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Am J Respir Crit Care Med 2001 Jun;163(7):1755-6
Effect of unplanned extubation on outcome of mechanical ventilation.
Kapadia F
Publication Types:
PMID: 11401899, UI: 21294719
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Anaesthesia 2001 Jul;56(7):670-5
A pilot study to investigate the effects of an infusion of aminophylline
on renal function following major abdominal surgery.
Parker MR, Willatts SM
Department of Anaesthetics, Bristol Royal Infirmary, Bristol BS2 8HW,
UK.
Acute renal failure is a frequent complication of critical illness and
optimal preventive therapy remains elusive. There is increasing evidence
from animal models and some human studies that adenosine receptor antagonism
by aminophylline may reduce the severity of renal impairment caused by
a variety of aetiologies. We studied the renal effects of intravenous
aminophylline in an unblinded, within-patient study of 20 patients admitted
to a general intensive care unit following major surgery. We demonstrated
that there were no adverse cardiovascular complications related to aminophylline
therapy. Renal sodium and osmolar clearance increased with a non-significant
trend towards increased diuresis during treatment. Creatinine clearance,
however, was unchanged but the study was not designed and did not have
the power to test whether aminophylline increased renal blood flow or
glomerular filtration rate. We suggest the renal actions of aminophylline
in critical illness merit further investigation.
Publication Types:
- Clinical trial
- Controlled clinical trial
PMID: 11437769, UI: 21331122
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Anaesthesist 2001 Jun;50(6):436-41
[Bicycling versus intensive care units--twice "hemoglobin doping"]?
[Article in German]
Welte M, Schaffartzik W
Klinik fur Anaesthesiologie und operative Intensivmedizin, Klinikum Benjamin
Franklin der Freien Universitat Berlin, Hindenburgdamm 30, 12200 Berlin.
welte@medizin.fu-berlin.de
Publication Types:
PMID: 11458726, UI: 21352364
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Anaesthesist 2001 May;50(5):329-32
[Malignant neuroleptic syndrome after haloperidol administration].
[Article in German]
Gerbershagen MU, Ito WD, Wappler F, Fiege M, Schulte am Esch J
Klinik fur Anasthesiologie, Universitatsklinikum Hamburg-Eppendorf, Martinistrasse
52, 20246 Hamburg. gerbershagen@uke.uni-hamburg.de
The neuroleptic malignant syndrome (NMS) is a rare complication of antipsychotic
therapy. We report on a 65-year-old patient who was treated with haloperidol,
diazepam and mirtazapin because of a severe depressive episode with psychotic
symptoms. He exhibited most of the signs and symptoms characteristic of
NMS, e.g.: hyperthermia, rigidity, elevated creatine phosphokinase, leukocytosis,
elevated liver enzymes, reduced consciousness and autonomic nervous system
disturbances. A secondary pneumonia was diagnosed 2 days after the onset
of the NMS, which might have been due to chest wall rigidity. Intensive
care treatment consisted of immediate discontinuation of the offending
agent, supportive therapy with rehydratation and catecholamines as well
as application of dantrolen. After 23 days of intensive therapy all pathological
parameters were normalised and the patient was transferred to an internal
ward. Three main theories on the pathogenesis of NMS exist: 1. blockade
of central receptors, 2. a skeletal muscle target model and 3. sympathoadrenal
hyperactivity. The differential diagnosis includes among others malignant
hyperthermia and serotonin syndrome.
PMID: 11417268, UI: 21310941
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Ann Intern Med 2001 Aug 7;135(3):175-83
The effect of vancomycin and third-generation cephalosporins on prevalence
of vancomycin-resistant enterococci in 126 U.S. adult intensive care units.
Fridkin SK, Edwards JR, Courval JM, Hill H, Tenover FC, Lawton R, Gaynes
RP, McGowan JE Jr
Division of Healthcare Quality Promotion, National Center for Infectious
Diseases, Centers for Disease Control and Prevention, MS A-35, 1600 Clifton
Road, Atlanta, GA 30333, USA. skf0@cdc.gov
BACKGROUND: Patient-specific risk factors for acquisition of vancomycin-resistant
enterococci (VRE) among hospitalized patients are becoming well defined.
