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.

Age, duration of mechanical ventilation and outcomes of patients who are critically ill

Age, duration of mechanical ventilation and outcomes of patients who are critically ill. Chest vol. 136(3), Sept. 2009, p. 759-764.

Feng, Y. et al.

http://www.chestjournal.org/content/136/3/759.full.pdf+html

Age and duration of mechanical ventilation (MV) are strongly associated with mortality and hospital discharge disposition. Methods: Electronic administrative records from a 425-bed community teaching hospital were obtained for 9,912 patients who were admitted to hospital ICUs between 2003 and 2008. Risk estimates of age and duration of MV for in-hospital mortality and discharge to home vs extended-care facilities (ECFs) also were obtained.
This study suggests that age and duration of MV are strongly associated with mortality
and posthospital disposition.

Effects on management and outcome of severe sepsis and septic shock patients admitted to the intensive care unit

Effects on management and outcome of severe sepsis and septic shock patients admitted to the intensive care unit after implementation of a sepsis program: a pilot study. Critical care Vol. 13(5), Sept 2009.

Girardis, M., et al.

http://ccforum.com/content/pdf/cc8029.pdf

The application in clinical practice of evidence-based guidelines for the management of patients with severe sepsis/septic shock is still poor in the emergency department, while little data are available for patients admitted to the intensive care unit (ICU). The aim of this study was to evaluate the effect of an in-hospital sepsis program on the adherence to evidence-based guidelines and outcome of patients with severe sepsis/septic shock admitted to the ICU.

Pain management within the palliative and end-of-life care experience in the ICU

Pain management within the palliative and end-of-life care experience in the ICU. Chest, May 2009, vol. 135(5), 1360-1369.

Mularski, R.A., et al.

http://www.chestjournal.org/content/135/5/1360.full.pdf+html

In the ICU where critically ill patients receive aggressive life-sustaining interventions, suffering is common and death can be expected in up to 20% of patients. 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.

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.