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Items 1 - 12 of 12 |
One page. |
Methicillin-resistant Staphylococcus aureus infections and colonizations in an intensive care unit apparently stopped by environmental factors.
Dealler S.
Department of Microbiology, Royal Lancaster Infirmary, Lancaster, UK.
Publication Types:
PMID: 15501341 [PubMed - in process]
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Genotyping analysis of colonizing candidal isolates from very-low-birthweight infants in a neonatal intensive care unit.
Huang YC, Su LH, Wu TL, Lin TY.
Division of Paediatric Infectious Diseases, Chang Gung Children's Hospital, Chang Gung University, 5, Fu-Shin Street, Kweishan, Taoyuan, Taiwan.
To analyse the relatedness of colonizing candidal isolates from very-low-birthweight infants hospitalized in a neonatal intensive care unit (NICU), we prospectively collected 86 candidal isolates from 20 infants, including 67 isolates of Candida albicans from 15 infants, 17 isolates of Candida parapsilosis from five infants and two isolates of Candida glabrata from one infant, who also had C. albicans colonization, over a one-year period. All 86 isolates were genotyped by infrequent-restriction-site polymerase chain reaction (IRS-PCR) and electrophoretic karyotyping (EK) with pulsed-field gel electrophoresis. A total of 15 genotypes were identified by IRS-PCR and 12 genotypes by EK. Some infants shared a common genotype. From a single infant, an identical genotype was found in 11 of 13 cases where at least two isolates of same Candida species were available for genotyping analysis, regardless of anatomical site, how many isolates were recovered or how many times. Should an infant harbour a candidal strain, they may harbour this strain at multiple sites and for a prolonged period.
PMID: 15501334 [PubMed - in process]
Is a restrictive transfusion strategy safe for resuscitated and critically ill trauma patients?
McIntyre L, Hebert PC, Wells G, Fergusson D, Marshall J, Yetisir E, Blajchman MJ; Canadian Critical Care Trials Group.
Centre for Transfusion and Clinical Epidemiology Program, Ottawa Health Research Institute, Ontario. lmcintyre@ottawahospital.on.ca
BACKGROUND: An analysis from the prospective multicenter randomized controlled trial (Transfusion Requirements in Critical Care Trial) compared the use of restrictive and liberal transfusion strategies with resuscitated critically ill trauma patients. METHODS: Critically ill trauma patients with a hemoglobin concentration less than 90 g/L within 72 hours of admission to the intensive care unit were randomized to a restrictive (hemoglobin concentration, 70 g/L) or liberal (hemoglobin concentration, 100 g/L) red blood cell transfusion strategy. RESULTS: The baseline characteristics in the restrictive (n = 100) and liberal (n = 103) transfusion groups were comparable. The average hemoglobin concentrations (82.7 +/- 6.2 g/L vs. 104.3 +/- 12.2 g/L; p < 0.0001) and the red blood cell units transfused per patient (2.3 +/- 4.4 vs. 5.4 +/- 4.3; p < 0.0001) were significantly lower in the restrictive group than in the liberal group. The 30-day all-cause mortality rates in the restrictive group were 10%, as compared with 9% in the liberal group (p = 0.81). The presence of multiple organ dysfunction (9.2 +/- 6.3 vs. 9.0 +/- 6.0; p = 0.81), the changes in multiple organ dysfunction from baseline scores adjusted for death (1.2 +/- 6.1 vs. 1.9 +/- 5.7; p = 0.44), and the length of stay in the intensive care unit (9.8 +/- 8.1 vs. 10.2 +/- 8.7 days; p = 0.73) and hospital (31.4 +/- 17.1 vs. 33.7 +/- 17.7 days; p = 0.34) also were similar between the restrictive and liberal transfusion groups. CONCLUSIONS: A restrictive red blood cell transfusion strategy appears to be safe for critically ill multiple-trauma patients. A randomized controlled trial would provide the appropriate level of evidence with regard to the daily use of blood in this population of patients.
PMID: 15454803 [PubMed - indexed for MEDLINE]
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Cumulative radiation dose caused by radiologic studies in critically ill trauma patients.
Kim PK, Gracias VH, Maidment AD, O'Shea M, Reilly PM, Schwab CW.
Division of Traumatology and Surgical Critical Care, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. kimp@uphs.upenn.edu
BACKGROUND: Critically ill trauma patients undergo many radiologic studies, but the cumulative radiation dose is unknown. The purpose of this study was to estimate the cumulative effective dose (CED) of radiation resulting from radiologic studies in critically ill trauma patients. METHODS: The study group was composed of trauma patients at an urban Level I trauma center with surgical intensive care unit length of stay (LOS) greater than 30 days. The radiology records were reviewed. A typical effective dose per study for each type of plain film radiograph, computed tomographic scan, fluoroscopic study, and nuclear medicine study was used to calculate CED. RESULTS: Forty-six patients met criteria. The mean surgical intensive care unit and hospital LOS were 42.7 +/- 14.0 and 59.5 +/- 28.5 days, respectively. The mean Injury Severity Score was 32.2 +/- 15.0. The mean number of studies per patient was 70.1 +/- 29.0 plain film radiographs, 7.8 +/- 4.1 computed tomographic scans, 2.5 +/- 2.6 fluoroscopic studies, and 0.065 +/- 0.33 nuclear medicine study. The mean CED was 106 +/- 59 mSv per patient (range, 11-289 mSv; median, 104 mSv). Among age, mechanism, Injury Severity Score, and LOS, there was no statistically significant predictor of high CED. The mean CED in the study group was 30 times higher than the average yearly radiation dose from all sources for individuals in the United States. The theoretical additional morbidity attributable to radiologic studies was 0.78%. CONCLUSION: From a radiobiologic perspective, risk-to-benefit ratios of radiologic studies are favorable, given the importance of medical information obtained. Current practice patterns regarding use of radiologic studies appear to be acceptable.
