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Items 1 - 8 of 8 |
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Comment on:
Breathing filters in anaesthesia and ICU: an overview.
Mahajan R.
Publication Types:
PMID: 15264749 [PubMed - indexed for MEDLINE]
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Implementing intensive insulin therapy: development and audit of the Bath insulin protocol.
Laver S, Preston S, Turner D, McKinstry C, Padkin A.
Department of Anaesthesia and Intensive Care, Royal United Hospital, Bath, United Kingdom.
Intensive insulin therapy to control blood glucose has been found to reduce mortality among critically ill patients in a surgical intensive care unit, though a simple prescriptive insulin infusion protocol to achieve this has not been published previously. This study documents the development and routine use of a simple prescriptive intravenous insulin infusion protocol for critically ill patients and compares the results with previous practice. During development the protocol was optimized and practical issues of implementation addressed. The optimized protocol was then used for all ICU admissions, and a prospectively defined retrospective chart audit performed for the first month of use. Results were compared with a similar time period the previous year. In September 2002, 27 admissions were started on the protocol. Blood glucose for the time on the protocol had a median value of 6.2 (IQR 5.9-7.1) mmol/l compared with 9.2 (IQR 8.1-10.2) mmol/l for those on insulin in 2001. Blood glucose for the whole ICU stay for those on the protocol in 2002 had a median value of 6.6 (IQR 6.0-7.4) mmol/l compared with 8.6 (IQR 8.0-9.4) mmol/l in 2001. Blood glucose for all ICU patients in 2002 had a median value of 6.5 (IQR 6.0-7.3) mmol/l compared with 7.2 (IQR 6.3-8.3) mmol/l in 2001. Three blood glucose recordings were less than 2.2 mmol/l in September 2002. This study provides initial effectiveness and safety data for the Bath Insulin Protocol Further audits in a larger patient population are now needed.
PMID: 15264724 [PubMed - indexed for MEDLINE]
[Selective intestinal decontamination in intensive care. Reduction inpatient mortality without an increase in resistant pathogens]
[Article in German]
Buchinger H.
Klinik fur Anaesthesiologie und Intensivmedizin, Universitatsklinikum des Saarlandes, Homburg/Saar. anhbuc@med-rz.uni-sb.de
PMID: 15098096 [PubMed - indexed for MEDLINE]
Erratum in:
- BMJ. 2004 Aug 21;329(7463):438.
 
Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery.
McKendry M, McGloin H, Saberi D, Caudwell L, Brady AR, Singer M.
Bloomsbury Institute of Intensive Care Medicine, Department of Medicine and Wolfson Institute of Biomedical Research, University College London, Middlesex Hospital, London W1T 3AA.
OBJECTIVE: To assess whether a nurse led, flow monitored protocol for optimising circulatory status in patients after cardiac surgery reduces complications and shortens stay in intensive care and hospital. DESIGN: Randomised controlled trial. SETTING: Intensive care unit and cardiothoracic unit of a university teaching hospital. PARTICIPANTS: 174 patients who underwent cardiac surgery between April 2000 and January 2003. INTERVENTIONS: Patients were allocated to conventional haemodynamic management or to an algorithm guided by oesophageal Doppler flowmetry to maintain a stroke index above 35 ml/m2. RESULTS: 26 control patients had postoperative complications (two deaths) compared with 17 (four deaths) protocol patients (P = 0.08). Duration of hospital stay in the protocol group was significantly reduced from a median of nine (interquartile range 7-12) days to seven (7-10) days (P = 0.02). The mean duration of hospital stay was reduced from 13.9 to 11.4 days, a saving in hospital bed days of 18% (95% confidence interval -12% to 47%). Usage of intensive care beds was reduced by 23% (-8% to 59%). CONCLUSION: A nurse delivered protocol for optimising circulatory status in the early postoperative period after cardiac surgery may significantly shorten hospital stay.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15242867 [PubMed - indexed for MEDLINE]
Reduction in mortality from severe head injury following introduction of a protocol for intensive care management{dagger}{ddagger}
Clayton TJ, Nelson RJ, Manara AR.
Intensive Care Unit, Frenchay Hospital, Bristol BS16 1LE, UK.
