Objective surveillance definitions for ventilator-associated pneumonia. Critical care medicine, Dec. 2012, Vol. 40(12), p.3154-61.
Klompas, M., et al.
http://journals.lww.com/ccmjournal/Abstract/2012/12000/Objective_surveillance_definitions_for.6.aspx
The subjectivity and complexity of surveillance definitions for ventilator-associated pneumonia preclude meaningful internal or external benchmarking and therefore hamper quality improvement initiatives for ventilated patients. We explored the feasibility of creating objective surveillance definitions for ventilator-associated pneumonia.
Monday, 17 December 2012
Pulmonary embolism in mechanically ventilated patients requiring computed tomography
Pulmonary embolism in mechanically ventilated patients requiring computed tomography: Prevalence, risk factors and outcome. Critical care medicine, Dec. 2012, Vol. 40(12), p.3202-08.
Minet, C., et al.
http://journals.lww.com/ccmjournal/Abstract/2012/12000/Pulmonary_embolism_in_mechanically_ventilated.12.aspx
In mechanically ventilated patients who needed a computed tomography, pulmonary embolism was more common than expected. Patients diagnosed with pulmonary embolism were all treated with therapeutic anticoagulation, and their intensive care unit or hospital mortality was not impacted by the pulmonary embolism occurrence.
Minet, C., et al.
http://journals.lww.com/ccmjournal/Abstract/2012/12000/Pulmonary_embolism_in_mechanically_ventilated.12.aspx
In mechanically ventilated patients who needed a computed tomography, pulmonary embolism was more common than expected. Patients diagnosed with pulmonary embolism were all treated with therapeutic anticoagulation, and their intensive care unit or hospital mortality was not impacted by the pulmonary embolism occurrence.
Effects of the neurological wake-up test on clinical examination, intracranial pressure, brain metabolism and brain tissue oxygenation in severely brain-injured patients
Effects of the neurological wake-up test on clinical examination, intracranial pressure, brain metabolism and brain tissue oxygenation in severely brain-injured patients. Critical care, Nov. 2012, 16: R22.
Helbok, R., et al.
http://ccforum.com/content/16/6/R226/abstract
Daily interruption of sedation (IS) has been implemented in 30- 40% of intensive care units worldwide and may improve outcome in medical intensive care patients. Little is known about the benefit of IS in acutely brain-injured patients.
Helbok, R., et al.
http://ccforum.com/content/16/6/R226/abstract
Daily interruption of sedation (IS) has been implemented in 30- 40% of intensive care units worldwide and may improve outcome in medical intensive care patients. Little is known about the benefit of IS in acutely brain-injured patients.
Feasibility of a sedation wake-up trial and spontaneous breathing trial in critically ill trauma patients
Feasibility of a sedation wake-up trial and spontaneous breathing trial in critically ill patients: A secondary analysis. Intensive & critical care nursing, Feb., 2013, Vol. 29(1), p.20-27.
Fiqueroa-Ramos, M.I., et al.
http://www.intensivecriticalcarenursing.com/article/PIIS0964339712000523/abstract?rss=yes
To determine the feasibility of conducting a sedation wake-up trial plus a spontaneous breathing trial in critically ill trauma patients based on the ability to implement the combined intervention; to measure and describe patients’ physiological responses; and to maintain patient safety.
Fiqueroa-Ramos, M.I., et al.
http://www.intensivecriticalcarenursing.com/article/PIIS0964339712000523/abstract?rss=yes
To determine the feasibility of conducting a sedation wake-up trial plus a spontaneous breathing trial in critically ill trauma patients based on the ability to implement the combined intervention; to measure and describe patients’ physiological responses; and to maintain patient safety.
Impact of a preventive programme on the occurrence of incidents during the transport of critically ill patients
Impact of a preventive programme on the occurrence of incidents during the transport of critically ill patients. Intensive & critical care nursing, Feb. 2013, Vol. 29(1), p.9-19.
