Procalcitonin as a marker of sepsis and outcome in patients with neurotrauma

Procalcitonin as a marker of sepsis and outcome in patients with neurotrauma: An observation study. BMC Anesthesiology, Dec 2013, 13:48.

Deng, S., et al.

http://www.biomedcentral.com/content/pdf/1471-2253-13-48.pdf

Procalcitonin (PCT) is a reliable biomarker of sepsis and infection. The level of PCT 
associated with sepsis and infection in patients with traumatic brain injury is currently 
unknown. The purpose of this study was to investigate the value of PCT and C-reactive 
protein (CRP) as diagnostic markers of sepsis and to evaluate the prognostic value of these 
markers related to the severity of injury, sepsis and mortality

A survey of the attitudes and perceptions of multidisciplinary team members towards family presence at bedside rounds in the intensive care unit

A survey of the attitudes and perceptions of multidisciplinary team members towards family presence at bedside rounds in the intensive care unit. Intensive and critical care nursing, Feb 2014, Vol. 30(1), p.13-21.

Santiago, C., et al.

http://www.intensivecriticalcarenursing.com/article/S0964-3397(13)00067-0/abstract?rss=yes

Objective: To describe the attitudes and perceptions of intensive care unit (ICU) staff [critical care physicians and fellows (MDs), registered nurses (RNs), allied health discipline (HD) and managers] towards family presence at bedside rounds. We developed, tested and administered a questionnaire to the multidisciplinary staff.

Prediction of death in less than 60 minutes following withdrawal of cardiorespiratory support in ICUs

Prediction of death in less than 60 minutes following withdrawal of cardiorespiratory support in ICUs. Critical care medicine, Dec 2013, Vol. 41(12), p.2677-87.

Brieva, J., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/12000/Prediction_of_Death_in_Less_Than_60_Minutes.2.aspx

Half of all ICU patients die within 60 minutes of withdrawal of cardiorespiratory support. Prediction of which patients die before and after 60 minutes would allow changes in service organization to improve patient palliation, family grieving, and allocation of ICU beds. This study tested various predictors of death within 60 minutes and explored which clinical variables ICU specialists used to make their prediction.

Understanding changes in established practice: Pulmonary artery catheter use in critically ill patients

Understanding changes in established practice: Pulmonary artery catheter use in critically ill patients. Critical care medicine, Dec 2013, Vol. 41(12), p.2667-76.

Gershengorn, H.B., and Wunsch, H.

http://journals.lww.com/ccmjournal/Abstract/2013/12000/Understanding_Changes_in_Established_Practice__.1.aspx

Multiple studies suggest that routine use of pulmonary artery catheters is not beneficial in critically ill patients. Little is known about the patterns of “uptake” of practice change that involves removal of a device previously considered standard of care, rather than adoption of a new technique or technology. Our objective was to assess recent pulmonary artery catheter use across ICUs and identify factors associated with high use.

Association between systemic hemodynamics and septic acute kidney injury in critically ill patients

Association between systemic hemodynamics and septic acute kidney injury in critically ill patients: A retrospective observational study. Critical care, Dec 2013, Vol. 17(6), R278.

Legrand, M., et al.

http://ccforum.com/content/17/6/R278/abstract

The role of systemic hemodynamics in the pathogenesis of septic acute kidney injury (AKI) has received little attention. The purpose of this study was to investigate the association between systemic hemodynamics and new or persistent of AKI in severe sepsis.

Optimal dosing of antibiotics in critically ill patients using continuous/extended infusions

Optimal dosing of antibiotics in critically ill patients using continous/extended infusions: A systematic review and meta-analysis.  Critical care, Dec 2013, Vol. 17(6), R279.

Chant, C., et al.

http://ccforum.com/content/17/6/R279/abstract

The aim of this study was to determine whether using pharmacodynamic-based dosing of antimicrobials such as extended/continuous infusions in critically ill patients is associated with improved outcomes as compared to traditional dosing methods.

Diagnosis and management of temperature abnormality in ICUs

Diagnosis and management of temperature abnormality in ICUs: A EUROBACT investigators survey. Critical care, Dec 2013, Vol. 13(6), R289.

Niven, D., et al.

http://ccforum.com/content/17/6/R289/abstract

Although fever and hypothermia are common abnormal physical signs observed in patients admitted to intensive care units (ICU), little data exists on their optimal management. The objective of this study was to describe contemporary practices and determinants of management of temperature abnormalities among patients admitted to ICUs.

Sustained high serum malondialdehyde levels are associated with severity and mortality in septic patients

Sustained high serum malondaildehyde levels are associated with severity and mortality in septic patients.  Critical care, Dec 2013, Vol. 17(6), R290.

Lorente, L., et al.

http://ccforum.com/content/17/6/R290/abstract

There is a hyperoxidative state in sepsis. The objective of this study was to determine serum malondialdehyde (MDA) levels during the first week of follow up, whether such levels are associated with severity during the first week and whether non-surviving patients showed higher MDA levels than survivors during the first week.

Metformin improves survival in intensive care unit patients, by why?

Metformin improves survival in intensive care unit patients, by why?  Critical care, Dec 2013, 17:471

Riksen, N.P., et al

http://ccforum.com/content/pdf/cc13156.pdf

Procalcitonin-guided therapy in intensive care unit patients with severe sepsis and septic shock

Procalcitonin-guided therapy in intensive care unit patients with severe sepsis and septic shock: A systematic review and meta analysis. Critical care, Dec 2013, Vol. 17(6): R291

Prkno, A., et al.

http://ccforum.com/content/17/6/R291/abstract

Procalcitonin (PCT) algorithms for antibiotic treatment decisions have been studied in adult patients from primary care, emergency department, and intensive care unit (ICU) settings, suggesting that procalcitonin-guided therapy may reduce antibiotic exposure without increasing the mortality rate. However, information on the efficacy and safety of this approach in the most vulnerable population of critically ill patients with severe sepsis and septic shock is missing.

ICU-acquired swallowing disorders

ICU-acquired swallowing disorders. Critical care medicine, Oct 2013, Vol. 41(10), p.2396-2405.

Macht, M., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/10000/ICU_Acquired_Swallowing_Disorders.16.aspx

Patients hospitalized in the ICU can frequently develop swallowing disorders, resulting in an inability to effectively transfer food, liquids, and pills from their mouth to stomach. The complications of these disorders can be devastating, including aspiration, reintubation, pneumonia, and a prolonged hospital length of stay. As a result, critical care practitioners should understand the optimal diagnostic strategies, proposed mechanisms, and downstream complications of these ICU-acquired swallowing disorders.

