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Sample records for care unit patients

  1. Modeling Safety Outcomes on Patient Care Units

    Science.gov (United States)

    Patil, Anita; Effken, Judith; Carley, Kathleen; Lee, Ju-Sung

    In its groundbreaking report, "To Err is Human," the Institute of Medicine reported that as many as 98,000 hospitalized patients die each year due to medical errors (IOM, 2001). Although not all errors are attributable to nurses, nursing staff (registered nurses, licensed practical nurses, and technicians) comprise 54% of the caregivers. Therefore, it is not surprising, that AHRQ commissioned the Institute of Medicine to do a follow-up study on nursing, particularly focusing on the context in which care is provided. The intent was to identify characteristics of the workplace, such as staff per patient ratios, hours on duty, education, and other environmental characteristics. That report, "Keeping Patients Safe: Transforming the Work Environment of Nurses" was published this spring (IOM, 2004).

  2. Critically ill obstetric patients in the intensive care unit.

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    Demirkiran, O; Dikmen, Y; Utku, T; Urkmez, S

    2003-10-01

    We aimed to determine the morbidity and mortality among obstetric patients admitted to the intensive care unit. In this study, we analyzed retrospectively all obstetric admissions to a multi-disciplinary intensive care unit over a five-year period. Obstetric patients were identified from 4733 consecutive intensive care unit admissions. Maternal age, gestation of newborns, mode of delivery, presence of coexisting medical problems, duration of stay, admission diagnosis, specific intensive care interventions (mechanical ventilation, continuous veno-venous hemofiltration, central venous catheterization, and arterial cannulation), outcome, maternal mortality, and acute physiology and chronic health evaluation (APACHE) II score were recorded. Obstetric patients (n=125) represented 2.64% of all intensive care unit admissions and 0.89% of all deliveries during the five-year period. The overall mortality of those admitted to the intensive care unit was 10.4%. Maternal age and gestation of newborns were similar in survivors and non-survivors. There were significant differences in length of stay and APACHE II score between survivors and non-survivors P intensive care unit admission was preeclampsia/eclampsia (73.6%) followed by post-partum hemorrhage (11.2%). Intensive care specialists should be familiar with these complications of pregnancy and should work closely with obstetricians.

  3. Low caspofungin exposure in patients in the Intensive Care Unit

    NARCIS (Netherlands)

    van der Elst, Kim C M; Veringa, Anette; Zijlstra, Jan G; Beishuizen, Albertus; Klont, Rob; Brummelhuis-Visser, Petra; Uges, Donald R A; Touw, Daan J; Kosterink, Jos G W; van der Werf, Tjip S; Alffenaar, Jan-Willem C

    2016-01-01

    In critically ill patients, drug exposure may be influenced by altered drug distribution and clearance. Earlier studies showed that the variability in caspofungin exposure was high in Intensive Care Unit (ICU) patients. The primary objective of this study was to determine if the standard dose of cas

  4. OBSTETRIC PATIENTS IN MULTIDISIPLINARY INTENSIVE CARE UNIT: RETROSPECTIVE ANALYSIS

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    Semih ARICI

    2014-03-01

    The aim of this study is to retrospectively evaluate the obstetric cases who referred to intensive care unit, and define the frequency, cause and clinic outcomes of the patients. Demographic data, causes of reference, interventions in the intensive care and the outcomes of 15 obstetric cases in the pregnancy and postpartum period, whose referred to Gaziosmanpasa University Hospital Intensive Care Unit between 2007 and 2013 were included and retrospectively evaluated. The frequency of patients who referred from another center to our intensive care unit was 10 (%66.6. The mean age of the patients was 28.80 +/- 5.74. The mean hospital stay time was 3.20 +/- 2.51. The most cause to refer into intensive care unit was postpartum hemorrhage. One of the cases was resulted in death. The mortality ratio was found as %6.7. In conclusion, the frequent cause of intensive care requirement of the obstetric cases were obstetric bleeding and uncontrolled hypertension. The maternal morbidity and mortality will be substantially decreased with advanced treatment modalities and maternal care before pregnancy. [J Contemp Med 2014; 4(1.000: 14-17

  5. Delirium in Prolonged Hospitalized Patients in the Intensive Care Unit

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    Vahedian Azimi

    2015-05-01

    Full Text Available Background Prolonged hospitalization in the intensive care unit (ICU can impose long-term psychological effects on patients. One of the most significant psychological effects from prolonged hospitalization is delirium. Objectives The aim of this study was to assess the effect of prolonged hospitalization of patients and subsequent delirium in the intensive care unit. Patients and Methods This conventional content analysis study was conducted in the General Intensive Care Unit of the Shariati Hospital of Tehran University of Medical Sciences, from the beginning of 2013 to 2014. All prolonged hospitalized patients and their families were eligible participants. From the 34 eligible patients and 63 family members, the final numbers of actual patients and family members were 9 and 16, respectively. Several semi-structured interviews were conducted face-to-face with patients and their families in a private room and data were gathered. Results Two main themes from two different perspectives emerged, 'patients' perspectives' (experiences during ICU hospitalization and 'family members' perspectives' (supportive-communicational experiences. The main results of this study focused on delirium, Patients' findings were described as pleasant and unpleasant, factual and delusional experiences. Conclusions Family members are valuable components in the therapeutic process of delirium. Effective use of family members in the delirium caring process can be considered to be one of the key non-medical nursing components in the therapeutic process.

  6. Respiratory syncytial virus rhinosinusitis in intensive care unit patients

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    Alexandre Rodrigues da Silva

    2007-02-01

    Full Text Available This study reported a case of rhinosinusitis for Respiratory Syncytial Virus in Intensive Care Unit patient. The settings were Intensive Care Unit at Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. One female HIV-infected patient with respiratory failure and circulatory shock due to splenic and renal abscesses, who developed rhinosinusitis caused by RSV and bacteria. Respiratory viruses can play a pathogenic role in airways infection allowing secondary bacterial overgrowth.

  7. Intensive care unit research ethics and trials on unconscious patients.

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    Gillett, G R

    2015-05-01

    There are widely acknowledged ethical issues in enrolling unconscious patients in research trials, particularly in intensive care unit (ICU) settings. An analysis of those issues shows that, by and large, patients are better served in units where research is actively taking place for several reasons: i) they do not fall prey to therapeutic prejudices without clear evidential support, ii) they get a chance of accessing new and potentially beneficial treatments, iii) a climate of careful monitoring of patients and their clinical progress is necessary for good clinical research and affects the care of all patients and iv) even those not in the treatment arm of a trial of a new intervention must receive best current standard care (according to international evidence-based treatment guidelines). Given that we have discovered a number of 'best practice' regimens of care that do not optimise outcomes in ICU settings, it is of great benefit to all patients (including those participating in research) that we are constantly updating and evaluating what we do. Therefore, the practice of ICU-based clinical research on patients, many of whom cannot give prospective informed consent, ticks all the ethical boxes and ought to be encouraged in our health system. It is very important that the evaluation of protocols for ICU research should not overlook obvious (albeit probabilistic) benefits to patients and the acceptability of responsible clinicians entering patients into well-designed trials, even though the ICU setting does not and cannot conform to typical informed consent procedures and requirements.

  8. Discomfort and factual recollection in intensive care unit patients

    NARCIS (Netherlands)

    van de Leur, JP; van der Schans, CP; Loef, BG; Deelman, BG; Geertzen, JHB; Zwaveling, JH

    2004-01-01

    Introduction A stay in the intensive care unit (ICU), although potentially life-saving, may cause considerable discomfort to patients. However, retrospective assessment of discomfort is difficult because recollection of stressful events may be impaired by sedation and severe illness during the ICU s

  9. Mobility decline in patients hospitalized in an intensive care unit

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    de Jesus, Fábio Santos; Paim, Daniel de Macedo; Brito, Juliana de Oliveira; Barros, Idiel de Araujo; Nogueira, Thiago Barbosa; Martinez, Bruno Prata; Pires, Thiago Queiroz

    2016-01-01

    Objective To evaluate the variation in mobility during hospitalization in an intensive care unit and its association with hospital mortality. Methods This prospective study was conducted in an intensive care unit. The inclusion criteria included patients admitted with an independence score of ≥ 4 for both bed-chair transfer and locomotion, with the score based on the Functional Independence Measure. Patients with cardiac arrest and/or those who died during hospitalization were excluded. To measure the loss of mobility, the value obtained at discharge was calculated and subtracted from the value obtained on admission, which was then divided by the admission score and recorded as a percentage. Results The comparison of these two variables indicated that the loss of mobility during hospitalization was 14.3% (p < 0.001). Loss of mobility was greater in patients hospitalized for more than 48 hours in the intensive care unit (p < 0.02) and in patients who used vasopressor drugs (p = 0.041). However, the comparison between subjects aged 60 years or older and those younger than 60 years indicated no significant differences in the loss of mobility (p = 0.332), reason for hospitalization (p = 0.265), SAPS 3 score (p = 0.224), use of mechanical ventilation (p = 0.117), or hospital mortality (p = 0.063). Conclusion There was loss of mobility during hospitalization in the intensive care unit. This loss was greater in patients who were hospitalized for more than 48 hours and in those who used vasopressors; however, the causal and prognostic factors associated with this decline need to be elucidated. PMID:27410406

  10. Oral care in patients on mechanical ventilation in intensive care unit: literature review

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    Selma Atay

    2014-06-01

    Full Text Available intensive care patients needs to oral assessment and oral care for avoid complications caused by orafarengeal bacteria. In this literature review, it is aimed to determine the practice over oral hygiene in mechanical ventilator patients in intensive care unit. For the purpose of collecting data, Medline/pub MED and EBSCO HOST databases were searched with the keywords and lsquo;oral hygiene, oral hygiene practice, mouth care, mouth hygiene, intubated, mechanical ventilation, intensive care and critical care and rdquo; between the years of 2000- 2012. Inclusion criteria for the studies were being performed in adult intensive care unit patients on mechanical ventilation, published in peer-reviewed journals in English between the years of 2000-2012, included oral care practice and presence of a nurse among researchers. A total of 304 articles were identified. Six descriptive evaluation studies, three randomised controlled trials, four literature reviews, three meta-Analysis randomized clinical trials, one qualitative study and one semi-experimental study total 18 papers met all of the inclusion criteria. Oral care is emphasized as an infection control practice for the prevention of Ventilator-Associated Pneumonia (VAP. In conclusion, we mention that oral care is an important nursing practice to prevent VAP development in intensive care unit patients; however, there is no standard oral evaluation tool and no clarity on oral care practice frequency, appropriate solution and appropriate material. It can be recommended that the study projects on oral care in intensive care patients to have high proof level and be experimental, and longitudinal. [Int J Res Med Sci 2014; 2(3.000: 822-829

  11. Intravenous lipids in adult intensive care unit patients.

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    Hecker, Matthias; Mayer, Konstantin

    2015-01-01

    Malnutrition of critically ill patients is a widespread phenomenon in intensive care units (ICUs) worldwide. Lipid emulsions (LEs) are able to provide sufficient caloric support and essential fatty acids to correct the energy deficit and improve outcome. Furthermore, components of LEs might impact cell and organ function in an ICU setting. All currently available LEs for parenteral use are effective in providing energy and possess a good safety profile. Nevertheless, soybean oil-based LEs have been associated with an elevated risk of adverse outcomes, possibly due to their high content of omega-6 fatty acids. More newly developed emulsions partially replace soybean oil with medium-chain triglycerides, fish oil or olive oil in various combinations to reduce its negative effects on immune function and inflammation. The majority of experimental studies and smaller clinical trials provide initial evidence for a beneficial impact of these modern LEs on critically ill patients. However, large, well-designed clinical trials are needed to evaluate which LE offers the greatest advantages concerning clinical outcome. Lipid emulsions (LEs) are a powerful source of energy that can help to adjust the caloric deficit of intensive care unit (ICU) patients. LEs possess various biological activities, but their subsequent impact on critically ill patients awaits further investigations.

