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Effect of kinetic therapy on pulmonary complications.
Ahrens T, Kollef M, Stewart J, Shannon W.
Barnes-Jewish Hospital, St. Louis, MO, USA.
BACKGROUND: Optimal turning of critically ill patients is not well established. Kinetic therapy (systematic mechanical rotation of patients with 40 degree turns) may improve pulmonary function more than the improvement in function achieved via the standard of care (turning patients every 2 hours). OBJECTIVE: To determine (1) if patients receiving mechanical ventilation who tolerate kinetic therapy have better pulmonary function than do patients treated with standard turning and (2) the cost-effectiveness of kinetic therapy. METHODS: A prospective, randomized, multicenter study including 234 medical, surgical, and trauma patients (137 control patients, 97 patients receiving kinetic therapy). RESULTS: Kinetic therapy significantly decreased the occurrence of ventilator-associated pneumonia and lobar atelectasis. The risk of pneumonia developing was lower (P = .002) in patients receiving kinetic therapy than in the control patients. The risk of lobar atelectasis developing was decreased (P = .02) for the patients receiving kinetic therapy. Lengths of stay in the intensive care unit and in the hospital did not differ between the groups. Charges for intensive care were less in the kinetic therapy group (81,700 dollars) than in the control group (84,958 dollars), but not significantly less. Twenty-one patients did not tolerate kinetic therapy and were not included in the analysis. CONCLUSION: Kinetic therapy helps prevent ventilator-associated pneumonia and lobar atelectasis in critically ill patients. Costs to rent the bed may be offset by the potential cost reduction associated with kinetic therapy.
Publication Types:
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
PMID: 15470853 [PubMed - indexed for MEDLINE]
[Teaching methods in anesthesia and intensive care medicine Chancen der neuen Approbationsordnung fur das Fachgebiet.]
[Article in German]
Stehr SN, Muller M, Frank MD, Grass R, Rammelt S, Dieter P, Hetze AM, Koch T, Ragaller MJ.
Klinik und Poliklinik fur Anasthesiologie und Intensivtherapie, Universitatsklinikum Carl Gustav Carus, Dresden.
BACKGROUND: As of October 1, 2003, a new government-initiated legislative basis for undergraduate medical education was initiated in Germany which resulted in substantial changes to the structure of the medical curriculum and in a heightened teaching load.METHODS: The Medical Faculty of the University of Dresden established an interdisciplinary reform curriculum in 1998. Since then a hybrid model of traditional lectures, seminars, practical and problem-based learning courses has been implemented for all courses in undergraduate medical training (Dresdener Integrated Problem-based Learning: DIPOL((R))).RESULTS: Exemplarily for all other DIPOL((R)) courses, the 2003 evaluation results of the "Emergency medicine-Injuries-Intensive care medicine" are presented and show that the course was very well received by students and tutors, and that 95% of the students passed the exams.CONCLUSIONS: The DIPOL((R)) anesthesiology course conforms with the new German federal law. A continuous further evaluation is an essential part of quality control and is necessary for the further development of a new curriculum.
PMID: 15711812 [PubMed - as supplied by publisher]
Prevalence of ischaemic heart disease at admission to intensive care and its influence on red cell transfusion thresholds: multicentre Scottish Study{dagger}
Walsh TS, McClelland DB, Lee RJ, Garrioch M, Maciver CR, McArdle F, Crofts SL, Mellor I.
Anaesthetics, Critical Care and Pain Medicine and Intensive Care Unit, New Edinburgh Royal Infirmary, Edinburgh, Scotland, UK.
