UI - 22509033
PMID- 12622107
DA - 20030306
DCOM- 20030325
IS - 0003-2409
VI - 58
IP - 2
DP - 2003 Feb
TI - White cell count and intensive care unit outcome.
PG - 180-2
AB - A high white cell count on admission to the intensive care unit (ICU) is
generally perceived to be associated with severe illness and poor outcome,
but the implications of a low white cell count are less well recognised.
We retrospectively analysed data on 4,165 patients. The white cell count
on admission was split into four categories, leucopenic (< 4.0 x
10(9).l(-1)), normal (4.001-10.0 x 10(9).l(-1)), leucemoid (10.001-25.0 x
10(9).l(-1)) and an exaggerated leucemoid response (> 25.001 x
10(9).l(-1)). The mortality of patients with leucopenia on admission to
the intensive care unit was higher than those with normal or moderately
raised white cell count (37.5% vs. 18.9% and 23.9%, respectively). A
leucopenic response, as well as an exaggerated leucemoid response, is
associated with an increased mortality.
AD - Hammersmith Hospital, London, UK.
FAU - Waheed, U
AU - Waheed U
FAU - Williams, P
AU - Williams P
FAU - Brett, S
AU - Brett S
FAU - Baldock, G
AU - Baldock G
FAU - Soni, N
AU - Soni N
LA - eng
PT - Journal Article
PT - Multicenter Study
CY - England
TA - Anaesthesia
JID - 0370524
SB - AIM
SB - IM
MH - APACHE
MH - Human
MH - *Intensive Care
MH - Length of Stay
MH - Leukemoid Reaction/*mortality
MH - Leukocyte Count
MH - Leukopenia/*mortality
MH - London/epidemiology
MH - Prognosis
MH - Retrospective Studies
MH - Survival Rate
EDAT- 2003/03/08 04:00
MHDA- 2003/03/26 05:00
PST - ppublish
SO - Anaesthesia 2003 Feb;58(2):180-2.
UI - 22509030
PMID- 12622105
DA - 20030306
DCOM- 20030325
IS - 0003-2409
VI - 58
IP - 2
DP - 2003 Feb
TI - The need for a regional weaning centre, a one-year survey of intensive
care weaning delay in the Northern Region of England.
PG - 161-5
AB - Over a period of one year, a weekly telephone survey identified 161 stable
patients with weaning delay (defined as patients ventilated for at least 6
h per day for more than 2 weeks) in intensive care units in the Northern
Region of England. Their median age was 69 years (range 21-88 years).
Sixty patients (37%) were admitted with medical conditions, 89 (55%) were
postoperative patients, whereas 12 (8%) were surgical but required
non-operative admission. One hundred and thirty (89%) were weaned and
discharged from the intensive care unit during the year. Twenty-two (14%)
died and two were transferred to the home ventilation service. Seven
patients remained ventilated in intensive care at the end of the study
period. Twenty patients (12%) required more than 28 days of respiratory
support. These patients occupied on average 6.0% of available intensive
care unit beds in the region. This study suggests that in the Northern
Region of England there are a significant number of stable but
ventilator-dependent patients occupying intensive care beds.
AD - Department of Anaesthesia and Intensive Care Unit, Royal Victoria
Infirmary, Newcastle upon Tyne, UK.
FAU - Robson, V
AU - Robson V
FAU - Poynter, J
AU - Poynter J
FAU - Lawler, P G
AU - Lawler PG
FAU - Baudouin, S V
AU - Baudouin SV
LA - eng
PT - Journal Article
CY - England
TA - Anaesthesia
JID - 0370524
SB - AIM
SB - IM
MH - Adult
MH - Age Distribution
MH - Aged
MH - Aged, 80 and over
MH - England
MH - Health Care Surveys
MH - Health Facility Planning/*statistics & numerical data
MH - *Health Services Needs and Demand
MH - Health Services Research
MH - Human
MH - Intensive Care/*statistics & numerical data
MH - Length of Stay/statistics & numerical data
MH - Middle Age
MH - Postoperative Care/statistics & numerical data
MH - Ventilator Weaning/*statistics & numerical data
EDAT- 2003/03/08 04:00
MHDA- 2003/03/26 05:00
PST - ppublish
SO - Anaesthesia 2003 Feb;58(2):161-5.