  12. Limitation to Advanced Life Support in patients admitted to intensive care unit with integrated palliative care

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    Mazutti, Sandra Regina Gonzaga; Nascimento, Andréia de Fátima; Fumis, Renata Rego Lins

    2016-01-01

    Objective To estimate the incidence of limitations to Advanced Life Support in critically ill patients admitted to an intensive care unit with integrated palliative care. Methods This retrospective cohort study included patients in the palliative care program of the intensive care unit of Hospital Paulistano over 18 years of age from May 1, 2011, to January 31, 2014. The limitations to Advanced Life Support that were analyzed included do-not-resuscitate orders, mechanical ventilation, dialysis and vasoactive drugs. Central tendency measures were calculated for quantitative variables. The chi-squared test was used to compare the characteristics of patients with or without limits to Advanced Life Support, and the Wilcoxon test was used to compare length of stay after Advanced Life Support. Confidence intervals reflecting p ≤ 0.05 were considered for statistical significance. Results A total of 3,487 patients were admitted to the intensive care unit, of whom 342 were included in the palliative care program. It was observed that after entering the palliative care program, it took a median of 2 (1 - 4) days for death to occur in the intensive care unit and 4 (2 - 11) days for hospital death to occur. Many of the limitations to Advanced Life Support (42.7%) took place on the first day of hospitalization. Cardiopulmonary resuscitation (96.8%) and ventilatory support (73.6%) were the most adopted limitations. Conclusion The contribution of palliative care integrated into the intensive care unit was important for the practice of orthothanasia, i.e., the non-extension of the life of a critically ill patient by artificial means. PMID:27626949

  13. Eye injury treatment in intensive care unit patients

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    L. K. Moshetova

    2015-01-01

    Full Text Available Aim. To describe eye injuries in intensive care unit (ICU patients with multitrauma, to study conjunctival microflora in these patients, and to develop etiologically and pathogenically targeted treatment and prevention of wound complications.Materials and methods. Study group included 50 patients (54 eyes with combined mechanical cerebral and eye injury. All patients underwent possible ophthalmological examination (biomicroscopy, ophthalmoscopy and ocular fundus photographing with portative fundus camera, tonometry, cranial CT and MRT, and bacteriological study of conjunctival smears. Results. Modern methods of ophthalmological examination of ICU patients provided correct diagnosis and prediction of wound healing. Eye injury treatment schedule provided maximum possible results in all ICU patients. Hospitalacquired infection results in asymptomatic dissemination of pathogenic microbes on ocular surface. Conclusions. 14-day topical treatment with antimicrobials, steroids, and NSAIDs reduces posttraumatic inflammation caused by mechanical eye injuries in ICU patients. Bacteriological studies of conjunctival smears demonstrate the presence of pathogenic flora in ICU patients. In these patients, the most effective antibacterial agents are third-generation fluoroquinolones. 

  14. Communication of mechanically ventilated patients in intensive care units

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    Martinho, Carina Isabel Ferreira; Rodrigues, Inês Tello Rato Milheiras

    2016-01-01

    Objective The aim of this study was to translate and culturally and linguistically adapt the Ease of Communication Scale and to assess the level of communication difficulties for patients undergoing mechanical ventilation with orotracheal intubation, relating these difficulties to clinical and sociodemographic variables. Methods This study had three stages: (1) cultural and linguistic adaptation of the Ease of Communication Scale; (2) preliminary assessment of its psychometric properties; and (3) observational, descriptive-correlational and cross-sectional study, conducted from March to August 2015, based on the Ease of Communication Scale - after extubation answers and clinical and sociodemographic variables of 31 adult patients who were extubated, clinically stable and admitted to five Portuguese intensive care units. Results Expert analysis showed high agreement on content (100%) and relevance (75%). The pretest scores showed a high acceptability regarding the completion of the instrument and its usefulness. The Ease of Communication Scale showed excellent internal consistency (0.951 Cronbach's alpha). The factor analysis explained approximately 81% of the total variance with two scale components. On average, the patients considered the communication experiences during intubation to be "quite hard" (2.99). No significant correlation was observed between the communication difficulties reported and the studied sociodemographic and clinical variables, except for the clinical variable "number of hours after extubation" (p < 0.05). Conclusion This study translated and adapted the first assessment instrument of communication difficulties for mechanically ventilated patients in intensive care units into European Portuguese. The preliminary scale validation suggested high reliability. Patients undergoing mechanical ventilation reported that communication during intubation was "quite hard", and these communication difficulties apparently existed regardless of the

  15. Palliative care for patients with HIV/AIDS admitted to intensive care units

    Science.gov (United States)

    Souza, Paola Nóbrega; de Miranda, Erique José Peixoto; Cruz, Ronaldo; Forte, Daniel Neves

    2016-01-01

    Objective To describe the characteristics of patients with HIV/AIDS and to compare the therapeutic interventions and end-of-life care before and after evaluation by the palliative care team. Methods This retrospective cohort study included all patients with HIV/AIDS admitted to the intensive care unit of the Instituto de Infectologia Emílio Ribas who were evaluated by a palliative care team between January 2006 and December 2012. Results Of the 109 patients evaluated, 89% acquired opportunistic infections, 70% had CD4 counts lower than 100 cells/mm3, and only 19% adhered to treatment. The overall mortality rate was 88%. Among patients predicted with a terminally ill (68%), the use of highly active antiretroviral therapy decreased from 50.0% to 23.1% (p = 0.02), the use of antibiotics decreased from 100% to 63.6% (p < 0.001), the use of vasoactive drugs decreased from 62.1% to 37.8% (p = 0.009), the use of renal replacement therapy decreased from 34.8% to 23.0% (p < 0.0001), and the number of blood product transfusions decreased from 74.2% to 19.7% (p < 0.0001). Meetings with the family were held in 48 cases, and 23% of the terminally ill patients were discharged from the intensive care unit. Conclusion Palliative care was required in patients with severe illnesses and high mortality. The number of potentially inappropriate interventions in terminally ill patients monitored by the palliative care team significantly decreased, and 26% of the patients were discharged from the intensive care unit. PMID:27737420

  16. Candida colonization in intensive care unit patients' urine

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    Xisto Sena Passos

    2005-12-01

    Full Text Available The objective of this study was to identify possible predisposing factors for candiduria in intensive care unit (ICU patients from Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Brazil, during one year. Urine samples from 153 ICU patients were obtained by catheterization on admission day and every seven days. Data such as sex, age, antifungal therapy, and variables as antibiotics, underlying diseases or comorbid conditions and stay in the hospital, were collected from patients who had at least one urine culture that yielded > 10³ yeast colonies/ml. Candiduria was recovered in 68 patients and the commonest predisposing factors were antibiotic therapy (100% and indwelling urinary catheter (92.6%. The percentage of Candida spp. isolation increased during the extended periods in which patients remained in the ICU. C. albicans was isolated in 69.1%, and the other species non-albicans as C. glabrata, C. kefyr, C. parapsilosis, C. famata, C. guilliermondii, C. krusei, and C. tropicalis were isolated in lower percentage. The high frequency of candiduria and the possible predisposing factors found in ICU patients show that candiduria surveillance should be performed to help reducing nosocomial infections.

  17. Structure and Function: Planning a New Intensive Care Unit to Optimize Patient Care

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    Jozef Kesecioğlu

    2014-08-01

    Full Text Available To survey the recent medical literature reporting effects of intensive care unit (ICU design on patients’ and family members’ well-being, safety and functionality. Features of ICU design linked to the needs of patients and their family are single-rooms, privacy, quiet surrounding, exposure to daylight, views of nature, prevention of infection, a family area and open visiting hours. Other features such as safety, working procedures, ergonomics and logistics have a direct impact on the patient care and the nursing and medical personnel. An organization structured on the needs of the patient and their family is mandatory in designing a new intensive care. The main aims in the design of a new department should be patient centered care, safety, functionality, innovation and a future-proof concept.

  18. [Interventional Patient Hygiene Model. A critical reflection on basic nursing care in intensive care units].

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    Bambi, Stefano; Lucchini, Alberto; Solaro, Massimo; Lumini, Enrico; Rasero, Laura

    2014-01-01

    Interventional Patient Hygiene Model. A critical reflection on basic nursing care in intensive care units. Over the past 15 years, the model of medical and nursing care changed from being exclusively oriented to the diagnosis and treatment of acute illness, to the achievement of outcomes by preventing iatrogenic complications (Hospital Acquired Conditions). Nursing Sensitive Outcomes show as nursing is directly involved in the development and prevention of these complications. Many of these complications, including falls from the bed, use of restraints, urinary catheter associated urinary infections and intravascular catheter related sepsis, are related to basic nursing care. Ten years ago in critical care, a school of thought called get back to the basics, was started for the prevention of errors and risks associated with nursing. Most of these nursing practices involve hygiene and mobilization. On the basis of these reflections, Kathleen Vollman developed a model of nursing care in critical care area, defined Interventional Patient Hygiene (IPH). The IPH model provides a proactive plan of nursing interventions to strengthen the patients' through the Evidence-Based Nursing Care. The components of the model include interventions of oral hygiene, mobilization, dressing changes, urinary catheter care, management of incontinence and bed bath, hand hygiene and skin antisepsis. The implementation of IPH model follows the steps of Deming cycle, and requires a deep reflection on the priorities of nursing care in ICU, as well as the effective teaching of the importance of the basic nursing to new generations of nurses.

  19. Low Caspofungin Exposure in Patients in Intensive Care Units.

    Science.gov (United States)

    van der Elst, Kim C M; Veringa, Anette; Zijlstra, Jan G; Beishuizen, Albertus; Klont, Rob; Brummelhuis-Visser, Petra; Uges, Donald R A; Touw, Daan J; Kosterink, Jos G W; van der Werf, Tjip S; Alffenaar, Jan-Willem C

    2017-02-01

    In critically ill patients, drug exposure may be influenced by altered drug distribution and clearance. Earlier studies showed that the variability in caspofungin exposure was high in intensive care unit (ICU) patients. The primary objective of this study was to determine if the standard dose of caspofungin resulted in adequate exposure in critically ill patients. A multicenter prospective study in ICU patients with (suspected) invasive candidiasis was conducted in the Netherlands from November 2013 to October 2015. Patients received standard caspofungin treatment, and the exposure was determined on day 3 of treatment. An area under the concentration-time curve from 0 to 24 h (AUC0-24) of 98 mg · h/liter was considered adequate exposure. In case of low exposure (i.e., caspofungin dose was increased and the exposure reevaluated. Twenty patients were included in the study, of whom 5 had a positive blood culture. The median caspofungin AUC0-24 at day 3 was 78 mg · h/liter (interquartile range [IQR], 69 to 97 mg · h/liter). A low AUC0-24 (caspofungin dose in mg/kg/day (P = 0.011). The median AUC0-24 with a caspofungin dose of 1 mg/kg was estimated using a pharmacokinetic model and was 114.9 mg · h/liter (IQR, 103.2 to 143.5 mg · h/liter). In conclusion, the caspofungin exposure in ICU patients in this study was low compared with that in healthy volunteers and other (non)critically ill patients, most likely due to a larger volume of distribution. A weight-based dose regimen is probably more suitable for patients with substantially altered drug distribution. (This study has been registered at ClinicalTrials.gov under registration no. NCT01994096.).

  20. Patient room considerations in the intensive care unit: caregiver, patient, family.

    Science.gov (United States)

    Evans, Jennie; Reyers, Evelyn

    2014-01-01

    The Patient Room is one of the most important and costly rooms in the design of an inpatient bed unit. As a result, the patient room mock-up requires knowledge of the components that inform the patient room environment. This article provides the intensive care nurse with questions about patient care processes and unit policies that should be considered in a mock-up. The mock-up outcome should align with the project's goals and objectives of the health care system, infuse the principles of evidence-based design, and ensure that the design accommodates the best workflow for the patient population that will be served. The template will serve as a guide to evaluate the various features of the patient room and for the mock-up discussion between the nurse and the architect.

