Prognosis and ICU outcome of systematic vasculitis. BMC Anesthesiology 2013, 13:27
Befort, P., et al.
http://www.biomedcentral.com/1471-2253/13/27/abstract
Systemic vasculitis may cause life threatening complications requiring admission to an intensive care unit (ICU). The aim of this study was to evaluate outcomes of systemic vasculitis patients admitted to the ICU and to identify prognosis factors.
Monday, 14 October 2013
Body temperature patterns as a predictor of hospital-acquired sepsis in afebrile adult intensive care unit patients
Body temperature patterns as a predictor of hospital-acquired sepsis in afebrile adult intensive care unit patients: A case-control study. Critical care, Sept 2013, 17: R200
Drewry, A.M., et al.
http://ccforum.com/content/17/5/R200/abstract
Early treatment of sepsis improves survival, but early diagnosis of hospital-acquired sepsis, especially in critically ill patients, is challenging. Evidence suggests that subtle changes in body temperature patterns may be an early indicator of sepsis, but data is limited. The aim of this study was to examine whether abnormal body temperature patterns, as identified by visual examination, could predict the subsequent diagnosis of sepsis in afebrile critically ill patients.
Drewry, A.M., et al.
http://ccforum.com/content/17/5/R200/abstract
Early treatment of sepsis improves survival, but early diagnosis of hospital-acquired sepsis, especially in critically ill patients, is challenging. Evidence suggests that subtle changes in body temperature patterns may be an early indicator of sepsis, but data is limited. The aim of this study was to examine whether abnormal body temperature patterns, as identified by visual examination, could predict the subsequent diagnosis of sepsis in afebrile critically ill patients.
Resuscitation fluids
Resuscitation fluids. NEJM, Oct 2013, 369: 1243-51
Myburgh, J.A. and Mythen, M.G.
http://www.cwrumedicine.org/images/current_residents/resuscitation%20fluids.pdf
Fluid resuscitation with colloid and crystalloid solutions is a ubiquitous intervention in acute medicine. The selection and use of resuscitation fluids is based on physiological principles, but clinical practice is determined largely by clinician preference with marked regional variation. No ideal resuscitation fluid exists. There is emerging evidence that the type and dose of resuscitation fluid may affect patient-centered outcomes.
Myburgh, J.A. and Mythen, M.G.
http://www.cwrumedicine.org/images/current_residents/resuscitation%20fluids.pdf
Fluid resuscitation with colloid and crystalloid solutions is a ubiquitous intervention in acute medicine. The selection and use of resuscitation fluids is based on physiological principles, but clinical practice is determined largely by clinician preference with marked regional variation. No ideal resuscitation fluid exists. There is emerging evidence that the type and dose of resuscitation fluid may affect patient-centered outcomes.
Long-term cognitive impairment after critical illness
Long-term cognitive impairment after critical illness. NEJM, Oct 2013, 369: 1306-16
Pandharipande, P.P., et al.
http://www.nejm.org/doi/full/10.1056/NEJMoa1301372?af=R&rss=currentIssue
Survivors of critical illness often have a prolonged and disabling form of cognitive impairment that remains inadequately characterized. We enrolled adults with respiratory failure or shock in the medical or surgical intensive care unit (ICU), evaluated them for in-hospital delirium, and assessed global cognition and executive function 3 and 12 months after discharge.
Pandharipande, P.P., et al.
http://www.nejm.org/doi/full/10.1056/NEJMoa1301372?af=R&rss=currentIssue
Survivors of critical illness often have a prolonged and disabling form of cognitive impairment that remains inadequately characterized. We enrolled adults with respiratory failure or shock in the medical or surgical intensive care unit (ICU), evaluated them for in-hospital delirium, and assessed global cognition and executive function 3 and 12 months after discharge.
Intensivists at night
Intensivists at night: putting resources in the right place. Critical care, October 2013, 17: 1008
Levy, M.M.
