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Items 1 - 19 of 19 |
One page. |
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Organisation and delivery of perinatal services.
Tucker J, Parry G, Fowlie PW, McGuire W.
Dugald Baird Centre, Department of Obstetrics and Gynaecology, University of Aberdeen.
Publication Types:
PMID: 15388617 [PubMed - indexed for MEDLINE]
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Bench-to-bedside review: Microdialysis in intensive care medicine.
Klaus S, Heringlake M, Bahlmann L.
Department of Anaesthesiology, Medical University of Luebeck, Luebeck, Germany. stephan.klaus@gmx.de.
Microdialysis is a technique used to measure the concentrations of various compounds in the extracellular fluid of an organ or in a body fluid. It is a form of metabolic monitoring that provides real-time, continuous information on pathophysiological processes in target organs. It was introduced in the early 1970s, mainly to measure concentrations of neurotransmitters in animal experiments and clinical settings. Using commercial equipment it is now possible to conduct analyses at the bedside by collecting interstitial fluid for measurement of carbohydrate and lipid metabolites. Important research has been reported in the field of neurosurgery in recent decades, but use of metabolic monitoring in critical care medicine is not yet routine. The present review provides an overview of findings from clinical studies using microdialysis in critical care medicine, focusing on possible indications for clinical biochemical monitoring. An important message from the review is that sequential and tissue-specific metabolic monitoring, in vivo, is now available.
PMID: 15469599 [PubMed - in process]
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Clinical review: Moral assumptions and the process of organ donation in the intensive care unit.
Streat S.
Intensivist, Department of Critical Care Medicine, Auckland Hospital, New Zealand. stephens@adhb.govt.nz.
The objective of the present article is to review moral assumptions underlying organ donation in the intensive care unit. Data sources used include personal experience, and a Medline search and a non-Medline search of relevant English-language literature. The study selection included articles concerning organ donation. All data were extracted and analysed by the author. In terms of data synthesis, a rational, utilitarian moral perspective dominates, and has captured and circumscribed, the language and discourse of organ donation. Examples include "the problem is organ shortage", "moral or social duty or responsibility to donate", "moral responsibility to advocate for donation", "requesting organs" or "asking for organs", "trained requesters", "pro-donation support persons", "persuasion" and defining "maximising donor numbers" as the objective while impugning the moral validity of nonrational family objections to organ donation. Organ donation has recently been described by intensivists in a morally neutral way as an "option" that they should "offer", as "part of good end-of-life care", to families of appropriate patients. In conclusion, the review shows that a rational utilitarian framework does not adequately encompass interpersonal interactions during organ donation. A morally neutral position frees intensivists to ensure that clinical and interpersonal processes in organ donation are performed to exemplary standards, and should more robustly reflect societal acceptability of organ donation (although it may or may not "produce more donors").
PMID: 15469581 [PubMed - in process]
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Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review.
Arabi Y, Haddad S, Shirawi N, Al Shimemeri A.
Deputy Chairman, Intensive Care Department (MC 1425), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. arabi@ngha.med.sa.
