The impact of delirium on clinical outcomes in mechanically ventilated surgical and trauma patients. Critical Care Medicine vol. 37(6), June 2009, pp 1898-1905.
Lat, I., McMillian, W., Taylor, S., Janzen, J.M., Papadopoulos, S., Korth, L., Ehtisham, A., Nold, J., Agarwal, S., Azocar, R., Burke, P.Issue:
http://ovidsp.uk.ovid.com/spa/ovidweb.cgi?&S=NODKPDLLCDHFJNDMFNFLOGHHMNONAA00&Link+Set=S.sh.2.14.16.17.65.67%7c11%7csl_10
Delirium is classically defined as an acute cognitive impairment accompanied with fluctuating mental status, inattention, and disorganized thought. Several validated tools exist to assist in the diagnosis of delirium in the critically ill population. The Society of Critical Care Medicine has recommended the implementation of delirium assessments as a standard of care. The development of delirium is frequent in critically ill patients. Prior work has demonstrated that delirium is an independent risk factor for mortality, longer intensive care unit (ICU) and hospital stays, and is associated with numerous complications.
Wednesday, 3 June 2009
Comparison of delirium assessment tools in a mixed intensive care unit
Comparison of delirium assessment tools in a mixed intensive care unit. Critcal Care Medicine, vol. 37(6), June 2009, pp 1881-1885 [journal article]
van Eijk, M.M.J., van Marum, R.J., Klijn, I.A.M., de Wit, N., Kesecioglu, J., Slooter, A.J.C.
http://ovidsp.uk.ovid.com/spa/ovidweb.cgi?&S=NODKPDLLCDHFJNDMFNFLOGHHMNONAA00&Link+Set=S.sh.2.14.16.17.65.67%7c8%7csl_10
Delirium is a frequent problem in the intensive care unit (ICU) associated with poor prognosis. Delirium in the ICU is underdiagnosed by nursing and medical staff. Several detection methods have been developed for use in ICU patients. The aim of this study was to compare the value of three detection methods (the Confusion Assessment Method for the ICU [CAM-ICU], the Intensive Care Delirium Screening Checklist [ICDSC] and the impression of the ICU physician with the diagnosis of a psychiatrist, neurologist, or geriatrician).
van Eijk, M.M.J., van Marum, R.J., Klijn, I.A.M., de Wit, N., Kesecioglu, J., Slooter, A.J.C.
http://ovidsp.uk.ovid.com/spa/ovidweb.cgi?&S=NODKPDLLCDHFJNDMFNFLOGHHMNONAA00&Link+Set=S.sh.2.14.16.17.65.67%7c8%7csl_10
Delirium is a frequent problem in the intensive care unit (ICU) associated with poor prognosis. Delirium in the ICU is underdiagnosed by nursing and medical staff. Several detection methods have been developed for use in ICU patients. The aim of this study was to compare the value of three detection methods (the Confusion Assessment Method for the ICU [CAM-ICU], the Intensive Care Delirium Screening Checklist [ICDSC] and the impression of the ICU physician with the diagnosis of a psychiatrist, neurologist, or geriatrician).
Procalcitonin as a prognostic and diagnostic tool for septic complications after major trauma
Procalcitonin as a prognostic and diagnostic tool for septic complications after major trauma. Critical Care Medicine, vol 37(6), June 2009, pp 1845-1849 [journal article]
Castelli, G.P., Pognani, C., Cita, M., Paladini, R.
http://ovidsp.uk.ovid.com/spa/ovidweb.cgi?&S=NODKPDLLCDHFJNDMFNFLOGHHMNONAA00&Link+Set=S.sh.2.14.16.17.65.67%7c2%7csl_10
Severe trauma is a potent cause of the systemic inflammatory response syndrome (SIRS). Although SIRS is present in >90% of the surgical intensive care unit (ICU) patients, classic inflammatory criteria such as body temperature, heart rate, white blood cell count, and respiratory rate are often variable and do not seem useful in predicting infection or severity of illness. Although early diagnosis and treatment of infection are associated with improved mortality, diagnosis of infection in these patients is often delayed due to long culture times and difficulties in isolation from local colonization.
Castelli, G.P., Pognani, C., Cita, M., Paladini, R.
http://ovidsp.uk.ovid.com/spa/ovidweb.cgi?&S=NODKPDLLCDHFJNDMFNFLOGHHMNONAA00&Link+Set=S.sh.2.14.16.17.65.67%7c2%7csl_10
Severe trauma is a potent cause of the systemic inflammatory response syndrome (SIRS). Although SIRS is present in >90% of the surgical intensive care unit (ICU) patients, classic inflammatory criteria such as body temperature, heart rate, white blood cell count, and respiratory rate are often variable and do not seem useful in predicting infection or severity of illness. Although early diagnosis and treatment of infection are associated with improved mortality, diagnosis of infection in these patients is often delayed due to long culture times and difficulties in isolation from local colonization.
