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Items 1 - 10 of 10 |
One page. |
Immediate care of the preterm infant.
Fowlie PW, McGuire W.
Publication Types:
PMID: 15472269 [PubMed - indexed for MEDLINE]
Preventing surgical deaths: critical care and intensive care outreach services in the postoperative period.
Goldhill DR.
The Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK.
PMID: 15486009 [PubMed - as supplied by publisher]
The yield of flexible fiberoptic bronchoscopy in pediatric intensive care patients.
Bar-Zohar D, Sivan Y.
Pediatric Intensive Care, Dana Children's Hospital, Tel-Aviv Medical Center, 6 Weizman Street, Tel-Aviv 64239, Israel.
STUDY OBJECTIVE: To evaluate the contribution of flexible fiberoptic bronchoscopy (FFB) and BAL to the clinical management of patients in a pediatric ICU (PICU).Setting and design: A retrospective study based on medical records in a six-bed pediatric ICU of a tertiary care children's hospital serving as a referral center for airway surgery.Patients and participants: One hundred consecutive infants and children hospitalized in a PICU, who underwent FFB with or without BAL. MEASUREMENTS AND RESULTS: One hundred fifty-five procedures were performed, for the following causes: search for airways anatomic pathologies (114 of 155 procedures, 74%), including 55 procedures during the perioperative period of airway surgery; treatment of atelectasis (35 of 155 procedures, 22.5%); and BAL (30 of 155 procedures, 19%). Thirty-five percent of procedures had more than one cause. Airway pathology was observed in 79 of 114 procedures (69%). Management changed from conservative to surgical in 44 of 114 procedures (39%). In airway surgery cases, reoperation subsequent to postoperative FFB took place in 35%. BAL results changed antimicrobial treatment in 15 of 30 cases, with clinical improvement in 10 of 30 cases (33%). Treatment of atelectasis was successful in 26 of 35 cases (74.3%). No procedure-related mortality, life-threatening complications, or significant changes in patient status occurred. CONCLUSIONS: FFB is an important and safe procedure in very sick infants and children with a variety of respiratory diseases, and significantly contributes to their management. FFB should be considered to be a PICU staff expertise.
PMID: 15486403 [PubMed - in process]
Guidelines and levels of care for pediatric intensive care units.
Rosenberg DI, Moss MM; American College of Critical Care Medicine of the Society of Critical Care Medicine.
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: 15483423 [PubMed - in process]
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Eliminating catheter-related bloodstream infections in the intensive care unit.
Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley JE, Milanovich S, Garrett-Mayer E, Winters BD, Rubin HR, Dorman T, Perl TM.
Departments of Anesthesiology/CCM and Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
OBJECTIVE: To determine whether a multifaceted systems intervention would eliminate catheter-related bloodstream infections (CR-BSIs). DESIGN: Prospective cohort study in a surgical intensive care unit (ICU) with a concurrent control ICU. SETTING: The Johns Hopkins Hospital. PATIENTS: All patients with a central venous catheter in the ICU. INTERVENTION: To eliminate CR-BSIs, a quality improvement team implemented five interventions: educating the staff; creating a catheter insertion cart; asking providers daily whether catheters could be removed; implementing a checklist to ensure adherence to evidence-based guidelines for preventing CR-BSIs; and empowering nurses to stop the catheter insertion procedure if a violation of the guidelines was observed. MEASUREMENT: The primary outcome variable was the rate of CR-BSIs per 1,000 catheter days from January 1, 1998, through December 31, 2002. Secondary outcome variables included adherence to evidence-based infection control guidelines during catheter insertion. MAIN RESULTS: Before the intervention, we found that physicians followed infection control guidelines during 62% of the procedures. During the intervention time period, the CR-BSI rate in the study ICU decreased from 11.3/1,000 catheter days in the first quarter of 1998 to 0/1,000 catheter days in the fourth quarter of 2002. The CR-BSI rate in the control ICU was 5.7/1,000 catheter days in the first quarter of 1998 and 1.6/1,000 catheter days in the fourth quarter of 2002 (p = .56). We estimate that these interventions may have prevented 43 CR-BSIs, eight deaths, and 1,945,922 dollars in additional costs per year in the study ICU. CONCLUSIONS: Multifaceted interventions that helped to ensure adherence with evidence-based infection control guidelines nearly eliminated CR-BSIs in our surgical ICU.
PMID: 15483409 [PubMed - in process]
Post mortem examination in the intensive care unit: still useful?
Dimopoulos G, Piagnerelli M, Berre J, Salmon I, Vincent JL.
Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Route de Lennik 808, 1070, Brussels, Belgium.