  1. Characterization of Acinetobacter baumannii from intensive care units and home care patients in Palermo, Italy.

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    Mammina, C; Bonura, C; Aleo, A; Calà, C; Caputo, G; Cataldo, M C; Di Benedetto, A; Distefano, S; Fasciana, T; Labisi, M; Sodano, C; Palma, D M; Giammanco, A

    2011-11-01

    In this study 45 isolates of Acinetobacter baumannii identified from patients in intensive care units of three different hospitals and from pressure ulcers in home care patients in Palermo, Italy, during a 3-month period in 2010, were characterized. All isolates were resistant to at least three classes of antibiotics, but susceptible to colistin and tygecycline. Forty isolates were non-susceptible to carbapenems. Eighteen and two isolates, respectively, carried the bla(OXA-23-like) and the bla(OXA-58-like) genes. One strain carried the VIM-4 gene. Six major rep-PCR subtype clusters were defined, including isolates from different hospitals or home care patients. The sequence type/pulsed field gel electrophoresis group ST2/A included 33 isolates, and ST78/B the remaining 12. ST2 clone proved to be predominant, but a frequent involvement of the ST78 clone was evident.

  2. Myasthenic crisis patients who require intensive care unit management.

    Science.gov (United States)

    Sakaguchi, Hideya; Yamashita, Satoshi; Hirano, Teruyuki; Nakajima, Makoto; Kimura, En; Maeda, Yasushi; Uchino, Makoto

    2012-09-01

    The purpose of this report was to investigate predictive factors that necessitate intensive care in myasthenic crisis (MC). We retrospectively reviewed MC patients at our institution and compared ICU and ward management groups. Higher MG-ADL scale scores, non-ocular initial symptoms, infection-triggered findings, and higher MGFA classification were observed more frequently in the ICU group. In patients with these prognostic factors, better outcomes may be obtained with early institution of intensive care.

  3. Oral care practices for patients in Intensive Care Units: A pilot survey

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    Alexandre Franco Miranda

    2016-01-01

    Full Text Available Objective: To assess the level of knowledge and difficulties concerning hospitalized patients regarding preventive oral health measures among professionals working in Intensive Care Units (ICUs. Study Population and Methods: A cross-sectional survey was conducted among 71 health professionals working in the ICU. A self-administered questionnaire was used to determine the methods used, frequency, and attitude toward oral care provided to patients in Brazilian ICUs. The variables were analyzed using descriptive statistics (percentages. A one-sample t-test between proportions was used to assess significant differences between percentages. t-statistics were considered statistically significant for P < 0.05. Bonferroni correction was applied to account for multiple testing. Results: Most participants were nursing professionals (80.3% working 12-h shifts in the ICU (70.4%; about 87.3% and 66.2% reported having knowledge about coated tongue and nosocomial pneumonia, respectively (P < 0.05. Most reported using spatulas, gauze, and toothbrushes (49.3% or only toothbrushes (28.2% with 0.12% chlorhexidine (49.3% to sanitize the oral cavity of ICU patients (P < 0.01. Most professionals felt that adequate time was available to provide oral care to ICU patients and that oral care was a priority for mechanically ventilated patients (80.3% and 83.1%, respectively, P < 0.05. However, most professionals (56.4% reported feeling that the oral cavity was difficult to clean (P < 0.05. Conclusion: The survey results suggest that additional education is necessary to increase awareness among ICU professionals of the association between dental plaque and systemic conditions of patients, to standardize oral care protocols, and to promote the oral health of patients in ICUs.

  4. Scoring system for the selection of high-risk patients in the intensive care unit

    NARCIS (Netherlands)

    Iapichino, G; Mistraletti, G; Corbella, D; Bassi, G; Borotto, E; Miranda, DR; Morabito, A

    2006-01-01

    Objective. Patients admitted to the intensive care unit greatly differ in severity and intensity of care. We devised a system for selecting high-risk patients that reduces bias by excluding low-risk patients and patients with an early death irrespective of the treatment. Design: A posteriori analysi

  5. Cultural and religious aspects of care in the intensive care unit within the context of patient-centred care.

    Science.gov (United States)

    Danjoux, Nathalie; Hawryluck, Laura; Lawless, Bernard

    2007-01-01

    On January 31, 2007, Ontario's Critical Care Strategy hosted a workshop for healthcare providers examining cultural and religious perspectives on patient care in the intensive care unit (ICU). The workshop provided an opportunity for the Ministry of Health and Long-Term Care (MOHLTC) to engage service providers and discuss important issues regarding cultural and religious perspectives affecting critical care service delivery in Ontario. While a favourable response to the workshop was anticipated, the truly remarkable degree to which the more than 200 front-line healthcare providers, policy developers, religious and cultural leaders, researchers and academics who were in attendance embraced the need for this type of dialogue to take place suggests that discussion around this and other "difficult" issues related to care in a critical care setting is long overdue. Without exception, the depth of interest in being able to provide patient-centred care in its most holistic sense--that is, respecting all aspects of the patients' needs, including cultural and religious--is a top-of-mind issue for many people involved in the healthcare system, whether at the bedside or the planning table. This article provides an overview of that workshop, the reaction to it, and within that context, examines the need for a broad-based, non-judgmental and respectful approach to designing care delivery in the ICU. The article also addresses these complex and challenging issues while recognizing the constant financial and human resource constraints and the growing demand for care that is exerting tremendous pressure on Ontario's limited critical care resources. Finally, the article also explores the healthcare system's readiness and appetite for an informed, intelligent and respectful debate on the many issues that, while often difficult to address, are at the heart of ensuring excellence in critical care delivery.

  6. Nurses' Patient-Centeredness and Perceptions of Care among Medicaid Patients in Hospital Obstetrical Units.

    Science.gov (United States)

    Aragon, Stephen J; Richardson, Liana J; Lawrence, Wanda; Gesell, Sabina B

    2013-01-01

    Objective. This study examined to what degree patient-centeredness-measured as an underlying ability of obstetrical nurses-influenced Medicaid patients' satisfaction with care in hospital obstetrical units. Design. Multigroup structural equation modeling design, using three cross-sectional random samples (n = 300 each) from the 2003 Press Ganey National Inpatient Database. Setting. Self-administered mail surveys. Participants. 900 Medicaid recipients recently discharged from inpatient hospital obstetrical units across the United States. Methods. Multigroup structural equation modeling was used to test the goodness of fit between a hypothesized model based on the Primary Provider Theory and patients' ratings of nurses. Results. The model fitted the data well, was stable across three random samples, and was sustained when compared to a competing model. The patient-centeredness of nurses significantly influenced overall patient satisfaction and explained 66% of its variability. When nurses' patient-centeredness increased by one standard deviation, patients' satisfaction increased by 0.80 standard deviation. Conclusion. This study offers a novel approach to the measurement of the patient-centeredness of nurses and a paradigm for increasing it and its influence on Medicaid patients' satisfaction in hospital obstetrical units.

  7. Nurses' Patient-Centeredness and Perceptions of Care among Medicaid Patients in Hospital Obstetrical Units

    Science.gov (United States)

    Aragon, Stephen J.; Richardson, Liana J.; Lawrence, Wanda; Gesell, Sabina B.

    2013-01-01

    Objective. This study examined to what degree patient-centeredness—measured as an underlying ability of obstetrical nurses—influenced Medicaid patients' satisfaction with care in hospital obstetrical units. Design. Multigroup structural equation modeling design, using three cross-sectional random samples (n = 300 each) from the 2003 Press Ganey National Inpatient Database. Setting. Self-administered mail surveys. Participants. 900 Medicaid recipients recently discharged from inpatient hospital obstetrical units across the United States. Methods. Multigroup structural equation modeling was used to test the goodness of fit between a hypothesized model based on the Primary Provider Theory and patients' ratings of nurses. Results. The model fitted the data well, was stable across three random samples, and was sustained when compared to a competing model. The patient-centeredness of nurses significantly influenced overall patient satisfaction and explained 66% of its variability. When nurses' patient-centeredness increased by one standard deviation, patients' satisfaction increased by 0.80 standard deviation. Conclusion. This study offers a novel approach to the measurement of the patient-centeredness of nurses and a paradigm for increasing it and its influence on Medicaid patients' satisfaction in hospital obstetrical units. PMID:24027634

  8. Role of oral care to prevent VAP in mechanically ventilated Intensive Care Unit patients

    Directory of Open Access Journals (Sweden)

    A Gupta

    2016-01-01

    Full Text Available Ventilator associated pneumonia (VAP is the most common nosocomial infection in Intensive Care Unit. One major factor causing VAP is the aspiration of oral colonization because of poor oral care practices. We feel the role of simple measure like oral care is neglected, despite the ample evidence of it being instrumental in preventing VAP.

  9. Observational study of admission and triage decisions for patients referred to a regional intensive care unit.

    Science.gov (United States)

    Howe, D C

    2011-07-01

    The objectives of this study were to identify factors associated with decisions concerning triage and admission to the intensive care unit and to describe the outcome of patients referred to intensive care unit for admission. The study was a single-centre, prospective, observational study. It was performed in the general intensive care unit of a tertiary regional hospital, over the period of February to June 2009. The patients were non-elective, acute medical in-patients. For 100 patients referred, only 36 were admitted to the intensive care unit. The remaining 64 were declined admission: nine were declined admission because they were assessed as too sick to benefit, 41 were declined admission because they were assessed as too well to benefit and 14 were deemed to potentially benefit from intensive care unit admission but were not admitted ('triage'). Patients most likely to receive triage decisions were medical in-patients who had expressed wishes about end-of-life care, who were functionally limited with co-morbid conditions affecting their performance status. Patients referred by Resident Medical Officers were also more likely to receive a triage decision. Age, gender Aboriginal and Torres Strait Islander status, diagnostic category and reason for referral did not impact on admission or triage decisions. Bed status in intensive care unit at the time of referral affected neither admission nor triage decisions. Hospital mortality in patients deemed too well to benefit from intensive care unit was 7.3%, suggesting that all patients referred for consideration of admission to intensive care unit should be classified as 'high risk'.

  10. Nursing students’ experiences of professional patient care encounters in a hospital unit

    DEFF Research Database (Denmark)

    Kaldal, Maiken Holm; Kristiansen, Jette; Uhrenfeldt, Lisbeth

    2015-01-01

    REVIEW QUESTION / OBJECTIVE The objective of this systematic review is to identify, appraise and synthesize the best available evidence on nursing students’ experiences of professional patient care encounters in a hospital unit. More specifically the research questions are: How do nursing students...... describe their experiences of professional patient care in a hospital unit? What kinds of experiences do nursing students have in professional patient care encounters? INCLUSION CRITERIA Types of participants This review will consider studies that include undergraduate and postgraduate nursing students...... experiences of professional patient care encounters where students engage with patients and provide nursing care within the basic principles of nursing care relating to the patients’ physiological and psychological needs. Studies that reflect nursing students’ comprehension of or attitudes towards nursing...

  11. Nurses’ Patient-Centeredness and Perceptions of Care among Medicaid Patients in Hospital Obstetrical Units

    Directory of Open Access Journals (Sweden)

    Stephen J. Aragon

    2013-01-01

    Full Text Available Objective. This study examined to what degree patient-centeredness—measured as an underlying ability of obstetrical nurses—influenced Medicaid patients’ satisfaction with care in hospital obstetrical units. Design. Multigroup structural equation modeling design, using three cross-sectional random samples (n=300 each from the 2003 Press Ganey National Inpatient Database. Setting. Self-administered mail surveys. Participants. 900 Medicaid recipients recently discharged from inpatient hospital obstetrical units across the United States. Methods. Multigroup structural equation modeling was used to test the goodness of fit between a hypothesized model based on the Primary Provider Theory and patients’ ratings of nurses. Results. The model fitted the data well, was stable across three random samples, and was sustained when compared to a competing model. The patient-centeredness of nurses significantly influenced overall patient satisfaction and explained 66% of its variability. When nurses’ patient-centeredness increased by one standard deviation, patients’ satisfaction increased by 0.80 standard deviation. Conclusion. This study offers a novel approach to the measurement of the patient-centeredness of nurses and a paradigm for increasing it and its influence on Medicaid patients’ satisfaction in hospital obstetrical units.

