Ultimo Aggiornamento: 20 Gennaio 2004

1: Anaesth Intensive Care. 2003 Dec;31(6):653-7.

The influence of a blood conserving device on anaemia in intensive care
patients.

MacIsaac CM, Presneill JJ, Boyce CA, Byron KL, Cade JF.

Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Victoria.

The contribution of iatrogenic blood loss through diagnostic testing to the
anaemia of critical illness remains controversial. We measured the effect of an
arterial line blood conservation device upon blood loss and anaemia in adult
intensive care patients. This randomized controlled trial of 160 patients in a
major Intensive Care Unit (ICU) compared a blood conservation device (Venous
Arterial Blood Management Protection Plus, VAMP Plus system, Baxter Healthcare)
(VAMP group) to a standard arterial pressure line set attached to an arterial
catheter (control group). The primary outcome measured was the change in
haemoglobin concentration (Hb) during each patient's ICU admission and the
volume of blood lost through diagnostic testing in ICU was also recorded. Both
groups of 80 patients were matched for age, gender, severity of illness (APACHE
II), baseline Hb on entry and ICU length of stay. Both groups had a similar
(median [range]) change in Hb during ICU admission (VAMP-7 [-84 to +21] g/l;
Control -4 [-67 to +40] g/l; P = 0.33). The VAMP patients lost significantly
less blood for diagnostic testing while in ICU (VAMP 63 [0 to 787] ml; Control
133 [7 to 1227] ml; P = 0.001). We conclude that the VAMP Plus system
significantly reduced iatrogenic blood loss in critically ill patients, but this
reduction did not affect the fall in Hb that accompanies critical illness.

PMID: 14719427 [PubMed - in process]

2: Arch Dis Child. 2003 Dec;88(12):1065-9.

The clinical and health economic burden of respiratory syncytial virus disease
among children under 2 years of age in a defined geographical area.

Deshpande SA, Northern V.

Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury SY3 8XQ, UK.
deshpande@which.net

AIMS: To describe the clinical and health economic impact of respiratory
syncytial virus (RSV) disease in children under 2 years of age. METHODS:
Hospitalised children less than 2 years of age with a respiratory illness were
studied over three consecutive RSV seasons (1996-99). RESULTS: The rates (per
1000 infants under 1 year of age) of hospitalisations from bronchiolitis and RSV
illness were 30.8 and 24.4 respectively. The rates of death, intensive care
admission, and need for ventilatory assistance during RSV related
hospitalisation were 0.2%, 2.7%, and 1.5% respectively. From a cohort of 841
preterm infants, 6.3% had an RSV related hospitalisation during the study
period, with the rate rising to 9.2% among those who were either born before 36
weeks gestation and were under 6 months of age at the onset of the RSV seasons,
or were less than 2 years of age with chronic lung disease needing home oxygen
therapy. Eight of 25 children on home oxygen therapy had RSV related
rehospitalisation. Need for assisted ventilation during the neonatal period and
discharge home on oxygen therapy were significantly associated with the risk of
subsequent RSV related hospitalisation in preterm infants less than 6 months of
age. The direct health authority cost of all RSV hospitalisations was pound 542
203, while the currently recommended immunoprophylaxis for the high risk infants
would have cost pound 652 960. CONCLUSIONS: Preterm infants receiving assisted
ventilation and those on home oxygen therapy are particularly at risk of RSV
related hospitalisation. Serious adverse outcomes are however uncommon even
among these high risk infants.

PMID: 14670770 [PubMed - indexed for MEDLINE]

3: Br J Anaesth. 2004 Feb;92(2):296-7.

New method to evaluate the practice of positive pressure ventilation in
intensive care units.

Hunter J, Rothwell M, Roche RJ.

Macclesfield, UK Leeds, UK.

PMID: 14722191 [PubMed - in process]

4: Crit Care Med. 2003 Dec;31(12 Suppl):S715-20.

Blood conservation in the intensive care unit.

Fowler RA, Berenson M.

