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Items 1 - 19 of 19 |
One page. |
Reduction in mortality from severe head injury following introduction of a protocol for intensive care management.
Young SP, Manara AR.
Glasgow, UK.
PMID: 15758084 [PubMed - in process]
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Maternal deaths from anaesthesia. An extract from Why Mothers Die 2000-2002, the Confidential Enquiries into Maternal Deaths in the United Kingdom: Chapter 17: Trends in intensive care.
Clutton-Brock T.
University Hospital Birmingham, Birmingham, UK.
This is the second of two extracts from Why Mothers Die 2000-2002, issued on 12 November 2004 by the Confidential enquiry into Maternal and Child Health (CEMACH), reproduced with permission. The full report can be accessed via their web site: http://www.cemach.org.uk/
PMID: 15758082 [PubMed - in process]
Can single nucleotide polymorphisms in innate immune receptors predict development of septic complications in intensive care unit patients?
Wang JE.
Publication Types:
PMID: 15753780 [PubMed - in process]
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General anesthesia in the intensive care unit? Is it ready for "prime time"?
Maccioli GA, Cohen NH.
Publication Types:
PMID: 15753774 [PubMed - in process]
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The Bispectral Index: expanded performance for everyday use in the intensive care unit?
Nasraway SA Jr.
Publication Types:
PMID: 15753773 [PubMed - in process]
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A looming crisis in demand for intensive care unit resources?
Schumaker GL, Hill NS, Garpestad E, Teres D.
Publication Types:
PMID: 15753772 [PubMed - in process]
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Intensive care or end-of-life care for critically ill cancer patients?
Peters SG.
Publication Types:
PMID: 15753768 [PubMed - in process]
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Ambient isoflurane pollution and isoflurane consumption during intensive care unit sedation with the Anesthetic Conserving Device.
Sackey PV, Martling CR, Nise G, Radell PJ.
Department of Anesthesiology and Intensive Care, Karolinska University Hospital Solna, Stockholm, Sweden.
OBJECTIVE: To examine ambient isoflurane pollution, scavenging efficacy, and isoflurane consumption using the Anesthetic Conserving Device (ACD) for prolonged isoflurane sedation in the intensive care unit. DESIGN: Prospective observational study. SETTING: Multidisciplinary university intensive care unit. PATIENTS: Fifteen adult ventilator-dependent intensive care unit patients sedated with isoflurane for 12-96 hrs. INTERVENTIONS: Isoflurane was infused to the ACD for sedation of study subjects. Changing of the ACD, isoflurane syringe, and opening of the respiratory circuit were performed in a standardized fashion according to investigator instructions. Active scavenging of waste gas from the ventilator was performed in ten patients; in five patients no active scavenging was performed. MEASUREMENTS AND MAIN RESULTS: Continuous spectrophotometric measurement of ambient isoflurane pollution in parts per million (ppm) at 0.5 m from the patient's head and passive lapel dosimeter sampling for ten staff nurses over 8-hr shifts. Isoflurane requirement and agent consumption were registered in all patients. Spectrophotometric readings (0.1 +/- 0.2 ppm) were well below internationally recommended long-term exposure limits in all cases. Isoflurane peaks during nursing procedures were brief, infrequent, and of low amplitude. There was no observed difference between isoflurane trace levels with or without an active scavenging system in use. Passive dosimeter values were also low, ranging from undetectable to 0.16 ppm. Mean isoflurane consumption was 2.1 +/- 1.0 mL/hr. This is approximately one fourth of predicted and previously reported consumption of isoflurane with vaporizer-administered sedation in the intensive care unit setting. CONCLUSIONS: In the present setting, isoflurane via the ACD is an environmentally safe method of sedation provided users follow instructions for standardizing procedures with potential spillage of isoflurane. This method of sedation requires considerably less isoflurane than with traditional vaporizer technique.
PMID: 15753751 [PubMed - in process]
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Comparison of two bispectral index algorithms in monitoring sedation in postoperative intensive care patients.
Tonner PH, Wei C, Bein B, Weiler N, Paris A, Scholz J.