Influence of respiratory rate on stroke volume variation in mechanically ventilaed patients
Influence of respiratory rate on stroke volume variation in mechanically ventilated patients. Anesthesiology, vol. 110(5), May 2009, pp 1092-1097
De Backer, D., Taccone, F.S., Holsten, R., Ibrahimi, F., Vincent, J.L.
http://ovidsp.uk.ovid.com/spa/ovidweb.cgi?&S=NODKPDLLCDHFJNDMFNFLOGHHMNONAA00&Link+Set=S.sh.2.14.16.17.53.59%7c25%7csl_10
Heart-lung interactions are used to evaluate fluid responsiveness in mechanically ventilated patients, but these indices may be influenced by ventilatory conditions. The authors evaluated the impact of respiratory rate (RR) on indices of fluid responsiveness in mechanically ventilated patients, hypothesizing that pulse pressure variation and respiratory variation in aortic flow would decrease at high RRs.
De Backer, D., Taccone, F.S., Holsten, R., Ibrahimi, F., Vincent, J.L.
http://ovidsp.uk.ovid.com/spa/ovidweb.cgi?&S=NODKPDLLCDHFJNDMFNFLOGHHMNONAA00&Link+Set=S.sh.2.14.16.17.53.59%7c25%7csl_10
Heart-lung interactions are used to evaluate fluid responsiveness in mechanically ventilated patients, but these indices may be influenced by ventilatory conditions. The authors evaluated the impact of respiratory rate (RR) on indices of fluid responsiveness in mechanically ventilated patients, hypothesizing that pulse pressure variation and respiratory variation in aortic flow would decrease at high RRs.
In death, truth lies: why do patients with sepsis die?
In death, truth lies: why do patients with sepsis die? Anaesthesia & Analgesia, vol 108(6), June 2009, p 1731-1733. [editorial]
Tenhunen, J. J.
http://ovidsp.uk.ovid.com/spa/ovidweb.cgi?&S=NODKPDLLCDHFJNDMFNFLOGHHMNONAA00&Link+Set=S.sh.2.14.16.17.20.44%7c3%7csl_10
It is no news that, even today, sepsis is associated with high mortality. All of us who regularly practice intensive care medicine have seen our patients with sepsis die. Yet, it seems acceptable to claim that we do not know ultimately why these patients die. Some die despite full continuing therapeutic efforts, although others die after therapy has been withheld or withdrawn. Most patients who die with or because of sepsis, die with established multiple organ dysfunction or failure. Although the clinical cause of death can be classified as “refractory septic shock,” “multiple organ failure,” or “acute circulatory failure,” the actual causes and mechanisms for treatment failure and death remain mostly unidentified.
Tenhunen, J. J.
http://ovidsp.uk.ovid.com/spa/ovidweb.cgi?&S=NODKPDLLCDHFJNDMFNFLOGHHMNONAA00&Link+Set=S.sh.2.14.16.17.20.44%7c3%7csl_10
It is no news that, even today, sepsis is associated with high mortality. All of us who regularly practice intensive care medicine have seen our patients with sepsis die. Yet, it seems acceptable to claim that we do not know ultimately why these patients die. Some die despite full continuing therapeutic efforts, although others die after therapy has been withheld or withdrawn. Most patients who die with or because of sepsis, die with established multiple organ dysfunction or failure. Although the clinical cause of death can be classified as “refractory septic shock,” “multiple organ failure,” or “acute circulatory failure,” the actual causes and mechanisms for treatment failure and death remain mostly unidentified.
Thursday, 28 May 2009
Prolonged acute mechanical ventilation: implications for hospital benchmarking
Prolonged acute mechanical ventilation: implications for hospital benchmarking. CHEST May 2009, vol. 135 no. 5 1157-1162 [journal article]
Zilberberg, M.D., Kramer, A.A., Higgins, T.L., Shorr, A.F.
http://www.chestjournal.org/content/135/5/1157.short?rss=1
Hospital performance measures rely on aggregate outcomes. For patients receiving mechanical ventilation (MV), outcomes depend on severity of illness, hospital MV volume, and case mix. Patients requiring prolonged acute MV (PAMV) [MV for ≥ 96 h] comprise a resource-intensive group, but the impact of its volume on aggregate outcomes is unknown.