However, few studies have reported data on the institutional risk factors,
including rates of antimicrobial use, that predict rates of VRE. Identifying
modifiable institutional factors can advance quality-improvement efforts
to minimize hospital-acquired infections with VRE. OBJECTIVE: To determine
the independent importance of any association between antimicrobial use
and risk factors for nosocomial infection on rates of VRE in intensive
care units (ICUs). DESIGN: Prospective ecologic study. SETTING: 126 adult
ICUs from 60 U.S. hospitals from January 1996 through July 1999. PATIENTS:
All patients admitted to participating ICUs. MEASUREMENTS: Monthly use
of antimicrobial agents (defined daily doses per 1000 patient-days), nosocomial
infection rates, and susceptibilities of all tested enterococci isolated
from clinical cultures. RESULTS: Prevalence of VRE (median, 10%; range,
0% to 59%) varied by type of ICU and by teaching status and size of the
hospital. Prevalence of VRE was strongly associated with VRE prevalence
among inpatient non-ICU areas and outpatient areas in the hospital, ventilator-days
per 1000 patient-days, and rate of parenteral vancomycin use. In a weighted
linear regression model controlling for type of ICU and rates of VRE among
non-ICU inpatient areas, rates of vancomycin use (P < 0.001) and third-generation
cephalosporin use (P = 0.02) were independently associated with VRE prevalence.
CONCLUSIONS: Higher rates of vancomycin or third-generation cephalosporin
use were associated with increased prevalence of VRE, independent of other
ICU characteristics and the endemic VRE prevalence elsewhere in the hospital.
Decreasing the use rates of these antimicrobial agents could reduce rates
of VRE in ICUs.
PMID: 11487484, UI: 21379786
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Br J Anaesth 2001 Aug;87(2):186-92
Sedative and analgesic practice in the intensive care unit: the results
of a European survey.
Soliman HM, Melot C, Vincent JL
Department of Intensive Care, Erasme University Hospital, Free University
of Brussels, Route de Lennik 808, B-1070 Brussels, BelgiumCorresponding
author.
[Medline record in process]
Sedation and analgesia are important aspects of patient care on the intensive
care unit (ICU), yet relatively little information is available on common
sedative and analgesic practice. We sought to assess international differences
in the prescription of sedative and analgesic drugs in western European
ICUs by means of a short, self-administered questionnaire. Six hundred
and forty-seven intensive care physicians from 16 western European countries
replied to the questionnaire. Midazolam was used as a sedative often or
always by 63% of respondents and propofol by 35%. There were considerable
international variations, with midazolam being preferred over propofol
in France, Germany, the Netherlands, Norway and Austria. For analgesia,
the drugs most commonly used were morphine (33%), fentanyl (33%) and sufentanil
(24%). Morphine was preferred over fentanyl and sufentanil in Norway,
UK and Ireland, Sweden, Switzerland, the Netherlands, and Spain and Portugal.
Fentanyl was preferred in France, Germany and Italy. Sufentanil was preferred
in Belgium and Luxemburg and in Austria. Multivariate analysis showed
that the combination of midazolam with fentanyl was most often used in
France; propofol with morphine in Sweden, the UK and Ireland, and Switzerland;
midazolam with morphine in Norway; and propofol with sufentanil in Belgium
and Luxemburg, Germany and Italy. The use of a sedation scale varied from
72% in the UK and Ireland to 18% in Austria. When used, the most common
sedation scale was the Ramsay scale. This study demonstrates substantial
international differences in sedative and analgesic practices in western
European ICUs. Br J Anaesth 2001; 87: 186-92
PMID: 11493487, UI: 21384799
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Br J Anaesth 2001 Jul;87(1):155-6
Right heart catheterization in intensive care.
Heneghan C
Publication Types:
PMID: 11460807, UI: 21353872
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Pediatrics 2001 Aug;108(2):426-31
Are neonatal intensive care resources located according to need? regional
variation in neonatologists, beds, and low birth weight newborns.
Goodman DC, Fisher ES, Little GA, Stukel TA, Chang Ch
Department of Pediatrics, Dartmouth Medical School, Hanover, New Hampshire.
[Medline record in process]
Objective. Despite marked growth in neonatal intensive care during the
past 30 years, it is not known if neonatologists and beds are preferentially
located in regions with greater newborn risk. This study reports the relationship
between regional measures of intensive care capacity and low birth weight
infants using newly developed market-based regions of neonatal intensive
care. Design. Cross-sectional small-area analysis of 246 neonatal intensive
care regions (NICRs). Data Sources. 1996 American Medical Association
and American Osteopathic Association masterfiles data of clinically active
neonatologists; 1999 American Academy of Pediatrics Section on Perinatal
Pediatrics survey of directors of neonatal intensive care units in the
United States with 100% response rate; 1995 linked birth/death data. Results.
The number of total births per neonatologist across NICRs ranged from
390 to 8197 (median: 1722) and the number of total births per intensive
care bed ranged from 72 to 1319 (median: 317). The associations between
capacity measures and low birth weight rates across NICRs were statistically
significant but negligible (R(2): 0.04 for neonatologists; 0.05 for beds).