OBJECTIVE. Post mortem examination rates have decreased worldwide and their usefulness has been challenged. The aim of this study was to compare ante- versus post mortem findings in a multidisciplinary ICU. DESIGN. Retrospective study. SETTING. Thirty-one-bed, medico-surgical ICU. PATIENTS. All patients who died on the ICU and underwent an autopsy examination in 1999. MEASUREMENTS. Records from autopsies were compared with clinical records. A modified Goldman's criteria was used to categorize the post mortem diagnoses. Unexpected findings were evaluated according to the duration of hospitalization prior to death (fewer than or more than 10 days). RESULTS. Among 2,984 ICU admissions, there were 489 deaths; 222 autopsies were conducted (45.4% autopsy rate). Post mortem examination revealed unexpected findings in 50 patients (22.5%), including malignancy (22 [9.9%]), fungal infections (9 [4%]), pulmonary embolism (7 [3.2%]), nosocomial infections (3 [1.3%]), Hashimoto's disease (3 [1.3%]), mesenteric infarction (2 [0.9%]), Barrett's esophagus (2 [0.9%]), endocarditis (1 [0.5%]) and myocardial infarction (1 [0.5%]). These unexpected findings were considered as major (Class I/II) in 19 (8.5%), and minor (Class III) in 31 (14%) patients. In patients with a short ICU length of stay (<10 days), there were more major unexpected findings than minor, while after a prolonged stay (>10 days), minor unexpected findings were more common. CONCLUSIONS. After a short ICU stay (<10 days), autopsy revealed discrepancies primarily related to the cause of death associated with diseases whose diagnosis can be difficult. Following more prolonged ICU stays (>10 days), autopsy was more likely to reveal coexisting diseases unrelated to death.
PMID: 15480565 [PubMed - as supplied by publisher]
An outbreak of imipenem-resistant Pseudomonas aeruginosa in an intensive care unit.
Majumdar S, Kirby A, Berry N, Williams C, Hassan I, Eddleston J, Burnie JP.
Publication Types:
PMID: 15474190 [PubMed - in process]
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Pseudo-outbreak of Burkholderia cepacia in a neonatal intensive care unit.
Manzar S, Nair AK, Pai MG, Al-Khusaiby SM.
Publication Types:
PMID: 15474189 [PubMed - in process]
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Intensive-care-unit-acquired bloodstream infections in a regional critically ill population.
Laupland KB, Kirkpatrick AW, Church DL, Ross T, Gregson DB.
Department of Critical Care Medicine, University of Calgary and Calgary Health Region, Calgary, Alta., Canada. kevin.laupland@calgaryhealthregion.ca
Bloodstream infection (BSI) is a serious complication of critical illness but it is uncertain whether acquisition of BSI in the intensive care unit (ICU) increases the risk of death. A study was conducted among all Calgary health region (population approximately 1 million) adults admitted to ICUs for 48 h or more during a three-year period to investigate the occurrence, microbiology and risk factors for developing an ICU-acquired BSI and to determine whether these infections independently predict mortality. One hundred and ninety-nine ICU-acquired BSI episodes occurred during 4933 ICU admissions for a cumulative incidence of 4% and an incidence density of 5.4 per 1000 ICU days. The most common isolates were Staphylococcus aureus (18%), coagulase-negative staphylococci (11%), and Enterococcus faecalis (8%); 12% of infections were due to antimicrobial-resistant bacteria. Admission to the regional neurosurgery/trauma ICU [odds ratio (OR) 2.86; 95% confidence interval (CI) 2.10-3.90] and increasing Acute Physiology and Chronic Health Evaluation II (APACHE II) score (OR 1.05 per point, 95% CI 1.03-1.07) were associated with higher risk, whereas a surgical diagnosis (OR 0.69; 95% CI 0.52-0.93) was associated with lower risk of developing ICU-acquired BSI in logistic regression analysis. The crude in-hospital death rate was 45% for patients with ICU-acquired BSI compared with 21% for those without (P < 0.0001) Development of an ICU-acquired BSI was an independent risk factor for death (OR 1.79; 95% CI 1.3-2.5) and increases the risk of dying from critical illness.
PMID: 15474185 [PubMed - in process]
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Ventilator-associated pneumonia.
Vincent JL.
Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Route de Lennik, 808, B-1070 Brussels, Belgium. jlvincent@ulb.ac.be
Ventilator-associated pneumonia is the most common nosocomial infection. Mortality rates, morbidity, and costs are all increased in the patient with VAP, and every measure should thus be taken to prevent its development. There are several clearly defined risk factors for VAP, and awareness of these can facilitate early diagnosis and hence treatment. In this article, we discuss the risk factors, strategies for prevention, approaches to diagnosis and management plan for the patient with VAP.
Publication Types:
PMID: 15262388 [PubMed - indexed for MEDLINE]
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