INTRODUCTION: Despite the integral role played by tracheostomy in the management of trauma patients admitted to intensive care units (ICUs), its timing remains subject to considerable practice variation. The purpose of this study is to examine the impact of early tracheostomy on the duration of mechanical ventilation, ICU length of stay, and outcomes in trauma ICU patients. METHODS: The following data were obtained from a prospective ICU database containing information on all trauma patients who received tracheostomy over a 5-year period: demographics, Acute Physiology and Chronic Health Evaluation II score, Simplified Acute Physiology Score II, Glasgow Coma Scale score, Injury Severity Score, type of injuries, ICU and hospital outcomes, ICU and hospital length of stay (LOS), and the type of tracheostomy procedure (percutaneous versus surgical). Tracheostomy was considered early if it was performed by day 7 of mechanical ventilation. We compared the duration of mechanical ventilation, ICU LOS and outcome between early and late tracheostomy patients. Multivariate analysis was performed to assess the impact of tracheostomy timing on ICU stay. RESULTS: Of 653 trauma ICU patients, 136 (21%) required tracheostomies, 29 of whom were early and 107 were late. Age, sex, Acute Physiology and Chronic Health Evaluation II score, Simplified Acute Physiology Score II and Injury Severity Score were not different between the two groups. Patients with early tracheostomy were more likely to have maxillofacial injuries and to have lower Glasgow Coma Scale score. Duration of mechanical ventilation was significantly shorter with early tracheostomy (mean +/- standard error: 9.6 +/- 1.2 days versus 18.7 +/- 1.3 days; P < 0.0001). Similarly, ICU LOS was significantly shorter (10.9 +/- 1.2 days versus 21.0 +/- 1.3 days; P < 0.0001). Following tracheostomy, patients were discharged from the ICU after comparable periods in both groups (4.9 +/- 1.2 days versus 4.9 +/- 1.1 days; not significant). ICU and hospital mortality rates were similar. Using multivariate analysis, late tracheostomy was an independent predictor of prolonged ICU stay (>14 days). CONCLUSION: Early tracheostomy in trauma ICU patients is associated with shorter duration of mechanical ventilation and ICU LOS, without affecting ICU or hospital outcome. Adopting a standardized strategy of early tracheostomy in appropriately selected patients may help in reducing unnecessary resource utilization.
PMID: 15469579 [PubMed - in process]
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The outcome of extubation failure in a community hospital intensive care unit: a cohort study.
Seymour CW, Martinez A, Christie JD, Fuchs BD.
INTRODUCTION: Extubation failure has been associated with poor intensive care unit (ICU) and hospital outcomes in tertiary care medical centers. Given the large proportion of critical care delivered in the community setting, our purpose was to determine the impact of extubation failure on patient outcomes in a community hospital ICU. METHODS: A retrospective cohort study was performed using data gathered in a 16-bed medical/surgical ICU in a community hospital. During 30 months, all patients with acute respiratory failure admitted to the ICU were included in the source population if they were mechanically ventilated by endotracheal tube for more than 12 hours. Extubation failure was defined as reinstitution of mechanical ventilation within 72 hours (n = 60), and the control cohort included patients who were successfully extubated at 72 hours (n = 93). RESULTS: The primary outcome was total ICU length of stay after the initial extubation. Secondary outcomes were total hospital length of stay after the initial extubation, ICU mortality, hospital mortality, and total hospital cost. Patient groups were similar in terms of age, sex, and severity of illness, as assessed using admission Acute Physiology and Chronic Health Evaluation II score (P > 0.05). Both ICU (1.0 versus 10 days; P < 0.01) and hospital length of stay (6.0 versus 17 days; P < 0.01) after initial extubation were significantly longer in reintubated patients. ICU mortality was significantly higher in patients who failed extubation (odds ratio = 12.2, 95% confidence interval [CI] = 1.5-101; P < 0.05), but there was no significant difference in hospital mortality (odds ratio = 2.1, 95% CI = 0.8-5.4; P < 0.15). Total hospital costs (estimated from direct and indirect charges) were significantly increased by a mean of US$33,926 (95% CI = US$22,573-45,280; P < 0.01). CONCLUSION: Extubation failure in a community hospital is univariately associated with prolonged inpatient care and significantly increased cost. Corroborating data from tertiary care centers, these adverse outcomes highlight the importance of accurate predictors of extubation outcome.
PMID: 15469575 [PubMed - in process]
Comment on:
Airway management is a crucial area of critical care practice.
Blevin AE, Lightfoot RA, Lim MS.
Publication Types:
PMID: 15343051 [PubMed - indexed for MEDLINE]
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What is taught, what is tested: findings and competency-based recommendations of the Undergraduate Medical Education Committee of the Society of Critical Care Medicine.
Frankel HL, Rogers PL, Gandhi RR, Freid EB, Kirton OC, Murray MJ; Undergraduate Medical Education Committee of the Society of Critical Care Medicine.
