Terminal Withdrawal of Mechanical Ventilation at a Long-Term Acute Care Hospital

Terminal Withdrawal of Mechanical Ventilation at a Long-Term Acute Care Hospital: Comparison with a medical ICU. Chest, vol. 136(2), Aug 2009, p.465-470.

White, A.C., et al.

http://www.chestjournal.org/content/136/2/465.full.pdf+html

Long-term acute care hospitals provide care for patients who require prolonged mechanical ventilation (MV) for respiratory failure. A multicenter study found weaning to be unsuccessful in 20% of patients receiving prolonged MV despite a multidisciplinary approach to care. The decision to terminally withdraw MV from critically ill patients in whom MV is no longer considered beneficial is common in ICUs in the United States and in Europe. Updated practice guidelines are available to inform practitioners in the terminal withdrawal of MV in the ICU.

A Randomized Trial of Dental Brushing for Prevening Ventilator-Associated Pneumonia

A Randomized Trial of Dental Brushing for Preventing Ventilator-Associated Pneumonia. Chest, vol. 136(2), Aug. 2009, p. 433-499.

Pobo, A., et al.

http://www.chestjournal.org/content/136/2/433.full.pdf+html

Poor oral hygiene is associated with respiratory pathogen colonization and secondary
lung infection. The impact of adding electric toothbrushing to oral care in order to reduce
ventilator-associated pneumonia (VAP) incidence is unknown. The study design was a prospective, simple-blind, randomized trial of adult patients intubated for > 48 h. Controlling for exposure to antibiotic treatment, patients were randomized to oral care every 8 h with 0.12% chlorhexidine digluconate (standard group) or standard oral care plus electric toothbrushing (toothbrush group). VAP was documented by quantitative respiratory cultures. Mechanical ventilation duration, hospital ICU length of stay, antibiotic use, and hospital ICU mortality were secondary end points.

Experiences of intensive care nurses assessing sedation/agitation in critically ill patients

Experiences of intensive care nurses assessing sedation/agitation in critically ill patients. Nursing in critical care, vol. 13(4), 2008. [journal article]

Weir, S. and O'Neill, A.

http://www3.interscience.wiley.com/cgi-bin/fulltext/119878662/PDFSTART

Patients admitted to the intensive care unit (ICU) will more often than not require sedative and analgesic drugs to enable them to tolerate the invasive procedures and therapies caused as a result of their underlying condition and/or necessary medical interventions. This article reports a study exploring the perceptions and experiences of intensive care nurses using a sedation/agitation scoring (SAS) tool to assess and manage sedation and agitation amongst critically ill patients.

Withdrawal of mechanical ventilation in anticipation of death in the intensive care unit. New England Journal of Medicine, vol. 349(12), Sept. 2003. [journal article]

Cook, D., et al.

http://content.nejm.org/cgi/reprint/349/12/1123.pdf

In critically ill patients who are receiving mechanical ventilation, the factors associated with physicians’ decisions to withdraw ventilation in anticipation of death are unclear. The objective of this study was to examine the clinical determinants that were associated with the withdrawal of mechanical ventilation.

Non-invasive ventilation: don't push too hard

Non-invasive ventilation: don't push too hard. New england journal of medicine, Vol. 350(24), June 2004. [journal article]

Truwit, J.D. and Bernard, G.R.

http://content.nejm.org/cgi/reprint/350/24/2512.pdf

Noninvasive mechanical ventilation has been used increasingly over the past decade in an effort to avoid endotracheal intubation and to accelerate the discontinuation of mechanical ventilation. Noninvasive ventilation as adjunctive therapy can be applied before intubation or after extubation. The literature indicates that in both settings, outcomes in patients with chronic obstructive pulmonary disease (COPD) or cardiogenic pulmonary edema are successful.

Hydrocortisone therapy for patients with septic shock

Hydrocortisone therapy for patients with septic shock. New england journal of medicine, Vol 358 (2), January 2008 [journal article]

Sprung, C.L., et al.

http://content.nejm.org/cgi/reprint/358/2/111.pdf


Hydrocortisone is widely used in patients with septic shock, even though a survival benefit has been reported only in patients who remained hypotensive after fluid and vasopressor resuscitation and whose plasma cortisol levels did not rise appropriately after the administration of corticotropin.

Determinants of weaning success in patients with prolonged mechanical ventilation

Determinants of weaning success in patients with prolonged mechanical ventilation. Critical care 13(3), June 2009 [journal article]

Carlucci, A., et al.

http://ccforum.com/content/13/3/R97

Physiological determinants of weaning success and failure are usually studied in ventilator-supported patients, comparing those who failed a trial of spontaneous breathing with those who tolerated such a trial and were successfully extubated. A major limitation of these studies was that the two groups may be not comparable, concerning the severity of the underlying disease and the presence of comorbidities. In this physiological study, we assessed the determinants
of weaning success in patients acting as their own control, once they are eventually liberated from the ventilator.

Ventilator-associated pneumonia in patients undergoing major heart surgery

Ventilator-associated pneumonia in patients undergoing major heart surgery: an incidence study in Europe. Critical Care 13(3), June 2009. [journal article]

Hortal, J., Munoz, P., Cuerpo, G., Litvan, H., Rosseel, P.M., Bouza, E.

http://ccforum.com/content/13/3/R80

Critical Care

Mechanical ventilation during experimental sepsis increases deposition of advanced glycation end products and myocardial inflammation
Kneyber MC, Gazendam RP, Niessen HW, Kuiper J, Dos Santos CC, Slutsky AS, Plotz FB Critical Care 2009, 13:R87 (9 June 2009)
[Abstract] [Provisional PDF] [PubMed]

New books in the Library

Quick reference to critical care by Nancy Diepenbrock 3rd edition 2008 is now available in the Health Sciences Library. Shelved at 616.028 DIE

Principles and practice of high dependency nursing edited by Sheppard and Wright 2006 is now available in the Health Sciences Library. Shelved at 616.028 SHE

The impact of delirium on clinical outcomes in mechanically ventilated surgical and trauma patients

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.

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).

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.

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.

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.