Ann Intern Med 2001 Aug 7;135(3):S-25
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PMID: 11496845, UI: 21381261
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Ann Intern Med 2001 Aug 7;135(3):149-64
Hygeia Associates, 17988 Brewer Road, Grass Valley, CA 95949, USA. mwilkes@hygeiaassociates.com
PURPOSE: To test the hypothesis that albumin administration is not associated with excess mortality. DATA SOURCES: Computer searches of the MEDLINE and EMBASE databases, the Cochrane Library, and Internet documents; hand searching of medical journals; inquiries to investigators and medical directors; and review of reference lists. STUDY SELECTION: Randomized, controlled trials comparing albumin therapy with crystalloid therapy, no albumin, or lower doses of albumin. DATA EXTRACTION: Two investigators independently extracted data. The primary end point was relative risk for death. Criteria used to assess methodologic quality were blinding, method of allocation concealment, presence of mortality as a study end point, and crossover. Small-trial bias was also investigated. DATA SYNTHESIS: Fifty-five trials involving surgery or trauma, burns, hypoalbuminemia, high-risk neonates, ascites, and other indications were included. Albumin administration did not significantly affect mortality in any category of indications. For all trials, the relative risk for death was 1.11 (95% CI, 0.95 to 1.28). Relative risk was lower among trials with blinding (0.73 [CI, 0.48 to 1.12]; n = 7), mortality as an end point (1.00 [CI, 0.84 to 1.18]; n = 17), no crossover (1.04 [CI, 0.89 to 1.22]; n = 35), and 100 or more patients (0.94 [CI, 0.77 to 1.14]; n = 10). In trials with two or more such attributes, relative risk was further reduced. CONCLUSIONS: Overall, no effect of albumin on mortality was detected; any such effect may therefore be small. This finding supports the safety of albumin. The influence of methodologic quality on relative risk for death suggests the need for further well-designed clinical trials.
PMID: 11487482, UI: 21379784
Br J Anaesth 2001 Sep;87(3):377-9
[Medline record in process]
PMID: 11517119, UI: 21407601
Intensive Care Med 2001 Aug;27(8):1436
Pediatric Intensive Care Unit, Emma Children's Hospital, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands. j.b.vanwoense@amc.vva.nl
PMID: 11511968, UI: 21402812
Intensive Care Med 2001 Aug;27(8):1433
Cardiac Department, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK. rachael.james@virgin.net
PMID: 11511965, UI: 21402809
Intensive Care Med 2001 Aug;27(8):1297-304
Division of Critical Care, Universite de Montreal, Montreal, Canada. skrobiky@total.net
OBJECTIVES: (1) To establish risk factors for the development of delirium in an intensive care unit (ICU) and (2) to determine the effect of delirium on morbidity, mortality and length of stay. DESIGN: Prospective study. SETTING: Sixteen-bed medical/surgical ICU in a university hospital. PATIENTS: Two hundred and sixteen consecutive patients admitted to the ICU for more than 24 h during 5 months were included in the study. INTERVENTIONS: Medical history, selected laboratory values, drugs received and factors that may influence patient psychological and emotional well-being were noted. All patients were screened with a delirium scale. A psychiatrist confirmed the diagnosis of delirium. Major complications such as self-extubation and removal of catheters, as well as mortality and length of stay were recorded. RESULTS: Forty patients (19%) developed delirium; of these, one-third were not agitated. In the multivariate analysis hypertension, smoking history, abnormal bilirubin level, epidural use and morphine were statistically significantly associated with delirium. Traditional factors associated with the development of delirium on general ward patients were not significant in our study. Morbidity (self-extubation and removal of catheters), but not mortality, was clearly increased. CONCLUSION: Predictive risk factors for the development of delirium in studies outside the ICU may not be applicable to critically ill patients. Delirium is associated with increased morbidity. Awareness of patients at risk may lead to better recognition and earlier intervention.
PMID: 11511942, UI: 21402786
Intensive Care Med 2001 Aug;27(8):1263-8
Service d'Hygiene Hospitaliere et d'Epidemiologie moleculaire, CHU Jean Minjoz, 25030 Besancon, France. daniel.talon@ufc-chu.univ-fcomte.fr
OBJECTIVE: We carried out a prospective study to evaluate the endemicity of Pseudomonas aeruginosa in intensive care units (ICUs). Pulsed-field gel electrophoresis (PFGE) was used to determine the genotypes of P. aeruginosa isolates. This allowed us to determine the importance of cross-colonisation and the colonisation routes of P. aeruginosa. DESIGN: We screened epidemiological specimens (rectal swab, nose swab and tracheal aspiration) and routine clinical cultures from patients admitted to ICUs during a 2-year period, from 1st January, 1998, to 31st December, 1999. SETTING: The study was carried out in four separate adult ICUs located in the Franche-Comte region of France. These four units admitted a total of 1,500 patients per year. RESULTS: A total of 1686 specimens were collected from 473 patients; 122 of these patients were positive on admission, 351 became positive during hospitalisation. The overall incidence of P. aeruginosa was 15.7 cases per 100 patients and 15.1 cases per 1000 days of hospitalisation. Of 184 patients with at least one ICU-acquired positive clinical culture, 104 had been previously identified as carriers by a similar genotype. Typing of 208 non-replicate isolates revealed 101 major DNA patterns. Approximately 50% of P. aeruginosa carriage or colonisation/infection was acquired via cross-transmission; the other cases probably originated from endogenous sources. CONCLUSION: Cross-colonisation seems to play an important role in the general spread of P. aeruginosa in ICUs.
