Weighing risks and benefits of stress ulcer prophylaxis in critically ill patients. Critical care, Oct 2012, Vol. 16(5): 322.
Chanpura, T. & Yende, S.
http://ccforum.com/content/16/5/322
Recent observational studies suggest that bleeding from stress ulceration is extremely uncommon in intensive care unit patients. Furthermore, the risk of bleeding may not be altered by the use of acid suppressive therapy. Early enteral tube feeding (initiated within 48 h of intensive care unit admission) may account for this observation. Stress ulcer prophylaxis may, however, increase the risk of hospital-acquired pneumonia and Clostridia difficile infection.
Thursday, 22 November 2012
Outcome of ICU patients with Clostridium difficile infection
Outcome of ICU patients with Clostridium difficile infection. Critical care, Nov. 2012, Vol. 16(6): R215.
Zahar, J-R., et al.
http://ccforum.com/content/16/6/R215/abstract
As data from Clostridium difficile infection in the intensive care unit are still scarce, our objectives were to assess the morbidity and mortality of ICU-acquired CDI.
Zahar, J-R., et al.
http://ccforum.com/content/16/6/R215/abstract
As data from Clostridium difficile infection in the intensive care unit are still scarce, our objectives were to assess the morbidity and mortality of ICU-acquired CDI.
Examining the positive effects of exercise in intubated adults in ICU
Examining the positive effects of exercise in intubated adults in ICU: A prospective repeated measures clinical study. Intensive & critical care nursing, Dec. 2012, Vol. 28(6), p.307-318.
Winkelman, C., et al.
http://www.intensivecriticalcarenursing.com/article/S0964-3397(12)00028-6/abstract
Determining the optimal timing and progression of mobility exercise has the potential to affect functional recovery of critically ill adults. This study compared standard care with care delivered using a mobility protocol.
Winkelman, C., et al.
http://www.intensivecriticalcarenursing.com/article/S0964-3397(12)00028-6/abstract
Determining the optimal timing and progression of mobility exercise has the potential to affect functional recovery of critically ill adults. This study compared standard care with care delivered using a mobility protocol.
Non-invasive mechanical ventilation in hematology patients
Non-invasive mechanical ventilation in hematology patients: Let's agree on several things first. Critical care 2012, 16:175.
Dnull, S., et al.
Acute respiratory failure is a dreaded and life-threatening event that represents the main reason for ICU admission. Respiratory events occur in up to 50% of hematology patients, including one-half of those admitted to the ICU. Mortality from acute respiratory failure in hematology patients depends on the patient's general status, acute respiratory failure etiology, need for mechanical ventilation and associated organ dysfunction. Non-invasive mechanical ventilation is clearly beneficial for chronic obstructive pulmonary disease exacerbation and cardiogenic pulmonary edema. These benefits are based mainly on the avoidance of invasive mechanical ventilation complications. Non-invasive mechanical has also been recommended in hematology patients with acute respiratory failure but its real benefits remain unclear in these settings. There is growing concern about the safety of non-invasive mechanical ventilation to treat hypoxemic acute respiratory failure overall, but also in hematology patients. Prophylactic non-invasive mechanical ventilation in patients with acute respiratory failure but not respiratory distress seems to be effective in hematology patients with a reduced rate of intubation. However, curative non-invasive mechanical ventilation should be restricted to those patients with isolated respiratory failure, with fast improvement of respiratory distress under non-invasive mechanical ventilation, and with rapid switch to intubation to avoid deleterious delays in optimal invasive mechanical ventilation.
Dnull, S., et al.
Acute respiratory failure is a dreaded and life-threatening event that represents the main reason for ICU admission. Respiratory events occur in up to 50% of hematology patients, including one-half of those admitted to the ICU. Mortality from acute respiratory failure in hematology patients depends on the patient's general status, acute respiratory failure etiology, need for mechanical ventilation and associated organ dysfunction. Non-invasive mechanical ventilation is clearly beneficial for chronic obstructive pulmonary disease exacerbation and cardiogenic pulmonary edema. These benefits are based mainly on the avoidance of invasive mechanical ventilation complications. Non-invasive mechanical has also been recommended in hematology patients with acute respiratory failure but its real benefits remain unclear in these settings. There is growing concern about the safety of non-invasive mechanical ventilation to treat hypoxemic acute respiratory failure overall, but also in hematology patients. Prophylactic non-invasive mechanical ventilation in patients with acute respiratory failure but not respiratory distress seems to be effective in hematology patients with a reduced rate of intubation. However, curative non-invasive mechanical ventilation should be restricted to those patients with isolated respiratory failure, with fast improvement of respiratory distress under non-invasive mechanical ventilation, and with rapid switch to intubation to avoid deleterious delays in optimal invasive mechanical ventilation.
