Sex and severe sepsis. Critical care 2013, 17:144
Guidet, B. and Maury, E.
http://ccforum.com/content/17/3/144
Epidemiological studies document that males are more prone than females to develop severe sepsis and this is confirmed by Sakr and colleagues in the previous issue of Critical Care. However, the impact of gender on prognosis of severe sepsis is a matter of debate. Sakr and colleagues report a higher mortality in septic females than in males. This puzzling result might be explained by confounding factors such as age, nosocomial infections, follow-up period, and case mix. The impact of sexual hormones in older females is less relevant. Treatments aimed at modifying sexual hormone profile are promising but need to be tested in future trials.
Thursday, 16 May 2013
How do we know when patients sleep properly or why they do not?
How do we know when patients sleep properly or why they do not? Critical care 2013, 17:145
Sjoberg, F. and Svanborg, E.
http://ccforum.com/content/17/3/145/abstract
The importance of adequate sleep for good health and immune system function is well documented as is reduced sleep quality experienced by ICU patients. In this issue of Critical Care, Elliot and co-workers present, a well done, largest of its kind, single center study on sleep patterns in critically ill patients. They base their study on the "gold standard", the polysomnography technique (PSG), which is resource demanding to perform and often difficult to evaluate.
Sjoberg, F. and Svanborg, E.
http://ccforum.com/content/17/3/145/abstract
The importance of adequate sleep for good health and immune system function is well documented as is reduced sleep quality experienced by ICU patients. In this issue of Critical Care, Elliot and co-workers present, a well done, largest of its kind, single center study on sleep patterns in critically ill patients. They base their study on the "gold standard", the polysomnography technique (PSG), which is resource demanding to perform and often difficult to evaluate.
Monday, 13 May 2013
Does space make waste? The influence of ICU bed capacity on admission decisions
Does space make waste? The influence of ICU bed capacity on admission decisions. Critical care, May 2013, 17: 315.
Esteban, M. and Khan, JM.
http://ccforum.com/content/17/3/315
Intensive care unit (ICU) beds are a scarce resource, and admissions may require prioritization when demand exceeds supply. However, there are few empiric data on whether the availability of ICU beds influences triage and processes of care for hospitalized patients who develop sudden clinical deterioration.
Esteban, M. and Khan, JM.
http://ccforum.com/content/17/3/315
Intensive care unit (ICU) beds are a scarce resource, and admissions may require prioritization when demand exceeds supply. However, there are few empiric data on whether the availability of ICU beds influences triage and processes of care for hospitalized patients who develop sudden clinical deterioration.
Monday, 29 April 2013
Mortality and quality of life in the five years after severe sepsis
Mortality and quality of life in the five years after severe sepsis. Critical care, 2013, 17: R70.
Cuthbertson, B.H., et al.
http://ccforum.com/content/17/2/R70/abstract
Severe sepsis is associated with high levels of morbidity and mortality placing a high burden on healthcare resources. We aimed to study outcomes in the 5 years after severe sepsis.
Cuthbertson, B.H., et al.
http://ccforum.com/content/17/2/R70/abstract
Severe sepsis is associated with high levels of morbidity and mortality placing a high burden on healthcare resources. We aimed to study outcomes in the 5 years after severe sepsis.
Decreasing severe pain and serious adverse events while moving intensive care unit patients
Decreasing severe pain and serious adverse events while moving intensive care unit patients: a prospective interventional study. Critical care, 2013, 17: R74.
de Jong, A., et al.
http://ccforum.com/content/17/2/R74/abstract
A quality-improvement project was conducted to reduce severe pain and stress-related events while moving ICU-patients. The Plan-Do-Check-Adjust cycle was studied during four one-month phases, separated by five-month interphases. All consecutive patients staying more than 24 hours were evaluated every morning while being moved for nursing care (bathing, massage, sheet-change, repositioning).
de Jong, A., et al.
http://ccforum.com/content/17/2/R74/abstract
A quality-improvement project was conducted to reduce severe pain and stress-related events while moving ICU-patients. The Plan-Do-Check-Adjust cycle was studied during four one-month phases, separated by five-month interphases. All consecutive patients staying more than 24 hours were evaluated every morning while being moved for nursing care (bathing, massage, sheet-change, repositioning).
A comparative study of varying doses of enoxaparin for thromboprophylaxis in critically ill patients
A comparative study of varying doses of enoxaparin for thromboprophylaxis in critically ill patients: double-blinded, randomised controlled trial. Critical care, 2013, 17: R75.