  12. Stressors in the relatives of patients admitted to an intensive care unit

    Science.gov (United States)

    Barth, Angélica Adam; Weigel, Bruna Dorfey; Dummer, Claus Dieter; Machado, Kelly Campara; Tisott, Taís Montagner

    2016-01-01

    Objective To identify and stratify the main stressors for the relatives of patients admitted to the adult intensive care unit of a teaching hospital. Methods Cross-sectional descriptive study conducted with relatives of patients admitted to an intensive care unit from April to October 2014. The following materials were used: a questionnaire containing identification information and demographic data of the relatives, clinical data of the patients, and 25 stressors adapted from the Intensive Care Unit Environmental Stressor Scale. The degree of stress caused by each factor was determined on a scale of values from 1 to 4. The stressors were ranked based on the average score obtained. Results The main cause of admission to the intensive care unit was clinical in 36 (52.2%) cases. The main stressors were the patient being in a state of coma (3.15 ± 1.23), the patient being unable to speak (3.15 ± 1.20), and the reason for admission (3.00 ± 1.27). After removing the 27 (39.1%) coma patients from the analysis, the main stressors for the relatives were the reason for admission (2.75 ± 1.354), seeing the patient in the intensive care unit (2.51 ± 1.227), and the patient being unable to speak (2.50 ± 1.269). Conclusion Difficulties in communication and in the relationship with the patient admitted to the intensive care unit were identified as the main stressors by their relatives, with the state of coma being predominant. By contrast, the environment, work routines, and relationship between the relatives and intensive care unit team had the least impact as stressors. PMID:27737424

  13. Nurses' experiences of caring for critically ill, non-sedated, mechanically ventilated patients in the Intensive Care Unit

    DEFF Research Database (Denmark)

    Laerkner, Eva; Egerod, Ingrid; Hansen, Helle Ploug

    2015-01-01

    OBJECTIVE: The objective was to explore nurses' experiences of caring for non-sedated, critically ill patients requiring mechanical ventilation. DESIGN AND SETTING: The study had a qualitative explorative design and was based on 13 months of fieldwork in two intensive care units in Denmark where...... a protocol of no sedation is implemented. Data were generated during participant observation in practice and by interviews with 16 nurses. Data were analysed using thematic interpretive description. FINDINGS: An overall theme emerged: "Demanding, yet rewarding". The demanding aspects of caring for more awake...... closeness. CONCLUSION: Despite the complexity of care, nurses preferred to care for more awake rather than sedated patients and appreciated caring for just one patient at a time. The importance of close collaboration between nurses and doctors to ensure patient comfort during mechanical ventilation...

  14. Consensus guidelines on analgesia and sedation in dying intensive care unit patients

    Directory of Open Access Journals (Sweden)

    Lemieux-Charles Louise

    2002-08-01

    Full Text Available Abstract Background Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. Methods Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1 Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9; 2 Deputy chief provincial coroners (N = 5; 3 Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12. Results After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU. Conclusion Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia.

  15. Cost-benefit analysis: patient care at neurological intensive care unit.

    Science.gov (United States)

    Kopacević, Lenka; Strapac, Marija; Mihelcić, Vesna Bozan

    2013-09-01

    Modern quality definition relies on patient centeredness and on patient needs for particular services, continuous control of the service provided, complete service quality management, and setting quality indicators as the health service endpoints. The health service provided to the patient has certain costs. Thus, one can ask the following: "To what extent does the increasing cost of patient care with changes in elimination improve the quality of health care and what costs are justifiable?" As stroke is the third leading cause of morbidity and mortality in Europe and worldwide, attention has been increasingly focused on stroke prevention and providing quality care for stroke patients. One of the most common medical/nursing problems in these patients is change in elimination, which additionally affects their mental health.

  16. Effects of nursing care and staff skill mix on patient outcomes within acute care nursing units.

    Science.gov (United States)

    Hart, Patricia; Davis, Nancy

    2011-01-01

    This article presents the findings from a study that evaluates the relationships between staffing indicators and patient outcomes at the hospital unit level. Nursing administrators should not only evaluate the impact staffing decisions have on patient outcomes at the hospital level but also examine these relationships at the unit level. The findings from this study have implications for nursing practice in the areas of staff orientation, education, and patient outcome monitoring.

  17. Access to Care for Methadone Maintenance Patients in the United States

    Science.gov (United States)

    Hettema, Jennifer E.; Sorensen, James L.

    2009-01-01

    This policy commentary addresses a significant access to care issue that faces methadone maintenance patients seeking residential treatment in the United States. Methadone maintenance therapy (MMT) has demonstrated strong efficacy in the outpatient treatment of opiate dependence. However, many opiate dependent patients are also in need of more…

  18. Influence of Patients' "Sense of Coherence" on Main Postoperative Variables in the Postanesthesia Care Unit

    DEFF Research Database (Denmark)

    Hasfeldt, Dorthe; Maindal, Helle Terkildsen; Toft, Palle;

    2015-01-01

    The objective of this study was to investigate whether patients' sense of coherence (SOC)--ability to comprehend their whole situation and their capacity to use available resources--influences acute postoperative complications in the postanesthesia care unit (PACU). We hypothesized that patients...

  19. Evaluation of vitamin D level in patients from neurosurgical intensive care unit

    Institute of Scientific and Technical Information of China (English)

    Ho Jun Yi; Je Hoon Jeong; Eun-Sun Jin; Il Young Shin; Hyung Sik Hwang; Seung-Myung Moon

    2013-01-01

    Vitamin D plays an important role in maintaining normal bone metabolism. Recent studies have suggested that vitamin D influences many other physiological processes, including muscle function, cardiovascular homeostasis, nerve function, and immune response. Furthermore, accumulated evidence suggests that vitamin D also mediates the immune system response to infection. Critical neurosurgical patients have higher infection and mortality rates. To correlate vitamin D deficiency to the immunological status of neurosurgical intensive care unit patients, we detected serum vitamin D level in 15 patients with clinically suspected infection and 10 patients with confirmed infection. Serum level of 25-hydroxyvitamin D, the primary circulating form of vitamin D, was significantly decreased in patients with suspected or confirmed infection after a 2-week neurosurgical intensive care unit hospitalization, while serum level of 1,25-dihydroxyvitamin D, the active form of vitamin D, was significantly decreased in patients after a 4-week neurosurgical intensive care unit hospitalization. These findings suggest that vitamin D deficiency is linked to the immunological status of neurosurgical intensive care unit patients and vitamin D supplementation can improve patient's immunological status.

  20. Who should be admitted to the intensive care unit? The outcome of intensive care unit admission in stage IIIB-IV lung cancer patients.

    Science.gov (United States)

    Kim, Yu Jung; Kim, Mi-Jung; Cho, Young-Jae; Park, Jong Sun; Kim, Jin Won; Chang, Hyun; Lee, Jeong-Ok; Lee, Keun-Wook; Kim, Jee Hyun; Yoon, Ho Il; Bang, Soo-Mee; Lee, Jae Ho; Lee, Choon-Taek; Lee, Jong Seok

    2014-03-01

    Critical care for advanced lung cancer patients is still controversial, and the appropriate method for the selection of patients who may benefit from intensive care unit (ICU) care is not clearly defined. We retrospectively reviewed the medical records of stage IIIB-IV lung cancer patients admitted to the medical ICU of a university hospital in Korea between 2003 and 2011. Of 95 patients, 64 (67%) had Eastern Cooperative Oncology Group (ECOG) performance status (PS)≥2, and 79 (84%) had non-small-cell lung cancer. In total, 28 patients (30%) were newly diagnosed or were receiving first-line treatment, and 22 (23%) were refractory or bedridden. Mechanical ventilation was required in 85 patients (90%), and ICU mortality and hospital mortality were 57 and 78%, respectively. According to a multivariate analysis, a PaO2/FiO2 ratiocare. Oncologists should try to discuss palliative care and end-of-life issues in advance to avoid futile care.

  1. Primary immunodeficiency investigation in patients during and after hospitalization in a pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Erica Suavinho

    2014-03-01

    Full Text Available Objective: To analyze whether the patients with severe infections, admitted in the Pediatric Intensive Care Unit of the Hospital de Clínicas of the Universidade Federal de Uberlândia, underwent the active screening for primary immunodeficiencies (PID. Methods: Retrospective study that assessed the data records of patients with any severe infections admitted in the Pediatric Intensive Care Unit, covering a period from January 2011 to January 2012, in order to confirm if they performed an initial investigation for PID with blood count and immunoglobulin dosage. Results: In the studied period, 53 children were hospitalized with severe infections in the Pediatric Intensive Care Unit, and only in seven (13.2% the initial investigation of PID was performed. Among these patients, 3/7 (42.8% showed quantitative alterations in immunoglobulin G (IgG levels, 1/7 (14.3% had the diagnosis of cyclic neutropenia, and 1/7 (14.3% presented thrombocytopenia and a final diagnosis of Wiskott-Aldrich syndrome. Therefore, the PID diagnosis was confirmed in 5/7 (71.4% of the patients. Conclusions: The investigation of PID in patients with severe infections has not been routinely performed in the Pediatric Intensive Care Unit. Our findings suggest the necessity of performing PID investigation in this group of patients.

  2. Candiduria in catheterized intensive care unit patients : Emerging microbiological trends

    Directory of Open Access Journals (Sweden)

    Manisha Jain

    2011-01-01

    Full Text Available Objectives: Urinary tract infection (UTI as a result of Candida spp. is becoming increasingly common in hospitalized setting. Clinicians face dilemma in differentiating colonization from true infection and whether to treat candiduria or not. The objective of the present study was to look into the significance of candiduria in catheterized patients admitted in the ICUs and perform microbiological characterization of yeasts to guide treatment protocols. Materials and Methods: One hundred consecutive isolates of Candida spp. from the urine sample of 70 catheterized patients admitted in the ICU were collected and stocked for further characterization. A proforma was maintained containing demographic and clinical details. Blood cultures were obtained from all these 70 patients and processed. Species identification of yeasts was done on VITEK. Results: Candiduria was more common at extremes of age. The mean duration of catheter days was 11.1 ± 6 days. Other associated risk factors such as diabetes mellitus and antibiotic usage were seen in 38% and 100% of our study group. Concomitant candidemia was seen in 4.3% of cases. Non-albicans Candida spp. (71.4% emerged as the predominant pathogen causing nosocomial UTI. Conclusion: The present study reiterates the presence of candiduria in catheterized patients, especially in the presence of diabetes and antibiotic usage. Non-albicans Candida spp. are replacing Candida albicans as the predominant pathogen for nosocomial UTI. Hence, we believe that surveillance for nosocomial candiduria should be carried out in hospitalized patients.

  3. Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?

    Science.gov (United States)

    Ekerstad, Niklas; Karlson, Björn W; Dahlin Ivanoff, Synneve; Landahl, Sten; Andersson, David; Heintz, Emelie; Husberg, Magnus; Alwin, Jenny

    2017-01-01

    Objective The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit. Design This is a clinical, prospective, randomized, controlled, one-center intervention study. Setting This study was conducted in a large county hospital in western Sweden. Participants The study included 408 frail elderly patients, aged ≥75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206) or control group (n=202). Mean age of the patients was 85.7 years, and 56% were female. Intervention This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. Measurements The primary outcome was the change in health-related quality of life (HRQoL) 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3). Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. Results After adjustment by regression analysis, patients in the intervention group were less likely to present with decline in HRQoL after 3 months for the following dimensions: vision (odds ratio [OR] =0.33, 95% confidence interval [CI] =0.14–0.79), ambulation (OR =0.19, 95% CI =0.1–0.37), dexterity (OR =0.38, 95% CI =0.19–0.75), emotion (OR =0.43, 95% CI =0.22–0.84), cognition (OR = 0.076, 95% CI =0.033–0.18) and pain (OR =0.28, 95% CI =0.15–0.50). Treatment in a CGA unit was independently associated with lower 3-month mortality adjusted by Cox regression analysis (hazard ratio [HR] =0.55, 95% CI =0.32–0.96), and the two groups did not differ significantly in terms of hospital care costs (P>0.05). Conclusion Patients in an acute CGA unit were less likely to present with decline in HRQoL after 3 months, and the care in a CGA unit was also independently associated with lower mortality

  4. Intake of Dietary Supplements and Malnutrition in Patients in Intensive Care Unit

    OpenAIRE

    2016-01-01

    Background: Malnutrition is prevalent among patients hospitalized in Intensive Care Units (ICUs) and causes various complications. Dietary supplementation to provide appropriate nutritional support may reduce the malnutrition and complications through improvement in nutritional status. This study was carried out to assess the association between dietary supplementation and malnutrition among patients in ICUs. Methods: A case-control study was conducted on 180 male patients aged 20-60 year...