Department of Medicine and Interdepartmental Division of Critical Care Medicine,
Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.

OBJECTIVE: To describe blood conservation strategies for critically ill
patients. DATA SOURCES: By using a predefined strategy, we searched the
electronic databases of Medline, EMBASE, CINAHL, the Cochrane database of
systematic reviews, Cochrane central register of controlled trials, ACP Journal
Club, Database of abstracts of reviews and effects, and HealthSTAR for
descriptions and evaluations of strategies of blood conservation among
critically ill patients. DATA SUMMARY: A number of blood conservation strategies
have been used to prevent or treat anemia among critically ill patients. These
include restrictive diagnostic phlebotomy using small-volume or pediatric
phlebotomy tubes, point-of-care and inline bedside microanalysis, minimization
of diagnostic sample waste, minimization of routine multiple daily phlebotomies,
red blood cell salvage and antifibrinolytic agents for bleeding patients,
consideration of removal of central venous and arterial catheters when no longer
required for physiologic monitoring, threshold-based transfusion policy, and
healthcare professional education. CONCLUSIONS: There are many strategies of
blood conservation for critically ill patients. The effects of these strategies
on phlebotomy volumes, hemoglobin and hematocrit levels, transfusion
requirements, clinical outcomes, as well as intensive care unit and laboratory
resources and costs should be further evaluated.

PMID: 14724470 [PubMed - in process]

5: Crit Care Nurse. 2003 Oct;23(5):88, 86-7.

Multihospital system adapts AACN synergy model.

[No authors listed]

PMID: 14606130 [PubMed - indexed for MEDLINE]

6: Crit Care Nurse. 2003 Oct;23(5):47-50.

New graduates a precious critical care resource.

Nibert AT.

College of Nursing, Houston Baptist University, Houston, Tex., USA.

The shortage of nurses is here, and the complexity of the issues involved will
take time to resolve. Undoubtedly, this process will be slow and frustrating.
Critically ill patients who require intensive, highly skilled nursing care are
among those most affected by the shortage of nurses. Nursing service, in
partnership with nursing education, should create innovative strategies that
will ultimately alleviate the shortage of nurses. What we have to gain is more
precious resources, our new graduates filling all the chairs in future summer
critical care orientation classes.

PMID: 14606126 [PubMed - indexed for MEDLINE]

7: Crit Care Nurse. 2003 Oct;23(5):38-42; quiz 43-4.

HIV disease and aging. The hidden epidemic.

Ress B.

Fairmont HIV Services, Alameda County Medical Center, San Leandro, Calif., USA.

Publication Types:
Case Reports
Review
Review, TutorialPMID: 14606125 [PubMed - indexed for MEDLINE]

8: Crit Care Nurse. 2003 Oct;23(5):24-30, 32-6.

Resiliency of accomplished critical care nurses in a natural disaster.

Sebastian SV, Styron SL, Reize SN, Houston S, Luquire R, Hickey JV.

Neuroscience Intensive Care Unit, St Luke's Episcopal Hospital, Houston, Tex.,
USA.

PMID: 14606124 [PubMed - indexed for MEDLINE]

9: Crit Care Nurse. 2003 Oct;23(5):8, 10.

The value of certification as a critical care nurse.

Alspach G.

Publication Types:
EditorialPMID: 14606122 [PubMed - indexed for MEDLINE]

10: Intensive Care Med. 2004 Jan 13 [Epub ahead of print]

Reply to Comment on "Changes in cerebral interstitial glycerol concentration in
head injured patients; correlation with secondary events", Intensive Care Med
(2003) 29:1825-1828.

Peerdeman SM, Vandertop WP.

Department of Neurosurgery, VU University Medical Center, Amsterdam, The
Netherlands.

PMID: 14722638 [PubMed - as supplied by publisher]

11: Intensive Care Med. 2004 Jan 13 [Epub ahead of print]

Transient Bcl-2 gene down-expression in circulating mononuclear cells of severe
sepsis patients who died despite appropriate intensive care.