UI - 22509972
PMID- 12624700
DA - 20030307
IS - 0003-2417
VI - 52
IP - 2
DP - 2003 Feb
TI - [Selective digestive tract decontamination in intensive care medicine.
Fundamentals and current evaluation]
PG - 142-52
AB - Selective digestive tract decontamination (SDD) is a method where topical
non-absorbable antibiotics are applied to the oropharynx and stomach which
primarily is aimed at the prevention of ventilator-associated pneumonia.
The rationale for SDD is that ventilatorassociated pneumonia usually
originates from the patients'own oropharyngeal microflora. SDD is also
used for the prevention of gut-derived infections in acute necrotizing
pancreatitis and in liver transplantation. Despite numerous clinical
trials and several meta-analyses, SDD is still a controversial topic. It
is now commonly accepted that the incidence of pneumonia is
reduced,however, the concept of using topical antibiotics has its inherent
limitations and the best results have been obtained by combination with a
short course of intravenous antibiotics. Several issues surrounding the
notorious difficulties in establishing the diagnosis of
ventilator-associated pneumonia especially in the presence of antibiotics
are an on-going matter of debate.Furthermore, pneumonia is the leading
cause of death from nosocomial infections and its prevention was not
adequately followed by reduced mortality in most individual trials,
however, a benefit was suggested by recalculation of data in
meta-analyses.Patients are not well defined by their need for ICU
admission and mechanical ventilation and the attributable mortality of
infections depends more on the type and severity of the underlying
diseases.Recently published trials substantially improved our
understanding as to which patients may derive most benefit from
SDD.Currently, it seems that an improved survival can be achieved in
surgical and trauma patients with severe but salvageable diseases, which
might be classified e.g.by calculation of APACHE-II scores on
admission.However, the most important drawback of SDD is the development
of resistance and an increased selection pressure towards Gram-positive
pathogens, especially in institutions with endemic multi-resistant
microorganisms.Thus, it appears that "selective" must not only be
interpreted as selective suppression of pathogenic bacteria but rather as
selection of appropriate groups of patients with respect to underlying
diseases and severity of illness. Furthermore, it means selection of ICUs
where the endemic resistance patterns might allow the use of SDD at a
relatively low risk for selection of resistant microorganisms, which is
still the major concern associated with SDD.
AD - Klinik fur Anaesthesiologie und Intensivmedizin, Universitatsklinikum
Tubingen.
FAU - Krueger, W A
AU - Krueger WA
FAU - Heininger, A
AU - Heininger A
FAU - Unertl, K E
AU - Unertl KE
LA - ger
PT - Journal Article
TT - Selektive Darmdekontamination in der Intensivmedizin Grundlagen und
aktuelle Bewertung.
CY - Germany
TA - Anaesthesist
JID - 0370525
SB - IM
EDAT- 2003/03/08 04:00
MHDA- 2003/03/08 04:00
AID - 10.1007/s00101-002-0443-1 [doi]
PST - ppublish
SO - Anaesthesist 2003 Feb;52(2):142-52.
UI - 22372859
PMID- 12486591
DA - 20021217
DCOM- 20030307
IS - 0003-2417
VI - 51
IP - 12
DP - 2002 Dec
TI - [50th anniversary of the Swiss Society for Anesthesiology and
Resuscitation]
PG - 1015-9
AD - Institut fur Anasthesiologie, Universitatsspital Zurich.
thomas.pasch@ifa.usz.ch
FAU - Pasch, T
AU - Pasch T
FAU - Frei, F
AU - Frei F
LA - ger
PT - Historical Article
PT - Journal Article
TT - 50 Jahre Schweizerische Gesellschaft fur Anasthesiologie und Reanimation.
CY - Germany
TA - Anaesthesist
JID - 0370525
SB - IM
MH - Anesthesiology/*history/manpower/standards
MH - History of Medicine, 20th Cent.
MH - Human
MH - Intensive Care/history
MH - Societies, Medical/*history
MH - Switzerland
EDAT- 2002/12/18 04:00
MHDA- 2003/03/08 04:00
AID - 10.1007/s00101-002-0422-6 [doi]
PST - ppublish
SO - Anaesthesist 2002 Dec;51(12):1015-9.
UI - 22414863
PMID- 12527587
DA - 20030115
DCOM- 20030304
IS - 0012-3692
VI - 123
IP - 1 Suppl
DP - 2003 Jan
TI - End-of-life care in patients with lung cancer.