  5. Care of severe head injury patients in the Sarawak General Hospital: intensive care unit versus general ward.

    Science.gov (United States)

    Sim, S K; Lim, S L; Lee, H K; Liew, D; Wong, A

    2011-06-01

    Intensive care for severe head injury patients is very important in the prevention and treatment of secondary brain injury. However, in a resources constraint environment and limited availability of Intensive Care Unit (ICU) beds in the hospitals, not all severe head injury patients will receive ICU care. This prospective study is aimed to evaluate the outcome of severe head injured patients who received ICU and general ward care in Sarawak General Hospital (SGH) over a 6-month period. A total of thirty five severe head injury patients were admitted. Twenty three patients (65.7%) were ventilated in general ward whereas twelve patients (34.3%) were ventilated in ICU. Overall one month mortality in this study was 25.7%. Patients who received ICU care had a lower one month mortality than those who received general ward care (16.7% vs 30.4%), although it was not statistically different. Multivariate analysis revealed only GCS on admission (OR 0.731; 95% CI 0.460 to 0.877; P=0.042) as the independent predictive factor for one month mortality in this study.

  6. Characterization of Patients with Acinetobacter baumannii Ventilator-associated Pneumonia in Progressive Care Units

    Directory of Open Access Journals (Sweden)

    Leonardo Maikel Gómez Carcassés

    2016-08-01

    Full Text Available Background: Acinetobacter baumannii has become one of the most important nosocomial pathogens. Objective: to characterize the patients diagnosed with ventilator-associated pneumonia due to Acinetobacter baumannii in the Progressive Care Units. Methods: a case series study of patients diagnosed with ventilator-associated pneumonia due to Acinetobacter baumannii was conducted in the Progressive Care Units of the Dr. Gustavo Aldereguía Lima Hospital of Cienfuegos from December 2013 through December 2014. The study variables included: age, sex, comorbid conditions, cause of admission, duration of ventilation, length of stay, antibiotic used, and status at discharge. Results: a total of 39 patients were studied, which accounted for 69.2% of the patients in Progressive Care Units. The mean age was 55.7 years. Males predominated. Sixty four point two percent of patients reported one or more past illnesses. Most admissions to emergency services were due to clinical reasons (51.3%. Sixty nine point two percent of patients received mechanical ventilation for 3 to 21 days. The average stay was 14.7 days. Seventy one point eight percent received a combined antimicrobial treatment and most of them were discharged alive (64.1%. Overall mortality was 35.9%. Conclusions: there was a predominance of males, patients over 60 years of age and clinical cases. The study patients needed mechanical ventilation for a medium length of time and combined antimicrobial treatment. Most patients were discharged alive, and mortality was within the range of that reported in the scientific literature.

  7. Computers in hospital management and improvements in patients care--new trends in the United States.

    Science.gov (United States)

    Pierskalla, W P; Woods, D

    1988-12-01

    This article discusses the current state of informations systems in hospital management. Decision Support Systems (DSS) for the management, administrative and patient care units of the hospital are described. These DSS's include market planning, nurse scheduling and blood screening systems. Trends for future uses of information systems in the hospital environment are addressed.

  8. The low therapeutic efficacy of postoperative chest radiographs for surgical intensive care unit patients

    NARCIS (Netherlands)

    A. Kröner; E. van Iperen; J. Horn; J.M. Binnekade; P.E. Spronk; J. Stoker; M.J. Schultz

    2011-01-01

    Background. The clinical value of postoperative chest radiographs (CXRs) for surgical intensive care unit (ICU) patients is largely unknown. In the present study, we determined the diagnostic and therapeutic efficacy of postoperative CXRs for different surgical subgroups and related their efficacy t

  9. Giving information to family members of patients in the intensive care unit: Iranian nurses' ethical approaches.

    Science.gov (United States)

    Farahani, Mansoureh A; Gaeeni, Mina; Mohammadi, Nooreddin; Seyedfatemi, Naima

    2014-01-01

    Receiving information related to patients hospitalized in the intensive care unit is among the most important needs of the family members of such patients. When health care professionals should decide whether to be honest or to give hope, giving information becomes an ethical challenge We conducted a research to study the ethical approaches of Iranian nurses to giving information to the family members of patients in the intensive care units. This research was conducted in the intensive care units of three teaching hospitals in Iran. It employed a qualitative approach involving semi-structured and in-depth interviews with a purposive sample of 12 nurses to identify the ethical approaches to giving information to family members of the intensive care unit patients. A conventional content analysis of the data produced two categories and five subcategories. The two categories were as follows: a) informational support, and b) emotional support. Informational support had 2 subcategories consisting of being honest in giving information, and providing complete and understandable information. Emotional support in giving information had 3 sub-categories consisting of gradual revelation, empathy and assurance. Findings of the study indicated that ethical approaches to giving information can be in the form of either informational support or emotional support, based on patients' conditions and prognoses, their families' emotional state, the necessity of providing a calm atmosphere in the ICU and the hospital, and other patients and their families' peace. Findings of the present study can be used as a basis for further studies and for offering ethical guidelines in giving information to the families of patients hospitalized in the ICU.

  10. Deciding intensive care unit-admission for critically ill cancer patients

    Directory of Open Access Journals (Sweden)

    Thiery Guillaume

    2007-01-01

    Full Text Available Over the last 15 years, the management of critically ill cancer patients requiring intensive care unit admission has substantially changed. High mortality rates (75-85% were reported 10-20 years ago in cancer patients requiring life sustaining treatments. Because of these high mortality rates, the high costs, and the moral burden for patients and their families, ICU admission of cancer patients became controversial, or even clearly discouraged by some. As a result, the reluctance of intensivists regarding cancer patients has led to frequent refusal admission in the ICU. However, prognosis of critically ill cancer patients has been improved over the past 10 years leading to an urgent need to reappraise this reluctance. In this review, the authors sought to highlight that critical care management, including mechanical ventilation and other life sustaining therapies, may benefit to cancer patients. In addition, criteria for ICU admission are discussed, with a particular emphasis to potential benefits of early ICU-admission.

  11. Evaluation of an interprofessional practice placement in a UK in-patient palliative care unit.

    Science.gov (United States)

    Dando, Nicholas; d'Avray, Lynda; Colman, Jane; Hoy, Andrew; Todd, Jennifer

    2012-03-01

    This paper reports on undergraduate students' evaluation of a new hospice-based interprofessional practice placement (IPP) that took place in the voluntary sector from 2008 to 2009. Ward-based interprofessional training has been successfully demonstrated in a range of clinical environments. However, the multidisciplinary setting within a hospice in-patient unit offered a new opportunity for interprofessional learning. The development and delivery of the IPP initiative is described, whereby multidisciplinary groups of 12 students provided hands-on care for a selected group of patients, under the supervision of trained health care professionals. The placement was positively evaluated and students reported an increased understanding of both their own role and that of other professionals in the team. The evaluation also suggests that additional learning opportunities were provided by the in-patient palliative care unit. The results of this evaluation suggest that the in-patient unit of a hospice caring for patients with life-limiting illness provides a suitable environment to demonstrate and learn about interprofessional practice.

  12. Patient perception of pain care in hospitals in the United States

    Directory of Open Access Journals (Sweden)

    Anita Gupta

    2009-11-01

    Full Text Available Anita Gupta1, Sarah Daigle2, Jeffrey Mojica3, Robert W Hurley41Pain Management Division, Department of Anesthesiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; 2Department of Anesthesiology and Critical Care, 3Department of Anesthesiology and Critical Care, Division of Pain Medicine, University of Pennsylvania, Philadelphia, PA, USA; 4Medical Director of the Johns Hopkins Pain Treatment Center, Division of Pain Medicine, Deparment of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USAStudy objective: Assessment of patients’ perception of pain control in hospitals in the United States.Background: Limited data are available regarding the quality of pain care in the hospitalized patient. This is particularly valid for data that allow for comparison of pain outcomes from one hospital to another. Such data are critical for numerous reasons, including allowing patients and policy-makers to make data-driven decisions, and to guide hospitals in their efforts to improve pain care. The Hospital Quality Alliance was recently created by federal policy makers and private organizations in conjunction with the Centers for Medicare and Medicare Services to conduct patient surveys to evaluate their experience including pain control during their hospitalization.Methods: In March 2008, the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS survey was released for review for health care providers and researchers. This survey includes a battery of questions for patients upon discharge from the hospital including pain-related questions and patient satisfaction that provide valuable data regarding pain care nationwide. This study will review the results from the pain questions from this available data set and evaluate the performance of these hospitals in pain care in relationship to patient satisfaction. Furthermore, this analysis will be providing valuable

  13. Assessment of Sedation and Analgesia in Mechanically Ventilated Patients in Intensive Care Unit

    OpenAIRE

    2008-01-01

    Post traumatic stress resulting from an intensive care unit(ICU) stay may be prevented by adequate level of sedation and analgesia. Aims of the study were reviewing the current practices of sedation and analgesia in our ICU setup and to assess level of sedation and analgesia to know the requirement of sedative and analgesics in mechani-cally ventilated ICU patients. This prospective observational study was conducted on 50 consecutive mechanically ventilated patients in ICU over a period of 6 ...

  14. Nursing care of the brain injury patient on a locked neurobehavioral unit.

    Science.gov (United States)

    Becker, Christine

    2012-01-01

    Behavioral problems after a brain injury can be extremely challenging for those working with brain injured people. Nursing staff must be familiar with commonly used post brain injury medications and their effects, behavioral management plans, appropriate use of restrictive devices, and verbal or physical crisis intervention techniques when necessary. Rehabilitation nurses caring for brain injured patients on a locked neurobehavioral unit must maintain continual training and specific competence in this environment to ensure patient and staff safety.

  15. Enteral nutritional therapy in septic patients in the intensive care unit: compliance with nutritional guidelines for critically ill patients

    OpenAIRE

    Pasinato, Valeska Fernandes; Berbigier, Marina Carvalho; Rubin, Bibiana de Almeida; Castro, Kamila; Moraes,Rafael Barberena; Perry, Ingrid Dalira Schweigert

    2013-01-01

    Objective Evaluate the compliance of septic patients' nutritional management with enteral nutrition guidelines for critically ill patients. Methods Prospective cohort study with 92 septic patients, age ≥18 years, hospitalized in an intensive care unit, under enteral nutrition, evaluated according to enteral nutrition guidelines for critically ill patients, compliance with caloric and protein goals, and reasons for not starting enteral nutrition early or for discontinuing it. Prognostic scores...

  16. Patient safety culture at neonatal intensive care units: perspectives of the nursing and medical team

    Directory of Open Access Journals (Sweden)

    Andréia Tomazoni

    2014-10-01

    Full Text Available OBJECTIVE: to verify the assessment of the patient safety culture according to the function and length of experience of the nursing and medical teams at Neonatal Intensive Care Units.METHOD: quantitative survey undertaken at four Neonatal Intensive Care Units in Florianópolis, Brazil. The sample totaled 141 subjects. The data were collected between February and April 2013 through the application of the Hospital Survey on Patient Safety Culture. For analysis, the Kruskal-Wallis and Chi-Square tests and Cronbach's Alpha coefficient were used. Approval for the research project was obtained from the Ethics Committee, CAAE: 05274612.7.0000.0121.RESULTS: differences in the number of positive answers to the Hospital Survey on Patient Safety Culture, the safety grade and the number of reported events were found according to the professional characteristics. A significant association was found between a shorter Length of work at the hospital and Length of work at the unit and a larger number of positive answers; longer length of experience in the profession represented higher grades and less reported events. The physicians and nursing technicians assessed the patient safety culture more positively. Cronbach's alpha demonstrated the reliability of the instrument.CONCLUSION: the differences found reveal a possible relation between the assessment of the safety culture and the subjects' professional characteristics at the Neonatal Intensive Care Units.

