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Items 1 - 13 of 13 |
One page. |
Proceedings of the 6th International Symposium of Memory and Awareness in Anaesthesia and Intensive Care. June 2-4, 2004, University of Hull, United Kingdom.
[No authors listed]
Publication Types:
PMID: 15372729 [PubMed - indexed for MEDLINE]
Effect of gastrointestinal motility and feeding tube site on aspiration risk in critically ill patients: a review.
Metheny NA, Schallom ME, Edwards SJ.
Saint Louis University School of Nursing, MO 63104-1099, USA.
OBJECTIVE: The purpose of this literature review is to examine the effect of the interaction between gastrointestinal motility and feeding site on the aspiration risk in critically ill, tube-fed patients. METHODS AND RESULTS: A single answer to the question of the preferred feeding site is not likely to be found because the degree of aspiration risk varies significantly according to individual variations in gastrointestinal motility and multiple pre-existing and treatment-related risk factors. However, regardless of the feeding site, it is ultimately regurgitated gastric contents that are aspirated into the lungs. For this reason, the clinical assessment of greatest interest is the evaluation of gastric emptying, usually monitored clinically by measuring gastric residual volumes. CONCLUSION: Current recommendations for monitoring residual volumes and preventing aspiration are provided.
Publication Types:
PMID: 15136773 [PubMed - indexed for MEDLINE]
Bedside estimation of absolute renal blood flow and glomerular filtration rate in the intensive care unitA validation of two independent methods.
Sward K, Valsson F, Sellgren J, Ricksten SE.
Department of Cardiothoracic Anaesthesia and Intensive Care, Sahlgrenska University Hospital Goteborg, 41345, Goteborg, Sweden.
OBJECTIVE. To evaluate various treatment strategies in critically ill patients with ischaemic acute renal failure, there is a need for reliable bedside measurements of total renal blood flow (RBF), glomerular filtration rate (GFR) and renal oxygen consumption without the need for urine collection. DESIGN. The continuous renal vein thermodilution method and the infusion clearance techniques were validated against the gold standard technique, the urinary clearance of paraaminohippurate (PAH) and chromium ethylenediaminetetraacetic acid, respectively. SETTING. University hospital cardiothoracic ICU. PATIENTS. Seventeen uncomplicated mechanically ventilated post-cardiac surgical patients. INTERVENTIONS. None. MEASUREMENTS AND RESULTS. Renal blood flow, GFR and the renal filtration fraction (FF) were measured for two consecutive 30-min periods by urinary clearance and compared with simultaneous measurements made by the thermodilution and infusion clearance techniques. Urinary clearance for PAH was corrected for by renal extraction of PAH. The within-group error, repeatability coefficient and the coefficient of variation were highest for the thermodilution technique and lowest for the infusion clearance technique with regard to RBF, GFR and FF. The infusion clearance technique had a higher agreement with the urinary clearance method than the thermodilution method. For estimations of RBF and GFR, the between-group errors were 33% and 43% comparing infusion clearance with urinary clearance and 65% and 67% comparing thermodilution with urinary clearance. CONCLUSIONS. The infusion clearance method had the highest reproducibility and the highest agreement with the urinary clearance reference method. The renal vein thermodilution technique is less reliable in the ICU setting due to poor repeatability and poor agreement with the reference method.
PMID: 15375650 [PubMed - in process]
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Application of therapeutic hypothermia in the intensive care unit.
Moran JL, Solomon PJ.
Department of Intensive Care Medicine, Queen Elizabeth Hospital, 28 Woodville Road, SA 5011, Woodville, Australia.
PMID: 15372151 [PubMed - as supplied by publisher]
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Infective endocarditis in the intensive care unit: clinical spectrum and prognostic factors in 228 consecutive patients.
Mourvillier B, Trouillet JL, Timsit JF, Baudot J, Chastre J, Regnier B, Gibert C, Wolff M.
Service de Reanimation Medicale et des Maladies Infectieuses, Hopital Bichat-Claude-Bernard, AP-HP, 46 rue Henri-Huchard, 75877 Paris Cedex 18, France.
