Am J Respir Crit Care Med 2001 Oct 15;164(8 Pt 1):1362-75
Division of Pulmonary and Critical Care Medicine, Loyola University of Chicago Stritch School of Medicine and Hines Veterans Affairs Hospital, Hines, Illinois 60141, USA. mtobin2@luc.edu
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PMID: 11704580, UI: 21560034
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Am J Respir Crit Care Med 2001 Oct 15;164(8 Pt 1):1347-61
PMID: 11704579, UI: 21560033
Am J Respir Crit Care Med 2001 Oct 15;164(8 Pt 1):1333-5
PMID: 11704571, UI: 21560025
Arch Dis Child 2002 Jan;86(1):65
School for Health and Related Research, University of Sheffield, Regent Street, Sheffield S1 4DA, UK g.parry@sheffield.ac.uk UK PICOS Intensive Care National Audit & Research Centre London WC1H 9HR, UK
[Medline record in process]
PMID: 11806893, UI: 21665700
Arch Dis Child 2002 Jan;86(1):65-66
Paediatric Intensive Care Unit, Guy's Hospital, London, UK Shane.Tibby@gstt.sthames.nhs.uk Royal Children's Hospital, Parkville, Victoria 3051, Australia Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK Gale.Pearson@bhamchildrens.wmids.nhs.uk
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PMID: 11806892
Crit Care Med 2001 Dec;29(12):2392-4
PMID: 11801851, UI: 21659458
Crit Care Med 2001 Dec;29(12):2332-48
Ethics Committee, American College of Critical Care Medicine.
PMID: 11801837, UI: 21659444
Crit Care Med 2001 Dec;29(12):2303-9
Service de reanimation polyvalente, CHR Orleans la Source, France.
OBJECTIVE: To evaluate the mortality rate attributable to nosocomial ventilator-associated pneumonia in an intensive care unit. DESIGN: Prospective, matched, risk-adjusted cohort study. SETTING: A 18-bed adult medical-surgical intensive care unit in a 1,100-bed regional and teaching hospital in France. PATIENTS: From January 1, 1996, to April 30, 1999, 135 patients who developed nosocomial pneumonia were matched with 135 control patients without nosocomial pneumonia. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Nosocomial pneumonia was identified on the basis of results of distal bronchial samples. The matching process was conducted according to the following primary criteria: cause of admission, indication for ventilatory support, immunologic status, cardiac status, probability of death (+/-5%), Glasgow Coma Scale score (+/-2 points), age (+/-7 yrs), and duration of exposure to risk. When possible, case and control patients were matched according to five secondary criteria: respiratory and alcoholism status before admission, diagnosis categories, surgical procedure or not, and gender. The mortality rates were compared between case and control patients by using the Kaplan-Meier estimate and the log-rank test. The influence of nosocomial pneumonia on mortality rate then was tested by adjusting for the secondary criteria and other possible confounding factors by using the Cox proportional-hazards model. The matching process was successful for 1,080 of 1,080 primary criteria. The crude intensive care unit mortality rate was higher in patients with nosocomial pneumonia than in control patients (41 vs. 14%; p <.0001). In actuarial survival analysis, the probability of intensive care unit death was higher in the case patients (odds ratio = 2.7, 95% confidence interval = 1.8-3.1, p =.028). After adjustment, the occurrence of nosocomial pneumonia remained an independent risk factor of death (odds ratio = 2.1, 95% confidence interval = 1.2-3.6, p =.008). Nosocomial pneumonia attributable to multiresistant microorganisms was significantly associated with death (odds ratio = 2.6, 95% confidence interval = 1.1-5.8, p =.02). The length of intensive care unit stay was higher in case than in control patients (31 +/- 19 vs. 26 +/- 17 days, p <.0001). CONCLUSIONS: Nosocomial pneumonia is independently associated with death in the intensive care unit. In addition, it increases the length of intensive care unit stay.
PMID: 11801831, UI: 21659438
Crit Care Med 2001 Dec;29(12):2276-80
Departments of Pediatric Hematology and Oncology (RH, DTS, DK, UG) and Neonatology and Pediatric Intensive Care Medicine (HS, PL), Children's Hospital, Heinrich-Heine University, Duesseldorf, Germany.