  17. Which nutritional regimen for the comorbid complex intensive care unit patient?

    Science.gov (United States)

    Singer, Pierre; Weinberger, Hadas; Tadmor, Boaz

    2013-01-01

    Intensive care patient nutritional therapy has been standardized by guidelines for decades. However, the same nutritional regimen to such a heterogeneous population seems a difficult task. These patients have various genotypes, numerous comorbidities, different severities and lengths of acute illness, and multiple interventions. Therefore, a new way of approaching the complexity of these patients is required, progressing from the whole body to compartments, organs, pericellular space, and cellular metabolism. We propose to untangle the complexity of intensive care unit patients by analyzing the complexity and deciding on the appropriate measures. These activities should aim towards personalized identification and prediction of adequate recovery measures, considering the generalization of guidelines based on the accumulated experience. Defining the specific nutrition supplement to affect various body niches could produce a significant contribution to the monitoring of nutritional complications, better understanding of the published nutritional interventions, and wise use of the nutritional tool in the complex patient.

  18. The effect of Echinacea mouthwash on ventilator associated pneumonia in patients in intensive care units

    Directory of Open Access Journals (Sweden)

    Gholami Mehrabadi M

    2015-11-01

    Full Text Available Background and Objective: Ventilator associated pneumonia (VAP is one of the most prevalent hospital infections in intensive care units. Mouthwash is one of the caring procedures which can be effective in decreasing the rate of VAP. The present study was conducted to determine the effect of Echinacea mouthwash on prevalence of ventilator associated pneumonia in intensive care units. Materials and Method: In this clinical trial study, population was the intubated patients in intensive care units of educational hospitals in Arak in 2014. 70 patients were selected purposively and then were randomly allocated into two intervention and control groups, In intervention group, mouthwash with Echinacea and in control group with normal saline was done twice daily. The rate of VAP was assessed by Clinical Pulmonary Infection Scale (CPIS, before and on the fifth day of intervention. Data were analyzed by Chi square, independent T-test and fisher’s exact test through using SPSS16. Results: prevalence of Ventilator associated pneumonia was 60 percent in normal saline and 51.4 percent in Echinacea group buth the Chi square test didn’t show significant difference between two groups. Conclusion: According to results, Echinacea can relatively decrease the rate of VAP in ventilated patients, but more investigations in this area are essential.

  19. What Makes a Good Palliative Care Physician? A Qualitative Study about the Patient's Expectations and Needs when Being Admitted to a Palliative Care Unit.

    Directory of Open Access Journals (Sweden)

    Eva K Masel

    Full Text Available The aims of the study were to examine a patients' knowledge of palliative care, b patients' expectations and needs when being admitted to a palliative care unit, and c patient's concept of a good palliative care physician.The study was based on a qualitative methodology, comprising 32 semistructured interviews with advanced cancer patients admitted to the palliative care unit of the Medical University of Vienna. Interviews were conducted with 20 patients during the first three days after admission to the unit and after one week, recorded digitally, and transcribed verbatim. Data were analyzed using NVivo 10 software, based on thematic analysis enhanced with grounded theory techniques.The results revealed four themes: (1 information about palliative care, (2 supportive care needs, (3 being treated in a palliative care unit, and (4 qualities required of palliative care physicians. The data showed that patients lack information about palliative care, that help in social concerns plays a central role in palliative care, and attentiveness as well as symptom management are important to patients. Patients desire a personal patient-physician relationship. The qualities of a good palliative care physician were honesty, the ability to listen, taking time, being experienced in their field, speaking the patient's language, being human, and being gentle. Patients experienced relief when being treated in a palliative care unit, perceived their care as an interdisciplinary activity, and felt that their burdensome symptoms were being attended to with emotional care. Negative perceptions included the overtly intense treatment.The results of the present study offer an insight into what patients expect from palliative care teams. Being aware of patient's needs will enable medical teams to improve professional and individualized care.

  20. Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?

    Directory of Open Access Journals (Sweden)

    Ekerstad N

    2016-12-01

    Full Text Available Niklas Ekerstad,1,2 Björn W Karlson,3 Synneve Dahlin Ivanoff,4 Sten Landahl,5 David Andersson,6 Emelie Heintz,7 Magnus Husberg,2 Jenny Alwin2 1Department of Cardiology, NU (NÄL-Uddevalla Hospital Group, Trollhattan, 2Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, 3Department of Molecular and Clinical Medicine, Institute of Medicine, 4Centre for Ageing and Health, AGECAP, Department of Health and Rehabilitation, 5Department of Geriatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 6Division of Economics, Department of Management and Engineering, Linköping University, Linköping, 7Health Outcomes and Economic Evaluation Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden Objective: The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA unit is superior to the care in a conventional acute medical care unit. Design: This is a clinical, prospective, randomized, controlled, one-center intervention study. Setting: This study was conducted in a large county hospital in western Sweden. Participants: The study included 408 frail elderly patients, aged ≥75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206 or control group (n=202. Mean age of the patients was 85.7 years, and 56% were female. Intervention: This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. Measurements: The primary outcome was the change in health-related quality of life (HRQoL 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3. Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. Results: After adjustment by

  1. Acute kidney injury biomarkers for patients in a coronary care unit: a prospective cohort study.

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    Tien-Hsing Chen

    Full Text Available BACKGROUND: Renal dysfunction is an established predictor of all-cause mortality in intensive care units. This study analyzed the outcomes of coronary care unit (CCU patients and evaluated several biomarkers of acute kidney injury (AKI, including neutrophil gelatinase-associated lipocalin (NGAL, interleukin-18 (IL-18 and cystatin C (CysC on the first day of CCU admission. METHODOLOGY/PRINCIPAL FINDINGS: Serum and urinary samples collected from 150 patients in the coronary care unit of a tertiary care university hospital between September 2009 and August 2010 were tested for NGAL, IL-18 and CysC. Prospective demographic, clinical and laboratory data were evaluated as predictors of survival in this patient group. The most common cause of CCU admission was acute myocardial infarction (80%. According to Acute Kidney Injury Network criteria, 28.7% (43/150 of CCU patients had AKI of varying severity. Cumulative survival rates at 6-month follow-up following hospital discharge differed significantly (p<0.05 between patients with AKI versus those without AKI. For predicting AKI, serum CysC displayed an excellent areas under the receiver operating characteristic curve (AUROC (0.895 ± 0.031, p < 0.001. The overall 180-day survival rate was 88.7% (133/150. Multiple Cox logistic regression hazard analysis revealed that urinary NGAL, serum IL-18, Acute Physiology, Age and Chronic Health Evaluation II (APACHE II and sodium on CCU admission day one were independent risk factors for 6-month mortality. In terms of 6-month mortality, urinary NGAL had the best discriminatory power, the best Youden index, and the highest overall correctness of prediction. CONCLUSIONS: Our data showed that serum CysC has the best discriminative power for predicting AKI in CCU patients. However, urinary NGAL and serum IL-18 are associated with short-term mortality in these critically ill patients.

  2. Serologic prevalence of amoeba-associated microorganisms in intensive care unit pneumonia patients.

    Directory of Open Access Journals (Sweden)

    Sabri Bousbia

    Full Text Available BACKGROUND: Patients admitted to intensive care units are frequently exposed to pathogenic microorganisms present in their environment. Exposure to these microbes may lead to the development of hospital-acquired infections that complicate the illness and may be fatal. Amoeba-associated microorganisms (AAMs are frequently isolated from hospital water networks and are reported to be associated to cases of community and hospital-acquired pneumonia. METHODOLOGY/PRINCIPAL FINDINGS: We used a multiplexed immunofluorescence assay to test for the presence of antibodies against AAMs in sera of intensive care unit (ICU pneumonia patients and compared to patients at the admission to the ICU (controls. Our results show that some AAMs may be more frequently detected in patients who had hospital-acquired pneumonia than in controls, whereas other AAMs are ubiquitously detected. However, ICU patients seem to exhibit increasing immune response to AAMs when the ICU stay is prolonged. Moreover, concomitant antibodies responses against seven different microorganisms (5 Rhizobiales, Balneatrix alpica, and Mimivirus were observed in the serum of patients that had a prolonged ICU stay. CONCLUSIONS/SIGNIFICANCE: Our work partially confirms the results of previous studies, which show that ICU patients would be exposed to water amoeba-associated microorganisms, and provides information about the magnitude of AAM infection in ICU patients, especially patients that have a prolonged ICU stay. However, the incidence of this exposure on the development of pneumonia remains to assess.

  3. Incidence of violent behavior among patients in Psychiatric Intensive Care Units

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    Valentina C. Iversen

    2016-03-01

    Full Text Available Background and Objectives: Both psychiatric acute units and psychiatric intensive care units (PICUs focus on acute treatment of behavioral disturbances such as violence and aggressive threats and acts. The aim of the present study is to describe the frequency of violent behavior; such as verbal or physical threats and physical attacks, among patients admitted to psychiatric intensive care unit (PICU. In addition the relationship between the episodes of threats and/or attacks in relation to time of the day, days of the week, and their seasonal variations was explored. Methods: All violent behavior was continuously assessed at the psychiatric emergency department. Data were collected during the period from May 2010 to May 2012. Results: Patients with only one hospitalization were less violent than those who have had two hospitalizations. There was a statistically significant difference in violence among patients without formal secondary education and those who have not formal education. Violent behavior showed two peaks during the day; the first occurring at 1 pm and the second at 8 pm. In regard to seasonality, summer had a higher incidence of violence. The most peaceful seasons of the year were spring and autumn. Conclusions: Violent behavior shows variation in daytime, days of the week and season in acute psychiatric intensive care. Daytime variation shows two peaks of violence at 1 pm and 8 pm, Sundays and Wednesdays being the quietest days regarding violence both in winter and summer. Patient's level of education and hospitalization status partially explain the variation.

  4. Indications and outcome for obstetric patients' admission to intensive care unit: a 7-year review.

    Science.gov (United States)

    Lataifeh, I; Amarin, Z; Zayed, F; Al-Mehaisen, L; Alchalabi, H; Khader, Y

    2010-05-01

    The objective of this retrospective study was to investigate the indications, interventions and clinical outcome of pregnant and newly delivered women admitted to the multidisciplinary intensive care unit at the King Abdullah University Hospital in Jordan over a 7-year period from January 2002 to December 2008. The collected data included demographic characteristics of the patients, mode of delivery, pre-existing medical conditions, reason for admission, specific intervention, length of stay and maternal outcome. A total of 43 women required admission to the intensive care unit (ICU), which represented 0.37% of all deliveries. The majority (95.3%) of patients were admitted to the ICU postpartum. The most common reasons for admissions were (pre)eclampsia (48.8%) and obstetric haemorrhage (37.2). The remainder included adult respiratory distress syndrome (6.9%), pulmonary embolism (2.3%) and neurological disorders (4.6%). Mechanical ventilation was required to support 18.6% of patients and transfusion of red blood cells was needed for 48.8% of patients. There were three maternal deaths (6.9%). A multidisciplinary team approach is essential to improve the management of hypertensive disorders and postpartum haemorrhage to achieve significant improvements in maternal outcome. A large, prospective study to know which women are at high risk of admission to the intensive care units and to prevent serious maternal morbidity and mortality is warranted.

  5. [Patients at the end of life in the intensive care unit: cultural aspects of accompaniment].

    Science.gov (United States)

    Grom, I-U; Vagts, D A; Kampa, U; Pfeiffer, G; Schreiber-Winzig, L; Wiese, C H R

    2013-06-01

    The accompaniment of people in the face of death offers insights into dimensions which are mostly not seen in ordinary life. These insights also exist in intensive care in German hospitals and are highly relevant in medical decision making. End-of-life decisions in particular often determine medical, cultural and spiritual aspects concerning medical treatment and therapeutic targets and if necessary new therapy targets. The following article especially illuminates cultural aspects and their characteristics in patients at the end of life in the intensive care unit.