Epidemiology of critically ill patients in intensive care units

Epidemiology of critically ill patients in intensive care units: A population-based observational study. Critical care, Sept 2013, Vol. 17(5), R:212

Garland, A., et al.

http://ccforum.com/content/17/5/R212

Epidemiologic assessment of critically ill people in Intensive Care Units (ICUs) is needed to ensure the health care system can meet current and future needs. However, few such studies have been published.

Management of arterial lines and blood sampling in intensive care

Management of arterial lines and blood sampling in intensive care: A threat to patient safety. Anaesthesia, Nov 2013, Vol. 68(11), p.1114-19.

Leslie, R.A., et al.

http://onlinelibrary.wiley.com/doi/10.1111/anae.12389/full

In 2008, the UK National Patient Safety Agency (NPSA) made recommendations for safe arterial line management. Following a patient safety incident in our intensive care unit (ICU), we surveyed current practice in arterial line management and determined whether these recommendations had been adopted. 

Top 10 myths regarding sedation and delirium in the ICU

Top 10 myths regarding sedation and delirium in the ICU. Critical care medicine, Sept 2013, Vol. 41(9), p.S46-56.

Peitz, G.J., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/09001/Top_10_Myths_Regarding_Sedation_and_Delirium_in.5.aspx

The management of pain, agitation, and delirium in critically ill patients can be complicated by multiple factors. Decisions to administer opioids, sedatives, and antipsychotic medications are frequently driven by a desire to facilitate patients’ comfort and their tolerance of invasive procedures or other interventions within the ICU. 

Implementing the awakening and breathing coordination, delirium monitoring/management and early exercise/mobility bundle into everyday care

Implementing the awakening and breathing coordination, delirium monitoring/management and early exercise/mobility bundle into everyday care: Opportunities, challenges and lessons learned for implementing the ICU pain, agitation and delirium guidelines. Critical care medicine, Sept 2013, Vol. 41(9), p.S116-127.

Balas, M.C., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/09001/Implementing_the_Awakening_and_Breathing.10.aspx

The awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle is an evidence-based interprofessional multicomponent strategy for minimizing sedative exposure, reducing duration of mechanical ventilation, and managing ICU-acquired delirium and weakness. The purpose of this study was to identify facilitators and barriers to awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle adoption and to evaluate the extent to which bundle implementation was effective, sustainable, and conducive to dissemination.

The impact of body temperature abnormalities on the disease severity and outcome in patients with severe sepsis

The impact of body temperature abnormalities on the disease severity and outcome in patients with severe sepsis: An analysis from a multicenter, prospective survey of severe sepsis. Critical care, Nov 2013, Vol. 17(6), R: 271.

Kushimoto, S., et al. 

http://ccforum.com/content/17/6/R271/abstract

Abnormal body temperatures (Tb) are frequently seen in patients with severe sepsis. However, the relationship between Tb abnormalities and the severity of disease is not clear. This study investigated the impact of Tb on disease severity and outcomes in patients with severe sepsis.

Making the GRADE

Making the GRADE: how useful are the new surviving sepsis campaign guidelines? Critical care, Nov 2013, Vol. 17(6), R328.

Vo, M. and Kahn, J.N.

http://ccforum.com/content/17/6/328

Updated guidelines are needed to guide physicians to care for patients with severe sepsis on the basis of recent advances.

Initial use of one or two antibiotics for critically ill patients with community-acquired pneumonia

Initial use of one or two antibiotics for critically ill patients with community-acquired pneumonia: Impact on survival and bacterial resistance. Critical care, Nov 2013, Vol. 17(6), R:267.

Adrie, C., et al.

http://ccforum.com/content/17/6/R265/abstract

Several guidelines recommend initial empirical treatment with two antibiotics instead of one to decrease mortality in community-acquired pneumonia (CAP) requiring intensive-care-unit (ICU) admission. We compared the impact on 60-day mortality of using one or two antibiotics. We also compared the rates of nosocomial pneumonia and multidrug-resistant bacteria.

Outcome and quality of life in patients with postoperative delirium during an ICU stay following major surgery

Outcome and quality of life in patients with postoperative delirium during and ICU stay following major surgery. Critical care, Oct 2013, Vol. 17(5), R257

Abelha, F.J., et al.

http://ccforum.com/content/17/5/R257/abstract

Delirium is an acute disturbance of consciousness and cognition that has been shown to be associated with poor outcomes, including increased mortality. We aimed to evaluate outcome after postoperative delirium in a cohort of surgical intensive care unit (SICU) patients.

Prognosis and ICU outcome of systematic vasculitis

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

Befort, P., et al.

http://www.biomedcentral.com/1471-2253/13/27/abstract

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.

http://ccforum.com/content/17/5/R200/abstract

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.

http://www.cwrumedicine.org/images/current_residents/resuscitation%20fluids.pdf

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.

http://www.nejm.org/doi/full/10.1056/NEJMoa1301372?af=R&rss=currentIssue

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.

Implementing delirium screening in the ICU

Implementing delirium screening in the ICU: Secrets to success.  Critical care medicine, Sept 2013, Vol. 41(9), p.2196-2208.

Brummel, N.E. et al.

http://journals.lww.com/ccmjournal/Abstract/2013/09000/Implementing_Delirium_Screening_in_the_ICU__.15.aspx

To review delirium screening tools available for use in the adult ICU and PICU, to review evidence-based delirium screening implementation, and to discuss common pitfalls encountered during delirium screening in the ICU.

The pain, agitation and delirium care bundle

The pain, agitation and delirium care bundle: Synergistic benefits of implementing the 2013 pain, agitation and delirium guidelines in an integrated and interdisciplinary fashion. Critical care medicine, Sept 2013, Vol. 41(9), p.S99-115

Barr, J. and  Pandharipande, P.P.

http://journals.lww.com/ccmjournal/Abstract/2013/09001/The_Pain,_Agitation,_and_Delirium_Care_Bundle__.9.aspx

In 2013, the American College of Critical Care Medicine published a revised version of the pain, agitation, and delirium guidelines. The guidelines included an ICU pain, agitation, and delirium care bundle designed to facilitate implementation of the pain, agitation, and delirium guidelines.

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

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.

http://ccforum.com/content/pdf/cc12894.pdf

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.