[no online link available]
During the past 50 years, caring for the critically ill has become increasingly complex and the need for an intensivist has become more evident. Management by intensivists has become a quality indicator for many ICUs. Numerous small studies have demonstrated the beneficial effect of intensivists on outcomes in the critically ill, and some clinicians have advanced the argument that a night-time intensivist is essential for the care of critically ill patients. In response, many institutions have hired full-time intensivists for both day and night coverage in the ICU. Two recent studies have been conducted that make a compelling argument for redirecting funding of night-time intensivists to areas of greater need in health care. In a retrospective analysis of a large database that involved more than 65,000 patients, no benefit of night-time intensivists could be found in ICUs where care is managed by intensivists during the day. Only in ICUs where management by intensivists is not mandated could a beneficial impact on mortality be found. The second study, a randomized controlled trial, evaluated the effect of night-time intensivists on length of stay, mortality, and other outcomes and was a negative trial. In this methodologically rigorous trial, there was no difference in outcomes between the intensivist and control group, which consisted of in-house resident coverage at night with availability by telephone of fellows and intensivists. These two robust studies clearly suggest that night-time intensivists do not improve mortality in ICUs managed by intensivists during the day. Though possibly beneficial in low-intensity environments, the widespread drive to add night-time intensivist coverage may have been premature.
Levy, M.M.
[no online link available]
During the past 50 years, caring for the critically ill has become increasingly complex and the need for an intensivist has become more evident. Management by intensivists has become a quality indicator for many ICUs. Numerous small studies have demonstrated the beneficial effect of intensivists on outcomes in the critically ill, and some clinicians have advanced the argument that a night-time intensivist is essential for the care of critically ill patients. In response, many institutions have hired full-time intensivists for both day and night coverage in the ICU. Two recent studies have been conducted that make a compelling argument for redirecting funding of night-time intensivists to areas of greater need in health care. In a retrospective analysis of a large database that involved more than 65,000 patients, no benefit of night-time intensivists could be found in ICUs where care is managed by intensivists during the day. Only in ICUs where management by intensivists is not mandated could a beneficial impact on mortality be found. The second study, a randomized controlled trial, evaluated the effect of night-time intensivists on length of stay, mortality, and other outcomes and was a negative trial. In this methodologically rigorous trial, there was no difference in outcomes between the intensivist and control group, which consisted of in-house resident coverage at night with availability by telephone of fellows and intensivists. These two robust studies clearly suggest that night-time intensivists do not improve mortality in ICUs managed by intensivists during the day. Though possibly beneficial in low-intensity environments, the widespread drive to add night-time intensivist coverage may have been premature.
Thursday, 26 September 2013
Implementing delirium screening in the ICU
Implementing delirium screening in the ICU: Secrets to success. Critical care medicine, Sept 2013, Vol. 41(9), p.2196-2208.
Brummel, N.E. et al.
http://journals.lww.com/ccmjournal/Abstract/2013/09000/Implementing_Delirium_Screening_in_the_ICU__.15.aspx
To review delirium screening tools available for use in the adult ICU and PICU, to review evidence-based delirium screening implementation, and to discuss common pitfalls encountered during delirium screening in the ICU.
Brummel, N.E. et al.
http://journals.lww.com/ccmjournal/Abstract/2013/09000/Implementing_Delirium_Screening_in_the_ICU__.15.aspx
To review delirium screening tools available for use in the adult ICU and PICU, to review evidence-based delirium screening implementation, and to discuss common pitfalls encountered during delirium screening in the ICU.
The pain, agitation and delirium care bundle
The pain, agitation and delirium care bundle: Synergistic benefits of implementing the 2013 pain, agitation and delirium guidelines in an integrated and interdisciplinary fashion. Critical care medicine, Sept 2013, Vol. 41(9), p.S99-115
Barr, J. and Pandharipande, P.P.
http://journals.lww.com/ccmjournal/Abstract/2013/09001/The_Pain,_Agitation,_and_Delirium_Care_Bundle__.9.aspx
In 2013, the American College of Critical Care Medicine published a revised version of the pain, agitation, and delirium guidelines. The guidelines included an ICU pain, agitation, and delirium care bundle designed to facilitate implementation of the pain, agitation, and delirium guidelines.
Barr, J. and Pandharipande, P.P.
http://journals.lww.com/ccmjournal/Abstract/2013/09001/The_Pain,_Agitation,_and_Delirium_Care_Bundle__.9.aspx
In 2013, the American College of Critical Care Medicine published a revised version of the pain, agitation, and delirium guidelines. The guidelines included an ICU pain, agitation, and delirium care bundle designed to facilitate implementation of the pain, agitation, and delirium guidelines.