Berube, M., et al.
http://www.intensivecriticalcarenursing.com/article/PIIS0964339712000742/abstract?rss=yes
Incidents related to transport of critically ill patients have been extensively reported. The objective of this study was to determine the effect of an interdisciplinary preventive programme used by all intensive care unit team members involved in patients’ transport on the rate of these incidents.
Berube, M., et al.
http://www.intensivecriticalcarenursing.com/article/PIIS0964339712000742/abstract?rss=yes
Incidents related to transport of critically ill patients have been extensively reported. The objective of this study was to determine the effect of an interdisciplinary preventive programme used by all intensive care unit team members involved in patients’ transport on the rate of these incidents.
Participation and support in intensive care as experienced by close relatives of patients
Participation and support in intensive care as experienced by close relatives of patients: A phenomenological study. Intensive and critical care nursing, Feb. 2013, Vol. 29(1), p.1-8.
Blom, H., et al.
http://www.intensivecriticalcarenursing.com/article/S0964-3397(12)00048-1/abstract
Participation with and support from health-care professionals are important for the relatives’ well-being and their ability to contribute to the patients’ care. Health-care professionals, especially critical care nurses, need to create an atmosphere that invites relatives to participate in the care provided at an ICU.
Blom, H., et al.
http://www.intensivecriticalcarenursing.com/article/S0964-3397(12)00048-1/abstract
Participation with and support from health-care professionals are important for the relatives’ well-being and their ability to contribute to the patients’ care. Health-care professionals, especially critical care nurses, need to create an atmosphere that invites relatives to participate in the care provided at an ICU.
Safety and efficacy of the Abcde bundle in critically-ill patients receiving mechanical ventilation
Safety and efficacy of the Abcde bundle in critically-ill patients receiving mechanical ventilation. Critical care medicine, oral abstract session.
Balas, M., et al.
http://journals.lww.com/ccmjournal/Abstract/2012/12001/1___Safety_and_Efficacy_of_the_Abcde_Bundle_in.4.aspx
There is strong, recent, convincing evidence that delirium, immobility, sedation, and ventilator management are closely interrelated. The purpose of this study was to evaluate the efficacy and safety of the ABCDE bundle in critically-ill patients receiving mechanical ventilation.
Balas, M., et al.
http://journals.lww.com/ccmjournal/Abstract/2012/12001/1___Safety_and_Efficacy_of_the_Abcde_Bundle_in.4.aspx
There is strong, recent, convincing evidence that delirium, immobility, sedation, and ventilator management are closely interrelated. The purpose of this study was to evaluate the efficacy and safety of the ABCDE bundle in critically-ill patients receiving mechanical ventilation.
Give enteral nutrition a chance in the critically ill
Give enteral nutrition a chance in the critically ill. BMJ 2012; 345:e8387.
http://www.bmj.com/highwire/filestream/619732/field_highwire_article_pdf/0/bmj.e8387
Intensive care specialists are still debating the best way to meet the complex nutritional needs of critically ill adults. International guidelines recommend enteral nutrition first but diverge on what to do when this is not enough.
http://www.bmj.com/highwire/filestream/619732/field_highwire_article_pdf/0/bmj.e8387
Intensive care specialists are still debating the best way to meet the complex nutritional needs of critically ill adults. International guidelines recommend enteral nutrition first but diverge on what to do when this is not enough.
Thursday, 22 November 2012
Weighing risks and benefits of stress ulcer prophylaxis in critically ill patients
Weighing risks and benefits of stress ulcer prophylaxis in critically ill patients. Critical care, Oct 2012, Vol. 16(5): 322.
Chanpura, T. & Yende, S.
http://ccforum.com/content/16/5/322
Recent observational studies suggest that bleeding from stress ulceration is extremely uncommon in intensive care unit patients. Furthermore, the risk of bleeding may not be altered by the use of acid suppressive therapy. Early enteral tube feeding (initiated within 48 h of intensive care unit admission) may account for this observation. Stress ulcer prophylaxis may, however, increase the risk of hospital-acquired pneumonia and Clostridia difficile infection.