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
OBJECTIVE: Comparison of two versions of bispectral index (BIS) derived from the electroencephalogram in mechanically ventilated and continuously sedated patients after major abdominal surgery. DESIGN: Prospective, cohort, observational, unblinded study. SETTING: Surgical intensive care unit of a university hospital. PATIENTS: Forty-six patients undergoing major abdominal surgery scheduled for postoperative mechanical ventilation and continuous sedation. INTERVENTIONS: Patients were continuously sedated using propofol and sufentanil. MEASUREMENTS AND MAIN RESULTS: Electrodes for determination of BIS were placed at the forehead of the patients according to the manufacturer's specifications immediately after arrival to the intensive care unit. The level of consciousness was assessed every 2 hrs by a clinical sedation scale (Ramsay sedation scale, levels 1-6). BIS, electromyographic activity, and signal quality index were recorded simultaneously at the same time as the Ramsay scale for 24 hrs or until patients were ready for extubation. BIS (version 2.10) and BIS XP (version 3.12) were determined at 2-hr intervals. BIS and BIS XP showed a high correlation of readings (rs = .79, p < .01). However, the methods did not yield identical results. Both variables were significantly influenced by electromyographic activity, especially at high values, whereas there was only a weak correlation with body temperature. Some of the deeply sedated patients (Ramsay 5 or 6) had BIS readings >80 (BIS, 16%; BIS XP, 13%; p = not significant). CONCLUSIONS: The newer algorithm BIS XP did not perform better than the previous version BIS in patients after major surgery who were mechanically ventilated and sedated on an intensive care unit. This precludes the use of BIS or BIS XP for distinguishing, among deeply sedated ICU patients, those with and without preserved cerebral electrical activity.
PMID: 15753750 [PubMed - in process]
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Five-year survival, quality of life, and individual costs of 303 consecutive medical intensive care patients--a cost-utility analysis.
Graf J, Wagner J, Graf C, Koch KC, Janssens U.
Medical Clinic I, University Hospital Aachen, Aachen, Germany.
OBJECTIVE: To assess long-term survival, health-related quality of life, and associated costs 5 yrs after discharge from a medical intensive care unit. DESIGN: Prospective cohort study. SETTING: Medical intensive care unit of a German university hospital. PATIENTS: Three hundred and three consecutive patients with predominantly cardiovascular and pulmonary disorders admitted between November 1997 and February 1998 with an intensive care unit length of stay >24 hrs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Demographic data, Simplified Acute Physiology Score II, Sequential Organ Failure Assessment, simplified Therapeutic Intervention Scoring System, and individual intensive care unit and hospital costs were prospectively recorded. Primary outcomes included 5-yr survival, functional status, health-related quality of life (Medical Outcome Short Form, SF-36), effective costs per survivor, and costs per life year and per quality-adjusted life year gained.Of 303 patients, 44 (14.5%) died in the hospital. Among the remaining 259 patients, 190 (73%) survived the 5-yr follow up and 173 patients (91%) completed the questionnaire. Baseline demographics including gender, age, Simplified Acute Physiology Score II, Sequential Organ Failure Assessment, simplified Therapeutic Intervention Scoring System, and admission diagnosis were similar between hospital and long-term survivors (p > .05 for all). The health status index of those patients surviving the 5-yr follow-up was 0.88, independent of patients' severity of illness. The average effective costs per survivor were 8.827 for intensive care unit costs and 14.130 for intensive care unit and hospital costs. Mean costs per life year and per quality-adjusted life year gained amounted to 19.330 and 21.922 , respectively. Increasing severity of illness was associated with higher costs. CONCLUSIONS: Considering the severity of illness and the patients' outcome, the costs associated with both life year and quality-adjusted life year gained were within generally accepted limits for other potentially life-saving treatments.
PMID: 15753746 [PubMed - in process]
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End-of-life education in the pediatric intensive care unit.
Roberts KE, Boyle LA.
Pediatric intensive care unit, Children's Hospital of Philadelphia, PA, USA.
PMID: 15754565 [PubMed - in process]
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Assessing and treating sleep problems in family caregivers of intensive care unit patients.
Carter PA, Clark AP.
University of Texas at Austin School of Nursing, USA.
PMID: 15754563 [PubMed - in process]
Withholding and withdrawal of life-sustaining treatment in a Lebanese intensive care unit: a prospective observational study.
Yazigi A, Riachi M, Dabbar G.
Department of Anesthesiology and Surgical Intensive Care, Hotel-Dieu de France Hospital, Saint Joseph University, Adib Ishac Street, Beirut, Lebanon, ritalama@idm.net.lb.
OBJECTIVE: To evaluate the implementation and process of withholding and withdrawing life-sustaining treatment in an intensive care unit.DESIGN AND SETTING: Prospective observational study in the medical intensive care unit of a university hospital in Lebanon.PATIENTS: Forty-five consecutive adult patients admitted to the ICU for a 1-year period and for whom a decision to withholding and withdrawal of life-sustaining treatment was made.MEASUREMENTS AND RESULTS: Patients were followed up until their death. Data regarding all aspects of the implementation and the process of withholding and withdrawal of life-sustaining treatment were recorded by a senior staff nurse. Withholding and withdrawing life-sustaining treatment was applied to 9.6% of all admitted patients to ICU. Therapies were withheld in 38% and were withdrawn in 7% of patients who died. Futility of care and poor quality of life were the two most important factors supporting these decisions. The nursing staff was not involved in 26% of the decisions to limit care. Families were not implicated in 21% of the cases. Decisions were not notified in the patients' medical record in 23% of the cases. Sixty-three percent of patients did not have a sedative or an analgesic to treat discomfort during end-of-life care.CONCLUSIONS: Life-sustaining treatment were frequently withheld or withdrawn from adult patients in the Lebanese ICU. Cultural differences and the lack of guidelines and official statements could explain the ethical limitations of the decision-making process recorded in this study.
