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Comment on:
Rehospitalization of very preterm infants.
Kollee LA.
Department of Paediatrics, University Medical Centre Children's Hospital, Nijmegen, The Netherlands. l.kollee@cukz.umcn.nl
Rehospitalization rates of very preterm infants because of reasons that are related to neonatal morbidity states can be decreased with further improvement of neonatal intensive care provided. Conclusion: Analysis of rehospitalization data should be included in follow-up programmes as a contribution to the development of strategies to improve neonatal care and the ultimate outcome for very-low-birthweight infants.
Publication Types:
PMID: 15499942 [PubMed - indexed for MEDLINE]
Comment on:
Mannose-binding lectin deficiency provides a genetic basis for the use of SIRS/sepsis definitions in critically ill patients.
Carcillo JA.
Publication Types:
PMID: 15221132 [PubMed - indexed for MEDLINE]
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Noninvasive vs invasive ventilation in COPD patients with severe acute respiratory failure deemed to require ventilatory assistance.
Squadrone E, Frigerio P, Fogliati C, Gregoretti C, Conti G, Antonelli M, Costa R, Baiardi P, Navalesi P.
ICU, Azienda Ospedaliera S.Luigi Gonzaga, Orbassano, Italy.
OBJECTIVE: To determine whether non-invasive ventilation (NIV) may be an effective and safe alternative to invasive mechanical ventilation in chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF) meeting criteria for mechanical ventilation. DESIGN AND SETTING: Matched case-control study conducted in ICU. PATIENTS AND INTERVENTION: NIV was prospectively applied to 64 COPD patients with advanced ARF. Their outcomes were compared with those of a control group of 64 COPD patients matched on age, FEV(1), Simplified Acute Physiology Score II, and pH at ICU admission, previously treated in the same ICU with conventional invasive mechanical ventilation. METHODS AND RESULTS: NIV failed in 40 patients who required intubation. Mortality rate, duration of mechanical ventilation, and lengths of ICU and post-ICU stay were not different between the two groups. The NIV group had fewer complications ( P = 0.01) and showed a trend toward a lower proportion of patients remaining on mechanical ventilation after 30 days ( P = 0.056). Compared to the control group, the outcomes of the patients who failed NIV were no different. Compared to the patients who received intubation, those who succeeded NIV had reduced mortality rate and lengths of ICU and post-ICU stay. CONCLUSIONS: In COPD patients with advanced hypercapnic acute respiratory failure, NIV had a high rate of failure, but, nevertheless, provided some advantages, compared to conventional invasive ventilation. Subgroup analysis suggested that the delay in intubation was not deleterious in the patients who failed NIV, whereas a better outcome was confirmed for the patients who avoided intubation.
Publication Types:
- Clinical Trial
- Controlled Clinical Trial
PMID: 15197438 [PubMed - indexed for MEDLINE]
Comment on:
Putting it all together to predict extubation outcome.
Epstein SK.
Publication Types:
PMID: 15160236 [PubMed - indexed for MEDLINE]
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Safe paediatric intensive care. Part 2: workplace organisation, critical incident monitoring and guidelines.
Frey B, Argent A.
Department of Intensive Care and Neonatology, University Children's Hospital, 8032 Zurich, Switzerland. Bernhard.Frey@kispi.unizh.ch
In order to optimise safety within the paediatric intensive care unit (PICU), it is essential to optimise organisation, identify problem areas and implement standards and guidelines for safe practice (with appropriate monitoring). Organisational issues have a major impact on safety: the introduction and-recently-centralisation of paediatric intensive care, the appointment of dedicated paediatric intensivists, nursing staffing, handovers, rounds, the number of work hours and night shifts with the associated problems of disturbed circadian rhythms.The technique of voluntary, anonymous, non-punitive critical incident reporting has the potential to identify incidents and latent errors before they become self-evident through a major incident. This systems approach focuses on organisational and communication problems.Standards and guidelines may help in weighing up the benefits and risks of invasive procedures, and interventional studies have shown that implementation of standards and guidelines can improve outcome. Mortality prediction models enable us to monitor quality of care and, thus, to investigate the best ways of organising intensive care and monitoring the effects of changes in practice.
Publication Types:
PMID: 15118817 [PubMed - indexed for MEDLINE]
Comment in:
Introducing Critical Care Outreach: a ward-randomised trial of phased introduction in a general hospital.
Priestley G, Watson W, Rashidian A, Mozley C, Russell D, Wilson J, Cope J, Hart D, Kay D, Cowley K, Pateraki J.
York Hospitals NHS Trust, Bootham Park, York, YO30 7BY, UK.
OBJECTIVE: The purpose of the study was to investigate the effects of introducing a critical care outreach service on in-hospital mortality and length of stay in a general acute hospital. DESIGN: A pragmatic ward-randomised trial design was used, with intervention introduced to all wards in sequence. No blinding was possible. SETTING: Sixteen adult wards in an 800-bed general hospital in the north of England. PATIENTS AND PARTICIPANTS: All admissions to the 16 surgical, medical and elderly care wards during 32-week study period were included (7450 patients in total, of whom 2903 were eligible for the primary comparison). INTERVENTIONS: Essential elements of the Critical Care Outreach service introduced during the study were a nurse-led team of nurses and doctors experienced in critical care, a 24-h service, emphasis on education, support and practical help for ward staff. MEASUREMENTS AND RESULTS: The main outcome measures were in-hospital mortality and length of stay. Outreach intervention reduced in-hospital mortality compared with control (two-level odds ratio: 0.52 (95% CI 0.32-0.85). A possible increased length of stay associated with outreach was not fully supported by confirmatory and sensitivity analyses. CONCLUSIONS: The study suggests outreach reduces mortality in general hospital wards. It may also increase length of stay, but our findings on this are equivocal.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15112033 [PubMed - indexed for MEDLINE]
Comment on:
Critical care outreach: some answers, more questions.
Parr M.
Publication Types:
PMID: 15103458 [PubMed - indexed for MEDLINE]
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