Skeletal muscle predicts ventilator-free days, ICU-free days and mortality in elderly ICU patients

Skeletal muscle predicts ventilator-free days, ICU-free days and mortality in elderly ICU patients. Critical care, Sept 2013, 17: R206

Mosiey, L.L., et al.

http://ccforum.com/content/pdf/cc12901.pdf

As the population ages, the number of injured elderly is increasing. We sought to determine if 
low skeletal muscle mass adversely affected outcome in elderly patients following trauma.

Developing an early screening instrument for predicting psychological morbidity after critical illness

Developing an early screening instrument for predicting psychological morbidity after critical illness. Critical care, Sept 2013, 17: R210 

Schandl, A., et al.

http://ccforum.com/content/pdf/cc13018.pdf

Guidelines recommend follow-up for patients after intensive care unit (ICU) stay. Methods for identifying patients with psychological problems after intensive care would be of value, to optimize treatment and to improve adequate resource allocation in ICU followup of ICU survivors. The aim of the study was to develop a predictive screening instrument – for use at ICU discharge – to identify patients at risk for post-traumatic stress, anxiety or depression.

A prospective longitudinal multicentre study of health related qualify of life in ICU survivors with COPD

A prospective longitudinal multicentre study of health related quality of life of ICU survivors with COPD. Critical care, Sept 2013, 17:R211

Berkius, J., et al.

http://ccforum.com/content/pdf/cc13019.pdf

Mortality amongst COPD patients treated on the ICU is high. Health-related quality of life (HRQL) after intensive care is a relevant concern for COPD patients, their families and providers of health care. Still, there are few HRQL studies after intensive care of this patient group. Our hypothesis was that HRQL of COPD patients treated on the ICU declines rapidly with time.

Severe sepsis and septic shock

Severe sepsis and septic shock.  N Engl J Med 2013; 369: p.840-851

Angus, D.C. and van der Poll, T.

http://www.nejm.org/doi/full/10.1056/NEJMra1208623?af=R&rss=currentIssue

Sepsis is one of the oldest and most elusive syndromes in medicine. Hippocrates claimed that sepsis (σήψις) was the process by which flesh rots, swamps generate foul airs, and wounds fester.Galen later considered sepsis a laudable event, necessary for wound healing. With the confirmation of germ theory by Semmelweis, Pasteur, and others, sepsis was recast as a systemic infection, often described as “blood poisoning,” and assumed to be the result of the host's invasion by pathogenic organisms that then spread in the bloodstream. However, with the advent of modern antibiotics, germ theory did not fully explain the pathogenesis of sepsis: many patients with sepsis died despite successful eradication of the inciting pathogen. 

Physical therapy for the critically ill in the ICU

Physical therapy for the critically ill in the ICU: A systematic review and meta-analysis. Critical care medicine, June 2013, Vol. 41(6), p.1543-54.

Kayambu, G., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/06000/Physical_Therapy_for_the_Critically_Ill_in_the.19.aspx

The purpose of this systematic review was to review the evidence base for exercise in critically ill patients.

Physical rehabilitation of the critically ill trauma patient in the ICU

Physical rehabilitation of the critically ill trauma patient in the ICU. Critical care medicine, July 2013, Vol. 41(7), p. 1790-1801.

Engels, P.T., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/07000/Physical_Rehabilitation_of_the_Critically_Ill.24.aspx

Objectives: To review the existing evidence for early mobilization of the critically ill patients in the ICU with polytrauma; provide intensivists with an introduction to the biomechanics, physiology, and nomenclature of injuries; summarize the evidence for early mobilization in each anatomic area; and provide recommendations for the mobilization of these patients.

Do windows or natural views affect outcomes or costs among patients in ICUs?

Do windows or natural views affect outcomes or costs among patients in ICUs?  Critical care medicine, July 2013, Vol. 41(7), p.1645-55.

Kohn, R., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/07000/Do_Windows_or_Natural_Views_Affect_Outcomes_or.7.aspx

Objective: To determine whether potential exposure to natural light via windows or to more pleasing views through windows affects outcomes or costs among critically ill patients.

Fever in adult ICUs

Fever in adult ICUs: An interrupted time series analysis. Critical care medicine, Aug 2013, Vol. 41(8), p.1863-69.  

Niven, D.J., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/08000/Fever_in_Adult_ICUs___An_Interrupted_Time_Series.5.aspx

Fever is common and associated with increased mortality among patients admitted to adult ICUs, yet recent literature suggests that the incidence of fever may be decreasing. The objective of this study was to determine whether the incidence of fever in adult ICUs changed over time and the factors responsible for the observed change.

Evaluating pain, sedation and delirium in the neurologically critically ill

Evaluating pain, sedation and delirium in the neurologically critically ill - feasibility and reliability of standardized tools: A multi-institutional study.  Critical care medicine, Aug 2013, Vol. 41(8), 2002-07.

Yu, A., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/08000/Evaluating_Pain,_Sedation,_and_Delirium_in_the.21.aspx

Objectives: To assess the feasibility and reliability of systematic evaluations of analgesia, sedation level, and delirium features in the neurologically critically ill and to determine whether delirium features are linked to clinical outcomes in this population.

Body mass index is associated with hospital mortality in critically ill patients

Body mass index is associated with hospital mortality in critically ill patients: An observational cohort study. Critical care medicine, Aug 2013, Vol. 41(8), p.1878-83.

Pickkers, P., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/08000/Body_Mass_Index_Is_Associated_With_Hospital.7.aspx

Obesity is associated with a variety of diseases, which results in a decreased overall life expectancy. Nevertheless, some studies suggest that being overweight may reduce hospital mortality of certain patient groups, referred to as obesity paradox. Conflicting results for critically ill patients are reported. Therefore, we wished to investigate the association of body mass index and hospital mortality in critically ill patients.

Clostridium difficile infection

Clostridium difficile infection: A multicenter study of epidemiology and outcomes in mechanically ventilated patients. Critical care medicine, Aug 2013, Vol. 41(8), p.1968-75.

Micek, S.T., et al.

Clostridium difficile is a leading cause of hospital-associated infection in the United States. The purpose of this study is to assess the prevalence of C. difficile infection among mechanically ventilated patients within the ICUs of three academic hospitals and secondarily describe the influence of C. difficile infection on the outcomes of these patients.

Atypical sleep in ventilated patients

Atypical sleep in ventilated patients: Empirical electroencephalography findings and the path towards revised ICU sleep scoring criteria. Critical care medicine Aug 2013, Vol. 41(8), 1958-67.