PMID: 15454795 [PubMed - indexed for MEDLINE]
Comment on:
Fluid resuscitation in the intensive care unit.
Neff TA, Stocker R, Spahn DR.
Publication Types:
PMID: 15515220 [PubMed - indexed for MEDLINE]
Comment on:
Fluid resuscitation in the intensive care unit.
Barone JE.
Publication Types:
PMID: 15515219 [PubMed - indexed for MEDLINE]
Comment on:
Fluid resuscitation in the intensive care unit.
Primack WA, Estes K.
Publication Types:
PMID: 15515218 [PubMed - indexed for MEDLINE]
Comment on:
Fluid resuscitation in the intensive care unit.
Walter EC, Wendorf R, Kim Y.
Publication Types:
PMID: 15515217 [PubMed - indexed for MEDLINE]
Comment on:
Fluid resuscitation in the intensive care unit.
Haynes GR, Berman KE.
Publication Types:
PMID: 15509826 [PubMed - indexed for MEDLINE]
Comment in:
Effect of reducing interns' work hours on serious medical errors in intensive care units.
Landrigan CP, Rothschild JM, Cronin JW, Kaushal R, Burdick E, Katz JT, Lilly CM, Stone PH, Lockley SW, Bates DW, Czeisler CA.
Division of Sleep Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. clandrigan@rics.bwh.harvard.edu
BACKGROUND: Although sleep deprivation has been shown to impair neurobehavioral performance, few studies have measured its effects on medical errors. METHODS: We conducted a prospective, randomized study comparing the rates of serious medical errors made by interns while they were working according to a traditional schedule with extended (24 hours or more) work shifts every other shift (an "every third night" call schedule) and while they were working according to an intervention schedule that eliminated extended work shifts and reduced the number of hours worked per week. Incidents were identified by means of a multidisciplinary, four-pronged approach that included direct, continuous observation. Two physicians who were unaware of the interns' schedule assignments independently rated each incident. RESULTS: During a total of 2203 patient-days involving 634 admissions, interns made 35.9 percent more serious medical errors during the traditional schedule than during the intervention schedule (136.0 vs. 100.1 per 1000 patient-days, P<0.001), including 56.6 percent more nonintercepted serious errors (P<0.001). The total rate of serious errors on the critical care units was 22.0 percent higher during the traditional schedule than during the intervention schedule (193.2 vs. 158.4 per 1000 patient-days, P<0.001). Interns made 20.8 percent more serious medication errors during the traditional schedule than during the intervention schedule (99.7 vs. 82.5 per 1000 patient-days, P=0.03). Interns also made 5.6 times as many serious diagnostic errors during the traditional schedule as during the intervention schedule (18.6 vs. 3.3 per 1000 patient-days, P<0.001). CONCLUSIONS: Interns made substantially more serious medical errors when they worked frequent shifts of 24 hours or more than when they worked shorter shifts. Eliminating extended work shifts and reducing the number of hours interns work per week can reduce serious medical errors in the intensive care unit. Copyright 2004 Massachusetts Medical Society.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15509817 [PubMed - indexed for MEDLINE]
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Monitoring mixed venous oxygen saturation in patients with obstructive shock after massive pulmonary embolism.
Krivec B, Voga G, Podbregar M.
Department for Intensive Internal Medicine, General Hospital Celje, Slovenia.
BACKGROUND: Patients with massive pulmonary embolism and obstructive shock usually require hemodynamic stabilization and thrombolysis. Little is known about the optimal and proper use of volume infusion and vasoactive drugs, or about the titration of thrombolytic agents in patients with relative contraindication for such treatment. The aim of the study was to find the most rapidly changing hemodynamic variable to monitor and optimize the treatment of patients with obstructive shock following massive pulmonary embolism. PATIENTS AND METHODS: Ten consecutive patients hospitalized in the medical intensive care unit in the community General Hospital with obstructive shock following massive pulmonary embolism were included in the prospective observational study. Heart rate, systolic arterial pressure, central venous pressure, mean pulmonary-artery pressure, cardiac index, total pulmonary vascular-resistance index, mixed venous oxygen saturation, and urine output were measured on admission and at 1, 2, 3, 4, 8, 12, and 16 hours. Patients were treated with urokinase through the distal port of a pulmonary-artery catheter. RESULTS: At 1 hour, mixed venous oxygen saturation, systolic arterial pressure and cardiac index were higher than their admission values (31+/-10 vs. 49+/-12%, p<0.0001; 86+/-12 vs. 105+/-17 mmHg, p<0.01; 1.5+/-0.4 vs. 1.9+/-0.7 L/min/m2, p<0.05; respectively), whereas heart rate, central venous pressure, mean pulmonary-artery pressure and urine output remained unchanged. Total pulmonary vascular-resistance index was lower than at admission (29+/-10 vs. 21+/-12 mmHg/L/min/m2, p<0.05). The relative change of mixed venous oxygen saturation at hour 1 was higher than the relative changes of all other studied variables (p<0.05). Serum lactate on admission and at 12 hours correlated to mixed venous oxygen saturation (r=-0.855, p<0.001). CONCLUSION: In obstructive shock after massive pulmonary embolism, mixed venous oxygen saturation changes more rapidly than other standard hemodynamic variables.
PMID: 15237659 [PubMed - indexed for MEDLINE]
Comment on:
Why albumin may still work.
Groeneveld J.
Publication Types:
PMID: 15237651 [PubMed - indexed for MEDLINE]
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