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Unexpected failure of a laryngoscope.
Doddi MK, Heidemann BH.
Publication Types:
PMID: 14984545 [PubMed - indexed for MEDLINE]
Comment on:
ICU, cervical collars and immobilisation.
Jones PS, Healy M.
Publication Types:
PMID: 14984532 [PubMed - indexed for MEDLINE]
[Quality assurance in intensive care medicineSARI-Surveillance on antibiotic use and bacterial resistance in intensive care units]
[Article in German]
Meyer E, Schroeren-Boersch B, Schwab F, Jonas D, Ruden H, Gastmeier P, Daschner FD.
Institut fur Umweltmedizin und Krankenhaushygiene, Universitatsklinikum Freiburg.
Intensive care units (ICUs) are high risk areas for emergence and spread of multiresistant bacterial pathogens. In Germany, there are no representative epidemiological data on antibiotic resistance, prophylactic or therapeutic use of antibiotics in ICUs, or on the correlation between antibiotic use and emergence of resistance. Supported by the German Ministry of Science and Education, project SARI (Surveillance on antibiotic use and bacterial resistance in ICUs) started in 02/2000 and now includes data on antibiotic use and resistance rates in 35 medical, surgical and interdisciplinary ICUs. To date (2/2000-12/2002), a total of 939 participant months, 339,461 patient days and 452,282 defined daily doses (DDD) have been covered with a mean antibiotic usage density (AD) of 1,332 DDDs/1,000 patient days and resistance data on 31,189 isolates from ICUs. The design of the project and first results of SARI are presented. The epidemiological data of SARI form a basis for improved antibiotic and infection control management in ICUs (http://www.sari-antibiotika.de).
PMID: 15004690 [PubMed - as supplied by publisher]
Comment on:
Locating and selecting appraisal studies for reviews.
Yoo HH, Queluz TT.
Publication Types:
PMID: 14769771 [PubMed - indexed for MEDLINE]
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Toxicity of Food Drug and Cosmetic Blue No. 1 dye in critically ill patients.
Lucarelli MR, Shirk MB, Julian MW, Crouser ED.
Division of Pulmonary and Critical Care Medicine, Department of Pharmacy, The Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University Medical Center, 473 West Twelfth Avenue, Columbus, OH 43210-1252, USA.
Food Drug and Cosmetic Blue No. 1 dye (FD&C Blue No. 1) is commonly added to enteral nutrition formulations in order to facilitate the detection of gastric aspirate in tracheal secretions of critically ill patients. However, reports of systemic blue dye absorption and associated adverse outcomes are emerging. We report two cases of abnormal systemic absorption of FD&C Blue No. 1 in critically ill patients who subsequently died of refractory shock and metabolic acidosis. Risk factors and mechanisms of FD&C Blue No. 1 toxicity are discussed, and alternate approaches to gastric aspiration detection in critically ill patients are considered.
Publication Types:
PMID: 14769768 [PubMed - indexed for MEDLINE]
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Prevalence and outcomes of caregiving after prolonged (> or =48 hours) mechanical ventilation in the ICU.
Im K, Belle SH, Schulz R, Mendelsohn AB, Chelluri L; QOL-MV Investigators.
Epidemiology Data Center, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 Desoto Street, 127 Parran Hall, Pittsburgh, PA 15261, USA. im@edu.pitt.edu
OBJECTIVES: (1) To estimate caregiver support required by patients 2 months after prolonged (at least 48 h) mechanical ventilation (MV) in an ICU; (2) to describe caregiver burden, caregiver depressive symptomatology, and caregiver limitations in activities; and (3) to investigate factors related to depressive symptoms at 2 months in caregivers. DESIGN: Prospective cohort study. STUDY PARTICIPANTS: Caregivers of 115 patients who received prolonged MV in an ICU. MEASUREMENTS: Sociodemographics, employment status, hours spent providing care, help from paid caregiving sources, caregiver burden, and caregiver depressive symptoms. RESULTS: The proportion of patients who survived at least 2 months and required caregiver support was 74.8%. The average age of caregivers was 52.9 years (SD, 14.2), 76.5% were women, and more than half were spouses (52.2%). Only 33 of the caregivers (28.7%) were working, and 30.3% had to reduce their time spent at work to provide care to the patient. The prevalence of risk of clinical depression (defined as Center for Epidemiological Studies depression scale [CES-D] score > or =16) among caregivers was 33.9%. The mean caregiver CES-D score was 13.2 (SD, 11; median, 10). Multiple linear regression analysis showed that higher CES-D score was associated with more hours per day helping with patients' activities of daily living and instrumental activities of daily living (p = 0.003). CONCLUSIONS: Two months after being placed on MV for at least 48 h, a high proportion of patients need caregiver support. Approximately 34% of caregivers are at risk of clinical depression. Many caregivers report lifestyle changes and burden when providing care for the patients.
