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Crit Care Med 2002 Jul;30(7):1661-3
Department of Critical Care; Maine Medical Center; Portland, ME.
[Medline record in process]
Publication Types:
PMID: 12131001, UI: 22122899
Other Formats:
Crit Care Med 2002 Jul;30(7):1650-1
Program in Ethics and Ethics Consultation Service; Chicago, IL.
PMID: 12130994, UI: 22122892
Crit Care Med 2002 Jul;30(7):1610-5
Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Florida Health Science Center, Jacksonville, FL, USA. afessa.bekele@mayo.edu
OBJECTIVE: To describe prognostic factors, clinical course, and hospital outcome of patients with chronic obstructive pulmonary disease admitted to an intensive care unit for acute respiratory failure. DESIGN: Analysis of prospectively collected data. SETTING: A multidisciplinary intensive care unit of an inner-city university hospital. PATIENTS: Patients with chronic obstructive pulmonary disease admitted to an intensive care unit for acute respiratory failure from August 1995 through July 1998. MEASUREMENTS AND MAIN RESULTS: Data were obtained concerning demographics, arterial blood gas, Acute Physiology and Chronic Health Evaluation (APACHE) II score, sepsis, mechanical ventilation, organ failure, complications, and hospital mortality rate. Fifty-nine percent of patients were male, 63% white, and 36% African-American; the mean age was 63.1 +/- 8.9 yrs. Noninvasive mechanical ventilation was tried in 40% of patients and was successful in 54% of them. Invasive mechanical ventilation was required in 61% of the 250 admissions. Sepsis developed in 31% of patients, nonpulmonary organ failure in 20%, pneumothorax in 3%, and acute respiratory distress syndrome in 2%. Multiple organ failure developed in 31% of patients with sepsis compared with 3% without sepsis (p <.0001). Predicted and observed hospital mortality rates were 30% and 15%, respectively. Differences in age and arterial carbon dioxide and oxygen tensions between survivors and nonsurvivors were not significant. Arterial pH was lower in nonsurvivors than in survivors (7.21 vs. 7.25, p =.0408). The APACHE II-predicted mortality rate (p =.0001; odds ratio, 1.046; 95% confidence interval, 1.022-1.070) and number of organ failures (p <.0001; odds ratio, 5.524; 95% confidence interval, 3.041-10.031) were independent predictors of hospital outcome; invasive mechanical ventilation was not an independent predictor. CONCLUSIONS: Physiologic abnormalities at admission to an intensive care unit and development of nonrespiratory organ failure are important predictors of hospital outcome for critically ill patients with chronic obstructive pulmonary disease who have acute respiratory failure. Improved outcome would require prevention and appropriate treatment of sepsis and multiple organ failure.
PMID: 12130987, UI: 22122885
Crit Care Med 2002 Jul;30(7):1436-8
Department of Gastroenterology (DAN), Allegheny General Hospital, Pittsburgh, PA; and Gastroenterology and Hepatology (MHDL), Medical University of South Carolina, Charleston, SC.
OBJECTIVE: To compare the outcomes of intensive care unit patients fed through a nasogastric vs. a nasal-small-bowel tube including the time from tube placement to feeding, time to reach goal rate, and adverse events. DESIGN: Sixty patients were prospectively randomized to receive gastric or small-bowel tube feedings. Nursing staff attempted to place a feeding tube in the desired position, and placement was confirmed radiographically after each bedside attempt. After two unsuccessful attempts, the feeding tube was placed under fluoroscopy. Feedings were started at 30 mL/hr and advanced to the patient's specific goal rate. SETTING: Twenty-bed medical intensive care unit. PATIENTS: Sixty medical patients admitted/transferred to the intensive care unit. INTERVENTIONS: Tube feeds were held for 2 hrs if any residual was >200 mL. MEASUREMENTS: Times were recorded at the initial tube insertion, onset of feeding, achievement of goal rate, and termination of feeding. Adverse outcomes included witnessed aspiration, vomiting, and clinical/radiographic evidence of aspiration. Patients were followed up for the duration of feeding, until leaving the intensive care unit, or for a maximum of 14 days. MAIN RESULTS: Patients fed in the stomach received nutrition sooner from initial placement attempt (11.2 hrs vs. 27.0 hrs) and with fewer attempts (one vs. two) than those fed in the small bowel. Patients achieve goal rate sooner (28.8 hrs vs. 43.0 hrs) with gastric feeding compared with small-bowel feeding. There was no difference in aspiration events. CONCLUSIONS: Gastric feeding demonstrates no increase in aspiration or other adverse outcomes compared with small-bowel feeding in the intensive care unit. Gastric feeding can be started and advanced to goal sooner with fewer placement attempts than small-bowel feeding.