Watson, P.L., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/08000/Atypical_Sleep_in_Ventilated_Patients___Empirical.16.aspx

Standard sleep scoring criteria may be unreliable when applied to critically ill patients. We sought to quantify typical and atypical polysomnographic findings in critically ill patients and to begin development and reliability testing of methodology to characterize the atypical polysomnographic tracings that confound standard sleep scoring criteria.

Safety of intrahospital transport in ventilated critically ill patients

Safety of intrahospital transport in ventilated critically ill patients: A multicenter cohort study. Critical care medicine, Aug 2013, Vol. 41(8), p.1919-28.

Schwebel, C., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/08000/Safety_of_Intrahospital_Transport_in_Ventilated.12.aspx

Objective: To describe intrahospital transport complications in critically ill patients receiving invasive mechanical ventilation.

Usefulness of combined bedside lung ultrasound and echocardiography to assess weaning failure from mechanical ventilation

Usefulness of combined bedside lung ultrasound and echocardiography to assess weaning failure from mechanical ventilation: A suggestive case.  Critical care medicine, Aug 2013, Vol. 41(8) [online case report]

Mongodi, S., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/08000/Usefulness_of_Combined_Bedside_Lung_Ultrasound_and.50.aspx

Recognition of the cardiac origin of weaning failure is a crucial issue for successful discontinuation of mechanical ventilation. Bedside lung ultrasound and echocardiography have shown a potential in predicting weaning failure. Objective of this report was to describe the case of a patient repeatedly failing to wean from mechanical ventilation, where the combined use of lung ultrasound and echocardiography during a spontaneous breathing trial uncovered an unexpected cause of the failure.

Therapeutic drug monitoring of Amikacin in septic patients

Therapeutic drug monitoring of Amikacin in septic patients. Critical care, July 2013, 17: R165.

Duszynska, W., et al.

http://ccforum.com/content/17/4/R165/abstract

Use of higher than standard doses of amikacin (AMK) has been proposed during sepsis, especially to treat less susceptible bacterial strains. However, few data are available on drug concentrations during prolonged therapy and on potential adverse events related to this strategy.

Routine use of Staphylococcus aureus rapid diagnostic test in patients with suspected ventilator-associated pneumonia

Routine use of Staphylococcus aureus rapid diagnostic test in patients with suspected ventilator-associated pneumonia. Critical care, Aug 2013, 17 R:170.

Leone, M., et al.

http://ccforum.com/content/17/4/R170/abstract

In patients with ventilator-associated pneumonia (VAP), administration of an appropriate empirical antimicrobial treatment is associated with improved outcomes, leading to the prescription of broad-spectrum antibiotics including drugs active against methicillin resistant Staphylococcus aureus (MRSA). In order to avoid the overuse of antibiotics, the present study aimed to evaluate the technical characteristics of a rapid diagnostic test (Cepheid Xpert assay) in patients with suspected VAP.

Screening and risk factors of exocrine pancreatic insufficiency in critically ill adult patients

Screening and risk factors of exocrine pancreatic insufficiency in critically ill adult patients receiving enteral nutrition. Critical care, Aug 2013, 17 R171.

Wang, S., et al.

http://ccforum.com/content/17/4/R171/abstract

Malnutrition is a frequent problem associated with detrimental clinical outcomes in critically ill patients. To avoid malnutrition, most studies focus on the prevention of inadequate nutrition delivery, whereas little attention is paid to the potential role of exocrine pancreatic insufficiency (EPI). We therefore aim to evaluate the prevalence of EPI and identify its potential risk factors in critically ill adult patients without pre-existing pancreatic diseases.

Critical care - an all-encompassing specialty

Critical care - an all-encompassing specialty. N Engl J Med, Aug 2013; 369:669-670.

Finfer, S. and Vincent J-L.

http://www.nejm.org/doi/full/10.1056/NEJMe1304035?af=R&rss=currentIssue

The August 29 issue of the NEJM will include the first in a series of review articles on critical care. Critical care is a young specialty that is generally considered to have developed from the successful use of invasive ventilation during the 1952 polio epidemic in Copenhagen. From these beginnings, critical care has spread to most countries in the world. In many developed societies, the number of critical care beds is increasing while total number of acute care hospital beds is decreasing; the proportion of acute care hospital beds that are intensive care unit beds is increasing substantially.

Surviving intensive care

Surviving intensive care: A systematic review of healthcare resource use after hospital discharge. Critical care medicine, Aug 2013, Vol. 41(8), p.1832-43.

Lone, N.I., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/08000/Surviving_Intensive_Care___A_Systematic_Review_of.2.aspx

Intensive care survivors continue to experience significant morbidity following acute hospital discharge, but healthcare costs associated with this ongoing morbidity are poorly described. As the demand for intensive care increases, understanding the magnitude of postacute hospital healthcare costs is of increasing relevance to clinicians and healthcare planners. We undertook a systematic review of the literature reporting major healthcare resource use by intensive care survivors following discharge from the hospital and identified factors associated with increased resource use.

Atypical sleep in ventilated patients

Atypical sleep in ventilated patients: Empirical electroencephalography findings and the path toward revised ICU sleep scoring criteria. Critical care medicine, Aug 2013, Vol. 41(8), p.1958-67.

Watson, P.L., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/08000/Atypical_Sleep_in_Ventilated_Patients___Empirical.16.aspx

Standard sleep scoring criteria may be unreliable when applied to critically ill patients. We sought to quantify typical and atypical polysomnographic findings in critically ill patients and to begin development and reliability testing of methodology to characterize the atypical polysomnographic tracings that confound standard sleep scoring criteria.

Clostridium difficile infection

Clostridium difficile infection: A multicenter study of epidemiology and outcomes in mechanically ventilated patients. Critical care medicine, Aug 2013, Vol. 41(8), p.1968-75.

Micek, S.T., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/08000/Clostridium_difficile_Infection___A_Multicenter.17.aspx

Clostridium difficile is a leading cause of hospital-associated infection in the United States. The purpose of this study is to assess the prevalence of C. difficile infection among mechanically ventilated patients within the ICUs of three academic hospitals and secondarily describe the influence of C. difficile infection on the outcomes of these patients.

Diarrhoea in the ICU

Diarrhoea in the ICU: Respective contribution of feeding and antibiotics. Critical care, July 2013, 17: R153

Thibault, R., et al.

http://ccforum.com/content/17/4/R153/abstract

Diarrhoea is frequently reported in the ICU. Little is known about diarrhoea incidence and the role of the different risk factors alone or in combination. This prospective observational study aims at determining diarrhoea incidence and risk factors in the first 2 weeks of ICU stay, focusing on the respective contribution of feeding, antibiotics, and antifungal drugs.

