Acta Paediatr 2001 Sep;90(9):1068-72
Children's Hospital, Leicester Royal Infirmary, UK.
AIM: To study the experience of, training in, and confidence in the transportation of critically ill neonates amongst paediatric trainees in one UK region. DESIGN: An anonymized questionnaire was sent to all middle grades with paediatrics National Training Numbers from the Trent region. RESULTS: The response rate was 78%. Less than half (45%) of the respondents reported receiving any training in the transportation of neonates, either in the UK or abroad; 45% (30/66) of the trainees reported having performed 10 or fewer neonatal transfers. The self-perceived confidence for transporting neonates was scored on a 10-point scale, to produce a "confidence score", the median score being 7 (IQ range 5, 8). Both as a group and individually, the trainee paediatricians were more confident in transporting neonates than older infants or children (p < 0.0001). Using multiple analysis of covariance, it was found that the most important and significant variables affecting the "confidence scores" for the inter-hospital transportation of critically ill neonates were receipt of any relevant transport training, and the current frequency of transports performed. CONCLUSIONS: Many training-grade paediatricians lack both the experience and training in transporting critically ill neonates, factors that were found to affect their confidence in transferring sick neonates. As the overwhelming majority of neonatal transports in the UK are still arranged by individual units and performed by training-grade paediatricians, concerns regarding both the safety and effectiveness of the current service provision for the inter-hospital transfer of critically ill neonates remain valid.
PMID: 11683197, UI: 21539391
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Am J Crit Care 2002 Mar;11(2):132-40
University of California, Los Angeles, Medical Center, USA.
[Medline record in process]
BACKGROUND: Patients requiring mechanical ventilation for prolonged periods typically are sicker and have more comorbid illnesses than do patients who can be weaned more rapidly. As a result, the weaning process is often complex, requiring shared decision making by a skilled, multidisciplinary team. Unfortunately, many of the structures used in critical care units to plan and evaluate care do not lend themselves to collaborative management of patients. OBJECTIVE: To evaluate the effect of a collaborative weaning plan on outcomes, including duration of mechanical ventilation, for patients treated with mechanical ventilation for 7 days or more. METHODS: A collaborative weaning plan (weaning board and flow sheet) was introduced into the medical intensive care unit at the University of California Los Angeles, Medical Center. A historical design was used to compare outcomes before and after the plan was used. The primary outcome variable was duration of mechanical ventilation. Other outcomes studied included length of stay in the unit, cost, prevalence of complications (ie, reventilation, readmission to the intensive care unit), and mortality rate. RESULTS: The collaborative weaning plan decreased duration of ventilation by 4.9 days (P=.02) and decreased median length of stay in the unit by 4.5 days (P=.004). The median cost per stay in the unit decreased from $50462 to $37330 (P=.004). The prevalence of complications did not differ significantly between groups. CONCLUSIONS: Collaborative structures (eg, weaning boards, flow sheets) are useful in decreasing duration of mechanical ventilation for patients receiving long-term ventilation.
PMID: 11888125, UI: 21884969
Anaesthesia 2002 Feb;57(2):183
Publication Types:
PMID: 11871960, UI: 21861120
PMID: 11871958, UI: 21861118
Crit Care Med 2002 Jan;30(2 Supp):S97-S123
[Record supplied by publisher]
PMID: 11891410
Crit Care Med 2002 Feb;30(2):489
PMID: 11889340, UI: 21886138
Crit Care Med 2002 Feb;30(2):362-7
Service de Reanimation Medicale, CHU Sainte Marguerite, Marseille, France.
OBJECTIVE: To determine whether Doppler transmitral and pulmonary venous flow pattern is related to left ventricular filling pressures in critically ill patients. DESIGN: Prospective clinical investigation. SETTING: Medical intensive care unit of a university hospital. PATIENTS: Fifty-four mechanically ventilated patients (age, 63 +/- 16 yrs) were investigated via transthoracic echocardiography and Doppler. Main diagnoses were pneumonia (31%), acute exacerbation of chronic obstructive pulmonary disease (24%), congestive heart failure (11%), and poisoning (11%). INTERVENTIONS: Doppler examinations were performed simultaneously with measurements of pulmonary artery occlusion pressure via a right heart catheter. MEASUREMENTS AND MAIN RESULTS: Pulmonary artery occlusion pressure correlated with transmitral peak E-wave velocity (r =.46) and E/A ratio (r =.55). Pulmonary artery occlusion pressure inversely correlated with deceleration time of the transmitral E-wave (r = -.52), pulmonary venous peak S-wave velocity (r = -.37), and systolic fraction of the pulmonary forward flow (r = -.56). An E/A ratio >2 predicted a pulmonary artery occlusion pressure >18 mm Hg with a positive predictive value of 100%. A duration of pulmonary venous A-wave reversal flow exceeding the duration of the transmitral A-wave forward flow predicted a pulmonary artery occlusion pressure >15 mm Hg with a positive predictive value of 83%. A systolic fraction of the pulmonary venous forward flow <0.4 predicted a pulmonary artery occlusion pressure >12 mm Hg with a positive predictive value of 100%. CONCLUSION: Transmitral and pulmonary venous flow patterns measured by transthoracic Doppler echocardiography can be used to estimate the left ventricular filling pressure in critically ill patients.
PMID: 11889311, UI: 21886109
Crit Care Med 2002 Feb;30(2):338-42
Department of Anesthesiology and Intensive Care Medicine, University Hospital Giessen, Giessen, Germany.