PG - 312S-331S
AB - Evidence-based practice guidelines for end-of-life care for patients with
lung cancer have been previously available only from the British
health-care system. Currently in this setting, there has been increasing
concern in attaining control of the physical, psychological, social, and
spiritual distress of the patient and family. This American College of
Chest Physicians'-sponsored multidisciplinary panel has generated
recommendations for improving quality of life after examining the
English-language literature for answers to some of the most important
questions in end-of-life care. Communication between the doctor, patient,
and family is central to the active total care of patients with disease
that is not responsive to curative treatment. The advance care directive,
which has been slowly evolving and is presently limited in application and
often circumstantially ineffective, better protects patient autonomy. The
problem-solving capability of the hospital ethics committee has been
poorly utilized, often due to a lack of understanding of its composition
and function. Cost considerations and a sense of futility have confused
caregivers as to the potentially important role of the critical care
specialist in this scenario. Symptomatic and supportive care provided in a
timely and consistent fashion in the hospice environment, which treats the
patient and family at home, has been increasingly used, and at this time
is the best model for end-of-life care in the United States.
AD - Division of Pulmonary and Critical Care Medicine, Department of Medicine,
College of Medicine, The University of Tennessee Health Science Center,
956 Court Avenue, Room H 314, Memphis, TN 38163, USA. jpgriffin@utmem.edu
FAU - Griffin, John P
AU - Griffin JP
FAU - Nelson, Judith E
AU - Nelson JE
FAU - Koch, Kathryn A
AU - Koch KA
FAU - Niell, Harvey B
AU - Niell HB
FAU - Ackerman, Terrence F
AU - Ackerman TF
FAU - Thompson, Melinda
AU - Thompson M
FAU - Cole, F Hammond Jr
AU - Cole FH Jr
CN - American College of Chest Physicians.
LA - eng
PT - Guideline
PT - Journal Article
PT - Practice Guideline
PT - Review
PT - Review, Academic
CY - United States
TA - Chest
JID - 0231335
SB - AIM
SB - IM
MH - Advance Directives
MH - Communication
MH - Critical Care/methods
MH - Ethics Committees, Clinical
MH - Ethics Consultation
MH - Hospice Care
MH - Human
MH - Lung Neoplasms/*therapy
MH - Physician-Patient Relations
MH - Quality of Life/psychology
MH - Spirituality
MH - *Terminal Care/ethics/methods/psychology/standards
MH - Time Factors
RF - 152
EDAT- 2003/01/16 04:00
MHDA- 2003/03/05 04:00
PST - ppublish
SO - Chest 2003 Jan;123(1 Suppl):312S-331S.
UI - 0
PMID- 12618919
DA - 20030305
IS - 0342-4642
DP - 2003 Mar 5
TI - Invasive group A streptococcal disease and intensive care unit admissions.
AD - Epidemiology Discipline, School of Public Health, University of Texas
Health Science Center at Houston, 1100 North Stanton Street, Suite 110, El
Paso, Texas 79902, USA, zmulla@utep.edu
AU - Mulla ZD
LA - ENG
PT - JOURNAL ARTICLE
TA - Intensive Care Med
JID - 7704851
EDAT- 2003/03/06 04:00
MHDA- 2003/03/06 04:00
AID - 10.1007/s00134-003-1728-9 [doi]
PST - aheadofprint
SO - Intensive Care Med 2003 Mar 5;.
UI - 0
PMID- 12618918
DA - 20030305
IS - 0342-4642
DP - 2003 Mar 5
TI - Nasal carriage of Staphylococcus aureus on admission to intensive care:
incidence and prognostic significance.
AB - We retrospectively studied the prevalence of the nasal carriage of
methicillin-sensitive Staphylococcus aureus (MSSA) and
methicillin-resistant Staphylococcus aureus (MRSA) on admission to a
medical surgical intensive care unit (ICU). We also compared the intensive
care survival of MSSA carriers with non-carriers. Records of 678 patients
admitted over a 24-month period were retrospectively reviewed. Nasal swabs
were taken from 565 patients on admission to the ICU. MSSA was isolated
from the anterior nares of 126 (22%) patients, MRSA was isolated in 16
(3%) patients and 423 (75%) patients had no nasal carriage identified.