Exercise rehabilitation for patients with critical illness

Exercise rehabilitation for patients with critical illness: A randomized controlled trial with 12 moths of follow-up.  Critical Care, July 2013, 17: R156

Denehy, L., et al.

http://ccforum.com/content/17/4/R156/abstract

The purpose of this trial was to investigate the effectiveness of an exercise rehabilitation program commencing during ICU admission and continuing into the outpatient setting compared with usual care on physical function and health-related quality of life in ICU survivors.

Whole body protein kinetics during hypocaloric and normocaloric feeding in critically ill patients

Whole body protein kinetics during hypocaloric and normocaloric feeding in critically ill patients. Critical care, July 2013, 17: R158

Berg, A., et al.

http://ccforum.com/content/17/4/R158/abstract

Optimal feeding of critically ill patients in the ICU is controversial. Existing guidelines rest on rather weak evidence. Whole body protein kinetics may be an attractive technique for assessing optimal protein intake. In this study, critically ill patients were investigated during hypocaloric and normocaloric IV nutrition.

A systematic review of evidence-informed practices for patient care rounds in the ICU

A systematic review of evidence-informed practices for patient care rounds in the ICU. Critical care medicine, Vol. 41(8), p.2015-29.

Lane, D., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/08000/A_Systematic_Review_of_Evidence_Informed_Practices.23.aspx

Patient care rounds are a key mechanism by which healthcare providers communicate and make patient care decisions in the ICU but no synthesis of best practices for rounds currently exists. Therefore, we systematically reviewed the evidence for facilitators and barriers to patient care rounds in the ICU.

Body mass index is associated with hospital mortality in critically ill patients

Body mass index is associated with hospital mortality in critically ill patients: An observational cohort study. Critical care medicine, August 2013, Vol. 41(8), p.1878-83.

Pickkers, P., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/08000/Body_Mass_Index_Is_Associated_With_Hospital.7.aspx

Obesity is associated with a variety of diseases, which results in a decreased overall life expectancy. Nevertheless, some studies suggest that being overweight may reduce hospital mortality of certain patient groups, referred to as obesity paradox. Conflicting results for critically ill patients are reported. Therefore, we wished to investigate the association of body mass index and hospital mortality in critically ill patients.

Surviving intensive care

Surviving intensive care: A systematic review of healthcare resource use after hospital discharge. Critical care medicine, August 2013, Vol. 41(8), p.1832-43.

Lone, N.I., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/08000/Surviving_Intensive_Care___A_Systematic_Review_of.2.aspx

Intensive care survivors continue to experience significant morbidity following acute hospital discharge, but healthcare costs associated with this ongoing morbidity are poorly described. As the demand for intensive care increases, understanding the magnitude of post-acute hospital healthcare costs is of increasing relevance to clinicians and healthcare planners. We undertook a systematic review of the literature reporting major healthcare resource use by intensive care survivors following discharge from the hospital and identified factors associated with increased resource use.

Fever in adult ICUs

Fever in adult ICUs: An interrupted time series analysis. Critical care medicine, August 2013, Vol. 41(8), p.1863-69.

Niven, D.J., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/08000/Fever_in_Adult_ICUs___An_Interrupted_Time_Series.5.aspx

Fever is common and associated with increased mortality among patients admitted to adult ICUs, yet recent literature suggests that the incidence of fever may be decreasing. The objective of this study was to determine whether the incidence of fever in adult ICUs changed over time and the factors responsible for the observed change.

Therapeutic hypothermia: is it effective for non-VF/VT cardiac arrest?

Therapeutic hypothermia: is it effective for non-VF/VT cardiac arrest? Critical care, March 2013, 17: 215

Sandroni, C., et al.

http://ccforum.com/content/pdf/cc12524.pdf

Sudden cardiac death represents a major health problem. In adults, the prevalence of out-of-hospital cardiac arrest (OHCA) attended by the emergency medical services (EMS) ranges from 52 to 112 per 100,000 person-years in developed countries, whereas the prevalence of adult in-hospital cardiac arrest (IHCA) ranges from 1 to 5 per 1,000 patient admissions. Mortality from cardiac arrest exceeds 90 % in OHCA 
and 70 % in most studies on IHCA. Patients who have a shock able rhythm, i.e., ventricular fibrillation 
(VF) or pulseless ventricular tachycardia (VT), on initial electrocardiogram (EKG) have a consistently higher 
survival than those whose initial cardiac rhythm is nonshockable, i.e., asystole or pulseless electrical activity 
(PEA).

Assessment of volume responsiveness during mechanical ventilation

Assessment of volume responsiveness during mechanical ventilation: recent advances. Critical care, March 2013, R:217

Monnet, X. and Teboul, J-L.

http://ccforum.com/content/pdf/cc12526.pdf

Predicting which patients with acute circulatory failure will respond to fluid by a significant increase in cardiac output is a daily challenge, in particular in the setting of the intensive care unit (ICU). This challenge has become even more crucial because evidence is growing that administering excessive amounts of fluid is a risk factor in critically ill patients, in particular in patients with lung injury.

Patient monitoring alarms in the ICU and in the operating room

Patient monitoring alarms in the ICU and in the operating room. Critical care, March 2013, 17: R216

Schmid, F., et al.

http://ccforum.com/content/pdf/cc12525.pdf

In complex fields of work like aviation, mining, anesthesiology, and intensive care medicine – and here
particularly with regard to monitoring of vital functions – alarms are ubiquitous and have been the subject of
medical, technical, and psychological research for decades. Monitoring of vital functions and function
of life-support devices is essential for critically ill patients, although real evidence based data are missing.

An exploration of social and economic outcome and associated health-related quality of life after critical illness in general intensive care unit survivors

An exploration of social and economic outcome and associated health-related quality of life after critical illness in general intensive care unit survivors: A 12-month follow-up study. Critical care, May 2013, R:100

Griffiths, J., et al.

http://ccforum.com/content/pdf/cc12745.pdf

The socio-economic impact of critical illnesses on patients and their families in Europe has yet to be
determined. The aim of this exploratory study was to estimate changes in family circumstances, social and
economic stability, care requirements and access to health services for patients during their first 12 months after ICU discharge.