OBJECTIVE: To evaluate the discriminative power on mortality of a modified Sequential Organ Failure Assessment (SOFA) score and derived measures (maximum SOFA, total maximum SOFA, and delta SOFA) for complete automatic computation in an operative intensive care unit (ICU). DESIGN: Retrospective study. SETTING: Operative ICU of the Department of Anesthesiology and Intensive Care Medicine. PATIENTS: Patients admitted to the ICU from April 1, 1999, to March 31, 2000 (n = 524). Data from patients under the age of 18 yrs and patients who stayed <24 hrs were excluded. In the case of patient readmittance, only data from the patient's last stay was included in the study. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The main outcome measure was survival status at ICU discharge. Based on Structured Query Language (SQL) scripts, a modified SOFA score for all patients who stayed in the ICU in 1 yr was calculated for each day in the ICU. Only routine data were used, which were supplied by the patient data management system. Score evaluation was modified in registering unavailable data as being not pathologic and in using a surrogate of the Glasgow Coma Scale. During the first 24 hrs, 459 survivors had an average SOFA score of 4.5 +/- 2.1, whereas the 65 deceased patients averaged 7.6 +/- 2.9 points. The area under the receiver operating characteristic (ROC) curve was 0.799 and significantly >0.5 (p <.01). A confidence interval (CI) of 95% covers the area (0.739-0.858). The maximum SOFA presented an area under the ROC of 0.922 (CI: 0.879-0.966), the total maximum SOFA of 0.921 (CI: 0.882-0.960), and the delta SOFA of 0.828 (CI: 0.763-0.893). CONCLUSION: Despite a number of differences between completely automated data sampling of SOFA score values and manual evaluation, the technique used in this study seems to be suitable for prognosis of the mortality rate during a patient's stay at an operative ICU.
PMID: 11889305, UI: 21886103
Crit Care Med 2002 Feb;30(2):290-6
Departments of Medicine (LS, DC, GG, JM) and Clinical Epidemiology & Biostatistics (DC, GG, LG, SW), McMaster University, Hamilton, ON, Canada.
OBJECTIVE: To examine the influence of education and clinical experience on residents' attitudes toward withdrawal of life support. DESIGN: Self-administered survey. SETTING: Four Canadian teaching hospitals. SUBJECTS: Residents rotating through four intensive care units. MEASUREMENTS AND MAIN RESULTS: The survey examined ethics education and experience regarding end-of-life care, importance of factors influencing withdrawal of life support, confidence in decisions, and recommendations for enhancing end-of-life education. The response rate was 83.9% (52 of 62). A minority of residents reported an appropriate amount of formal teaching on ethical principles (17.3%), patient-centered education (28.8%), and informal discussion (28.8%) before their intensive care unit rotation. During their rotation, most residents cared for patients in whom withdrawal of life support was considered. Although they usually attended family meetings, residents were never (34.6%) or rarely (42.3%) the primary discussant. Before the intensive care unit rotation, confidence in withdrawal decisions was related to male sex (p =.001) and previous patient-centered ethics education (p =.02). At the end of the intensive care unit rotation, only resident involvement in family meetings (p =.02) and being the primary discussant at such meetings (p =.01) were associated with confidence. After we adjusted for prerotation confidence in withdrawal of life support decision-making, the only predictor of postrotation confidence was family meeting involvement (p <.001). Residents recommended more patient-centered discussion, observation of attending physicians discussing end-of-life issues, and opportunity to lead family meetings. CONCLUSIONS: Experiential, case-based, patient-centered curricula are associated with resident confidence in withdrawal of life support decisions in the intensive care unit.
PMID: 11889295, UI: 21886093
J Hosp Infect 2002 Mar;50(3):207-12
Intensive Care Unit, Edouard Herriot Hospital, Lyon, Cedex, France
Over a 16-month period from September 1997 to December 1998, a prospective study was made of an on-site treatment of medical wastes in a 10-bed intensive care unit. First, the wastes were ground and then, a high concentration of ozone in air was repeatedly injected into the ground wastes. The study analysed the practical application of the system and its microbiological efficiency. Inactivation experiments were made with reference strains of Staphylococcus aureus, Enterococcus hirae, Pseudomonas aeruginosa, Escherichia coli, Mycobacterium smegmatis, Bacillus subtilis var niger, Bacillus stearothermophilus, Candida albicans and Aspergillus niger. Two thousand eight hundred treatment cycles, i.e. 84000 grindings and 140000 ozone injections gave a treatment capacity of 50kg of waste per day with a good staff acceptability. All kinds of medical devices used in an intensive care unit were treated. In untreated ground wastes, the median bacterial load was 105.86 (range 10(2.35)--10(8.05)) cfu/g. After ozone treatment, bacteria and fungi were reduced by a factor of 10(5). Aero-contamination of the ward was unchanged. Computer control allowed all events to be tracked. On-site medical waste treatment appears to be an efficient alternative to the usual centralized collection and treatment. Copyright 2002 The Hospital Infection Society.
PMID: 11886197, UI: 21884132
J Hosp Infect 2002 Mar;50(3):170-4
Department of Microbiology, Erciyes University, Kayseri, 38039, Turkey
At the end of 1999, a case of polymicrobial ventriculitis in the Department of Neurosurgery followed by an outbreak of Serratia marcescens mediastinitis in the intensive care unit of cardiovascular surgery occurred. These nosocomial surgical infections were considered to be the result of contamination of surgical sites with inadequately sterilized instruments or theatre linen. An epidemiological survey was focused on the central sterilization unit of the hospital. The microbiological results of this survey proved that the cause of the outbreak was the use of inadequately decontaminated theatre linen. This study indicates that strict infection control measures including the control of sterilization procedures and a well-organized infection control team are necessary to prevent nosocomial surgical infections. Copyright 2002 The Hospital Infection Society.
PMID: 11886191, UI: 21884126
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