, (ie, “Leuven 1”) that targeted euglycemia in a population of mechanically ventilated patients in a surgical intensive care unit (ICU).