Department of Surgery, Yale University, New Haven, CT 06520-8062, USA. heidi.frankel@yale.edu
INTRODUCTION: Addressing an unexpected shortfall of intensivists requires early identification and training of appropriate personnel. The purpose of this study was to determine how U.S. medical students are currently educated and tested on acute care health principles. HYPOTHESIS/METHODS: A survey of critical care education with telephone follow-up was mailed to the deans of all 126 medical schools. Web site review of medical school curricula for critical care education was performed. Upon invited request, four members of the Undergraduate Medical Education Committee (UGMEC) reviewed 1,200 pool questions of step II of the U.S. Medical Licensing Examination (USMLE) given to graduating medical students for critical care content. Descriptive statistics are employed. RESULTS: Survey response rate was 49% and 88% by the second mailing with Web site review. Forty-five percent of U.S. medical schools responding had formal undergraduate critical care didactic curricula averaging 12 +/- 3 hrs: 60% were elective, 60% taught in the 4th year. Eighty percent of clinical ICU rotations offered were elective. Sixty percent of schools taught 11 key critical care procedures in the 3rd or 4th year; 17% required them to graduate. Nineteen percent of Step II USMLE questions had critical care content; 58% dealt with pulmonary or cardiac disease. CONCLUSIONS: Graduating medical students are tested (and licensed accordingly) on critical care knowledge, despite an inconsistent exposure to the discipline in medical school. The UGMEC has drafted competency-based recommendations for acute health care delivery that encourage mandatory didactic and procedural critical care training. The UGMEC recommends that critical care rotations with didactic curricula be required for undergraduate education and that acute care procedural skills be an important component of these curricula.
PMID: 15343025 [PubMed - indexed for MEDLINE]
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Developing an interdisciplinary model of care in a progressive medical care unit.
Quintero JR.
Virginia Commonwealth University Medical Center, Richmond, Va, USA.
Publication Types:
PMID: 15341237 [PubMed - indexed for MEDLINE]
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Amniotic fluid embolism: an obstetric emergency.
Perozzi KJ, Englert NC.
University of Pittsburgh School of Nursing, Pittsburgh, Pa, USA.
AFE is an unpredictable, unpreventable, and, for the most part, an untreatable obstetric emergency. Management of this condition includes prompt recognition of the signs and symptoms, aggressive resuscitation efforts, and supportive therapy. Any delays in diagnosis and treatment can result in increased maternal and/or fetal impairment or death. Whereas once the invariable outcome of AFE was death of the mother, today the prognosis is somewhat brighter thanks to increased awareness of the syndrome and advances in intensive care medicine. In any case, intensive care nurses are called on to provide physical, life-saving care to the patient and her fetus. Both during and after the event, supportive care must be administered to the patient's family members, who are dealing with crisis and loss.
Publication Types:
PMID: 15341235 [PubMed - indexed for MEDLINE]
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Culturally competent nursing care: a challenge for the 21st century.
Flowers DL.
East Central Oklahoma Department of Nursing, Ada, Okla, USA.
Publication Types:
PMID: 15341234 [PubMed - indexed for MEDLINE]
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Delirium doulas: an innovative approach to enhance care for critically ill older adults.
Balas MC, Gale M, Kagan SH.
University of Pennsylvania School of Nursing, Philadelphia, Pa, USA.
Publication Types:
PMID: 15341233 [PubMed - indexed for MEDLINE]
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Profiles in dignity: perspectives on nursing and critically ill older adults.
Jacelon CS, Henneman EA.
School of Nursing, University of Massachusetts, Amherst, Mass, USA.
Publication Types:
- Case Reports
- Review
- Review, Tutorial
PMID: 15341232 [PubMed - indexed for MEDLINE]
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Critical care of patients with obesity.
Charlebois D, Wilmoth D.
University of Virginia Medical Center, Charlottesville, Va, USA.
Publication Types:
PMID: 15341231 [PubMed - indexed for MEDLINE]
Comment on:
Temporary invasive cardiac pacing.
Harper JP.
