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Items 1 - 2 of 2 |
One page. |
Safety in training and learning in the intensive care unit.
Heffner JE, Ellis R, Zeno B.
Medical University of South Carolina, 169 Ashley Avenue, P.O. Box 250332, Charleston, SC 29425, USA.
Resident and subspecialty fellow trainees in the intensive care unit (ICU) present risks for patient safety because of their inexperience yet offer opportunities to promote safe patient care because of their around-the-clock presence and their involvement in frontline processes of care. Most trainees approach their ICU experiences without previous education in performance improvement or patient safety. This article reviews the barriers that are faced by residents in providing safe patient care and outlines the nature of a patient safety curriculum that could tap the opportunities that are presented by trainees to promote safer patient care.
PMID: 15579357 [PubMed - in process]
Outcome of severe adult thrombotic microangiopathies in the intensive care unit.
Pene F, Vigneau C, Auburtin M, Moreau D, Zahar JR, Coste J, Heshmati F, Mira JP.
Medical Intensive Care Unit Department, Cochin Hospital, Assistance Publique-Hopitaux de Paris, 27 rue du faubourg Saint-Jacques, 75679 Paris, France, and Universite Paris V, France, frederic.pene@cch.ap-hop-paris.fr.
OBJECTIVE: Thrombotic microangiopathies, namely thrombotic thrombocytopenic purpura and hemolytic uremic syndrome, are uncommon microvascular occlusive diseases. Despite the dramatic improvement in the outcome by exogenous plasma supply, either through plasma infusion or through plasma exchange, patients frequently require support in the intensive care unit. In the present study, we evaluated the outcome of a large cohort of patients with severe thrombotic microangiopathies.DESIGN: A retrospective multicenter study from January 1998 to June 2001.SETTING: Fourteen French university hospital medical intensive care units.PATIENTS: Sixty three adult patients with severe thrombotic microangiopathies.MEASUREMENTS AND RESULTS: Of the 63 patients, 19 had a clinical presentation of thrombotic thrombocytopenic purpura, 18 had hemolytic uremic syndrome and 26 had combined neurologic and renal failures. Infections were the main etiology associated with thrombotic microangiopathies. The mortality rate was 35%. Of the survivors, all achieved complete remission. Whereas neurologic failure assessed through the Glasgow coma scale was an independent predictor of mortality [HR=0.845 (CI 95%: 0.759-0.940), P=0.002], renal impairment did not appear to be an adverse prognostic factor. The use of plasma exchange was independently associated with survival [HR=0.269 (CI 95%: 0.104-0.691), P=0.006].CONCLUSIONS: Thrombotic microangiopathies with severe organ dysfunctions leading to hospitalization in the intensive care unit are associated with high mortality. Neurologic impairment appears to be the main adverse prognostic factor correlated to mortality, and the study confirms the importance of plasma exchange in the treatment of high-risk patients.
PMID: 15580333 [PubMed - as supplied by publisher]
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