One year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation

One year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation. Annals of internal medicine, vol. 153(3), p. 167-175

Unroe, M. et al.

http://www.annals.org/content/153/3/167.abstract

Growing numbers of critically ill patients receive prolonged mechanical ventilation. Little is known about the patterns of care as patients transition from acute care hospitals to postacute care facilities or about the associated resource utilization.

Survivorship will be the defining challenge of critical care in the 21st century

Survivorship will be the defining challenge of critical care in the 21st century. Annals of internal medicine, August 3, 2010 vol. 153(3), p. 204-205.

Iwashyna, T.J.

http://www.annals.org/content/153/3/204.short?rss=1

Distracted by the high mortality rate of critical illness, we tend to overlook the essential fact that most patients survive the intensive care unit (ICU). Every year, millions of patients are discharged from the ICU to face the challenges of critical illness survivorship—the complex burdens and legacies of surviving a potentially fatal disease, often after harsh and painful treatment.

Decrease in long-term survival for hospitalized patients with community-acquired pneumonia

Decrease in long-term survival for hospitalized patients with community-acquired pneumonia. CHEST August 2010 vol. 138 (2), p. 279-283

Bordon, J., et al.

http://chestjournal.chestpubs.org/content/138/2/279.abstract

The association of hospitalization because of community-acquired pneumonia (CAP) and long-term survival has not been fully examined. This study measured the long-term survival of hospitalized patients with CAP adjusted for the effects of comorbidities.

Predictors of time to death after terminal withdrawal of mechanical ventilation in the ICU

Predictors of Time to Death After Terminal Withdrawal of Mechanical Ventilation in the ICU.
CHEST August 2010 vol. 138 (2), p. 289-297

Cooke, C.R., et al.

http://chestjournal.chestpubs.org/content/138/2/289.short?rss=1

Little information exists about the expected time to death after terminal withdrawal of mechanical ventilation. This study seeks to determine the independent predictors of time to death after withdrawal of mechanical ventilation.

Outcomes of patients ventilated with synchronized intermittent mandatory ventilation with pressure support

Outcomes of patients ventilated with synchronized intermittent mandatory ventilation with pressure support. CHEST, June 2010 Vol. 137(6), p. 1265-1277.

Ortiz, G., et al.

http://chestjournal.chestpubs.org/content/137/6/1265.short?rss=1

Few data are available regarding the benefits of one mode over another for ventilatory support. We set out to compare clinical outcomes of patients receiving synchronized intermittent mandatory ventilation with pressure support (SIMV-PS) compared with assist-control (A/C) ventilation as their primary mode of ventilatory support.

Effects of ear plugs and eye masks on nocturnal sleep, melatonin and cortisol in a simulated ICU environment

Effects of ear plugs and eye masks on nocturnal sleep, melatonin and cortisol in a simulated ICU environment. Critical Care vol. 14 (2), Apr 2010, p.

Hu, R. et al.

http://ccforum.com/content/14/2/R66

Environmental stimulus, especially noise and light, is thought to disrupt sleep in patients in the ICU. This study aimed to determine the physiological and psychological effects of ICU noise and light, and of earplugs and eye masks, used in these conditions in healthy subjects.

The effect of multidisciplinary care teams on intensive care unit mortality

The effect of multidisciplinary care teams on intensive care unit mortality. Archives of Internal Medicine, 2010; Vol. 170(4), pages 369-376.

Kim, M.M. et al.

http://archinte.ama-assn.org/cgi/content/full/170/4/369?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=Michelle%2BM.%2BKim&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

Critically ill patients are medically complex and may benefit from a multidisciplinary approach to care. Daily rounds by a multidisciplinary team are associated with lower mortality among medical ICU patients. The survival benefit of intensivist physician staffing is in part explained by the presence of multidisciplinary teams in high-intensity physician-staffed ICUs.

Hypoglycemia in the critically ill: how low is too low?

Hypoglycemia in the critically ill: how low is too low? Mayo clinic proceedings, March 2010, Vol. 85(3), p. 215-216.

Krinsley, J.S.

http://www.mayoclinicproceedings.com/content/85/3/215.full

Tight glycemic control in critically ill patients became a therapeutic paradigm after the 2001 publication of a landmark single-center interventional trial in Leuven, Belgium, (ie, “Leuven 1”) that targeted euglycemia in a population of mechanically ventilated patients in a surgical intensive care unit (ICU).