BACKGROUND: To determine the effect of an intensive care management protocol on the intensive care unit (ICU) and hospital mortality of severely head-injured patients, we designed a longitudinal observational study of all patients admitted with a head injury between 1992 and 2000. METHODS: A computerized patient database was used to identify all patients with severe head injury admitted to the ICU at Frenchay Hospital, Bristol, UK: a tertiary referral centre for the clinical neurosciences. We compared the ICU and hospital mortality and length of stay in patients before and after implementation of a protocol for their ICU management in 1997. RESULTS: Implementation of the protocol was associated with a significant reduction in ICU mortality from 19.95% to 13.5% (odds ratio 0.47; 95% CI 0.29-0.75), and in hospital mortality from 24.55% to 20.8% (odds ratio 0.48; 95% CI 0.31-0.74). This was achieved despite a significant increase in the median APACHE II score (14 vs 18) of patients admitted after implementation of the protocol. The median ICU and hospital length of stay remained constant over the study period. CONCLUSIONS: The introduction of an evidence-based protocol to guide the ICU management of patients with severe head injury has been associated with a significant reduction in both ICU and hospital mortality.
PMID: 15347602 [PubMed - as supplied by publisher]
Comparison of antibiotic dispensing data with administration data in intensive care.
Solano T, Matthews Z.
Publication Types:
PMID: 15350721 [PubMed - in process]
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Use of palivizumab to control an outbreak of syncytial respiratory virus in a neonatal intensive care unit.
Abadesso C, Almeida HI, Virella D, Carreiro MH, Machado MC.
Department of Paediatrics, Hospital Fernando Fonseca, IC 19 2700 Amadora, Lisbon, Portugal.
To evaluate the safety and effectiveness of a humanized respiratory syncytial virus (RSV) monoclonal antibody (palivizumab) to control an outbreak of RSV in a neonatal intensive care unit (NICU), we retrospectively analysed two RSV outbreaks. Between 11 November 1998 and 18 March 1999, two separate RSV outbreaks occurred in a large (26 beds) NICU. All procedures for preventing nosocomial spread of RSV (including the use of palivizumab in the second outbreak) were retrospectively analysed. The cumulative incidence (CI), secondary attack rate (SAR) and risk ratio of infection were determined before and after the use of palivizumab for all patients and for those with gestational age below and above 32 weeks in the NICU during the second outbreak. Standard infection control measures were effective in the first outbreak (three cases). In the second outbreak, after three index cases, five additional infants were newly RSV-infected within one month. Three infants had RSV pneumonia and required mechanical ventilation; one infant died. Standard infection control procedures were initiated from the beginning of this outbreak. Palivizumab was given to all infants in the NICU after the fifth case was identified. CI was 2.4% in the first 15 days and 10.5% in the second, and SAR was 2.9 per thousand in the first 15 days and 14.1 per thousand in the second, both dropping to zero after the administration of palivizumab. The risk ratio of infection was 4.65 times higher in infants under 32 weeks gestational age. After the use of palivizumab, there were no additional identified cases. In addition to careful infection control procedures, the use of palivizumab might have contributed to arresting the outbreak of RSV infection in the NICU, suggesting that it could be an additional resource in the control of severe nosocomial RSV outbreaks.
PMID: 15350712 [PubMed - in process]
Neonatal resuscitation: review of ventilation equipment and survey of practice in Australia and New Zealand.
O'Donnell CP, Davis PG, Morley CJ.
Division of Neonatal Services, Royal Women's Hospital, Carlton, Victoria, Australia. colm.odonell@rwh.org.au
OBJECTIVE: The equipment used to provide positive pressure ventilation at neonatal resuscitation varies between institutions. Available devices were reviewed and their use surveyed in a geographically defined region. The aim of this study was to establish which resuscitation equipment is used at neonatal intensive care units in Australia and New Zealand. METHODS: A questionnaire was sent to a neonatologist at each of the 29 neonatal intensive care units in Australia and New Zealand, asking which resuscitation equipment they used. If it was not returned, follow up was by email and telephone. RESULTS: Data was obtained from all units. Round face masks are used at all centres. Anatomically shaped masks are infrequently used at two of the three centres (10%) that have them. Straight endotracheal tubes are used exclusively at 23 (79%) centres. Shouldered tubes are used infrequently at three of the six centres that have them. The Laerdal Infant Resuscitator self-inflating bag is used at 22 (76%) centres. Flow-inflating bags are used at 12 (41%) centres. The Neopuff Infant Resuscitator is used at 14 (48%) centres. Varying oxygen concentrations are provided at delivery at 6/25 (24%) centres. CONCLUSIONS: There is a paucity of evidence for the efficacy of the equipment used currently to resuscitate newborn infants. This complete survey of the tertiary centres in a geographical region shows considerable variation in practice, reflecting this lack of evidence and consequent uncertainty among clinicians. Further research is necessary to determine which devices are preferable for this most important and common intervention.
PMID: 15009551 [PubMed - indexed for MEDLINE]
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