Chanpura, T. & Yende, S.
http://ccforum.com/content/16/5/322
Recent observational studies suggest that bleeding from stress ulceration is extremely uncommon in intensive care unit patients. Furthermore, the risk of bleeding may not be altered by the use of acid suppressive therapy. Early enteral tube feeding (initiated within 48 h of intensive care unit admission) may account for this observation. Stress ulcer prophylaxis may, however, increase the risk of hospital-acquired pneumonia and Clostridia difficile infection.
Outcome of ICU patients with Clostridium difficile infection
Outcome of ICU patients with Clostridium difficile infection. Critical care, Nov. 2012, Vol. 16(6): R215.
Zahar, J-R., et al.
http://ccforum.com/content/16/6/R215/abstract
As data from Clostridium difficile infection in the intensive care unit are still scarce, our objectives were to assess the morbidity and mortality of ICU-acquired CDI.
Zahar, J-R., et al.
http://ccforum.com/content/16/6/R215/abstract
As data from Clostridium difficile infection in the intensive care unit are still scarce, our objectives were to assess the morbidity and mortality of ICU-acquired CDI.
Examining the positive effects of exercise in intubated adults in ICU
Examining the positive effects of exercise in intubated adults in ICU: A prospective repeated measures clinical study. Intensive & critical care nursing, Dec. 2012, Vol. 28(6), p.307-318.
Winkelman, C., et al.
http://www.intensivecriticalcarenursing.com/article/S0964-3397(12)00028-6/abstract
Determining the optimal timing and progression of mobility exercise has the potential to affect functional recovery of critically ill adults. This study compared standard care with care delivered using a mobility protocol.
Winkelman, C., et al.
http://www.intensivecriticalcarenursing.com/article/S0964-3397(12)00028-6/abstract
Determining the optimal timing and progression of mobility exercise has the potential to affect functional recovery of critically ill adults. This study compared standard care with care delivered using a mobility protocol.
Non-invasive mechanical ventilation in hematology patients
Non-invasive mechanical ventilation in hematology patients: Let's agree on several things first. Critical care 2012, 16:175.
Dnull, S., et al.
Acute respiratory failure is a dreaded and life-threatening event that represents the main reason for ICU admission. Respiratory events occur in up to 50% of hematology patients, including one-half of those admitted to the ICU. Mortality from acute respiratory failure in hematology patients depends on the patient's general status, acute respiratory failure etiology, need for mechanical ventilation and associated organ dysfunction. Non-invasive mechanical ventilation is clearly beneficial for chronic obstructive pulmonary disease exacerbation and cardiogenic pulmonary edema. These benefits are based mainly on the avoidance of invasive mechanical ventilation complications. Non-invasive mechanical has also been recommended in hematology patients with acute respiratory failure but its real benefits remain unclear in these settings. There is growing concern about the safety of non-invasive mechanical ventilation to treat hypoxemic acute respiratory failure overall, but also in hematology patients. Prophylactic non-invasive mechanical ventilation in patients with acute respiratory failure but not respiratory distress seems to be effective in hematology patients with a reduced rate of intubation. However, curative non-invasive mechanical ventilation should be restricted to those patients with isolated respiratory failure, with fast improvement of respiratory distress under non-invasive mechanical ventilation, and with rapid switch to intubation to avoid deleterious delays in optimal invasive mechanical ventilation.
Dnull, S., et al.
Acute respiratory failure is a dreaded and life-threatening event that represents the main reason for ICU admission. Respiratory events occur in up to 50% of hematology patients, including one-half of those admitted to the ICU. Mortality from acute respiratory failure in hematology patients depends on the patient's general status, acute respiratory failure etiology, need for mechanical ventilation and associated organ dysfunction. Non-invasive mechanical ventilation is clearly beneficial for chronic obstructive pulmonary disease exacerbation and cardiogenic pulmonary edema. These benefits are based mainly on the avoidance of invasive mechanical ventilation complications. Non-invasive mechanical has also been recommended in hematology patients with acute respiratory failure but its real benefits remain unclear in these settings. There is growing concern about the safety of non-invasive mechanical ventilation to treat hypoxemic acute respiratory failure overall, but also in hematology patients. Prophylactic non-invasive mechanical ventilation in patients with acute respiratory failure but not respiratory distress seems to be effective in hematology patients with a reduced rate of intubation. However, curative non-invasive mechanical ventilation should be restricted to those patients with isolated respiratory failure, with fast improvement of respiratory distress under non-invasive mechanical ventilation, and with rapid switch to intubation to avoid deleterious delays in optimal invasive mechanical ventilation.