BACKGROUND: Restrictive transfusion triggers are safe for most critically ill patients, but doubts exist for patients with ischaemic heart disease (IHD). We investigated the prevalence of reported IHD at admission to the intensive care unit (ICU) and investigated how this influenced red cell transfusion triggers. We also compared observed practice with the clinicians' responses to clinical scenarios. METHODS: We studied 1023 sequential ICU admissions over 100 days to 10 Scottish ICUs. Daily haemoglobin, red cell transfusion, and haemorrhage data were available for 99.4% of 5638 ICU patient days. We recorded if IHD was recorded in clinical records at ICU admission. We grouped admissions as having a non-cardiac primary ICU diagnosis and no documentary evidence of IHD (Group 1, n=697), a non-cardiac primary ICU diagnosis with evidence of IHD (Group 2, n=213), or a cardiac primary ICU admission diagnosis (Group 3, n=113). We examined pre-transfusion haemoglobin concentration (Hb) for transfusion episodes not associated with haemorrhage. Clinical transfusion scenarios were sent to intensivists in the ICUs after data collection, which were designed to explore the clinicians' attitude to transfusion triggers in patients with IHD. RESULTS: Previous myocardial infarction was documented in 159 (16%), cardiac failure in 142 (14%), and angina in 167 (16%). Overall, 28.8% of admissions had >/=1 of these documented. The adjusted mean (SE) pre-transfusion Hb concentrations varied across the groups. These were 74 (2.2) g litre(-1) in Group 1, 77 (2.3) g litre(-1) in Group 2, and 79 (3.1) g litre(-1) in Group 3 (P=0.003 across the groups). There was concordance between observed practice and responses to the scenario similar to Group 1, but discordance for patients with IHD (Groups 2 and 3). In scenario responses, intensivists stated these patients should have significantly higher transfusion triggers than were actually observed (median [IQR] response for both groups: 90 [80-100] g litre(-1)). CONCLUSIONS: About 29% of patients admitted to Scottish ICUs had documented IHD, which was associated with small adjustments to Hb transfusion triggers. In response to scenarios, clinicians believe that patients with IHD require higher transfusion triggers than are observed in practice.
PMID: 15708870 [PubMed - as supplied by publisher]
Impact of recommendations by clinical microbiologists on antimicrobial treatment in the intensive care units of a Dublin teaching hospital.
O'Neill E, Humphreys H, Smyth E.
Publication Types:
PMID: 15712097 [PubMed - in process]
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Year in review in intensive care medicine, 2004. III. Outcome, ICU organisation, scoring, quality of life, ethics, psychological problems and communication in the ICU, immunity and hemodynamics during sepsis, pediatric and neonatal critical care, experimental studies.
Andrews P, Azoulay E, Antonelli M, Brochard L, Brun-Buisson C, Dobb G, Fagon JY, Gerlach H, Groeneveld J, Mancebo J, Metnitz P, Nava S, Pugin J, Pinsky M, Radermacher P, Richard C, Tasker R, Vallet B.
Intensive Care Medicine Unit, Western General Hospital, Edinburgh, UK.
PMID: 15719149 [PubMed - as supplied by publisher]
Glucose control by insulin for critically ill surgical patients.
Khoury W, Klausner JM, Ben-Abraham R, Szold O.
Surgical Intensive Care Unit, Department of Surgery B, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel.
Publication Types:
PMID: 15580048 [PubMed - indexed for MEDLINE]
Are blood gases necessary in mechanically ventilated patients who have successfully completed a spontaneous breathing trial?
Pawson SR, DePriest JL.
Department of Internal Medicine, Memorial Medical Center, 1086 Franklin Street, Johnstown, PA 15905, USA.
BACKGROUND: The utility of routinely obtaining arterial blood gas analyses (ABGs) prior to extubation in patients who have successfully completed a spontaneous breathing trial is not known. OBJECTIVE: Review our practices and determine our extubation success rate with a policy of selective ABG utilization. METHODS: Retrospective chart review. RESULTS: We reviewed 54 extubations of 52 patients. Sixty-five percent of the extubations were performed without obtaining an ABG after the spontaneous breathing trial. The extubation success rate was 94% for the entire group and was the same regardless of whether an ABG measurement was obtained (94.7% vs 94.3%, respectively). CONCLUSION: ABG measurement does not appear to be a prerequisite to extubation following a clinically successful spontaneous breathing trial.
PMID: 15507165 [PubMed - indexed for MEDLINE]
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