Cardiac ischemia in patients with septic shock randomized to vasopressin or narepinephrine

Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine. Critical care, June 2013, 17:R117

Mehta, S., et al.

http://ccforum.com/content/pdf/cc12789.pdf

Cardiac ischemia occurs frequently in critically ill patients, and is associated with increased mortality. Given that most critically ill patients cannot communicate symptoms, the diagnosis of cardiac ischemia can be challenging and necessitates that clinicians rely on cardiac biomarkers and electrocardiograms (ECGs). Patients receiving vasopressors may be at even higher risk of cardiac ischemia than other patients because of coronary artery vasoconstriction, increased systemic vasoconstriction-induced afterload, or catecholamine-driven increases in myocardial oxygen demand. 

Continuous on-line glucose measurement by microdialysis in a central vein

Continuous on-line glucose measurement by microdialysis in a central vein. A pilot study. Critical care, May 2013, 17:R87

Blixt, C., et al.

http://ccforum.com/content/17/3/R87

Tight glucose control in the ICU has been proven difficult with an increased risk for hypoglycaemic episodes. Also the variability of glucose may have an impact on morbidity. An accurate and feasible on-line/continuous measurement is therefore desired. In this study a central vein catheter with a microdialysis membrane in combination with an on-line analyzer for continuous monitoring of circulating glucose and lactate by the central route was tested.

Patient photographs - a landmark for the ICU staff: A descriptive study

Patient photographs - a landmark for the ICU staff. A descriptive study. Intensive and critical care nursing, August 2013, Vol. 29(4), p.193-201.

Andersson, M., et al.

http://www.intensivecriticalcarenursing.com/article/S0964-3397(13)00037-2/abstract

The purpose of this study was to investigate ICU staff's perceptions of photographs displayed at the bedsides of unconscious patients and whether profession, years in ICU and work status had any influence on these perceptions.

Cognitive stimulation in ICU patients: should we pay more attention?

Cognitive stimulation in ICU patients: should we pay more attention? Critical care 2013, 17: 158

Turon, M., et al.

http://ccforum.com/content/pdf/cc12719.pdf

Advances in ICUs have raised survival rates, but they have highlighted the need to reduce the morbidity of ICU patients and improve their short- and long-term functional outcomes. Frequently these patients, especially with acute respiratory distress syndrome, present neurocognitive impairments that extend beyond their acute phase and hospital stay and lead to significant deficits in quality of life.

Do we need to innovate in critical care practice?

Do we need to innovate in critical care practice? Critical care 2013, 17: 166

Blanch, L., et al.

http://ccforum.com/content/pdf/cc12769.pdf

Clinical work and continuous investigation have improved the outcome of critically ill patients over time. Nowadays, innovation pulled by demand and translational research projects of excellence will constitute new opportunities for clinicians to improve care and provide economic incentives to be returned to the patient, institutions, and society.

Early alterations of B cells in patients with septic shock: another piece in the complex puzzle of the immune response in sepsis

Early alterations of B cells in patients with septic shock: another piece in the complex puzzle of the immune response to sepsis. Critical care, 2013, 17: 162

Girardis, M. and Cossarizza, A.

[No link available]

Impairment of the inflammatory-immune response is currently accepted as a hallmark of severe sepsis even in the early stages of the disease. In this context, the alterations of the circulating B-lymphocytes have never been described in detail. The study by Monserrat and colleagues in the previous issue of Critical Care indicated that, in patients with septic shock, the B-cell compartment is early and deeply altered with different patterns in subset distribution and activation between survivors and non-survivors.

The obesity paradox in the ICU

The obesity paradox in the ICU: real or not? Critical care, June 2013, 17: 154.

Dickerson, R.N.

[no link available]

The obesity paradox has been used to describe the observed phenomenon described by several studies that indicated improved survival for critically ill patients with mild to moderate obesity when compared with their lean counterparts. The study by Arabi and coworkers challenges the obesity paradox concept for critically ill obese patients with septic shock. Their data indicate that obesity, per se, does not significantly improve mortality when outcomes are adjusted for differences in baseline characteristics and sepsis interventions. Further studies are needed to assess the influence of body weight, lean weight, and fat mass for optimizing fluid resuscitation, pharmacotherapy, and nutritional therapy for critically ill patients with sepsis.

Intensive care sedation

Intensive care sedation: the past, present and the future. Critical care, June 2013, 17: 332.

Shehabi, Y., et al.

[no link available]

Despite the universal prescription of sedative drugs in the intensive care unit (ICU), current practice is not guided by high-level evidence. Landmark sedation trials have made significant contributions to our understanding of the problems associated with ICU sedation and have promoted changes to current practice. We identified challenges and limitations of clinical trials which reduced the generalizability and the universal adoption of key interventions. We present an international perspective regarding current sedation practice and a blueprint for future research, which seeks to avoid known limitations and generate much-needed high-level evidence to better guide clinicians' management and therapeutic choices of sedative agents.

Hospital variation and temporal trends in palliative and end-of-life care in the ICU

Hospital variation and temporal trends in palliative and end-of-life care in the ICU. Critical care medicine, June 2013, Vol. 41(6), p.1404-11

DeCato, T.W., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/06000/Hospital_Variation_and_Temporal_Trends_in.3.aspx

Although studies have shown regional and interhospital variability in the intensity of end-of-life care, few data are available assessing variability in specific aspects of palliative care in the ICU across hospitals or interhospital variability in family and nurse ratings of this care. Recently, relatively high family satisfaction with ICU end-of-life care has prompted speculation that ICU palliative care has improved over time, but temporal trends have not been documented. 

Physical therapy for the critically ill in the ICU

Physical therapy for the critically ill in the ICU: A systematic review and meta-analysis.  Critical care medicine, June 2013, Vol. 41(6), p.1543-54.

Kayambu, G., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/06000/Physical_Therapy_for_the_Critically_Ill_in_the.19.aspx

The purpose of this systematic review was to review the evidence base for exercise in critically ill patients.

Physicians' decision-making roles for an acutely unstable critically and terminally ill patient

Physicians' decision-making roles for an acutely unstable critically and terminally ill patient. Critical care medicine, June 2013, Vol. 41(6), p.1511-17

Uy, J., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/06000/Physicians__Decision_Making_Roles_for_an_Acutely.15.aspx

There is substantial variation in use of life sustaining technologies in patients near the end of life but little is known about variation in physicians’ initial ICU admission and intubation decision making processes. Our objective is to describe variation in hospital-based physicians’ communication behaviors and decision-making roles for ICU admission and intubation decisions for an acutely unstable critically and terminally ill patient.