  6. The prevalence and consequences of malnutrition risk in elderly Albanian intensive care unit patients

    OpenAIRE

    2015-01-01

    Vjollca Shpata,1 Ilir Ohri,2 Tatjana Nurka,1 Xhensila Prendushi1 1Faculty of Medical Technical Sciences, 2University Hospital Center of Tirana “Mother Theresa”, Faculty of Medicine, University of Medicine in Tirana, Tirana, Albania Purpose: Many investigators have reported rising numbers of elderly patients admitted to the intensive care units (ICUs). The aim of the study was to estimate the prevalence of malnutrition risk in the ICU by comparing the prevalence of malnutritio...

  7. The prevalence and consequences of malnutrition risk in elderly Albanian intensive care unit patients

    OpenAIRE

    2015-01-01

    Purpose Many investigators have reported rising numbers of elderly patients admitted to the intensive care units (ICUs). The aim of the study was to estimate the prevalence of malnutrition risk in the ICU by comparing the prevalence of malnutrition between older adults (aged 65 years and above) and adults (aged 18–64 years), and to examine the negative consequences associated with risk of malnutrition in older adults. Materials and methods A prospective cohort study in the ICU of the Universi...

  8. The prevalence and consequences of malnutrition risk in elderly Albanian intensive care unit patients

    OpenAIRE

    2015-01-01

    Vjollca Shpata,1 Ilir Ohri,2 Tatjana Nurka,1 Xhensila Prendushi1 1Faculty of Medical Technical Sciences, 2University Hospital Center of Tirana “Mother Theresa”, Faculty of Medicine, University of Medicine in Tirana, Tirana, Albania Purpose: Many investigators have reported rising numbers of elderly patients admitted to the intensive care units (ICUs). The aim of the study was to estimate the prevalence of malnutrition risk in the ICU by comparing the prevalence of mal...

  9. Condition of cleanliness of surfaces close to patients in an intensive care unit

    OpenAIRE

    Ferreira,Adriano Menis; Andrade,Denise de; Rigotti, Marcelo Alessandro; Ferreira, Maria Verônica Ferrareze

    2011-01-01

    ABSTRACT - Surface cleaning is a well-known control procedure against the dissemination of microorganisms in the hospital environment. This prospective study, carried out in an intensive care unit over the course of 14 days, describes the cleaning/disinfection conditions of four surfaces near patients. In total, 100 assessments of the surfaces were carried out after they were cleaned. Three methods were used to evaluate cleanliness: a visual inspection, an adenosine triphosphate (ATP) biolumi...

  10. The role of the intensive care unit in the management of the critically ill surgical patient.

    Science.gov (United States)

    Cuthbertson, B H; Webster, N R

    1999-10-01

    Surgical patients make up 60-70% of the work load of intensive care units in the UK. There is a recognised short fall in the resource allocation for high dependency units (HDUs) and intensive care units (ICUs) in this country, despite repeated national audits urging that this resource be increased. British ICUs admit patients later and with higher severity of illness scores than elsewhere and this leads to higher ICU mortality. How can this situation be improved? Scoring systems that allow selection of appropriate patients for admission to ICU and avoid inappropriate admission are still in development. Pre-operative admission and optimisation in ICU is rare in this country despite increasing evidence to support this practice in high risk surgical patients. Early admission to ICU, with potential improvement in outcomes, could also be achieved using multi-disciplinary medical emergency teams. These teams would be alerted by ward staff in response to set specific conditions and physiological criteria. These proposals are still under trial but may offer benefit by reducing mortality in critically ill surgical patients.

  11. Anticonvulsant use in elderly patients in long-term care units.

    LENUS (Irish Health Repository)

    Timmons, S

    2012-02-03

    BACKGROUND: Elderly patients in long-term care units are frailer than their community-dwelling peers and may be more at risk from toxic side-effects of anticonvulsant medication at standard doses. AIM: To examine the prescribing of anticonvulsants to patients in elderly care units. METHODS: Drug prescription sheets and case notes were reviewed. Serum anticonvulsant concentration, renal and liver profiles and albumin level were measured. RESULTS: Anticonvulsants were prescribed to twice as many male as female patients (32 vs 14%; p<0.03) and to 33% of those younger than 80 years of age versus 10% of those aged 80 years or older (p<0.0002). No patient had significant hypoalbuminaemia and routine measurement of serum anticonvulsant concentration did not indicate an alteration of dosage. CONCLUSIONS: Anticonvulsants appear to be well tolerated in these patients. The younger age of those receiving anticonvulsants is inadequately explained by the characteristics of the patient cohort and may reflect a shift towards a younger age in patients requiring anticonvulsants due to increased mortality in this group.

  12. Introducing the Comprehensive Unit-based Safety Program for mechanically ventilated patients in Saudi Arabian Intensive Care Units

    Science.gov (United States)

    Khan, Raymond M.; Aljuaid, Maha; Aqeel, Hanan; Aboudeif, Mohammed M.; Elatwey, Shaimaa; Shehab, Rajeh; Mandourah, Yasser; Maghrabi, Khalid; Hawa, Hassan; Khalid, Imran; Qushmaq, Ismael; Latif, Asad; Chang, Bickey; Berenholtz, Sean M.; Tayar, Sultan; Al-Harbi, Khloud; Yousef, Amin; Amr, Anas A.; Arabi, Yaseen M.

    2017-01-01

    Over the past decade, there have been major improvements to the care of mechanically ventilated patients (MVPs). Earlier initiatives used the concept of ventilator care bundles (sets of interventions), with a primary focus on reducing ventilator-associated pneumonia. However, recent evidence has led to a more comprehensive approach: The ABCDE bundle (Awakening and Breathing trial Coordination, Delirium management and Early mobilization). The approach of the Comprehensive Unit-based Safety Program (CUSP) was developed by patient safety researchers at the Johns Hopkins Hospital and is supported by the Agency for Healthcare Research and Quality to improve local safety cultures and to learn from defects by utilizing a validated structured framework. In August 2015, 17 Intensive Care Units (ICUs) (a total of 271 beds) in eight hospitals in the Kingdom of Saudi Arabia joined the CUSP for MVPs (CUSP 4 MVP) that was conducted in 235 ICUs in 169 US hospitals and led by the Johns Hopkins Armstrong Institute for Patient Safety and Quality. The CUSP 4 MVP project will set the stage for cooperation between multiple hospitals and thus strives to create a countrywide plan for the management of all MVPs in Saudi Arabia. PMID:28197216

  13. Introducing the Comprehensive Unit-based Safety Program for mechanically ventilated patients in Saudi Arabian Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Raymond M Khan

    2017-01-01

    Full Text Available Over the past decade, there have been major improvements to the care of mechanically ventilated patients (MVPs. Earlier initiatives used the concept of ventilator care bundles (sets of interventions, with a primary focus on reducing ventilator-associated pneumonia. However, recent evidence has led to a more comprehensive approach: The ABCDE bundle (Awakening and Breathing trial Coordination, Delirium management and Early mobilization. The approach of the Comprehensive Unit-based Safety Program (CUSP was developed by patient safety researchers at the Johns Hopkins Hospital and is supported by the Agency for Healthcare Research and Quality to improve local safety cultures and to learn from defects by utilizing a validated structured framework. In August 2015, 17 Intensive Care Units (ICUs (a total of 271 beds in eight hospitals in the Kingdom of Saudi Arabia joined the CUSP for MVPs (CUSP 4 MVP that was conducted in 235 ICUs in 169 US hospitals and led by the Johns Hopkins Armstrong Institute for Patient Safety and Quality. The CUSP 4 MVP project will set the stage for cooperation between multiple hospitals and thus strives to create a countrywide plan for the management of all MVPs in Saudi Arabia.

  14. Satisfaction Domains Differ between the Patient and Their Family in Adult Intensive Care Units

    Science.gov (United States)

    Song, Ge; Sim, Pei Zhen; Ting, Kit Cheng; Yoo, Jeffrey Kwang Sui; Wang, Qing Li; Mascuri, Raudhah Binte Haji Mohamad; Ong, Venetia Hui Ling; Phua, Jason; Kowitlawakul, Yanika

    2016-01-01

    Background. Patients' and family's satisfaction data from the Asian intensive care units (ICUs) is lacking. Objective. Domains between patient and family satisfaction and contribution of each domain to the general satisfaction were studied. Method. Over 3 months, adult patients across 4 ICUs staying for more than 48 hours with abbreviated mental test score of 7 or above and able to understand English and immediate family members were surveyed by separate validated satisfaction questionnaires. Results. Two hundred patients and 194 families were included in the final analysis. Significant difference in the satisfaction scores was observed between the ICUs. Patients were most and least satisfied in the communication (4.2 out of 5) and decision-making (2.9 out of 5) domains, respectively. Families were most and least satisfied in the relationship with doctors (3.9 out of 5) and family's involvement domains (3.3 out of 5), respectively. Domains contributing most to the general satisfaction were the illness management domain for patients (β coefficient = 0.44) and characteristics of doctors and nurses domain for family (β coefficient = 0.45). Discussion. In an Asian ICU community, patients and families differ in their expectations and valuations of health care processes. Health care providers have difficult tasks in attending to these different domains. PMID:28044138

  15. Satisfaction Domains Differ between the Patient and Their Family in Adult Intensive Care Units.

    Science.gov (United States)

    Mukhopadhyay, Amartya; Song, Ge; Sim, Pei Zhen; Ting, Kit Cheng; Yoo, Jeffrey Kwang Sui; Wang, Qing Li; Mascuri, Raudhah Binte Haji Mohamad; Ong, Venetia Hui Ling; Phua, Jason; Kowitlawakul, Yanika

    2016-01-01

    Background. Patients' and family's satisfaction data from the Asian intensive care units (ICUs) is lacking. Objective. Domains between patient and family satisfaction and contribution of each domain to the general satisfaction were studied. Method. Over 3 months, adult patients across 4 ICUs staying for more than 48 hours with abbreviated mental test score of 7 or above and able to understand English and immediate family members were surveyed by separate validated satisfaction questionnaires. Results. Two hundred patients and 194 families were included in the final analysis. Significant difference in the satisfaction scores was observed between the ICUs. Patients were most and least satisfied in the communication (4.2 out of 5) and decision-making (2.9 out of 5) domains, respectively. Families were most and least satisfied in the relationship with doctors (3.9 out of 5) and family's involvement domains (3.3 out of 5), respectively. Domains contributing most to the general satisfaction were the illness management domain for patients (β coefficient = 0.44) and characteristics of doctors and nurses domain for family (β coefficient = 0.45). Discussion. In an Asian ICU community, patients and families differ in their expectations and valuations of health care processes. Health care providers have difficult tasks in attending to these different domains.

  16. Balancing digital information-sharing and patient privacy when engaging families in the intensive care unit.

    Science.gov (United States)

    Brown, Samuel M; Aboumatar, Hanan J; Francis, Leslie; Halamka, John; Rozenblum, Ronen; Rubin, Eileen; Sarnoff Lee, Barbara; Sugarman, Jeremy; Turner, Kathleen; Vorwaller, Micah; Frosch, Dominick L

    2016-09-01

    Patients in intensive care units (ICUs) may lack decisional capacity and may depend on proxy decision makers (PDMs) to make medical decisions on their behalf. High-quality information-sharing with PDMs, including through such means as health information technology, could improve communication and decision making and could potentially minimize the psychological consequences of an ICU stay for both patients and their family members. However, alongside these anticipated benefits of information-sharing are risks of unwanted disclosure of sensitive information. Approaches to identifying the optimal balance between access to digital health information to facilitate engagement and protecting patient privacy are urgently needed. We identified eight themes that should be considered in balancing health information access and patient privacy: 1) potential benefits to patients from PDM data access; 2) potential harms to patients from such access; 3) the moral status of families within the patient-clinician relationship; 4) the scope of relevant information provided to PDMs; 5) issues around defining PDMs' authority; 6) methods for eliciting and documenting patient preferences about their family's information access; 7) the relevance of methods for ascertaining the identity of PDMs; and 8) the obligations of hospitals to prevent privacy breaches by PDMs. We conclude that PDMs should typically have access to health information from the current episode of care when the patient is decisionally impaired, unless the patient has previously expressed a clear preference that PDMs not have such access.