NICRs in the quintile with the greatest neonatologist capacity (average
of only 863 births per neonatologist) had very low birth weight (VLBW)
rates of 1.5% while those in the quintile of lowest neonatologist capacity
(average of 3718 births per neonatologist) had VLBW rates of 1.3%; a similar
lack of meaningful difference in VLBW rates was noted across quintiles
of intensive care bed capacity. Including midlevel providers and intermediate
care beds to the analyses did not alter the findings. Conclusions. Neonatal
intensive care capacity is not preferentially located in regions with
greater newborn need as measured by low birth weight rates. Whether greater
capacity affords benefits to the newborns remains unknown.
PMID: 11483810, UI: 21376732
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Pediatrics 2001 Apr;107(4):648-55
Effect of a statewide neonatal resuscitation training program on Apgar
scores among high-risk neonates in Illinois.
Patel D, Piotrowski ZH, Nelson MR, Sabich R
Catholic Health Partners-Saint Joseph Hospital, Chicago, Illinois, USA.
OBJECTIVE: The national Neonatal Resuscitation Program (NRP), started
in 1987, provided training to hospital delivery room personnel to standardize
knowledge and skills to reduce neonatal morbidity and mortality and increase
successful resuscitation during the first few critical minutes after birth.
The Apgar score continues to be used as the best established index of
immediate postnatal health. The purpose of this study was to evaluate
the impact of the NRP instruction in Illinois hospitals by examining Apgar
scores among high-risk infants who are likely to benefit from the NRP.
METHODS: A retrospective 3-time period cohort design was used (before
the introduction of the NRP, 1985-1988; transition when NRP training occurred,
1989-1990; and after NRP training was completed at least once for some
delivery room personnel in each Illinois hospital, 1991-1995). Illinois
computerized birth certificate files on a selected group of 636 429 high-risk
neonates provided information on Apgar scores and maternal characteristics.
The American Academy of Pediatrics provided instructor lists to determine
when NRP training started and when it was fully implemented in Illinois.
Illinois Department of Public Health provided data to categorize hospitals
into levels based on type and intensity of neonatal services (Level I,
II, II+, III). High-risk neonates were defined as meeting 1 of the following
criteria: maternal age <20 years old or >35 years old, birth weight
<2500 g or >4000 g, presence of a maternal medical risk factor,
and no prenatal care or prenatal care started after the first trimester.
Several exclusion criteria were applied including the following: birth
records with missing data, multiple birth or congenital anomaly, and hospital
information that indicate no birth deliveries in 1 of the 11 study years
or delivery outside of a hospital. One-minute and 5-minute Apgar scores
were divided into categories for analysis (0-3, 4-6, 7-10). No change
or a decrease in a low (0-6) 1-minute Apgar when compared with the 5-minute
Apgar was a primary measure to evaluate effect of NRP resuscitation. Variables
examined included the following: race/ethnicity, maternal age, level of
education, presence of maternal medical risk factor, trimester started
prenatal care, complications of labor and delivery, and a low birth weight.
Analysis consisted of chi(2) tests, relative risk calculations, and logistic
regression to reveal independent associations with no change in low 1-minute
Apgar score or continued low (0-6) 5-minute Apgar. RESULTS: A total of
636 429 high-risk birth records was selected for detailed analyses out
of 2 077 533 births in Illinois between 1985 and 1995 for 193 hospitals.
The number of active NRP instructors in Illinois changed dramatically
during the study period; for example, 1 to 6 between 1987 and 1988 to
1096 to 1242 between 1991 and 1995. The percentage of neonates reported
to have low (<7) 1-minute Apgar score decreased in 1991 to 1995 overall
and for each of 4 hospital levels. Overall and by hospital level, there
was a statistically significant lower proportion of high-risk newborns
who showed a decrease or no change in their 5-minute Apgar scores after
the NRP instruction. After adjusting for several maternal characteristics,
logistic regression analysis revealed that high-risk newborns with a low
1-minute Apgar were more likely to increase their 5-minute Apgar after
the NRP instruction in 1991 to 1995. Additional analyses indicated that
very low birth weight and low birth weight newborns benefited the most
from NRP instruction. CONCLUSION: Although previous research has shown
that the NRP instruction improves knowledge and skill among health care
personnel in the delivery room, both short-term and long-term, there has
been little evidence to demonstrate NRP impact on infant morbidity. Several
strategies were used in this study to control for bias and to adjust for
secular trends in decreased infant morbidity during the study period.
This study demonstrated sufficient support for the hypothesis that a significant
improvement occurred among neonates in their Apgar score after the NRP
instruction in Illinois. Empirical support is provided for the clinical
effectiveness of NRP instruction.
PMID: 11335738, UI: 21267183
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