Robinson, S., et al.
http://ccforum.com/content/17/2/R75/abstract
Critically ill patients are predisposed to venous thromboembolism. We hypothesized that higher doses of enoxaparin would improve thromboprophylaxis without increasing the risk of bleeding.
Robinson, S., et al.
http://ccforum.com/content/17/2/R75/abstract
Critically ill patients are predisposed to venous thromboembolism. We hypothesized that higher doses of enoxaparin would improve thromboprophylaxis without increasing the risk of bleeding.
The effects of the semirecumbent position on hemodynamic status in patients on invasive mechanical ventilation
The effects of the semirecumbent position on hemodynamic status in patients on invasive mechanical ventilation: prospective randomized multivariable analysis. Critical care 2013, 17: R80.
Gocze, I., et al.
http://ccforum.com/content/17/2/R80/abstract
Adopting the 45degrees semirecumbent position in mechanically ventilated critically ill patients is recommended, as it has been shown to reduce the incidence of ventilator-associated pneumonia. Although the benefits to the respiratory system are clear, it is not known whether elevating the head of the bed results in hemodynamic instability.
Gocze, I., et al.
http://ccforum.com/content/17/2/R80/abstract
Adopting the 45degrees semirecumbent position in mechanically ventilated critically ill patients is recommended, as it has been shown to reduce the incidence of ventilator-associated pneumonia. Although the benefits to the respiratory system are clear, it is not known whether elevating the head of the bed results in hemodynamic instability.
Thursday, 25 April 2013
Intensive care unit-acquired weakness
Intensive care unit-acquired weakness: clinical phenotypes and molecular mechanisms. American journal of respiratory and critical care medicine. February 2013, Vol. 187(3), p.238-46.
Batt, J. et al.
http://www.ncbi.nlm.nih.gov/pubmed/23204256?dopt=Abstract
Intensive care unit-acquired weakness begins within hours of mechanical ventilation and may not be completely reversible over time. It represents a major functional morbidity of critical illness and is an important patient-centered outcome with clear implications for quality of life and resumption of prior work and lifestyle.
Batt, J. et al.
http://www.ncbi.nlm.nih.gov/pubmed/23204256?dopt=Abstract
Intensive care unit-acquired weakness begins within hours of mechanical ventilation and may not be completely reversible over time. It represents a major functional morbidity of critical illness and is an important patient-centered outcome with clear implications for quality of life and resumption of prior work and lifestyle.
Oxygen therapy in critical illness
Oxygen therapy in critical illness: precise control of arterial oxygenation and permissive hypoxemia. Critical care medicine, Feb 2013, Vol. 41(2), p.423-32.
Martin, D.S. and Grocott, M.P.
http://www.ncbi.nlm.nih.gov/pubmed/23263574?dopt=Abstract
The management of hypoxemia in critically ill patients is challenging. Whilst the harms of tissue hypoxia are well recognized, the possibility of harm from excess oxygen administration, or other interventions targeted at mitigating hypoxemia, may be inadequately appreciated. The benefits of attempting to fully reverse arterial hypoxemia may be outweighed by the harms associated with high concentrations of supplemental oxygen and invasive mechanical ventilation strategies. We propose two novel related strategies for the management of hypoxemia in critically ill patients.
Martin, D.S. and Grocott, M.P.
http://www.ncbi.nlm.nih.gov/pubmed/23263574?dopt=Abstract
The management of hypoxemia in critically ill patients is challenging. Whilst the harms of tissue hypoxia are well recognized, the possibility of harm from excess oxygen administration, or other interventions targeted at mitigating hypoxemia, may be inadequately appreciated. The benefits of attempting to fully reverse arterial hypoxemia may be outweighed by the harms associated with high concentrations of supplemental oxygen and invasive mechanical ventilation strategies. We propose two novel related strategies for the management of hypoxemia in critically ill patients.
Toothbrushing for critically ill mechanically ventilated patients
Toothbrushing for critically ill mechanically ventilated patients: a systematic review and meta-analysis of randomized trials evaluating ventilator-associated pneumonia. Critical care medicine, Feb 2013, Vol. 41(2), p.646-55.
Alhazzani, W. et al.
http://www.ncbi.nlm.nih.gov/pubmed/23263588?dopt=Abstract
Oral care may decrease ventilator-associated pneumonia in the ICU. The objective of this review was to summarize and critically appraise randomized trials in mechanically ventilated patients in the ICU testing the effect of oral care strategies involving toothbrushing on ventilator-associated pneumonia.