Effects of etomidate on complications related to intubation and on mortality in septic shock patients treated with hydrocortisone
Effects of etomidate on complications related to intubation and on mortality in septic shock patients treated with hydrocortisone: a propensity score analysis. Critical care, November 2012, Vol. 16(6): R224.
Jung, B., et al.
http://ccforum.com/content/16/6/R224/abstract
Endotracheal intubation in the intensive care unit is associated with a high incidence of complications. Etomidate use is debated in septic shock because it increases the risk of critical illness-related corticosteroid insufficiency, which may impact outcome. We hypothesized that hydrocortisone, administered in all septic shock in our intensive care unit, and may counteract some negative effects of etomidate. The aim of our study was to compare septic shock patients who received etomidate vs another induction drug both on the short-term safety and the long-term outcomes.
Jung, B., et al.
http://ccforum.com/content/16/6/R224/abstract
Endotracheal intubation in the intensive care unit is associated with a high incidence of complications. Etomidate use is debated in septic shock because it increases the risk of critical illness-related corticosteroid insufficiency, which may impact outcome. We hypothesized that hydrocortisone, administered in all septic shock in our intensive care unit, and may counteract some negative effects of etomidate. The aim of our study was to compare septic shock patients who received etomidate vs another induction drug both on the short-term safety and the long-term outcomes.
Probiotics in the critically ill
Probiotics in the critically ill: A systematic review of the randomized trial evidence. Critical care medicine, December 2012, Vol. 40(12), p.3290-3302.
Petrof, E.O., et al.
http://journals.lww.com/ccmjournal/Abstract/2012/12000/Probiotics_in_the_critically_ill___A_systematic.22.aspx
Critical illness results in changes to the microbiology of the gastrointestinal tract, leading to a loss of commensal flora and an overgrowth of potentially pathogenic bacteria. Administering certain strains of live bacteria (probiotics) to critically ill patients may restore balance to the microbiota and have positive effects on immune function and gastrointestinal structure and function. The purpose of this systematic review was to evaluate the effect of probiotics in critically ill patients on clinical outcomes.
Petrof, E.O., et al.
http://journals.lww.com/ccmjournal/Abstract/2012/12000/Probiotics_in_the_critically_ill___A_systematic.22.aspx
Critical illness results in changes to the microbiology of the gastrointestinal tract, leading to a loss of commensal flora and an overgrowth of potentially pathogenic bacteria. Administering certain strains of live bacteria (probiotics) to critically ill patients may restore balance to the microbiota and have positive effects on immune function and gastrointestinal structure and function. The purpose of this systematic review was to evaluate the effect of probiotics in critically ill patients on clinical outcomes.
Effects of norepinephrine on mean systemic pressure and venous return in human septic shock
Effects of norepinephrine on mean systemic pressure and venous return in human septic shock. Critical care medicine, December 2012, Vol. 40(12), p.3146-53.
Persichini, R., et al.
http://journals.lww.com/ccmjournal/Abstract/2012/12000/Effects_of_norepinephrine_on_mean_systemic.5.aspx
Norepinephrine exerts venoconstriction that could increase both the mean systemic pressure and the resistance to venous return, but this has not yet been investigated in human septic shock. We examined the relative importance of both effects and the resulting effect on venous return when decreasing the dose of norepinephrine.
Persichini, R., et al.
http://journals.lww.com/ccmjournal/Abstract/2012/12000/Effects_of_norepinephrine_on_mean_systemic.5.aspx
Norepinephrine exerts venoconstriction that could increase both the mean systemic pressure and the resistance to venous return, but this has not yet been investigated in human septic shock. We examined the relative importance of both effects and the resulting effect on venous return when decreasing the dose of norepinephrine.
The stress response and critical illness
The stress response and critical illness: A review. Critical care medicine, December 2012, Vol. 40(12), p.3283-89.
Cuesta, J. & Singer, M.
http://journals.lww.com/ccmjournal/Abstract/2012/12000/The_stress_response_and_critical_illness___A.21.aspx
Objectives: To describe different paradigms that define the stress response, and to postulate how stress is implicated in the pathophysiology of critical illness.