Body temperature patterns as a predictor of hospital-acquired sepsis in afebrile adult intensive care unit patients : a case-control study
Body temperature patterns as a predictor of hospital-acquired sepsis in afebrile adult intensive care unit patients: A case-control study. Critical care, Sept 2013, 17: R200
Drewry, A.M., et al.
http://ccforum.com/content/pdf/cc12894.pdf
Early treatment of sepsis improves survival, but early diagnosis of hospital-acquired sepsis, especially in critically ill patients, is challenging. Evidence suggests that subtle changes in body temperature patterns may be an early indicator of sepsis, but data is limited. The aim of this study was to examine whether abnormal body temperature patterns, as identified by visual examination, could predict the subsequent diagnosis of sepsis in afebrile critically ill patients.
Drewry, A.M., et al.
http://ccforum.com/content/pdf/cc12894.pdf
Early treatment of sepsis improves survival, but early diagnosis of hospital-acquired sepsis, especially in critically ill patients, is challenging. Evidence suggests that subtle changes in body temperature patterns may be an early indicator of sepsis, but data is limited. The aim of this study was to examine whether abnormal body temperature patterns, as identified by visual examination, could predict the subsequent diagnosis of sepsis in afebrile critically ill patients.
Skeletal muscle predicts ventilator-free days, ICU-free days and mortality in elderly ICU patients
Skeletal muscle predicts ventilator-free days, ICU-free days and mortality in elderly ICU patients. Critical care, Sept 2013, 17: R206
Mosiey, L.L., et al.
http://ccforum.com/content/pdf/cc12901.pdf
As the population ages, the number of injured elderly is increasing. We sought to determine if
low skeletal muscle mass adversely affected outcome in elderly patients following trauma.
Mosiey, L.L., et al.
http://ccforum.com/content/pdf/cc12901.pdf
As the population ages, the number of injured elderly is increasing. We sought to determine if
low skeletal muscle mass adversely affected outcome in elderly patients following trauma.
Developing an early screening instrument for predicting psychological morbidity after critical illness
Developing an early screening instrument for predicting psychological morbidity after critical illness. Critical care, Sept 2013, 17: R210
Schandl, A., et al.
http://ccforum.com/content/pdf/cc13018.pdf
Guidelines recommend follow-up for patients after intensive care unit (ICU) stay. Methods for identifying patients with psychological problems after intensive care would be of value, to optimize treatment and to improve adequate resource allocation in ICU followup of ICU survivors. The aim of the study was to develop a predictive screening instrument – for use at ICU discharge – to identify patients at risk for post-traumatic stress, anxiety or depression.
Schandl, A., et al.
http://ccforum.com/content/pdf/cc13018.pdf
Guidelines recommend follow-up for patients after intensive care unit (ICU) stay. Methods for identifying patients with psychological problems after intensive care would be of value, to optimize treatment and to improve adequate resource allocation in ICU followup of ICU survivors. The aim of the study was to develop a predictive screening instrument – for use at ICU discharge – to identify patients at risk for post-traumatic stress, anxiety or depression.
A prospective longitudinal multicentre study of health related qualify of life in ICU survivors with COPD
A prospective longitudinal multicentre study of health related quality of life of ICU survivors with COPD. Critical care, Sept 2013, 17:R211
Berkius, J., et al.
http://ccforum.com/content/pdf/cc13019.pdf
Mortality amongst COPD patients treated on the ICU is high. Health-related quality of life (HRQL) after intensive care is a relevant concern for COPD patients, their families and providers of health care. Still, there are few HRQL studies after intensive care of this patient group. Our hypothesis was that HRQL of COPD patients treated on the ICU declines rapidly with time.
Berkius, J., et al.
http://ccforum.com/content/pdf/cc13019.pdf
Mortality amongst COPD patients treated on the ICU is high. Health-related quality of life (HRQL) after intensive care is a relevant concern for COPD patients, their families and providers of health care. Still, there are few HRQL studies after intensive care of this patient group. Our hypothesis was that HRQL of COPD patients treated on the ICU declines rapidly with time.