Zilberberg, M.D., Kramer, A.A., Higgins, T.L., Shorr, A.F.
http://www.chestjournal.org/content/135/5/1157.short?rss=1
Hospital performance measures rely on aggregate outcomes. For patients receiving mechanical ventilation (MV), outcomes depend on severity of illness, hospital MV volume, and case mix. Patients requiring prolonged acute MV (PAMV) [MV for ≥ 96 h] comprise a resource-intensive group, but the impact of its volume on aggregate outcomes is unknown.
End of life care - nineteenth report of session 2009/09
End of life care - nineteenth report of session 2008/09. House of Commons, Public Accounts Committee, March 2009.
http://www.publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/99/99.pdf
This report examines the scale and quality of end of life care, the current and future approach to commissioning and funding of services, and the capability and capacity of NHS and social care staff to provide such care.
http://www.publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/99/99.pdf
This report examines the scale and quality of end of life care, the current and future approach to commissioning and funding of services, and the capability and capacity of NHS and social care staff to provide such care.
Weaning patients off invasive ventilation
Weaning patients off invasive ventilation. [editorial] BMJ 2009; 338:b728
http://www.bmj.com/cgi/content/full/338/may21_1/b728
At any given time, 30-70% of patients in the intensive care unit (ICU) are receiving mechanical ventilatory support; 70-80% of them are rapidly weaned off this support, often within a few days. Weaning is more problematic in the remaining 20-30% of patients, usually because of unfavourable respiratory mechanics, residual disease processes, cardiac dysfunction, respiratory muscle weakness, high secretion volumes, or altered mental status.
http://www.bmj.com/cgi/content/full/338/may21_1/b728
At any given time, 30-70% of patients in the intensive care unit (ICU) are receiving mechanical ventilatory support; 70-80% of them are rapidly weaned off this support, often within a few days. Weaning is more problematic in the remaining 20-30% of patients, usually because of unfavourable respiratory mechanics, residual disease processes, cardiac dysfunction, respiratory muscle weakness, high secretion volumes, or altered mental status.
Wednesday, 20 May 2009
Cytomegalovirus infection in critically ill patients: a systematic review
Cytomegalovirus infection in critically ill patients: a systematic
review. Critical Care 2009, 13: R68 [Article]
Osawa, R., Singh, N.
http://ccforum.com/content/13/3/R68
The precise role of cytomegalovirus (CMV) infection in contributing to outcomes in critically ill immunocompetent patients has not been fully defined. Studies in which critically ill
immunocompetent adults were monitored for CMV infection in the intensive care unit (ICU) were reviewed. Potential risk factors for CMV infection include sepsis, requirement of mechanical ventilation, and transfusions. CMV infection frequently occurs in critically ill immunocompetent patients and may be associated with poor outcomes.
review. Critical Care 2009, 13: R68 [Article]
Osawa, R., Singh, N.
http://ccforum.com/content/13/3/R68
The precise role of cytomegalovirus (CMV) infection in contributing to outcomes in critically ill immunocompetent patients has not been fully defined. Studies in which critically ill
immunocompetent adults were monitored for CMV infection in the intensive care unit (ICU) were reviewed. Potential risk factors for CMV infection include sepsis, requirement of mechanical ventilation, and transfusions. CMV infection frequently occurs in critically ill immunocompetent patients and may be associated with poor outcomes.
Dexmedetomidine vs haloperidol in delirious, agitated, intubated patients
Dexmedetomidine vs. haloperidol in delirious, agitated, intubated
patients: a randomised open-label trial. Critical Care 2009 13:R75 [Journal article]
Reade, M.C., O'Sullivan, K., Bates, S., Goldsmith, D., StJ Ainslie, W.R., Bellomo, R.
http://ccforum.com/content/13/3/R75
Agitated delirium is common in patients undergoing mechanical ventilation, and is often treated with haloperidol despite concerns about safety and efficacy. Use of conventional sedatives to control agitation can preclude extubation. Dexmedetomidine, a novel sedative and anxiolytic agent, may have particular utility in these patients. We sought to compare the efficacy of haloperidol and
dexmedetomidine in facilitating extubation. In this preliminary pilot study, we found dexmedetomidine a promising agent for the treatment of ICU-associated delirious agitation, and we suggest this warrants further testing in a definitive double-blind multi-centre trial.