Publication Types:
PMID: 15341230 [PubMed - indexed for MEDLINE]
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Extracorporeal life support in pulmonary failure after traumatic rupture of the thoracic aorta: a case report.
Masroor S, Tehrani H, Pham S, Neijman T, Martinez-Ruiz R, McKenney M, Salerno T.
University of Miami/Jackson Memorial Hospital, Department of Cardiothoracic Surgery, Miami, Florida 33136, USA.
PMID: 15345991 [PubMed - indexed for MEDLINE]
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Safe and delayed repair in acute aortic traumatic insufficiency based on echocardiographic criteria.
Camarasa P, Berkane N, Joly L, Theissen MA, Carles M, Samat-Long C, Guerin JP, Ichai C, Grimaud D.
Intensive Care Unit, Saint Roch University Hospital, Nice, France. camarasa.p@invivo.edu
Publication Types:
PMID: 15345990 [PubMed - indexed for MEDLINE]
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Early tracheostomy versus prolonged endotracheal intubation in severe head injury.
Bouderka MA, Fakhir B, Bouaggad A, Hmamouchi B, Hamoudi D, Harti A.
Department of Anesthesiology and Intensive Care Unit (P33), Ibn Rochd Hospital, Casablanca, Morocco. mabouderka@yahoo.fr
BACKGROUND: To see if early tracheostomy (fifth day) reduces duration of mechanical ventilation, ICU stay, incidence of pneumonia and mortality in comparison with prolonged intubation (PI) in patients with head injury. METHODS: Patients were prospectively included in this study if they met the following criteria: isolated head injury, Glasgow coma scale (GCS) score < or =8 on first and fifth day, with cerebral contusion on CT scan. On the fifth day, randomization was done in two groups: early tracheostomy group (T group, n = 31) and prolonged endotracheal intubation group (I group, n = 31). We evaluated total time of mechanical ventilation, ICU stay, pneumonia incidence and mortality. Complications related to each technique were noted. Analysis of data were performed using Yates and Kruskall Walis tests. p < 0.05 was considered significant. RESULTS: The two groups were comparable in term of age, sex, and Simplified Acute Physiologic Score (SAPS). The mean time of mechanical ventilatory support was shorter in T group (14.5 +/- 7.3) versus I group (17.5 +/- 10.6) (p = 0.02). After pneumonia was diagnosed, mechanical ventilatory time was 6 +/- 4.7 days for ET group versus 11.7 +/- 6.7 days for PEI group (p = 0.01). There was no difference in frequency of pneumonia or mortality between the two groups. CONCLUSION: In severe head injury early tracheostomy decreases total days of mechanical ventilation or mechanical ventilation time after development of pneumonia.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15345969 [PubMed - indexed for MEDLINE]
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Standardizing the assessment of clinical competence: an overview of intensive care course design.
McGaughey J.
The School of Nursing and Midwifery, Queens University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, Ireland. j.mcgaughey@qub.ac.uk
Rationale for the development of the Certificate in Health Studies: Intensive Care and High Dependency for Adults course developed at Queens University Belfast, Northern Ireland. Structure and content of clinical module reviewed. Clinical assessment strategy discussed. Focus on the utilization of a standardized portfolio, individualized learning contract and objective structured clinical examination (OSCE) to evaluate clinical competence. Evaluation of OSCE as an assessment tool and of the course provision.
PMID: 15462122 [PubMed - in process]
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Guidelines and levels of care for pediatric intensive care units.
Rosenberg DI, Moss MM; American Academy of Pediatrics Section on Critical Care; American Academy of Pediatrics Committee on Hospital Care.
The practice of pediatric critical care medicine has matured dramatically during the past decade. These guidelines are presented to update the existing guidelines published in 1993. Pediatric critical care services are provided in level I and level II units. Within these guidelines, the scope of pediatric critical care services is discussed, including organizational and administrative structure, hospital facilities and services, personnel, drugs and equipment, quality monitoring, and training and continuing education.
PMID: 15466118 [PubMed - in process]
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