PMID: 11511937, UI: 21402781
Intensive Care Med 2001 Aug;27(8):1254-62
Epidemiology and Public Health Unit, Faculty of Medicine, University of Navarre, Irunlarrea s/n, 31008 Pamplona, Navarra, Spain. jdeirala@unav.es
OBJECTIVE: Comparison of statistical methods and measurement scales to identify nosocomial infection risk factors in intensive care units (ICU). DESIGN: Prospective study in 558 patients admitted to the ICU of a referral hospital between February and November 1994. METHODS: Analysis using three logistic regression models, three standard Cox regression models, and two Cox regression models with time-dependent extrinsic factors. Different scales were used to measure exposures to risk factors (dichotomous, ordinal, quantitative, and time-dependent variables). RESULTS: The most appropriate models were those that measured exposure using dichotomous variables. Models using ordinal or quantitative variables estimated biased coefficients and/or failed to comply with the statistical assumptions underlying the analyses. The Cox regression model with quantitative time-dependent variables met all the statistical assumptions, obtained a precise assessment of risk by exposure time, and estimated unbiased coefficients. CONCLUSIONS: The Cox regression analysis with quantitative time-dependent variables is the most valid alternative for assessing the risk of nosocomial infection per day of exposure to an extrinsic risk factor in the ICU.
PMID: 11511936, UI: 21402780
J Hosp Infect 2001 Sep;49(1):62-8
Service de Microbiologie, Hopital Paul Brousse, Villejuif, France
Increased isolation of coagulase-negative staphylococci (CoNS) with decreased susceptibility to teicoplanin prompted this epidemiological survey in the authors intensive care unit. Of 224 medical and surgical patients with hepatobiliary disease, in hospital between December 1998 and July 1999, 14 (6.3%) had at least one isolate of CoNS with decreased susceptibility to teicoplanin. A total of 27 isolates with decreased susceptibility to teicoplanin were recovered from these 14 patients. Pulsed field electrophoresis (PFGE) with Sma I endonuclease demonstrated that CoNS isolates obtained from different patients were unrelated. In addition, different isolates obtain from the same patient were also unrelated, with the exception of two patients. Eighteen out of 27 isolates (66.7%) with decreased susceptibility to teicoplanin were recovered after an earlier treatment with teicoplanin or vancomycin (median 13.1 g, range 2.4-32.7 g per patient). Only four CoNS strains with decreased susceptibility to teicoplanin induced serious infection, all of which responded well to vancomycin therapy.Emergence of CoNS strains with decreased susceptibility to teicoplanin remained limited in hospitalized patients, and was not related to a clonal spread of a particular resistant strain. Copyright 2001 The Hospital Infection Society.
PMID: 11516189, UI: 21408091
J Hosp Infect 2001 Sep;49(1):37-42
Institute of Microbiology, Medical Faculty of Palacky University, Olomouc, Czech Republic
We determined the relative roles of endogenous origin and patient-to-patient transmission in Candida colonization of patients on adult intensive care units (ICU). A total of 48 Candida albicans and 18 Candida glabrata strains from various clinical samples of 28 long-term patients, hospitalized in two neurological ICUs between April and June 1999, were typed using pulsed field gel electrophoresis (PFGE). Three patients were co-colonized by both C. albicans and C. glabrata strains. Twenty-four C. albicans and 17 C. glabrata karyotypes were defined. The colonization was found to be polyclonal in six C. albicans and five C. glabrata patients. Twenty-six patients (93%) carried strains, which were not detected in other patients hospitalized at the same time, i.e. they were colonized by unique C. albicans and C. glabrata strains. Only two patients, who were hospitalized during the same period of time, although in different rooms of the same ICU, shared strains with an identical PFGE type, indicating possible patient-to-patient transmission. Patient-to-patient transmission of yeasts played a minor role on these ICUs. Copyright 2001 The Hospital Infection Society.
PMID: 11516184, UI: 21408086
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