patients: a randomised open-label trial. Critical Care 2009 13:R75 [Journal article]
Reade, M.C., O'Sullivan, K., Bates, S., Goldsmith, D., StJ Ainslie, W.R., Bellomo, R.
http://ccforum.com/content/13/3/R75
Agitated delirium is common in patients undergoing mechanical ventilation, and is often treated with haloperidol despite concerns about safety and efficacy. Use of conventional sedatives to control agitation can preclude extubation. Dexmedetomidine, a novel sedative and anxiolytic agent, may have particular utility in these patients. We sought to compare the efficacy of haloperidol and
dexmedetomidine in facilitating extubation. In this preliminary pilot study, we found dexmedetomidine a promising agent for the treatment of ICU-associated delirious agitation, and we suggest this warrants further testing in a definitive double-blind multi-centre trial.
Model for predicting short-term mortality of severe sepsis
Model for predicting short-term mortality of severe sepsis. Critical Care 2009, 13:R72 [journal article].
Adrie, C., Francais, A., Alvarez-Gonzalez, A., Mounier, R., Azoulay, E., Zahar, J.R., Clec'h, C., Godgran-Toledano, D., Hammer, L., Descorps-Declere, A., Jamali, S., Timsit, J.F.
http://ccforum.com/content/13/3/R72
Development of a prognostic model for predicting 14-day mortality in ICU patients with severe sepsis.
Adrie, C., Francais, A., Alvarez-Gonzalez, A., Mounier, R., Azoulay, E., Zahar, J.R., Clec'h, C., Godgran-Toledano, D., Hammer, L., Descorps-Declere, A., Jamali, S., Timsit, J.F.
http://ccforum.com/content/13/3/R72
Development of a prognostic model for predicting 14-day mortality in ICU patients with severe sepsis.
Risk factors for delirium in intensive care patients: a prospective cohort study
Risk factors for delirium in intensive care patients: a prospective cohort study. Critical Care 2009, 13:R77 [journal article]
Van Rompaey, B., Elseviers, M.M., Schuurmans, M.J., Shortridge-Baggett, L.M., Truijen, S., Bossaert, L.
http://ccforum.com/content/13/3/R77
This multicenter study indicated risk factors for delirium in the intensive care unit related to patient characteristics, chronic pathology, acute illness and the environment. Several factors are suitable for preventive action.
Van Rompaey, B., Elseviers, M.M., Schuurmans, M.J., Shortridge-Baggett, L.M., Truijen, S., Bossaert, L.
http://ccforum.com/content/13/3/R77
This multicenter study indicated risk factors for delirium in the intensive care unit related to patient characteristics, chronic pathology, acute illness and the environment. Several factors are suitable for preventive action.
Thursday, 14 May 2009
Evaluation of pain in ICU patients
Evaluation of pain in ICU patients. CHEST vol 135(4), April 2009, p.1069-1074 [journal article].
Puntillo, K., Pasero, C., Li, D., Mularski, R.A., Grap, J.M., Erstad, B.L., Varkey, B., Gilbert, H.C., Medina, J. Sessler, C.N.
http://www.chestjournal.org/content/135/4/1069.short?rss=1
Pain is a common and distressing symptom in ICU patients. Yet a major challenge exists in assessing and evaluating the pain. Although the patient's self-report of pain is the "gold standard" for pain assessment, other methods must be considered when patients are unable
to self-report.
Pain management principles in the critically ill
Pain management principles in the critically ill. CHEST vol. 135(4), April 2009, p.1075-1086. [journal article]
Erstad, B.L., Puntillo, K., Gilbert. H.C., Grap, M.J., Li, D., Medina, J., Mularski, R.A. Pasero, C., Varkey, B., Sessler, C.N.
http://www.chestjournal.org/content/135/4/1075.short?rss=1This article addresses conventional pharmacologic and nonpharmacologic treatment of pain in patients in ICUs.
Pain management within the palliative and end-of-life care experience in the ICU.
CHEST vol 135(5), May 2009, p1360-1369 [journal article]. Pain management within the palliative and end-of-life care experience in the ICU.
Mularski, R. A., Puntillo, K., Varkey, B., Erstad, B. L., Grap, M. J., Gilbert, H. C., Li, D., Medina,
J., Pasero, C., Sessler, C. N.
http://www.chestjournal.org/content/135/5/1360.full.pdf+html
High-quality pain management is a part of optimal therapy and requires knowledge and skill in
pharmacologic, behavioral, social, and communication strategies grounded in the holistic palliative care approach. This contemporary review article focuses on pain management within comprehensive palliative and end-of-life care.
Subscribe to:
Posts (Atom)