PMID: 14769744 [PubMed - indexed for MEDLINE]
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Transpyloric feeding tube placement in critically ill patients using electromyogram and erythromycin infusion.
Levy H, Hayes J, Boivin M, Tomba T.
Division of Pulmonary and Critical Care, Department of Medicine, University of New Mexico Health Sciences Center, 2211 Lomas Boulevard NE, Albuquerque, NM 87131-5271, USA.
STUDY OBJECTIVES: Transpyloric feeding is desirable in critically ill patients who often have gastroparesis; however, correct placement is difficult, requiring fluoroscopy, endoscopy, or time-consuming blind attempts. This study evaluated the success rate and time required to place transpyloric tubes using erythromycin infusion and GI electromyogram (EMG) signal. DESIGN: Observational trial. SETTING: University hospital medical ICU. PATIENTS: Thirty-nine patients receiving mechanical ventilation for respiratory failure (n = 13), pancreatitis (n = 9), ARDS (n = 8), neurologic disease (n = 4), major surgery (n = 3), and GI disease (n = 2) were enrolled (25 men and 14 women; mean age, 48.4 years; range, 21 to 82 years). INTERVENTIONS: Unweighted Flexiflo 10F feeding tubes were modified by the placement of an electrode 4 to 8 cm from the tip to record electromyogram (EMG) signals (Ross Products Division; Columbus, OH). Gastric signals are high amplitude with a frequency of 3 cycles per minute, while the duodenum and jejunum are low amplitude and 11 to 13 cycles per minute. Erythromycin was infused at a dose of 3 mg/kg to enhance gastric motor activity and emptying. The transpyloric tube was placed in the stomach, and its position was confirmed by EMG, then slowly advanced until duodenal EMG was detected. Tube position was determined by abdominal radiography. Measurements and results: Thirty-one of 39 placements were immediately successful (initial success rate, 80%), 23 jejunal and 8 duodenal, requiring an average 7.8 min (range, 3 to 31 min). Six attempts in five patients were initial failures but were repeated, reaching the duodenum in one patient and the jejunum in four patients. CONCLUSION: Erythromycin infusion and EMG guidance can facilitate rapid transpyloric feeding tube placement in critically ill patients at the bedside.
PMID: 14769742 [PubMed - indexed for MEDLINE]
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A randomised controlled study of the efficacy of hypromellose and Lacri-Lube combination versus polyethylene/Cling wrap to prevent corneal epithelial breakdown in the semiconscious intensive care patient.
Koroloff N, Boots R, Lipman J, Thomas P, Rickard C, Coyer F.
Department of Intensive Care Medicine, Royal Brisbane Hospital, Level 3 Ned Hanlon Building, 4029, Herston, Queensland, Australia.
OBJECTIVE. To compare the efficacy of two forms of eye care (hypromellose and Lacri-Lube combination vs polyethylene/Cling wrap covers) for intensive care patients. DESIGN. Randomised-controlled trial. SETTING. University affiliated, tertiary referral hospital. PATIENTS AND PARTICIPANTS. One hundred ten patients with a reduced or absent blink reflex were followed through until they regained consciousness, were discharged from the facility during study enrolment, died or developed a positive corneal ulcer or eye infection. INTERVENTIONS. All patients received standard eye cleansing every 2 h. In addition to this, group one ( n=60) received a treatment combining hypromellose drops and Lacri-Lube (HL) to each eye every 2 h. Group two ( n=50) had polyethylene covers only placed over the eye to create a moisture chamber. MEASUREMENTS AND RESULTS. Corneal ulceration was determined using corneal fluorescein stains and mobile slit lamp evaluation, performed daily. No patients had corneal ulceration in the polyethylene cover group, but 4 patients had corneal ulceration in the HL group. CONCLUSIONS. Polyethylene covers are as effective as HL in reducing the incidence of corneal damage in intensive care patients.