Early alterations of B cells in patients with septic shock

Early alterations of B cells in patients with septic shock. Critical care, 2013, 17: R105

Monserrat, J., et al.

http://ccforum.com/content/17/3/R105/abstract

It has been recently proposed that B-lymphocytes are involved in sepsis pathogenesis. The goal of this study is to investigate potential abnormalities in subset distribution and activation of circulating B-lymphocytes in patients with septic shock.

Dexmedetomidine use in the ICU

Dexmedetomidine use in the ICU: Are we there yet?  Critical care, 2013, 17: R320.

Ahmed, S. and Murugan, R.

http://ccforum.com/content/17/3/320

Long-term sedation with midazolam or propofol in intensive care units (ICUs) has serious adverse effects. Dexmedetomidine, an alpha-2 agonist available for ICU sedation, may reduce the duration of mechanical ventilation and enhance patient comfort.

Assessment and clinical course of hypocalcemia in critical illness

Assessment and clinical course of hypocalcemia in critical illness. Critical care, 2013, 17: R106.

Steele, T., et al.

http://ccforum.com/content/17/3/R106/abstract

Hypocalcemia is common in critically ill patients. However, its clinical course during the early days of admission and the role of calcium supplementation remain uncertain, and the assessment of calcium status is inconsistent. We aimed to establish the course of hypocalcemia during the early days of critical illness in relation to mortality and to assess the impact of calcium supplementation on calcium normalization and mortality.

Early parenteral nutrition in critically ill patients

Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: a randomized controlled trial. JAMA, 309, 20; p.2130-38

Doig, G.S., et al.

http://jama.jamanetwork.com/article.aspx?articleid=1689534

Systematic reviews suggest adult patients in intensive care units (ICUs) with relative contraindications to early enteral nutrition (EN) may benefit from parenteral nutrition (PN) provided within 24 hours of ICU admission. Objective:  To determine whether providing early PN to critically ill adults with relative contraindications to early EN alters outcomes.

Continuous electroencephalography monitoring in critically ill patients

Continuous electroencephalography monitoring in critically ill patients: indications, limitations and strategies. Critical care medicine, April 2013, Vol. 41(4), p.1124-32

Sutter, R., et al.

[Link not available]

OBJECTIVE: Continuous electroencephalography as a bedside monitor of cerebral activity has been used in a range of critically ill patients. This review compiles the indications, limitations, and strategies for continuous electroencephalography in the ICU. DATA SOURCE: The authors searched the electronic MEDLINE database.
STUDY SELECTION AND DATA EXTRACTION: References from articles of special interest were selected.
DATA SYNTHESIS AND CONCLUSION: Electroencephalographically-defined suppression is routinely used as the basis for titration of pharmacologic therapy in refractory status epilepticus and intracranial hypertension. The increasing use of continuous electroencephalography reveals a clinically underappreciated burden of epileptiform and epileptic activity in patients with primary acute neurologic disorders, and also in critically ill patients with acquired encephalopathy. Status epilepticus is reported with continuous electroencephalography in 1% to 10% of patients with ischemic stroke, 8% to 14% with traumatic brain injury, 10% to 14% with subarachnoid hemorrhage, 1% to 21% with intracerebral hemorrhage, and 30% of patients following cardiorespiratory arrest. These figures underscore the importance of continuous electroencephalography in the critically ill. The interpretation of continuous electroencephalography in the ICU is challenged by electroencephalography artifacts and the frequent subtle differences between ictal and interictal patterns.

Targeted versus universal decolonization to prevent ICU infection

Targeted versus universal decolonization to prevent ICU infection. New england journal of medicine, May 2013 [published online]  DOI: 10.1056/NEJMoa1207290

Huang, S.S., et al.

http://www.nejm.org/doi/full/10.1056/NEJMoa1207290?af=R&rss=currentIssue#t=articleTop

Health care–associated infection is a leading cause of preventable illness and death and often results from colonizing bacteria that overcome body defenses. Among the pathogens causing health care–associated infection, methicillin-resistant Staphylococcus aureus (MRSA) has been given priority as a target of reduction efforts because of its virulence and disease spectrum, multidrug-resistant profile, and increasing prevalence in health care settings, particularly among patients in the intensive care unit (ICU).

Sex and severe sepsis

Sex and severe sepsis. Critical care 2013, 17:144

Guidet, B. and Maury, E.

http://ccforum.com/content/17/3/144

Epidemiological studies document that males are more prone than females to develop severe sepsis and this is confirmed by Sakr and colleagues in the previous issue of Critical Care. However, the impact of gender on prognosis of severe sepsis is a matter of debate. Sakr and colleagues report a higher mortality in septic females than in males. This puzzling result might be explained by confounding factors such as age, nosocomial infections, follow-up period, and case mix. The impact of sexual hormones in older females is less relevant. Treatments aimed at modifying sexual hormone profile are promising but need to be tested in future trials.

How do we know when patients sleep properly or why they do not?

How do we know when patients sleep properly or why they do not? Critical care 2013, 17:145

Sjoberg, F. and Svanborg, E.

http://ccforum.com/content/17/3/145/abstract

The importance of adequate sleep for good health and immune system function is well documented as is reduced sleep quality experienced by ICU patients. In this issue of Critical Care, Elliot and co-workers present, a well done, largest of its kind, single center study on sleep patterns in critically ill patients. They base their study on the "gold standard", the polysomnography technique (PSG), which is resource demanding to perform and often difficult to evaluate. 

Does space make waste? The influence of ICU bed capacity on admission decisions

Does space make waste? The influence of ICU bed capacity on admission decisions. Critical care, May 2013, 17: 315.

Esteban, M. and Khan, JM.

http://ccforum.com/content/17/3/315

Intensive care unit (ICU) beds are a scarce resource, and admissions may require prioritization when demand exceeds supply. However, there are few empiric data on whether the availability of ICU beds influences triage and processes of care for hospitalized patients who develop sudden clinical deterioration.

Mortality and quality of life in the five years after severe sepsis

Mortality and quality of life in the five years after severe sepsis. Critical care, 2013, 17: R70.

Cuthbertson, B.H., et al.

http://ccforum.com/content/17/2/R70/abstract

Severe sepsis is associated with high levels of morbidity and mortality placing a high burden on healthcare resources. We aimed to study outcomes in the 5 years after severe sepsis.