OBJECTIVE: Because the long-term survival of children with cancer has dramatically improved because of multimodal treatment strategies, intensive care medicine has become more relevant for these patients. This study was performed to assess the efficacy of intensive care medicine in newly diagnosed pediatric oncologic patients and in patients under ongoing oncologic treatment. DESIGN: A retrospective analysis of children admitted to the pediatric intensive care unit (PICU) of the University Hospital Duesseldorf for life-threatening conditions between 1995 and 1999 was performed to identify those patients with an oncologic condition. SETTING: University hospital. PATIENTS: A total of 123 patients were identified. Children admitted for uncomplicated postoperative care and children admitted after bone marrow transplantation were excluded from this analysis. Forty-eight patients could be divided into two groups. Group A contained children admitted to the PICU at the time of cancer diagnosis and group B children receiving ongoing oncologic treatment. INTERVENTIONS: The evaluation included diagnosis, risk factors, complications leading to PICU admission, PICU therapy, and outcome. Statistical analysis included evaluation of Pediatric Risk of Mortality (PRISM) and Therapeutic Intervention Scoring System (TISS) scores. MEASUREMENTS AND MAIN RESULTS: Respiratory insufficiency was the leading diagnosis for PICU admission, whereas in the remaining children cardiovascular insufficiency, renal failure, neurologic impairment, ileus, and tumor-associated complications led to PICU admission. The number of organ failures was correlated to outcome. All children but one of group A could be discharged from the PICU, whereas 12 of 35 children in group B died, despite intensive care treatment attempts. The PRISM and TISS scores at admission to the PICU were significantly higher in children who did not survive the period of intensive care treatment in group B. However, all patients with a PRISM score of >20 died. CONCLUSIONS: Diagnosis of cancer does not exclude potential benefit from intensive care medicine in these children, although severe complications might affect the prognosis.
PMID: 11801824, UI: 21659431
Crit Care Med 2001 Dec;29(12):2239-44
Department of Pharmacy Practice, University of Nebraska Medical Center, Omaha, NE.
OBJECTIVE: To characterize physician practice patterns regarding the clinical, microbiological, and antimicrobial-related events of suspected or documented aspiration and aspiration pneumonia within the intensive care unit. DESIGN: National mail survey. SETTING: University medical center. STUDY POPULATION: Critical care physician members of the Society of Critical Care Medicine. INTERVENTIONS: Survey questionnaire. MEASUREMENTS AND MAIN RESULTS: The response rate was 645 (32%) of 2,000 mailed surveys; analysis of data represents completed questionnaires from 605 respondents. Intensivists (42.3%), pulmonologists (22.6%), and surgeons (21.6%) represent the majority of respondents. Altered level of consciousness (67.9%) in the intensive care unit was identified as the predominant predisposing factor for aspiration pneumonia. Sixty-four percent of physicians used sputum specimens, rather than protected specimen brushes or bronchoalveolar lavage, as the diagnostic source of bacterial cultures in cases of suspected aspiration pneumonia. Microbiological assessment of aspiration pneumonia revealed the absence of any predominant pathogen, although Staphylococcus aureus and Pseudomonas aeruginosa were cited in 40.1% of combined responses, whereas anaerobes represented the fifth most prevalent cultured bacteria. In cases of suspected and confirmed aspiration, 51.9% and 77.7% of respondents, respectively, would prescribe an antimicrobial agent in the absence of a definitive infectious process, with administration of dual antimicrobial therapy increasing from 28.9% to 46.0% in suspected vs. confirmed cases of aspiration. In the treatment of aspiration pneumonia, 27.6% of physicians preferred pathogen-specific therapy, whereas the remainder (72.4%) selected an empirical antibiotic regimen based on prior clinical experience. Overall, a beta-lactam/beta-lactamase inhibitor, followed by a cephalosporin, aminoglycoside in combination, or clindamycin, was most often selected for empirical therapy of all defined aspiration-related clinical diagnoses. CONCLUSIONS: Our study revealed a divergent approach to antimicrobial treatment of cases of aspiration in the intensive care unit. Further investigation is warranted to determine why empirical antimicrobials are initiated frequently for noninfectious stages of aspiration.
PMID: 11801813, UI: 21659420
Heart Lung 2002 Jan-Feb;31(1):53-66
Northeastern University School of Nursing and The Ohio State University College of Nursing.
OBJECTIVE: The purpose of this study was to prospectively examine the long-term effects of the pediatric intensive care unit experience on parents and on family adaptation. DESIGN: A three-group prospective, comparison, convenience sample was used in this study. SETTING: The study took place in a midwestern university-affiliated tertiary pediatric medical center. SUBJECTS: Three groups of parents (parents with children in the pediatric intensive care unit, parents with children in a general care unit, and parents with nonhospitalized ill children) were studied. The children were ages 5 years or younger.Outcome Measures: Indicators of family adaptation included parental stress, stress symptoms, family functioning, and life events. RESULTS: The mothers' stress symptoms in all groups were more prevalent than a normative sample, and they perceived their families as dysfunctional after discharge from the hospital. Slope analysis was used to examine the patterns of stress symptoms and family functioning and indicated little directional change over time for the mothers. CONCLUSION: Despite the smaller than expected sample sizes over time, results suggest that parents are still having stress-related symptoms and difficulties with family functioning as long as 6 months after a child's illness event.
PMID: 11805751, UI: 21663745
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