OBJECTIVE. To identify factors associated with in-hospital outcome of adult patients admitted to the ICU with infective endocarditis (IE). DESIGN AND SETTING. Retrospective study performed in the two medical ICUs of a teaching hospital. PATIENTS AND PARTICIPANTS. The charts of all 228 consecutive patients aged 18 years or older admitted with infective IE between January 1993 and December 2000 were reviewed. All patients satisfied the modified Duke's criteria for definite IE. MEASUREMENTS AND RESULTS. There were 146 episodes of native valve endocarditis and 82 of prosthetic valve endocarditis. Staphylococcus aureus was the predominant causative micro-organism. Most complications occurred early during the course of IE. One-half of the patients underwent cardiac surgery during the same hospitalization and had a better outcome than nonoperated patients. The overall in-hospital mortality rate was 45% (102/228). Multivariate analysis revealed the following clinical factors in patients with native valve IE as independently associated with outcome: septic shock (odds ratio 4.81), cerebral emboli (3.00), immunocompromised state (2.88), and cardiac surgery (0.475); in patients with prosthetic valve IE the factors were: septic shock (4.07), neurological complications (3.1), and immunocompromised state (3.46). CONCLUSIONS. IE still carries high morbidity and mortality rates for the subset of patients requiring ICU admission. Most complications occur early making the decision process for optimal medical and surgical management more difficult. Surgical treatment appears to improve in-hospital outcome.
PMID: 15372147 [PubMed - as supplied by publisher]
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Research issues in the evaluation of cognitive impairment in intensive care unit survivors.
Jackson JC, Gordon SM, Ely EW, Burger C, Hopkins RO.
Division of Allergy, Pulmonary and Critical Care Medicine, T-1218 Medical Center North, Vanderbilt University School of Medicine, TN 37232, Nashville, USA.
Neuropsychological assessment has been utilized extensively in the research of cognitive outcomes associated with medical illnesses, such as HIV, and post-surgical procedures, such as coronary artery bypass graft. However, few investigations of intensive care unit (ICU) survivors have examined cognitive function as a clinical outcome. Significant clinical questions exist regarding the impact of critical illness on long-term cognitive function. Many of these questions can be systematically evaluated through the use of standardized neuropsychological assessment instruments within the context of well designed, prospective research trials. This review will provide information for clinical researchers interested in the study of neuropsychological outcomes in intensive care unit survivors ( a comparison article in this issue will address clinical issues related to cognitive functioning).
PMID: 15372146 [PubMed - as supplied by publisher]
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Mode of death after admission to an intensive care unit following cardiac arrest.
Laver S, Farrow C, Turner D, Nolan J.
Intensive Care Unit, Royal United Hospital, Combe Park, BA1 3NG, Bath, UK.
OBJECTIVE. To determine the mode of death in patients admitted to an intensive care unit (ICU) after cardiac arrest who died before hospital discharge. DESIGN. Prospectively defined retrospective review of a database and individual patient medical records and ICU charts. SETTING. Eleven-bed multidisciplinary intensive care unit in a general hospital in the United Kingdom. PATIENTS AND PARTICIPANTS. All patients admitted to ICU between February 1998 and July 2003 after a cardiac arrest in the previous 24 h. MEASUREMENTS AND RESULTS. The outcome at hospital discharge and mode of death in non-survivors were recorded. Based on the mode of death, non-survivors were placed in one of three groups: multiple organ failure death, neurological death or cardiovascular death. Two hundred and five patients were admitted to ICU after a cardiac arrest; 113 (55.1%) after out-of-hospital cardiac arrest and 92 (44.9%) after in-hospital cardiac arrest. One hundred and twenty-six (61.5%) patients died before hospital discharge and of these 58 (46.0%) died due to neurological injury. After cardiac arrest, 22.9% of the in-hospital patients and 67.7% of the out-of-hospital patients died due to neurological injury, irrespective of the primary cardiac arrest arrhythmia. CONCLUSIONS. Two-thirds of the patients dying after out-of-hospital cardiac arrest died due to neurological injury and this proportion was approximately the same for ventricular fibrillation/ventricular tachycardia and pulseless electrical activity/asystole. Approximately a quarter of the patients dying after in-hospital cardiac arrest died due to neurological injury.
PMID: 15365608 [PubMed - as supplied by publisher]
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Stress-hyperglycemia, insulin and immunomodulation in sepsis.
Marik PE, Raghavan M.
Department of Critical Care Medicine, University of Pittsburgh Medical Center, 640A Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA. maripe@ccm.upmc.edu
Stress-hyperglycemia and insulin resistance are exceedingly common in critically ill patients, particularly those with sepsis. Multiple pathogenetic mechanisms are responsible for this metabolic syndrome; however, increased release of pro-inflammatory mediators and counter-regulatory hormones may play a pivotal role. Recent data suggests that hyperglycemia may potentiate the pro-inflammatory response while insulin has the opposite effect. Furthermore, emerging evidence suggests that tight glycemic control will improve the outcome of critically ill patients. This paper reviews the pathophysiology of stress hyperglycemia in the critically ill septic patient and outlines a treatment strategy for the management of this disorder.