Bilbault P, Lavaux T, Lahlou A, Uring-Lambert B, Gaub MP, Ratomponirina C, Meyer
N, Oudet P, Schneider F.

Services de Reanimation Medicale, Hopital de Hautepierre, Avenue Moliere, 67098,
Strasbourg, France.

OBJECTIVE. To assess the levels of expression of the antiapoptotic gene Bcl-2
and the proapoptotic gene Bax in circulating mononuclear cells (CMNC) harvested
during the course of severe sepsis (SS) in formerly non-immunocompromised
patients undergoing hospital-acquired infection, in parallel to cytokine levels.
DESIGN. Prospective study. SETTING. Intensive care unit. PARTICIPANTS. A total
of 24 patients without immunodeficiency undergoing standard goal-directed
therapy for nosocomial SS, 10 critically ill patients without sepsis, and 10
healthy controls. INTERVENTIONS. Blood was collected before infection and within
12 h, 1, 3 and 7 days after fever onset, to determine plasma concentrations of
IL-6, IL-10, TNF-alpha, C-reactive protein, whole blood cell counts, lymphocyte
subsets, annexin V labelling for apoptosis, and Bax and Bcl-2 relative RNA
expression by real-time polymerase chain reaction. RESULTS. SS patients
displayed increased cytokine concentrations, TNF-alpha being significantly
increased at full-blown sepsis. Within 12 h after onset of infection, lymphocyte
counts were lower in SS patients than in critically ill controls ( p=0.001), and
this phenomenon was marked in CD4+ and CD8+ subsets ( p<0.001). This was
associated with enhanced apoptosis in CMNC (15.7+/-8.7% vs 3.4+/-2.1%, p<0.001)
and a significant down-expression of the Bcl-2 gene throughout the study (
p<0.05). In contrast, the expression of Bax did not change significantly. Within
12 h of fever onset, non-survivors expressed a 10-fold down-expression of Bcl-2
when compared to survivors ( p<0.001). CONCLUSIONS. An early transient
down-expression of the gene Bcl-2 occurred in CMNC harvested from SS patients
who died despite intensive care. In contrast, the expression of the gene Bax did
not change significantly.

PMID: 14722631 [PubMed - as supplied by publisher]

12: Intensive Care Med. 2004 Jan;30(1):4-6. Epub 2003 Nov 28.

The epidemiologist in the intensive care unit.

Rubenfeld GD, Christie JD.

Division of Pulmonary and Critical Care Medicine, Harborview Medical Center,
University of Washington, 325 9th Ave., Box 359762, 98104-2499, Seattle, WA,
USA, nodrog@u.washington.edu

PMID: 14716476 [PubMed - in process]

13: J Trauma. 2003 Dec;55(6):1095-108; discussion 1108-10.

Changing patterns in the management of penetrating abdominal trauma: the more
things change, the more they stay the same.

Nicholas JM, Rix EP, Easley KA, Feliciano DV, Cava RA, Ingram WL, Parry NG,
Rozycki GS, Salomone JP, Tremblay LN.

Emory University Department of Surgery/Grady Memorial Hospital and Rollins
School of Public Health, Atlanta, Georgia 03030, USA.
jeffrey_nicholas@emoryhealthcare.org