PMID: 12130958, UI: 22122856
Crit Care Med 2002 Jul;30(7):1413-8
Departments of Medicine, Kingston General Hospital, Kingston, Ontario, Canada. dkh2@post.queensu.ca
OBJECTIVE: To determine the level of satisfaction of family members with the care that they and their critically ill relative received. DESIGN: Prospective cohort study. SETTING: Six university-affiliated intensive care units across Canada. METHODS: We administered a validated questionnaire to family members who made at least one visit to intensive care unit patients who received mechanical ventilation for >48 hrs. We obtained self-rated levels of satisfaction with 25 key aspects of care related to the overall intensive care unit experience, communication, and decision making. For family members of survivors, the questionnaire was administered while the patient was still in the hospital. For family members of nonsurvivors, the questionnaire was mailed out to the family member 3-4 wks after the patient's death. MAIN RESULTS: A total of 891 family members received questionnaires; 624 were returned (70% response rate). The majority of respondents were satisfied with overall care and with overall decision making (mean +/- sd item score, 84.3 +/- 15.7 and 75.9 +/- 26.4, respectively). Families reported the greatest satisfaction with nursing skill and competence (92.4 +/- 14.0), the compassion and respect given to the patient (91.8 +/- 15.4), and pain management (89.1 +/- 16.7). They were least satisfied with the waiting room atmosphere (65.0 +/- 30.6) and frequency of physician communication (70.7 +/- 29.0). The variables significantly associated with overall satisfaction in a regression analysis were completeness of information received, respect and compassion shown to the patient and family member, and the amount of health care received. Satisfaction varied significantly across sites. CONCLUSIONS: Most family members were highly satisfied with the care provided to them and their critically ill relative in the intensive care unit. Efforts to improve the nature of interactions and communication with families are likely to lead to improvements in satisfaction.
PMID: 12130954, UI: 22122852
Intensive Care Med 2002 Jul;28(7):943-6
Rua das Aroeiras, 30 ap 22. Bairro Jardim, Santo Andre, Sao Paulo, 09090-000, Brazil, psls.nat@terra.com.br
AbstractOBJECTIVE. To test air insufflation as an adjunct to placement of enteral feeding tubes and the effectiveness of using a smaller insufflation volume in pediatric patients.DESIGN AND SETTING. A randomized, controlled study in a pediatric intensive care unit in two tertiary hospitals.PATIENTS. A total of 78 children with indication for transpyloric tube feeding were studied.INTERVENTIONS. An unweighted feeding tube was placed into the stomach through the nares; a 20-ml syringe was used to insufflate 10 ml/kg air into the stomach. The tube was advanced an estimated distance into the pylorus or beyond. The control group received the same procedure except for air insufflation. Resident physicians performed all procedures. Abdominal radiography was performed 3 h later.RESULTS. Of 38 tubes in the study group 33 (86.8%) were successfully placed in a single attempt, compared to 18 of 40 tubes (45%) in the control group. Compared with the technique of using 20 ml/kg air for insufflation, no statistically significant difference was observed. No significant complication was observed.CONCLUSIONS. The gastric insufflation technique required no expensive equipment, minimal training, and consistently allowed transpyloric passage of feeding tubes. The use of 10 ml/kg air may significantly improve the rate of success without increasing risks.
PMID: 12122534, UI: 22117574
Intensive Care Med 2002 Jul;28(7):898-907
Intensive Care Unit, Hospital Pedro Hispano, 4450, Matosinhos, Portugal, cristinagranja@hotmail.com
AbstractOBJECTIVE. To evaluate health-related quality of life (HR-QOL) and study its determinants in adult patients discharged from an intensive care unit (ICU).DESIGN. Cohort study.SETTING. Intensive care unit (ICU), tertiary care hospital, Oporto, Portugal.PATIENTS. Of all the patients discharged over a 2year period, 355 were considered eligible and 275 completed the study.MEASUREMENTS AND RESULTS. Patients were interviewed 6 months after ICU discharge using EuroQol 5-D (EQ-5D). At the interview only 29% reported feeling worse than 6 months before ICU admission. The proportions of those reporting moderate to extreme problems in the five dimensions studied were as follows: mobility (37%), self-care (22%), usual activities (46%), pain/discomfort (45%) and anxiety/depression (54%). Although 77% of patients reported a problem in at least one dimension, 44% referred to no problems or only moderate problems regarding pain or anxiety. EQ visual analogue scale (VAS) and EQ Index medians were 60 and 81, respectively.CONCLUSIONS. Intensive care unit variables (e.g., diagnosis, length of stay and severity of disease) and patient's background data (e.g., age, gender, education, main activity, smoking habits, experience with serious illness and previous health status) may be significant determinants of HR-QOL. However, when adjusted for background data, most ICU variables are no longer associated with EQ-5D. This should cause attention to be paid to the role of a patient's background in the evaluation of HR-QOL and to a careful interpretation of EQ-5D results when comparing ICUs.
PMID: 12122528, UI: 22117568
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