Decreasing severe pain and serious adverse events while moving intensive care unit patients

Decreasing severe pain and serious adverse events while moving intensive care unit patients: a prospective interventional study. Critical care, 2013, 17: R74.

de Jong, A., et al.

http://ccforum.com/content/17/2/R74/abstract

A quality-improvement project was conducted to reduce severe pain and stress-related events while moving ICU-patients. The Plan-Do-Check-Adjust cycle was studied during four one-month phases, separated by five-month interphases. All consecutive patients staying more than 24 hours were evaluated every morning while being moved for nursing care (bathing, massage, sheet-change, repositioning). 

A comparative study of varying doses of enoxaparin for thromboprophylaxis in critically ill patients

A comparative study of varying doses of enoxaparin for thromboprophylaxis  in critically ill patients: double-blinded, randomised controlled trial.  Critical care, 2013, 17: R75.

Robinson, S., et al.

http://ccforum.com/content/17/2/R75/abstract

Critically ill patients are predisposed to venous thromboembolism. We hypothesized that higher doses of enoxaparin would improve thromboprophylaxis without increasing the risk of bleeding. 

The effects of the semirecumbent position on hemodynamic status in patients on invasive mechanical ventilation

The effects of the semirecumbent position on hemodynamic status in patients on invasive mechanical ventilation: prospective randomized multivariable analysis. Critical care 2013, 17: R80.

Gocze, I., et al.

http://ccforum.com/content/17/2/R80/abstract

Adopting the 45degrees semirecumbent position in mechanically ventilated critically ill patients is recommended, as it has been shown to reduce the incidence of ventilator-associated pneumonia. Although the benefits to the respiratory system are clear, it is not known whether elevating the head of the bed results in hemodynamic instability.

Intensive care unit-acquired weakness

Intensive care unit-acquired weakness: clinical phenotypes and molecular mechanisms. American journal of respiratory and critical care medicine. February 2013, Vol. 187(3), p.238-46.

Batt, J. et al.

http://www.ncbi.nlm.nih.gov/pubmed/23204256?dopt=Abstract

Intensive care unit-acquired weakness begins within hours of mechanical ventilation and may not be completely reversible over time. It represents a major functional morbidity of critical illness and is an important patient-centered outcome with clear implications for quality of life and resumption of prior work and lifestyle.

Oxygen therapy in critical illness

Oxygen therapy in critical illness: precise control of arterial oxygenation and permissive hypoxemia. Critical care medicine, Feb 2013, Vol. 41(2), p.423-32.

Martin, D.S. and Grocott, M.P.

http://www.ncbi.nlm.nih.gov/pubmed/23263574?dopt=Abstract

The management of hypoxemia in critically ill patients is challenging. Whilst the harms of tissue hypoxia are well recognized, the possibility of harm from excess oxygen administration, or other interventions targeted at mitigating hypoxemia, may be inadequately appreciated. The benefits of attempting to fully reverse arterial hypoxemia may be outweighed by the harms associated with high concentrations of supplemental oxygen and invasive mechanical ventilation strategies. We propose two novel related strategies for the management of hypoxemia in critically ill patients. 

Toothbrushing for critically ill mechanically ventilated patients

Toothbrushing for critically ill mechanically ventilated patients: a systematic review and meta-analysis of randomized trials evaluating ventilator-associated pneumonia.  Critical care medicine, Feb 2013, Vol. 41(2), p.646-55.

Alhazzani, W. et al.

http://www.ncbi.nlm.nih.gov/pubmed/23263588?dopt=Abstract

Oral care may decrease ventilator-associated pneumonia in the ICU. The objective of this review was to summarize and critically appraise randomized trials in mechanically ventilated patients in the ICU testing the effect of oral care strategies involving toothbrushing on ventilator-associated pneumonia.

Surviving sepsis campaign

Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock. Critical care medicine, Feb 2013, Vol. 41(2); p.580-637.

Dellinger, R.P., et al.

http://www.ncbi.nlm.nih.gov/pubmed/23353941?dopt=Abstract

Objective: To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008.

Is this the end of the road for synthetic starches in critical illness?

Is this the end of the road for synthetic starches in critical illness? BMJ 2013, 346:f1805.

Prowle, J.R. and Pearse, R.M.

http://www.bmj.com/content/346/bmj.f1805.pdf%2Bhtml

Maintaining effective plasma volume is, perhaps, the most persistent challenge faced by clinicians who treat critically ill patients, in particular those with sepsis. In patients with sepsis, increased capillary permeability and loss of vascular tone cause loss of circulating plasma volume, which contributes to inadequate cardiac output and tissue perfusion. 

The effect of a quality improvement intervention on perceived sleep quality and cognition in a medical ICU

The effect of a quality improvement intervention on perceived sleep quality and cognition in a medical ICU.  Critical care medicine, March 2013, Vol. 41(3), p.800-09.

Kamdar, B.B., et al.

http://journals.lww.com/ccmjournal/Abstract/2013/03000/The_Effect_of_a_Quality_Improvement_Intervention.12.aspx

 An ICU-wide quality improvement intervention to improve sleep and delirium is feasible and associated with significant improvements in perceived nighttime noise, incidence of delirium/coma, and daily delirium/coma-free status. Improvement in perceived sleep quality did not reach statistical significance.

Hydroxyethyl starch in severe sepsis: End of starch era?

Hydroxyethyl starch in severe sepsis: End of starch era? Critical care, March 2013, 17: 310. 

Estrada, C.A. and Murugan, R.

http://ccforum.com/content/17/2/310

Hydroxyethyl starch (HES) is widely used for fluid resuscitation in ICUs, but its safety and efficacy have not been established in patients with severe sepsis. 

Characterisation of sleep in intensive care using 24 hour polysomnography : An observational study

Characterisation of sleep in intensive care using 24 hour polysomnography: An observational study.  Critical care, March 2013, 17:R46.

Elliott, R., et al.

http://ccforum.com/content/17/2/R46/abstract

Many intensive care patients experience sleep disruption potentially related to noise, light and treatment interventions. The purpose of this study was to characterise, in terms of quantity and quality, the sleep of intensive care patients, taking into account the impact of environmental factors.

The influence of gender on the epidemiology of and outcome from severe sepsis

The influence of gender on the epidemiology of and outcome from severe sepsis. Critical care, March 2013, 17: R50.

Sakr, Y., et al.

http://ccforum.com/content/17/2/R50/abstract

The impact of gender on outcome in critically ill patients is unclear. We investigated the influence of gender on the epidemiology of severe sepsis and associated morbidity and mortality in a large cohort of ICU patients in the region of Piedmont in Italy.