Cuesta, J. & Singer, M.
http://journals.lww.com/ccmjournal/Abstract/2012/12000/The_stress_response_and_critical_illness___A.21.aspx
Objectives: To describe different paradigms that define the stress response, and to postulate how stress is implicated in the pathophysiology of critical illness.
Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients
Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients.
Critical care medicine, December 2012, Vol. 40(12), p.3251-76.
Jacobi, J., et al.
http://journals.lww.com/ccmjournal/Abstract/2012/12000/Guidelines_for_the_use_of_an_insulin_infusion_for.19.aspx
Objective: To evaluate the literature and identify important aspects of insulin therapy that facilitate safe and effective infusion therapy for a defined glycemic end point.
Critical care medicine, December 2012, Vol. 40(12), p.3251-76.
Jacobi, J., et al.
http://journals.lww.com/ccmjournal/Abstract/2012/12000/Guidelines_for_the_use_of_an_insulin_infusion_for.19.aspx
Objective: To evaluate the literature and identify important aspects of insulin therapy that facilitate safe and effective infusion therapy for a defined glycemic end point.
Antibiotic subscription patterns in the empirical therapy of severe sepsis
Antibiotic subscription patterns in the empirical therapy of severe sepsis: combination of antimicrobials with different mechanisms of action reduces mortality. Critical care, November 2012, Vol. 12(6): R223.
Diaz-Martin, A., et al.
http://ccforum.com/content/16/6/R223/abstract
Although early institution of adequate antimicrobial therapy is life-saving in septic patients, optimal antimicrobial strategy has not been established. Moreover, the benefit of combination therapy over monotherapy remains to be determined. Our aims are to describe patterns of empirical antimicrobial therapy in severe sepsis, assessing the impact of combination therapy including antimicrobials with different mechanisms of action on mortality.
Diaz-Martin, A., et al.
http://ccforum.com/content/16/6/R223/abstract
Although early institution of adequate antimicrobial therapy is life-saving in septic patients, optimal antimicrobial strategy has not been established. Moreover, the benefit of combination therapy over monotherapy remains to be determined. Our aims are to describe patterns of empirical antimicrobial therapy in severe sepsis, assessing the impact of combination therapy including antimicrobials with different mechanisms of action on mortality.
Intensive care in low income countries
Intensive care in low income countries: A critical need. N Engl J Med 2012; 367:1974-1976
Firth, P. & Ttendo, S.
http://www.nejm.org/doi/full/10.1056/NEJMp1204957
Mbarara is a small town in the rural southwest of Uganda, one of the poorest countries in the world. The per capita income in this equatorial East African nation is less than $4 a day, and one third of the population lives below the poverty line. When the Ugandan government and foreign donors recently committed to upgrading Mbarara Hospital's aging infrastructure, the hospital steering committee identified the expansion of the intensive care unit (ICU) as a critical objective.
Firth, P. & Ttendo, S.
http://www.nejm.org/doi/full/10.1056/NEJMp1204957
Mbarara is a small town in the rural southwest of Uganda, one of the poorest countries in the world. The per capita income in this equatorial East African nation is less than $4 a day, and one third of the population lives below the poverty line. When the Ugandan government and foreign donors recently committed to upgrading Mbarara Hospital's aging infrastructure, the hospital steering committee identified the expansion of the intensive care unit (ICU) as a critical objective.
Using end of life care pathways for the last hours or days of life
Using end of life care pathways for the last hours or days of life. BMJ 2012; 345: e7718
Boyd, K. & Murray, S.
http://www.bmj.com/highwire/filestream/614798/field_highwire_article_pdf/0/bmj.e7718
There is international consensus about the importance of achieving a “good death” that is comfortable, dignified, and person centred.1 But controversy persists about the benefits and hazards of using an integrated care pathway to support the care of people who are expected to die soon. National end of life care programmes, in the United Kingdom and internationally, endorse tools designed to improve standards of care for people dying in the community, care homes, and hospitals
Boyd, K. & Murray, S.
http://www.bmj.com/highwire/filestream/614798/field_highwire_article_pdf/0/bmj.e7718
There is international consensus about the importance of achieving a “good death” that is comfortable, dignified, and person centred.1 But controversy persists about the benefits and hazards of using an integrated care pathway to support the care of people who are expected to die soon. National end of life care programmes, in the United Kingdom and internationally, endorse tools designed to improve standards of care for people dying in the community, care homes, and hospitals
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