Effects of etomidate on complications related to intubation and on mortality in septic shock patients treated with hydrocortisone
Effects of etomidate on complications related to intubation and on mortality in septic shock patients treated with hydrocortisone: a propensity score analysis. Critical care, November 2012, Vol. 16(6): R224.
Jung, B., et al.
http://ccforum.com/content/16/6/R224/abstract
Endotracheal intubation in the intensive care unit is associated with a high incidence of complications. Etomidate use is debated in septic shock because it increases the risk of critical illness-related corticosteroid insufficiency, which may impact outcome. We hypothesized that hydrocortisone, administered in all septic shock in our intensive care unit, and may counteract some negative effects of etomidate. The aim of our study was to compare septic shock patients who received etomidate vs another induction drug both on the short-term safety and the long-term outcomes.
Jung, B., et al.
http://ccforum.com/content/16/6/R224/abstract
Endotracheal intubation in the intensive care unit is associated with a high incidence of complications. Etomidate use is debated in septic shock because it increases the risk of critical illness-related corticosteroid insufficiency, which may impact outcome. We hypothesized that hydrocortisone, administered in all septic shock in our intensive care unit, and may counteract some negative effects of etomidate. The aim of our study was to compare septic shock patients who received etomidate vs another induction drug both on the short-term safety and the long-term outcomes.
Probiotics in the critically ill
Probiotics in the critically ill: A systematic review of the randomized trial evidence. Critical care medicine, December 2012, Vol. 40(12), p.3290-3302.
Petrof, E.O., et al.
http://journals.lww.com/ccmjournal/Abstract/2012/12000/Probiotics_in_the_critically_ill___A_systematic.22.aspx
Critical illness results in changes to the microbiology of the gastrointestinal tract, leading to a loss of commensal flora and an overgrowth of potentially pathogenic bacteria. Administering certain strains of live bacteria (probiotics) to critically ill patients may restore balance to the microbiota and have positive effects on immune function and gastrointestinal structure and function. The purpose of this systematic review was to evaluate the effect of probiotics in critically ill patients on clinical outcomes.
Petrof, E.O., et al.
http://journals.lww.com/ccmjournal/Abstract/2012/12000/Probiotics_in_the_critically_ill___A_systematic.22.aspx
Critical illness results in changes to the microbiology of the gastrointestinal tract, leading to a loss of commensal flora and an overgrowth of potentially pathogenic bacteria. Administering certain strains of live bacteria (probiotics) to critically ill patients may restore balance to the microbiota and have positive effects on immune function and gastrointestinal structure and function. The purpose of this systematic review was to evaluate the effect of probiotics in critically ill patients on clinical outcomes.
Effects of norepinephrine on mean systemic pressure and venous return in human septic shock
Effects of norepinephrine on mean systemic pressure and venous return in human septic shock. Critical care medicine, December 2012, Vol. 40(12), p.3146-53.
Persichini, R., et al.
http://journals.lww.com/ccmjournal/Abstract/2012/12000/Effects_of_norepinephrine_on_mean_systemic.5.aspx
Norepinephrine exerts venoconstriction that could increase both the mean systemic pressure and the resistance to venous return, but this has not yet been investigated in human septic shock. We examined the relative importance of both effects and the resulting effect on venous return when decreasing the dose of norepinephrine.
Persichini, R., et al.
http://journals.lww.com/ccmjournal/Abstract/2012/12000/Effects_of_norepinephrine_on_mean_systemic.5.aspx
Norepinephrine exerts venoconstriction that could increase both the mean systemic pressure and the resistance to venous return, but this has not yet been investigated in human septic shock. We examined the relative importance of both effects and the resulting effect on venous return when decreasing the dose of norepinephrine.
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