Severe sepsis and septic shock
Severe sepsis and septic shock. N Engl J Med 2013; 369: p.840-851
Angus, D.C. and van der Poll, T.
http://www.nejm.org/doi/full/10.1056/NEJMra1208623?af=R&rss=currentIssue
Sepsis is one of the oldest and most elusive syndromes in medicine. Hippocrates claimed that sepsis (σήψις) was the process by which flesh rots, swamps generate foul airs, and wounds fester.Galen later considered sepsis a laudable event, necessary for wound healing. With the confirmation of germ theory by Semmelweis, Pasteur, and others, sepsis was recast as a systemic infection, often described as “blood poisoning,” and assumed to be the result of the host's invasion by pathogenic organisms that then spread in the bloodstream. However, with the advent of modern antibiotics, germ theory did not fully explain the pathogenesis of sepsis: many patients with sepsis died despite successful eradication of the inciting pathogen.
Angus, D.C. and van der Poll, T.
http://www.nejm.org/doi/full/10.1056/NEJMra1208623?af=R&rss=currentIssue
Sepsis is one of the oldest and most elusive syndromes in medicine. Hippocrates claimed that sepsis (σήψις) was the process by which flesh rots, swamps generate foul airs, and wounds fester.Galen later considered sepsis a laudable event, necessary for wound healing. With the confirmation of germ theory by Semmelweis, Pasteur, and others, sepsis was recast as a systemic infection, often described as “blood poisoning,” and assumed to be the result of the host's invasion by pathogenic organisms that then spread in the bloodstream. However, with the advent of modern antibiotics, germ theory did not fully explain the pathogenesis of sepsis: many patients with sepsis died despite successful eradication of the inciting pathogen.
Thursday, 22 August 2013
Physical therapy for the critically ill in the ICU
Physical therapy for the critically ill in the ICU: A systematic review and meta-analysis. Critical care medicine, June 2013, Vol. 41(6), p.1543-54.
Kayambu, G., et al.
http://journals.lww.com/ccmjournal/Abstract/2013/06000/Physical_Therapy_for_the_Critically_Ill_in_the.19.aspx
The purpose of this systematic review was to review the evidence base for exercise in critically ill patients.
Kayambu, G., et al.
http://journals.lww.com/ccmjournal/Abstract/2013/06000/Physical_Therapy_for_the_Critically_Ill_in_the.19.aspx
The purpose of this systematic review was to review the evidence base for exercise in critically ill patients.
Physical rehabilitation of the critically ill trauma patient in the ICU
Physical rehabilitation of the critically ill trauma patient in the ICU. Critical care medicine, July 2013, Vol. 41(7), p. 1790-1801.
Engels, P.T., et al.
http://journals.lww.com/ccmjournal/Abstract/2013/07000/Physical_Rehabilitation_of_the_Critically_Ill.24.aspx
Objectives: To review the existing evidence for early mobilization of the critically ill patients in the ICU with polytrauma; provide intensivists with an introduction to the biomechanics, physiology, and nomenclature of injuries; summarize the evidence for early mobilization in each anatomic area; and provide recommendations for the mobilization of these patients.
Engels, P.T., et al.
http://journals.lww.com/ccmjournal/Abstract/2013/07000/Physical_Rehabilitation_of_the_Critically_Ill.24.aspx
Objectives: To review the existing evidence for early mobilization of the critically ill patients in the ICU with polytrauma; provide intensivists with an introduction to the biomechanics, physiology, and nomenclature of injuries; summarize the evidence for early mobilization in each anatomic area; and provide recommendations for the mobilization of these patients.
Do windows or natural views affect outcomes or costs among patients in ICUs?
Do windows or natural views affect outcomes or costs among patients in ICUs? Critical care medicine, July 2013, Vol. 41(7), p.1645-55.
Kohn, R., et al.
http://journals.lww.com/ccmjournal/Abstract/2013/07000/Do_Windows_or_Natural_Views_Affect_Outcomes_or.7.aspx
Objective: To determine whether potential exposure to natural light via windows or to more pleasing views through windows affects outcomes or costs among critically ill patients.
Kohn, R., et al.
http://journals.lww.com/ccmjournal/Abstract/2013/07000/Do_Windows_or_Natural_Views_Affect_Outcomes_or.7.aspx
Objective: To determine whether potential exposure to natural light via windows or to more pleasing views through windows affects outcomes or costs among critically ill patients.
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