Antibiotic strategies in severe nosocomial sepsis

Antibiotic strategies in severe nosocomial sepsis: why do we not de-escalate more often? Critical care medicine, May 2012, Vol. 40(5), p.1404-09.

Heenen, S., et al.

http://journals.lww.com/ccmjournal/Abstract/2012/05000/Antibiotic_strategies_in_severe_nosocomial_sepsis_.2.aspx

We reviewed all episodes of severe sepsis treated over a 1-yr period in the department of intensive care. Antimicrobial therapy was considered as appropriate when the antimicrobial had in vitro activity against the causative microorganisms.

Evaluating the use of recombinant human activated protein C in adult severe sepsis

Evaluating the use of recombinant human activated protein C in adult severe sepsis: results of the surviving sepsis campaign.  Critical care medicine, May 2012, Vol. 40(5), p.1417-1426.

Casserly, B., et al.

http://journals.lww.com/ccmjournal/Abstract/2012/05000/Evaluating_the_use_of_recombinant_human_activated.4.aspx

The Surviving Sepsis Campaign developed guidelines for the administration of recombinant human activated protein C in adult severe sepsis. However, it is not clear how these impacted clinical practice or patient outcome.

Active surveillance cultures of methicillin-resistant Staphylococcus aureus as a tool to predict methicillin-resistant S.aureus ventilator-associated pneumonia

Active surveillance cultures of methicillin-resistant Staphylococcus aureus as a tool to predict methicillin-resistant S.aureus ventilator-associated pneumonia. Critical care medicine, May 2012, Vol. 40(5), p.1437-1442.

Chan, J.D., et al.

http://journals.lww.com/ccmjournal/Abstract/2012/05000/Active_surveillance_cultures_of.6.aspx

Ventilator-associated pneumonia is one of the most common infections in the intensive care unit and methicillin-resistant Staphylococcus aureus has emerged as a common cause of ventilator-associated pneumonia. We sought to study the performance characteristics of once weekly active surveillance culture of methicillin-resistant S. aureuscolonization in predicting the development of methicillin-resistant S. aureus ventilator-associated pneumonia.  

The prognostic value of left ventricular systolic function measured by tissue Doppler imaging in septic shock

The prognostic value of left ventricular systolic function measured by tissue Doppler imaging in septic shock. Critical care, 2012, 16, R71.

Weng, L., et al.

http://ccforum.com/content/16/3/R71/abstract

Left ventricular (LV) dysfunction is common in septic shock. Its association with clinical outcome is still controversial. Tissue Doppler imaging (TDI) is a useful tool to quantify LV function, however, few knowledge is available about the prognostic value of these TDI variables in septic shock. Therefore, we performed this prospective study to determine the role of TDI variables in septic shock.

The effect of earplugs during the night on the onset of delirium and sleep perception

The effect of earplugs during the night on the onset of delirium and sleep perception: a randomized controlled trial in intensive care patients. Critical care, 2012, 16, R73.

Van Rompaey, B., et al.

http://ccforum.com/content/16/3/R73/abstract

This study hypothesised that a sound reduction during the night using earplugs could be beneficial in the prevention of intensive care delirium. Two research questions were formulated. First, does the use of earplugs during the night reduce the onset of delirium or confusion in the ICU? Second, does the use of earplugs during the night improve the quality of sleep in the ICU?

Brain natriuretic peptide for prediction of mortality in patients with sepsis

Brain natriurectic peptide for prediction of mortality in patients with sepsis: a systematic review and meta-analysis. Critical care, 2012, 16, R74.

Wang, F., et al.

http://ccforum.com/content/16/3/R74/abstract

Early identification of septic patients at high risk of dying remains a challenge. The prognostic role of brain natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) in septic patients remains controversial. The purpose of this systematic review and meta-analysis was to investigate the value of elevated BNP or NT-proBNP in predicting mortality in septic patients.

Higher vs lower fluid volume for septic shock

Higher vs lower fluid volume for septic shock: clinical characteristics and outcome in unselected patients in a prospective, multicenter cohort. Critical care, 2012, 16, R76.

Smith, S.H. and Perner, A.

http://ccforum.com/content/16/3/R76/abstract

Patients with septic shock require fluid, but the optimum amount is unknown. Therefore we assessed patient characteristics and outcome associated to fluid volume in unselected patients with septic shock including those with three days of shock.

Effects of increasing compliance with minimal sedation on duration of mechanical ventilation

Effects of increasing compliance with minimal sedation on duration of mechanical ventilation: a quality improvement intervention. Critical care, 2012, 16: R78.

Amaral, A., et al.


http://ccforum.com/content/16/3/R78/abstract


In the past two decades, healthcare adopted industrial strategies for process measurement and control. In the industry model, care is taken to avoid minimal deviations from a standard. In healthcare there is scarce data to support that a similar strategy can lead to better outcomes. Briefly, when compliance is high, further attempts to improve uptake of a process are seldom made. Our intensive care unit (ICU) improved the compliance with minimizing sedation from a high baseline of 80.4% (95% CI: 66.9 to 90.2) to 96.2% (95% CI: 95.2 to 97.0) 12 months after a quality improvement initiative.