PMID: 15750799 [PubMed - in process]
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An international survey of training in adult intensive care medicine.
Barrett H, Bion JF.
University Department of Anaesthesia and Intensive Care, N5 Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2TH, UK, h.barrett@bham.ac.uk.
OBJECTIVE: The aim of this international survey of training in adult intensive care medicine (ICM) was to characterise current structures, processes, and outcomes to determine the potential for convergence to a common competency-based training programme across national borders. This survey is the first phase of a 3 year project which will use consensus methods to build an international competency-based training programme in ICM in Europe (CoBaTrICE).METHODOLOGY: A survey by questionnaire, email, and direct discussion was undertaken with national ICM representatives from seven geographical regions.RESULTS: Responses were obtained from 41 countries (countries which share common training programmes were grouped together; n=38). Fifty-four different training programmes were identified, 37 within the European region; three (6%) were competency-based. Twenty (53%) permitted multidisciplinary access to a common training programme; in nine (24%) training was only available within anaesthesia. The minimum duration of ICM training required for recognition as a specialist varied from 3 months to 72 months (mode 24 months). The content of most (75%) ICM programmes was standardised nationally. Work-based assessment of competence was formally documented in nineteen (50%) countries. An exam was mandatory in twenty-nine (76%).CONCLUSION: There are considerable variations in the structures and processes of ICM training worldwide. However, as competency-based training is an outcome strategy rather than a didactic process, these differences should not impede the development of a common international competency-based training programme in ICM.
PMID: 15750798 [PubMed - in process]
Increased risk of bloodstream and urinary infections in intensive care unit (ICU) patients compared with patients fitting ICU admission criteria treated in regular wards.
Mnatzaganian G, Galai N, Sprung CL, Zitser-Gurevich Y, Mandel M, Ben-Hur D, Gurman G, Klein M, Lev A, Levi L, Bar-Lavi Y, Zveibil F, Simchen E.
Department of Health Services Research, Ministry of Health, P.O. Box 1176, Jerusalem 91010, Israel.
Critically ill patients, eligible for admission into intensive care units (ICUs), are often hospitalized in other wards due to a lack of ICU beds. Differences in morbidity between patients managed in ICUs and elsewhere are unknown, specifically the morbidity related to hospital-acquired infection. Patients fitting ICU admission criteria were identified by screening five entire hospitals on four separate days. Hospital infections within a 30-day follow-up period were compared in ICU patients and in patients on other wards using Kaplan-Meier curves. Residual differences in the patients' case mix between ICUs and other wards were adjusted for utilizing multivariate Cox models. Of 13415 patients screened, 668 were critically ill. The overall infection rates (per 100 patient-days) were 1.2 for bloodstream infection (BSI) and 1.9 for urinary tract infection (UTI). The adjusted hazard ratios in ICU patients compared with patients on regular wards were 3.1 (P<0.001) for BSI and 2.5 (P<0.001) for UTI. This increased risk persisted even after adjusting for the disparity in the number of cultures sent from ICUs compared with ordinary wards. No interdepartmental differences were found in the rates of pneumonia, surgical wound infections and other infections. Minimizing the differences between characteristics of patients hospitalized in ICUs and in other wards, and controlling for the higher frequency of cultures sent from ICUs did not eliminate the increased risk of BSI and UTI associated with admission into ICUs.
PMID: 15749322 [PubMed - in process]
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Relationship between nosocomial infection and mortality in a neurology intensive care unit in Turkey.
Cevik MA, Yilmaz GR, Erdinc FS, Ucler S, Tulek NE.
Infectious Diseases and Clinical Microbiology Department, Ankara Training and Research Hospital, Turkey.