Publication Types:
PMID: 14991101 [PubMed - indexed for MEDLINE]
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Citation classics in critical care medicine.
Baltussen A, Kindler CH.
Department of Anesthesia, Kantonsspital, University Clinics Basel, 4031 Basel, Switzerland.
OBJECTIVE: The number of citations an article receives after its publication reflects its impact on the scientific community. Our purpose was to identify and examine the characteristics of the most frequently cited articles in the field of critical care medicine. DESIGN: The 74 top-cited articles in critical care journals were identified by a computer search using the database of the Science Citation Index Expanded (SCI-EXPANDED, 1945 to present) and the Web of SCIENCE. The 45 top-cited critical care articles in all other biomedical journals were identified using the database SciSearch (1974 to present) with the key word "Critical Care". RESULTS: The most cited articles received 3402 and 2860 citations, respectively. The citation classics in critical care journals were published between 1968 and 1999 in six high-impact journals, led by Critical Care Medicine (37 articles), followed by the Journal of Trauma (21), and American Journal of Respiratory and Critical Care Medicine (9). Seventy articles were original publications, two were reviews or guidelines, and two were editorials. The top 45 classic articles in non-critical care journals were published in 13 different journals, led by the New England Journal of Medicine (11 articles), followed by JAMA and Lancet (6 articles each). The United States of America contributed most of the classic articles. Pathophysiology of the lung, sepsis and scoring systems were the primary focus of classic publications. CONCLUSIONS: Our analysis gives a historical perspective on the scientific progress of critical care medicine and allows for recognition of important advances in this specialty.
PMID: 14985952 [PubMed - indexed for MEDLINE]
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Continuing professional development: does it make a difference?
Tennant S, Field R.
Faculty of Health and Social Care Sciences, Kingston University and St George's Hospital Medical School, Kingston Hill, Kingston On Thames, UK. stennant@hscs.sghms.ac.uk
Continuing professional development (CPD) is costly in terms of both organizational resources and personal time and effort. It forms an important part of the strategy for modernizing the health service and is an expectation of qualified nurses. There is little evidence to demonstrate the impact of CPD in terms of improved patient care and services. A small pilot study was undertaken. A group of intensive therapy unit (ITU) managers developed a goal attainment scale (GAS) to evaluate the impact of an ITU course. Results suggest that the ITU course did make a difference to the development of ITU nurses, but the nurses who did not take the course also developed. This has implications for service providers and educationalists in terms of expectations, timing and content of courses. The GAS was a useful tool as an approach to evaluating the impact of CPD but requires more rigorous testing before it can be described as reliable and valid.
PMID: 15267165 [PubMed - indexed for MEDLINE]
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Education and training for acute care delivery: a needs analysis.
Wood I, Douglas J, Priest H.
Department of Nursing & Midwifery, Keele University, City General Hospital, Stoke on Trent, UK. i.m.wood@nur.keele.ac.uk
Technological and clinical advances have led to increased levels of patient dependency and shorter hospital stay, such that they are now often managed on general wards. Have staff been trained or educated for this change in focus? This project was designed to identify the education and training needs of health care professionals in assessing and managing acutely physically ill hospital patients, within the boundaries of one Strategic Health Authority (SHA) in the UK. Participants identified the knowledge, skills and resources required to assess and manage acutely ill patients. These issues may be addressed through the provision of an appropriate range of structured educational programmes and experiences with the ultimate aim of improving standards of patient care.
PMID: 15267164 [PubMed - indexed for MEDLINE]
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The role of the senior health care worker in critical care.
Ormandy P, Long AF, Hulme CT, Johnson M.
School of Nursing, University of Salford, Salford, UK. p.ormandy@salford.ac.uk
This article identifies that the introduction of the support worker role in the critical care team facilitates flexibility when organizing and managing patient care. Qualified nurses' time can be used more effectively, enhancing the quality of the patient care delivered. Aspects of the qualified nurses' workload in critical care can be shared and delegated successfully to unqualified staff. It is our view that staffing levels in critical care environments need to be reviewed with more flexible working practices to meet the current and future demands of critical care. There is a need for national consensus amongst qualified nurses to clarify and define the role of the support worker and develop a critical care competency framework to standardize training. To ensure proficiency, adequate training and appropriate accountability, support workers require regulation by a nationally recognized body.
PMID: 15267163 [PubMed - indexed for MEDLINE]
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Time for change--time to engage.
Smith C.
Publication Types:
PMID: 15267162 [PubMed - indexed for MEDLINE]
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