Association between ICU admission during morning rounds and mortality

Association between ICU admission during morning rounds and mortality. CHEST, Dec. 2009 vol. 136(6), p. 1489-1495.

Afessa, B. et al.

http://chestjournal.chestpubs.org/content/136/6/1489.full

Background: No previous study has evaluated the association between admission to ICUs during round time and patient outcome. The objective of this study was to determine the association between round-time ICU admission and patient outcome. Conclusions: Patients admitted to the ICU during morning rounds have higher severity of illness and mortality rates.

Evaluation of modernisation of adult critical care services in England

Evaluation of modernisation of adult critical care services in England: time series and cost effectiveness analysis. BMJ 2009;339:b4353

Hutchings, A., et al.

http://sccmwww.sccm.org/publications/eNewsletters_Archive/11_19_2009.htm#n1
(Click on link: British Medical Journal, full text)

Objective: To evaluate the impact and cost effectiveness of a programme to transform adult critical care throughout England initiated in late 2000. Design: Evaluation of trends in inputs, processes, and outcomes during 1998-2000 compared with last quarter of 2000-6.
Setting: 96 critical care units in England. Participants: 349 817 admissions to critical care units. Conclusion: Substantial improvements in NHS critical care have occurred in England since 2000. While it is unclear which factors were responsible, collectively the interventions represented a highly cost effective use of NHS resources.

Potential for response bias in family surveys about end-of-life care in the ICU

Potential for response bias in family surveys about end-of-life care in the ICU. CHEST, Dec. 2009, vol. 136 (6), p. 1496-1502.

Kross, E.K., et al.

http://chestjournal.chestpubs.org/content/136/6/1496.full

After-death surveys are an important source of information about the quality of end-of-life care, but response rates generally are low. Our goal was to understand the potential for nonresponse bias in survey studies of family members after a patient's death in the hospital ICU by identifying differences in patient demographics and delivery of palliative care between patients whose families respond to a survey about end-of-life care and those whose families do not.

International study of the prevalence and outcomes of infection in ICUs

International study of the prevalence and outcomes of infection in ICUs. JAMA. 2009;302(21):2323-2329.

Vincent, J.L. et al.

http://jama.ama-assn.org/cgi/content/full/302/21/2323

Infection is a major cause of morbidity and mortality in intensive care units (ICUs) worldwide. However, relatively little information is available about the global epidemiology of such infections. Objective: To provide an up-to-date, international picture of the extent and patterns of infection in ICUs. Conclusions: Infections are common in patients in contemporary ICUs, and risk of infection increases with duration of ICU stay. In this large cohort, infection was independently associated with an increased risk of hospital death.

ICU admissions after actual or planned hospital discharge

ICU admissions after actual or planned hospital discharge. Chest, vol. 136(5), Nov. 2009, p.1257-1262.

Chawla, S., et al.

http://chestjournal.chestpubs.org/content/136/5/1257.full

Unexpected ICU admissions may result from early or premature discharge from the hospital. We sought to determine the incidence, clinical characteristics, and outcomes of patients admitted to the ICU after actual or planned hospital discharge and to analyze whether the need for ICU admission was related or unrelated to the associated hospitalization.

Caring to the end?

Caring to the end? National confidential enquiry into patient outcome and death. A review of the care of patients who died in hospital within four days of admission. 2009.

Cooper, H. et al.

http://www.ncepod.org.uk/2009report2/Downloads/DAH_report.pdf

This report highlights the process of care of patients who died in acute hospitals within four days of admission. It takes a critical look at the areas where patient care might have been improved. Remediable factors have been identified in the clinical and the organisational care of these patients.

Prolonged acute mechanical ventilation: implications for hospital benchmarking

Prolonged acute mechanical ventilation: implications for hospital benchmarking. Chest, vol. 135(5), May 2009, p.1157-1162.

Zilberberg, M.D. et al.

http://chestjournal.chestpubs.org/content/135/5/1157.full

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. We investigated whether observed outcomes differed from those predicted by APACHE (acute physiology and chronic health evaluation) IV risk adjustment and the relationship between hospital MV volume and outcomes among patients receiving PAMV.