PMID: 15014864 [PubMed - as supplied by publisher]
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The clinical course of patients with septic abortion admitted to an intensive care unit.
Finkielman JD, De Feo FD, Heller PG, Afessa B.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic and Foundation, 200 First Street SW, MN 55905, Rochester, USA.
OBJECTIVE. The purpose of this study was to describe the clinical course, complications, and outcome of patients with septic abortion admitted to the intensive care unit (ICU). DESIGN, SETTING, AND PATIENTS. In this retrospective study, the records of 63 patients with septic abortion admitted to the ICU of a university hospital in Argentina between 1985 and 1995 were reviewed. RESULTS. The mean age of the patients was 28.5 years, and 33% had had previous abortions. The mean gestational age was 10.5 weeks. The first ICU day Acute Physiology and Chronic Health Evaluation (APACHE) II mean score was 13.9. Acute renal failure developed in 73% (46 of 63) of the patients, disseminated intravascular coagulation (DIC) in 31% (15 of 49), and septic shock in 32% (20 of 63). Blood cultures were positive in 24% (15 of 62). Twelve patients died (19%). Eight of the deaths occurred during the first 48 h of the ICU admission. Compared with survivors, non-survivors had higher median number of organ failures (1.0 vs 4.0, p<0.0001), mean first ICU day SOFA scores (6.6 vs 10.0, p=0.0059), and mean APACHE II scores (12.7 vs 20.2, p=0.0003), and were more likely to have septic shock (18 vs 92%, p<0.0001), and receive dopamine (37 vs 83%, p=0.0040), mechanical ventilation (8 vs 83%, p<0.0001), and pulmonary artery catheter (8 vs 41%, p=0.0026). CONCLUSIONS. Although it is an avoidable complication, septic abortion requiring admission to the ICU is associated with high morbidity and mortality.
PMID: 15007546 [PubMed - as supplied by publisher]
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Hospital mortality associated with day and time of admission to intensive care units.
Wunsch H, Mapstone J, Brady T, Hanks R, Rowan K.
Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, WC1E 7HT, London, UK.
OBJECTIVE. To investigate whether hospital mortality of patients was associated with the day of the week or time of admission to intensive care units (ICUs). DESIGN. Cohort study. SETTING. One hundred two adult, general (mixed medical/surgical) ICUs in England, Wales and Northern Ireland. PATIENTS AND PARTICIPANTS. A total of 56,250 admissions from 1995 to 2000 that fit the inclusion criteria for calculation of the APACHE II probability of hospital mortality. INTERVENTIONS. None. MEASUREMENTS AND RESULTS. Crude and case mix adjusted hospital mortality were examined by day of the week and time of day of admission to ICU. Patients admitted on Saturday and Sunday had higher crude hospital mortality compared with admissions on Wednesday [Saturday crude odds ratio (OR) 1.41, 95% CI 1.32-1.52; Sunday OR 1.56, 1.45-1.68]. The association was still significant after adjustment using the UK APACHE II model (Saturday OR 1.16, 1.1.07-1.26; Sunday OR 1.24, 1.14-1.35) but not after adjustment using individual components of the APACHE II model (Saturday OR 1.03, 0.95-1.12; Sunday OR 1.09, 1.00-1.19). Night admissions were also associated with higher mortality compared with day both before and after adjustment for case mix using the UK APACHE II model (crude OR 1.43, 1.37-1.51; adjusted OR 1.16, 1.10-1.23) but not after adjustment using components of the APACHE II model (OR 1.02, 95% CI 0.96-1.09). CONCLUSIONS. After appropriate adjustment for case mix, day of the week and time of day of admission of patients to ICU were not associated with significant differences in hospital mortality.
PMID: 15007545 [PubMed - as supplied by publisher]
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