Alhazzani, W. et al.
http://www.ncbi.nlm.nih.gov/pubmed/23263588?dopt=Abstract
Oral care may decrease ventilator-associated pneumonia in the ICU. The objective of this review was to summarize and critically appraise randomized trials in mechanically ventilated patients in the ICU testing the effect of oral care strategies involving toothbrushing on ventilator-associated pneumonia.
Surviving sepsis campaign
Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock. Critical care medicine, Feb 2013, Vol. 41(2); p.580-637.
Dellinger, R.P., et al.
http://www.ncbi.nlm.nih.gov/pubmed/23353941?dopt=Abstract
Objective: To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008.
Dellinger, R.P., et al.
http://www.ncbi.nlm.nih.gov/pubmed/23353941?dopt=Abstract
Objective: To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008.
Monday, 25 March 2013
Is this the end of the road for synthetic starches in critical illness?
Is this the end of the road for synthetic starches in critical illness? BMJ 2013, 346:f1805.
Prowle, J.R. and Pearse, R.M.
http://www.bmj.com/content/346/bmj.f1805.pdf%2Bhtml
Maintaining effective plasma volume is, perhaps, the most persistent challenge faced by clinicians who treat critically ill patients, in particular those with sepsis. In patients with sepsis, increased capillary permeability and loss of vascular tone cause loss of circulating plasma volume, which contributes to inadequate cardiac output and tissue perfusion.
Prowle, J.R. and Pearse, R.M.
http://www.bmj.com/content/346/bmj.f1805.pdf%2Bhtml
Maintaining effective plasma volume is, perhaps, the most persistent challenge faced by clinicians who treat critically ill patients, in particular those with sepsis. In patients with sepsis, increased capillary permeability and loss of vascular tone cause loss of circulating plasma volume, which contributes to inadequate cardiac output and tissue perfusion.
The effect of a quality improvement intervention on perceived sleep quality and cognition in a medical ICU
The effect of a quality improvement intervention on perceived sleep quality and cognition in a medical ICU. Critical care medicine, March 2013, Vol. 41(3), p.800-09.
Kamdar, B.B., et al.
http://journals.lww.com/ccmjournal/Abstract/2013/03000/The_Effect_of_a_Quality_Improvement_Intervention.12.aspx
An ICU-wide quality improvement intervention to improve sleep and delirium is feasible and associated with significant improvements in perceived nighttime noise, incidence of delirium/coma, and daily delirium/coma-free status. Improvement in perceived sleep quality did not reach statistical significance.
Kamdar, B.B., et al.
http://journals.lww.com/ccmjournal/Abstract/2013/03000/The_Effect_of_a_Quality_Improvement_Intervention.12.aspx
An ICU-wide quality improvement intervention to improve sleep and delirium is feasible and associated with significant improvements in perceived nighttime noise, incidence of delirium/coma, and daily delirium/coma-free status. Improvement in perceived sleep quality did not reach statistical significance.
Hydroxyethyl starch in severe sepsis: End of starch era?
Hydroxyethyl starch in severe sepsis: End of starch era? Critical care, March 2013, 17: 310.
Estrada, C.A. and Murugan, R.
http://ccforum.com/content/17/2/310
Hydroxyethyl starch (HES) is widely used for fluid resuscitation in ICUs, but its safety and efficacy have not been established in patients with severe sepsis.
Estrada, C.A. and Murugan, R.
http://ccforum.com/content/17/2/310
Hydroxyethyl starch (HES) is widely used for fluid resuscitation in ICUs, but its safety and efficacy have not been established in patients with severe sepsis.
Characterisation of sleep in intensive care using 24 hour polysomnography : An observational study
Characterisation of sleep in intensive care using 24 hour polysomnography: An observational study. Critical care, March 2013, 17:R46.
Elliott, R., et al.
http://ccforum.com/content/17/2/R46/abstract
Many intensive care patients experience sleep disruption potentially related to noise, light and treatment interventions. The purpose of this study was to characterise, in terms of quantity and quality, the sleep of intensive care patients, taking into account the impact of environmental factors.
Elliott, R., et al.
http://ccforum.com/content/17/2/R46/abstract
Many intensive care patients experience sleep disruption potentially related to noise, light and treatment interventions. The purpose of this study was to characterise, in terms of quantity and quality, the sleep of intensive care patients, taking into account the impact of environmental factors.
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