MSSA carriers were more likely to have been admitted to the ICU after less
than 24 h hospital stay (28% non-carriers, 44% MSSA carriers) and were
significantly younger (mean age of 50 years) than non-carriers (mean age
55 years). The median survival (with confidence intervals (CI)) was 29
days (CI 14-44) in non-carriers, 16 days (CI 10-22) in MSSA carriers and 6
days (CI 4-8) for the MRSA carriers. This difference was significant when
MSSA carriers were compared with non-carriers ( p=0.003). The ICU
mortality was also significantly higher ( p=0.004) in MSSA carriers (88 of
the 423 (21%) non-carriers and 40 of 126 (32%) MSSA carriers died prior to
ICU discharge).
AD - Department of Intensive Care Medicine, Hope Hospital, Stott Lane, M6 8HD,
Salford, United Kingdom.
AU - Porter R
AU - Subramani K
AU - Thomas AN
AU - Chadwick P
LA - ENG
PT - JOURNAL ARTICLE
TA - Intensive Care Med
JID - 7704851
EDAT- 2003/03/06 04:00
MHDA- 2003/03/06 04:00
AID - 10.1007/s00134-003-1679-1 [doi]
PST - aheadofprint
SO - Intensive Care Med 2003 Mar 5;.
UI - 22260234
PMID- 12373478
DA - 20021009
DCOM- 20030306
IS - 0342-4642
VI - 28
IP - 10
DP - 2002 Oct
TI - Acute lactic acidosis with Wernicke's encephalopathy due to acute thiamine
deficiency.
PG - 1499
FAU - Chadda, K
AU - Chadda K
FAU - Raynard, B
AU - Raynard B
FAU - Antoun, S
AU - Antoun S
FAU - Thyrault, M
AU - Thyrault M
FAU - Nitenberg, G
AU - Nitenberg G
LA - eng
PT - Letter
CY - United States
TA - Intensive Care Med
JID - 7704851
SB - IM
MH - Acidosis, Lactic/*etiology/therapy
MH - Acute Disease
MH - Case Report
MH - Female
MH - France
MH - Human
MH - Intensive Care
MH - Middle Age
MH - Thiamine Deficiency/*complications/therapy
MH - Wernicke Encephalopathy/*etiology/therapy
EDAT- 2002/10/10 04:00
MHDA- 2003/03/07 04:00
PHST- 2002/Mar/04 [received]
PHST- 2002/Jul/09 [accepted]
PHST- 2002/Sep/04 [aheadofprint]
AID - 10.1007/s00134-002-1436-x [doi]
PST - ppublish
SO - Intensive Care Med 2002 Oct;28(10):1499.
UI - 22260229
PMID- 12373473
DA - 20021009
DCOM- 20030306
IS - 0342-4642
VI - 28
IP - 10
DP - 2002 Oct
TI - Evaluation of a noninvasive method for cardiac output measurement in
critical care patients.
PG - 1470-4
AB - OBJECTIVE: Thermodilution (TD) is the gold standard to monitor cardiac
output (CO) in critical care. However, there is concern about the safety
of right-ventricular catheterization. The CO(2) rebreathing technique
allows noninvasive CO determination by means of the indirect Fick
principle. Our objectives were: (a) to assess the accuracy of a new system
of CO measurement using the CO(2) partial rebreathing method (PRCO); (b)
to evaluate whether the PRCO itself may induce changes in CO. DESIGN AND
SETTING: Prospective study in the intensive care department in a
university-affiliated hospital. PATIENTS: Twenty-two mechanically
ventilated critically ill patients. INTERVENTIONS: CO measured
simultaneously by PRCO and TDCO. MEASUREMENTS AND RESULTS: PRCO and TDCO
values were compared by concordance analysis. Stability of cardiac output
during PRCO was evaluated by comparing the TDCO measurements before,
during, and after the partial rebreathing period using analysis of
variance. From a total of 79 valid sets of measurements, bias and
precision was calculated at -0.18+/-1.39 l/min. The concordance analysis
of lower and intermediate CO values (<7 l/min) yielded a bias and
precision calculation of -0.07+/-0.91 l/min. No changes in hemodynamics
were observed during the partial rebreathing period. CONCLUSIONS: The
noninvasive partial CO(2) rebreathing technique may be an alternative
method for CO determination in mechanically ventilated critically ill
patients. The rebreathing maneuver alone does not induce changes in CO.
AD - Critical Care Center, Hospital San Martin, La Plata, Argentina.