Few previous studies have evaluated the relationship between nosocomial infection and mortality in a neurology intensive care unit (ICU). In this study, patients treated for more than 24h in the neurology ICU of the Ankara Training and Research Hospital, Turkey were followed until death or two days after discharge by prospective daily surveillance. The study period was 14 months. One hundred and sixty-nine ICU-acquired infections occurred in 74 (38.9%) of 190 patients during 2006 patient-days. The overall rate of ICU-acquired nosocomial infection was 88.9/100 patients and 84.2/1000 patient-days. While the overall mortality rate was 60%, mortality in patients with nosocomial infections was 69%. In univariate analysis, infection (nosocomial and community-acquired) (P=0.002), nosocomial infection (P<0.05), mechanical ventilation (P<0.0001), presence of two or more underlying diseases (P=0.01), parenteral nutrition (P<0.0001), steroid treatment (P=0.003) and a low Glasgow Coma Scale (GCS) score (P=0.0001) were identified as risk factors for mortality. Stepwise logistic regression analysis showed nosocomial infection (P<0.05), mechanical ventilation (P=0.009), the presence of two or more underlying diseases (P<0.05) and a low GCS score (P=0.0001) to be risk factors for ICU mortality. It was concluded that nosocomial infection increases the risk of mortality by a factor of 1.69. The impact of nosocomial infection on mortality in our ICU was higher in patients with high GCS scores and patients aged between 66 and 75 years. In particular, nosocomial infection increased mortality among patients with less severe illnesses.
PMID: 15749321 [PubMed - in process]
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Short antibiotic prophylaxis for bacterial infections in a neonatal intensive care unit: a randomized controlled trial.
Auriti C, Rava L, Di Ciommo V, Ronchetti MP, Orzalesi M.
Division of Neonatal Intensive Care, Bambino Gesu Children's Hospital, Rome, Italy.
We compared the effectiveness of a single dose and a three-day course of antibiotic prophylaxis in preventing bacterial infections in high-risk neonates. The study was a prospective, randomized controlled trial conducted in a 20-bed tertiary referral neonatal intensive care unit (NICU). A series of 130 neonates admitted consecutively to the NICU, fulfilling risk factors for infection, were assigned at random to receive intravenous antibiotic prophylaxis with ampicillin and netilmicin either in two daily doses for 72h (three-day-administration group, 67 infants) or in a single bolus injection on admission (bolus group, 63 infants). Hospital-acquired infection, the main outcome measure, was defined as infection that developed at least 48h after admission, and vertical infection (maternally transmitted) was considered to be present when clinical symptoms and abnormal laboratory findings became evident within 48h of birth. Infections were considered as suspected when clinical and laboratory findings of infection were present, without positive cultures, and as confirmed when positive cultures were also present. No significant differences were found between the two groups of neonates studied in mean birth weight, gestational age or postnatal age on admission. The incidence of vertical infection was similar in the two groups (16/67, 23.9% vs. 14/63, 22.2%). Of the 130 newborns studied, 29 (22.3%) acquired at least one nosocomial infection during their NICU stay; total hospital-acquired infections, calculated as the incidence density of infection (the number of infective episodes divided by the number of days in the NICU), were less frequent among newborns who received the three-day course than the bolus (relative risk 0.69). This difference, although not statistically significant, depended on the different incidence density of confirmed nosocomial infections rather than on suspected infections (relative risk 0.59; 95% confidence interval 0.32-1.09; P=0.1). There were no significant differences between the two groups in overall mortality. A single bolus administration on admission is therefore likely to be as effective as a three-day course of antibiotic prophylaxis in preventing bacterial infection in high-risk infants admitted to an NICU.
PMID: 15749316 [PubMed - in process]
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Rare but dangerous adverse effects of propofol and thiopental in intensive care.
Machata AM, Gonano C, Birsan T, Zimpfer M, Spiss CK.
Department of Anesthesiology and General Intensive Care, General Hospital, University of Vienna, Vienna, Austria. anette-marie.machata@univie.ac.at
PMID: 15761368 [PubMed - in process]
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Imported Dengue fever presenting with febrile diarrhoea: report of two cases.
Helbok R, Dent W, Gattringer K, Innerebner M, Schmutzhard E.
Department of Neurology, University of Innsbruck, Innsbruck, Austria. raimund_helbok@yahoo.com
Dengue fever is a significant health problem in most tropical regions and increasingly observed among travelers returning from tropical countries. Clinical presentation might not be typical in patients from non-endemic areas. We report 2 patients returning from South-East Asia with proven Dengue-virus infection initially presenting with "febrile diarrhea" followed by hemorrhagic skin lesions during hospitalization. Blood and stool examination remained negative for bacteria, parasites and plasmodia. Dengue fever was suspected early, mainly due to the typical course of the complete blood cell count with thrombocytopenia (19 x 10(9)/L and 86 x 10(9)/L) and leucopenia (3 x 10(9)/L and 1.8 x 10(9)/L). Both patients had a benign clinical course, which still required intensive care monitoring. Platelet inhibitors and NSAIDs should be stopped when Dengue infection (Dengue fever and Dengue hemorrhagic fever) is suspected in order to minimalize the risk of bleeding. Although presentation of the disease might not always be typical, Dengue infection has to be considered early in the course of disease by taking an in-depth history and profound physical examination.
Publication Types:
PMID: 15683045 [PubMed - indexed for MEDLINE]
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