Diabetes and hemoglobin a1c as risk factors for nosocomial infections in critically ill patients.
Conclusion. DM and HbA1c were not associated with increased VAP or BSI frequency. HbA1c was associated with repeated BSI episodes in the ICU. PMID: 24459586 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Bedside Percutaneous Tracheostomy versus Open Surgical Tracheostomy in Non-ICU Patients.
Authors: Brotfain E, Koyfman L, Frenkel A, Semyonov M, Peiser JG, Hayun-Maman H, Boyko M, Gruenbaum SE, Zlotnik A, Klein M Abstract Percutaneous bedside tracheostomy (PBT) is a one of the common and safe procedures in intensive care units through the world. In the present paper we published our clinical experience with a performance of PBTs in the regular ward by intensive care physicians' team. We found it safe and similar outcome in comparison to open surgical tracheostomy method in operation room by ENT team. The performance of PBT in the regular ward showed potential economic advantages in saving medical staff ...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Prehospital intubation in patients with isolated severe traumatic brain injury: a 4-year observational study.
Conclusion. PHI did not offer survival benefit in our group of patients with ISTBI based on the head AIS and the scene motor GCS. However, more studies are warranted to prove this finding and identify patients who may benefit from this intervention. PMID: 24527211 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Management of atrial fibrillation in critically ill patients.
Authors: Arrigo M, Bettex D, Rudiger A Abstract Atrial fibrillation (AF) is common in ICU patients and is associated with a two- to fivefold increase in mortality. This paper provides a reappraisal of the management of AF with a special focus on critically ill patients with haemodynamic instability. AF can cause hypotension and heart failure with subsequent organ dysfunction. The underlying mechanisms are the loss of atrial contraction and the high ventricular rate. In unstable patients, sinus rhythm must be rapidly restored by synchronised electrical cardioversion (ECV). If pharmacological treatment is indicated, ...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Etiology and Outcomes of ARDS in a Rural-Urban Fringe Hospital of South India.
Conclusion. Tropical infections form a major etiological component of acute lung injury in a developing country like India. Etiology and outcomes of ARDS may vary depending upon the geographic location and seasonal illnesses. PMID: 24660060 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Respiratory Variations in Pulse Pressure Reflect Central Hypovolemia during Noninvasive Positive Pressure Ventilation.
Authors: Hoff IE, Høiseth LØ, Hisdal J, Røislien J, Landsverk SA, Kirkebøen KA Abstract Background. Correct volume management is essential in patients with respiratory failure. We investigated the ability of respiratory variations in noninvasive pulse pressure (ΔPP), photoplethysmographic waveform amplitude (ΔPOP), and pleth variability index (PVI) to reflect hypovolemia during noninvasive positive pressure ventilation by inducing hypovolemia with progressive lower body negative pressure (LBNP). Methods. Fourteen volunteers underwent LBNP of 0, -20, -40, -60, and -80 m...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Acute kidney injury after major abdominal surgery: a retrospective cohort analysis.
Authors: Teixeira C, Rosa R, Rodrigues N, Mendes I, Peixoto L, Dias S, Melo MJ, Pereira M, Bicha Castelo H, Lopes JA Abstract Background. We analyzed the incidence, risk factors, and prognosis of acute kidney injury (AKI) in a cohort of patients undergoing major abdominal surgery. Methods. A total of 450 patients were retrospectively studied. AKI was defined by an increase in serum creatinine (SCr) ≥ 0.3 mg/dl or by an increase in SCr ≥ 50% and/or by a decrease in urine output to 0.5 ml/kg/hour for 6 hours, in the first 48 hours after surgery. Logistic regression method was used to determine pre...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Procalcitonin clearance for early prediction of survival in critically ill patients with severe sepsis.
Conclusions. PCTc-48 is associated with prediction of survival in critically ill patients with sepsis. This could assist clinicians in risk stratification; however, the small sample size, and a single-centre study, may limit the generalisability of the finding. This would benefit from replication in future multicentre study. PMID: 24719759 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Potentially ineffective care: time for earnest reexamination.
Authors: Jackson WL, Sales JF Abstract The rising costs and suboptimal quality throughout the American health care system continue to invite critical inquiry, and practice in the intensive care unit setting is no exception. Due to their relatively large impact, outcomes and costs in critical care are of significant interest to policymakers and health care administrators. Measurement of potentially ineffective care has been proposed as an outcome measure to evaluate critical care delivery, and the Patient Protection and Affordable Care Act affords the opportunity to reshape the care of the critically ill. Given the ...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Implementing a collaborative sepsis protocol on the time to antibiotics in an emergency department of a saudi hospital: quasi randomized study.
Conclusion. Implementation of ED sepsis protocol improved the time from recognition of severe sepsis/septic shock to first antibiotic dose delivery as well as the appropriateness of initial antibiotic therapy. PMID: 24818017 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Influence of an infectious diseases specialist on ICU multidisciplinary rounds.
Conclusion. The addition of an IDS to multidisciplinary ICU patient rounds resulted in a reduction in antibiotic DOT and attendant drug expense. PMID: 24860663 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Platelet Consumption and Filter Clotting Using Two Different Membrane Sizes during Continuous Venovenous Haemodiafiltration in the Intensive Care Unit.
Conclusion. Our study showed that a larger filter surface area did neither reduce the severity of thrombocytopenia and anaemia, nor decrease the frequency of clotting events. PMID: 24868460 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Bedside assessment of tissue oxygen saturation monitoring in critically ill adults: an integrative review of the literature.
Conclusions. Future research should be based on rigorous methods of sampling and design in order to enhance the internal and external validity of the findings. PMID: 24900919 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Suitability, efficacy, and safety of vernakalant for new onset atrial fibrillation in critically ill patients.
This study investigates the suitability, safety, and efficacy of vernakalant in critically ill patients with new onset atrial fibrillation (AF) after cardiac surgery. Methods. Patients were screened for inclusion and exclusion criteria according to the manufacturers' recommendations. Included patients were treated with 3 mg/kg of vernakalant over 10 min and, if unsuccessful, a second dose of 2 mg/kg. Blood pressure was measured continuously for 2 hours after treatment. Results. Of the 191 patients screened, 159 (83%) were excluded, most importantly due to hemodynamic instability (59%). Vernakalant was ...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