FAU - Murias, Gaston E
AU - Murias GE
FAU - Villagra, Ana
AU - Villagra A
FAU - Vatua, Sara
AU - Vatua S
FAU - del Mar Fernandez, Maria
AU - del Mar Fernandez M
FAU - Solar, Hector
AU - Solar H
FAU - Ochagavia, Ana
AU - Ochagavia A
FAU - Fernandez, Rafael
AU - Fernandez R
FAU - Lopez Aguilar, Josefina
AU - Lopez Aguilar J
FAU - Romero, Pablo V
AU - Romero PV
FAU - Blanch, Lluis
AU - Blanch L
LA - eng
PT - Evaluation Studies
PT - Journal Article
CY - United States
TA - Intensive Care Med
JID - 7704851
RN - 124-38-9 (Carbon Dioxide)
SB - IM
MH - Breath Tests
MH - Carbon Dioxide/analysis
MH - *Cardiac Output
MH - Critical Care/*methods
MH - Hospitals, University
MH - Human
MH - Intensive Care Units
MH - Monitoring, Physiologic/*methods
MH - Prospective Studies
MH - *Respiration, Artificial
MH - Spain
MH - Support, Non-U.S. Gov't
EDAT- 2002/10/10 04:00
MHDA- 2003/03/07 04:00
PHST- 2002/Feb/11 [received]
PHST- 2002/Jul/26 [accepted]
PHST- 2002/Sep/04 [aheadofprint]
AID - 10.1007/s00134-002-1477-1 [doi]
PST - ppublish
SO - Intensive Care Med 2002 Oct;28(10):1470-4.
UI - 22511148
PMID- 12623321
DA - 20030307
IS - 0195-6701
VI - 53
IP - 3
DP - 2003 Mar
TI - Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a
neonatal intensive care unit: risk factors for infection and colonization.
PG - 198-206
AB - An outbreak of extended spectrum beta-lactamase-producing Klebsiella
pneumoniae (ESBLKp) infections in a neonatal intensive care unit (NICU)
prompted a prospective investigation of colonization and infection with
this pathogen. From August 1, 1997 to May 30, 1999, neonates admitted to
the NICU for more than 24h were screened for ESBLKp acquisition. Neonatal
gastrointestinal screening was performed by means of faecal sampling
within 48h of admission and then weekly until discharge. Isolates were
typed using pulsed-field gel electrophoresis (PFGE). Time-dependent
proportional hazard models were used to identify independent effects of
invasive procedures and antimicrobials after controlling for duration of
stay at the NICU. During the study period, 464 neonates were admitted and
383 were regularly screened. Infections occurred in 13 (3.4%) neonates and
206 (53.8%) became colonized. Independent risk factors for colonization
during the first nine days in the NICU were the antimicrobial combination
cephalosporin plus aminoglycoside [hazard rate (HR)=4.60; 95% CI:
1.48-14.31], and each NICU-day was associated with a 26% increase in the
hazard rate for colonization (HR=1.26; 95% CI: 1.16-1.37). Previous
colonization (HR=5.19; 95% CI: 1.58-17.08) and central vascular catheter
use (HR=13.89; 95% CI: 2.71-71.3) were independent risk factors for
infection. In an outbreak setting the proportion of neonates colonized
with ESBLKp was observed to increase with the duration of stay and
antimicrobial use, and once colonized, infants exposed to invasive devices
may become infected.
AD - Faculdade de Medicina and Instituto de Microbiologia of Universidade
Federal do Rio de Janeiro, RJ, Brazil
FAU - Pessoa-Silva, C L
AU - Pessoa-Silva CL
FAU - Meurer Moreira, B
AU - Meurer Moreira B
FAU - Camara Almeida, V
AU - Camara Almeida V
FAU - Flannery, B
AU - Flannery B
FAU - Almeida Lins, M C
AU - Almeida Lins MC
FAU - Mello Sampaio, J L
AU - Mello Sampaio JL
FAU - Martins Teixeira, L
AU - Martins Teixeira L
FAU - Vaz Miranda, L E
AU - Vaz Miranda LE
FAU - Riley, L W
AU - Riley LW
FAU - Gerberding, J L
AU - Gerberding JL
LA - eng
PT - Journal Article
CY - England
TA - J Hosp Infect
JID - 8007166
SB - IM
EDAT- 2003/03/08 04:00
MHDA- 2003/03/08 04:00
AID - S0195670102913733 [pii]
PST - ppublish
SO - J Hosp Infect 2003 Mar;53(3):198-206.