BACKGROUND: Damage control surgery (DCS) and treatment of abdominal compartment
syndrome have had major impacts on care of the severely injured. The objective
of this study was to see whether advances in critical care, DCS, and recognition
of abdominal compartment syndrome have improved survival from penetrating
abdominal injury (PAI). METHODS: The care of 250 consecutive patients requiring
laparotomy for PAI (1997-2000) was reviewed retrospectively. Organ injury
patterns, survival, and use of DCS and its impact on outcome were compared with
a similar experience reported in 1988. RESULTS: Two hundred fifty patients had a
positive laparotomy for PAI. Twenty-seven (10.8%) required abdominal packing and
45 (17.9%) did not have fascial closure. Seven (2.8%) required emergency
department thoracotomy and 21 (8.4%) required operating room thoracotomy. Two
hundred seventeen (86.8%) survived overall. Small bowel (47.2%), colon (36.4%),
and liver (34.4%) were most often injured. Mortality was associated with the
number of organs injured (odds ratio, 1.98; 95% confidence interval, 1.65-2.37;
p < 0.001). Vascular injury was a risk factor for mortality (p < 0.001), as was
need for DCS (p < 0.001), emergency department thoracotomy (p < 0.001), and
operating room thoracotomy (p < 0.001). Seventy-nine percent of deaths occurred
within 24 hours from refractory hemorrhagic shock. DCS was used in 17.9% (n =
45) versus 7.0% (n = 21) in 1988, with a higher survival rate (73.3% vs. 23.8%,
p < 0.001). DCS was associated with significant morbidity including sepsis
(42.4%, p < 0.001), intra-abdominal abscess (18.2%, p = 0.009), and
gastrointestinal fistula (18.2%, p < 0.001). CONCLUSION: Penetrating abdominal
organ injury patterns and survival from PAI have remained similar over the past
decade. Death from refractory hemorrhagic shock in the first 24 hours remains
the most common cause of mortality. DCS and the open abdomen are being used more
frequently with improved survival but result in significant morbidity.

PMID: 14676657 [PubMed - indexed for MEDLINE]

14: Wien Klin Wochenschr. 2003 Sep 15;115(15-16):595-8.

Liver support in fulminant liver failure after hemorrhagic shock.

Faybik P, Hetz H, Krenn CG, Baker A, Germann P, Berlakovich G, Steininger R,
Steltzer H.

Department of Anaesthesia and Intensive Care Medicine, University Hospital,
Vienna, Austria. zralok@hotmail.com

Acute liver failure (ALF) is a rare clinical syndrome associated with a
mortality of up to 80% and its management remains an interdisciplinary
challenge. Despite recent improvements in intensive care management, the
mortality of patients with ALF remains high and is related to complications such
as cerebral edema, sepsis and multiple organ failure. Emergency orthotopic liver
transplantation (OLT) is currently the only effective treatment for those
patients who are unlikely to recover spontaneously. Nevertheless, OLT is not
always possible because of the shortage of the organs and/or complications
related to ALF. Newly introduced liver-assist devices can temporarily support
the patient's liver until native liver recovers or can serve as a bridging
device until a liver graft is available. The support devices use both cell-based
and non-cell-based techniques. One of the latest non-cell-based extracorporeal
hepatic support devices, the molecular adsorbent recycling system (MARS), is
based on the concept of albumin dialysis. MARS utilises selective
hemodiafiltration with countercurrent albumin dialysis aiming to selectively
remove both water-soluble and albumin-bound toxins of the low and middle
molecular-weight range. We report on a young patient who presented with clinical
symptoms of ischemic hepatitis and multi-organ failure (APACHE II score
38-->predicted postoperative mortality 87%) due to prolonged hemorrhagic shock.
OLT was contraindicated because of history of pancreas cancer with metastases.
It was necessary to use aggressive conservative therapy and an extracorporeal
liver-assist device until liver regeneration began and hemodynamic conditions
were stable. The patient underwent five treatments with MARS. During the
treatment, there were improvements of hemodynamics, respiratory function,
acid-base disturbances and laboratory parameters. The plasma disappearance rate
of indocyanine green, a parameter of dynamic liver function, improved during
MARS treatment. Although repeated neurological examination predicted diffuse
brain damage (brain oedema, decreased cerebral blood flow), the patient
recovered without any neurological deficits. The patient survived and was
discharged from the hospital in good condition. In this case MARS treatment was
successful in supporting the patient through the most critical period of ALF.

Publication Types:
Case ReportsPMID: 14531174 [PubMed - indexed for MEDLINE]

15: Wien Klin Wochenschr. 2003 Sep 15;115(15-16):547-8.

Liver support in acute liver failure.

Hughes RD.

Publication Types:
EditorialPMID: 14531165 [PubMed - indexed for MEDLINE]