An Observational Study on Early Empiric versus Culture-Directed Antifungal Therapy in Critically Ill with Intra-Abdominal Sepsis.
Conclusion. Early empiric antifungal therapy in surgical patients with intra-abdominal sepsis was associated with reduced mortality and warrants further evaluation in randomised controlled trials. PMID: 24959349 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Delirium during Weaning from Mechanical Ventilation.
Conclusion. Acute (traumatic or medical) neurological injuries were important risk factors in the development of delirium. During the weaning process, delirium developed predominantly before or on the same day of extubation and was generally hypoactive (more difficult to detect). Therefore, while planning early prevention strategies, attention must be focused on neurological patients who are receiving MV and possibly even on patients who are still under sedation. PMID: 24982804 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

A comparison of the glasgow coma scale score with full outline of unresponsiveness scale to predict patients' traumatic brain injury outcomes in intensive care units.
Conclusion. It appears that FOUR scale had better predictive power for mortality and may be a suitable alternative or complementary tool for GCS. PMID: 25013727 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

The effect of a nurse-led multidisciplinary team on ventilator-associated pneumonia rates.
Authors: Dosher WB, Loomis EC, Richardson SL, Crowell JA, Waltman RD, Miller LD, Nazim M, Khasawneh FA Abstract Background. Ventilator-associated pneumonia (VAP) is a worrisome, yet potentially preventable threat in critically ill patients. Evidence-based clinical practices targeting the prevention of VAP have proven effective, but the most optimal methods to ensure consistent implementation and compliance remain unknown. Methods. A retrospective study of the trend in VAP rates in a community-hospital's open medical intensive care unit (MICU) after the enactment of a nurse-led VAP prevention team. The period of the...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Timing of tracheotomy in mechanically ventilated critically ill morbidly obese patients.
Conclusions. The study suggests that tracheotomy in morbidly obese subjects performed within the first 9 days may reduce MV and decrease NP but may not affect hospital mortality. PMID: 25298891 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Early critical care course in children after liver transplant.
Conclusion. The postoperative course of children after OLT is associated with multiple complications. In recent years OLT was performed in younger children; living donors were more common; the rate of postoperative infection and suspected rejection was reduced significantly; however patients required longer MV and LOS in the PCCU. PMID: 25328695 [PubMed] (Source: Critical Care Research and Practice)
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Dose-Dependent Hemodynamic, Biochemical, and Tissue Oxygen Effects of OC99 following Severe Oxygen Debt Produced by Hemorrhagic Shock in Dogs.
Authors: Muir WW, Del Rio CL, Ueyama Y, Youngblood BL, George RS, Rausch CW, Lau BS, Hamlin RL Abstract We determined the dose-dependent effects of OC99, a novel, stabilized hemoglobin-based oxygen-carrier, on hemodynamics, systemic and pulmonary artery pressures, surrogates of tissue oxygen debt (arterial lactate 7.2 ± 0.1 mM/L and arterial base excess -17.9 ± 0.5 mM/L), and tissue oxygen tension (tPO2) in a dog model of controlled severe oxygen-debt from hemorrhagic shock. The dose/rate for OC99 was established from a pilot study conducted in six bled dogs. Subsequently twenty-four dog...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research