  17. Bloodstream infections in intensive care unit patients: distribution and antibiotic resistance of bacteria

    Directory of Open Access Journals (Sweden)

    Russotto V

    2015-08-01

    Full Text Available Vincenzo Russotto,1 Andrea Cortegiani,1 Giorgio Graziano,2 Laura Saporito,2 Santi Maurizio Raineri,1 Caterina Mammina,2 Antonino Giarratano1 1Department of Biopathology and Medical Biotechnologies (DIBIMED, Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Paolo Giaccone University Hospital, University of Palermo, Palermo, Italy; 2Department of Sciences for Health Promotion and Mother-Child Care, University of Palermo, Palermo, Italy Abstract: Bloodstream infections (BSIs are among the leading infections in critically ill patients. The case-fatality rate associated with BSIs in patients admitted to intensive care units (ICUs reaches 35%–50%. The emergence and diffusion of bacteria with resistance to antibiotics is a global health problem. Multidrug-resistant bacteria were detected in 50.7% of patients with BSIs in a recently published international observational study, with methicillin resistance detected in 48% of Staphylococcus aureus strains, carbapenem resistance detected in 69% of Acinetobacter spp., in 38% of Klebsiella pneumoniae, and in 37% of Pseudomonas spp. Prior hospitalization and antibiotic exposure have been identified as risk factors for infections caused by resistant bacteria in different studies. Patients with BSIs caused by resistant strains showed an increased risk of mortality, which may be explained by a higher incidence of inappropriate empirical therapy in different studies. The molecular genetic characterization of resistant bacteria allows the understanding of the most common mechanisms underlying their resistance and the adoption of surveillance measures. Knowledge of epidemiology, risk factors, mechanisms of resistance, and outcomes of BSIs caused by resistant bacteria may have a major influence on global management of ICU patients. The aim of this review is to provide the clinician an update on BSIs caused by resistant bacteria in ICU patients. Keywords: bloodstream infections, multidrug resistant

  18. Characteristics and mortality of elderly patients admitted to the Intensive Care Unit of a district hospital

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    José Carlos Llamas Reyes

    2016-01-01

    Full Text Available Aim: To study all the elderly patients (≥75 years who were admitted in an Intensive Care Unit (ICU of a Spanish hospital and identify factors associated with mortality. Patients and Methods: A retrospective, observational data collected prospectively in patients ≥75 years recruited from the ICU in the period of January 2004 to December 2010. Results: During the study period, 1661 patients were admitted to our unit, of whom 553 (33.3% were older than 75 years. The mean age was 79.9 years, 317 (57.3% were male, and the overall in-hospital mortality was 94 patients (17% confidence interval 14-20.3%. When comparing patients who survived to those who died, we found significant differences in mean age (P = 0.001, Acute Physiologic Assessment and Chronic Health Evaluation II and Simplified Acute Physiology Scoring II (SAPS II on admission (P 75 years was not significant (P = 0.1390. Conclusions: The percentage of elderly patients in our unit is high, with low mortality rates. The age itself is not the sole determinant for admission to the ICU and other factors should be taken into account.

  19. Educational Needs of Nurses in Intensive Care Unit for Poisoned Patients

    Directory of Open Access Journals (Sweden)

    Dadpour B

    2013-10-01

    Full Text Available Objectives: Poisoned patients are at risk of impaired ventilation in many situations. The purpose of this descriptive study was to investigate the impact of educational workshops on nurses' knowledge, confidence, and attitude in taking care of poisoned patients. Materials and Methods: This descriptive study was performed on 60 nursing staff in the intensive care unit (ICU for poisoned patients in Imam Reza (p hospital, Mashhad, Iran. Data was gathered by a researcher-designed questionnaire. Studied scales included perceived importance and novelty of educational meeting, matching with professional and educational needs, illustration of practical and knowledge weaknesses and strength and finally satisfaction in holding regular workshops annually. Two, half day workshops were held and various items were taught with various methods. The knowledge of participants was assessed by pretests and post-tests consisting of 12 items related to workshop topics. The impact of these educational meetings was evaluated and the results were analyzed by the SPSS software. Results: According to the results, workshops improved awareness of nurses about their weakness and strength points, professional knowledge and their interest and attention; likewise all participants had the same opinion about a strong need to hold similar workshops more than once and preferably 2 to 3 times annually. Conclusion: It seems that short educational courses in small groups for reviewing the old data and recent findings in the context of critical care are useful in order to promote the knowledge and skills of ICU staff in taking care of poisoned patients

  20. Patients with hypertensive crises who are admitted to a coronary care unit: clinical characteristics and outcomes.

    Science.gov (United States)

    González Pacheco, Héctor; Morales Victorino, Neisser; Núñez Urquiza, Juan Pablo; Altamirano Castillo, Alfredo; Juárez Herrera, Ursulo; Arias Mendoza, Alexandra; Azar Manzur, Francisco; Briseño de la Cruz, Jose Luis; Martínez Sánchez, Carlos

    2013-03-01

    Patients with hypertensive crises, especially hypertensive emergencies, require immediate admittance to an intensive care unit for rapid blood pressure (BP) control. The authors analyzed the prevalence of hypertensive crisis, the clinical characteristics, and the evolution of patients with hypertensive emergencies and urgencies. Patients were divided into 3 groups according to their BP values: group I, predominant systolic hypertension (≥180/≤119 mm Hg); group II, severe systolic and diastolic hypertension (≥180/≥120 mm Hg); and group III, predominant diastolic hypertension (≤179/≥120 mm Hg). Of all of the patients admitted to a coronary care unit, 538 experienced a hypertensive crisis, which represented 5.08% of all admissions. Hypertensive emergency was predominant in 76.6% of the cases, which corresponded to acute coronary syndrome and acute decompensated heart failure in 59.5% and 25.2% of the cases, respectively. A pattern of predominant systolic hypertension (≥180/≤119 mm Hg) was most commonly observed in the hypertensive crisis group (71.4%) and the hypertensive emergency group (72.1%). The medications that were most commonly used at onset included intravenous vasodilators (nitroglycerin in 63.4% and sodium nitroprusside in 16.4% of the patients). The overall mortality rate was 3.7%. The mortality rate was 4.6% for hypertensive emergency cases and 0.8% for hypertensive urgencies cases.

  1. Variation in Care for Patients with Irritable Bowel Syndrome in the United States.

    Directory of Open Access Journals (Sweden)

    Brian E Lacy

    Full Text Available Irritable bowel syndrome (IBS affects nearly one in seven Americans. Significant national variations in care may exist, due to a current lack of standardized diagnosis and treatment algorithms; this can translate into a substantial additional economic burden. The study examines healthcare resource utilization in patients with IBS and in the subset of IBS patients with constipation (IBS-C and analyzes the variation of IBS care for these patients across the United States (US.Healthcare resource use (HRU, including gastrointestinal (GI procedures and tests, all-cause and intestinal-related medical visits, GI specialist visits, and constipation or diarrhea pharmacy prescriptions for IBS patients enrolled in a large US administrative claims database (2001-2012 were analyzed for the 24-month period surrounding first diagnosis. Multivariate regression models, adjusting for age, gender, year of first diagnosis, insurance type, and Charlson comorbidity index, compared HRU across states (each state vs. the average of all other states.Of 201,322 IBS patients included, 77.2% were female. Mean age was 49.4 years. One in three patients had ≥3 distinct GI medical procedures or diagnostic tests; 50.1% visited a GI specialist. Significant HRU differences were observed in individual states compared to the national average. IBS-C patients had more medical visits, procedures, and pharmacy prescriptions for constipation/diarrhea than IBS patients without constipation.This study is the first to identify considerable regional variations in IBS healthcare across the US and to note a markedly higher HRU by IBS-C patients than by IBS patients without constipation. Identifying the reasons for these variations may improve quality of care and reduce the economic burden of IBS.

  2. Short- and long-term outcomes of AL amyloidosis patients admitted into intensive care units.

    Science.gov (United States)

    Guinault, Damien; Canet, Emmanuel; Huart, Antoine; Jaccard, Arnaud; Ribes, David; Lavayssiere, Laurence; Venot, Marion; Cointault, Olivier; Roussel, Murielle; Nogier, Marie-Béatrice; Pichereau, Claire; Lemiale, Virginie; Arnulf, Bertrand; Attal, Michel; Chauveau, Dominique; Azoulay, Elie; Faguer, Stanislas

    2016-09-01

    Amyloidosis is a rare and threatening condition that may require intensive care because of amyloid deposit-related organ dysfunction or therapy-related adverse events. Although new multiple myeloma drugs have dramatically improved outcomes in AL amyloidosis, the outcomes of AL patients admitted into intensive care units (ICUs) remain largely unknown. Admission has been often restricted to patients with low Mayo Clinic staging and/or with a complete or very good immunological response at admission. In a retrospective multicentre cohort of 66 adult AL (n = 52) or AA (n = 14) amyloidosis patients, with similar causes of admission to an ICU, the 28-d and 6-month survival rates of AA patients were significantly higher compared to AL patients (93% vs. 60%, P = 0·03; 71% vs. 45%, P = 0·02, respectively). In AL patients, the simplified Index of Gravity Score (IGS2) was the only independent predictive factor for death by day 28, whereas the Mayo-Clinic classification stage had no influence. In Cox's multivariate regression model, only cardiac arrest and on-going chemotherapy at ICU admission significantly predicted death at 6 months. Short-term outcomes of AL patients admitted into an ICU were mainly related to the severity of the acute medical condition, whereas on-going chemotherapy for active amyloidosis impacted on long-term outcomes.

  3. Use and misuse of antipsychotic drugs in patients with dementia in Alzheimer special care units.

    Science.gov (United States)

    Nobili, Alessandro; Pasina, Luca; Trevisan, Silvia; Riva, Emma; Lucca, Ugo; Tettamanti, Mauro; Matucci, Marina; Tarantola, Massimo

    2009-03-01

    The objective of this study was to estimate the prevalence of antipsychotic use and investigate their association with behavioural and psychological symptoms of dementia (BPSD) and other clinical predictors. Patients with dementia, aged 65 and above and resident in 35 Alzheimer special care units were sequentially enrolled into a 18-month prospective observational study. Data on sociodemographic, cognitive, functional, behavioural and clinical characteristics and drug exposure were collected at baseline and at 6-month intervals up to 18 months. The prevalence of antipsychotic use and the association with BPSD and clinical predictors were analysed. Of the 349 patients with dementia enrolled in the study, 209 (60%) were taking at least one antipsychotic. Risperidone and promazine were the most frequently prescribed antipsychotic; 40.7% simultaneously received a benzodiazepine, 20% an antidepressant. More than 50% were still taking antipsychotics at 18 months of follow-up. No associations were found between antipsychotic use and level of cognitive impairment, basal activity of daily living disability and comorbidity. Multivariate analysis showed that the use of antipsychotics was highest in patients in the highest quartiles of Neuropsychiatric Inventory Scale score (III quartile, odds ratio: 1.63; 95% confidence interval: 1.19-2.23; IV quartile, odds ratio: 2.27; 95% confidence interval: 1.61-3.26). This study found high rate of use of antipsychotics in patients with dementia resident in Alzheimer special care units, frequent associations with other psychotropic medications and a strong correlation with BPSD.

  4. Difficult airway in a patient with H1N1 pneumonia in intensive care unit

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    Meltem Türkay

    2014-12-01

    Full Text Available The difficult airway is a frequent problem among adult patients in intensive care unit. All critical patients should initially be evaluated as a potential difficult airway cases. Development of a serious desaturation should be considered since these patients have less physiological reserve compared to those with difficult airway due to elective surgery. Development of respiratory failure with H1N1 associated pneumonia is likely and support of intubation and mechanic ventilator shall be needed. The objective of this report is to present the management of a patient with H1N1 associated pneumonia who required intubation however could not be intubated due to difficult airway. J Clin Exp Invest 2014; 5 (4: 617-619

  5. Clinical, Epidemiological and Microbiological Study of Patients Admitted to Intensive Care Units with Mechanical Ventilation Related Pneumonia

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    Ledys Pérez Morales

    2012-09-01

    Full Text Available Background: Mechanical ventilation related pneumonia is a very current issue due to its frequency, severity and etiologic and therapeutic implications. Objective: To characterize, from a clinical, epidemiological and microbiological point of view, patients with ventilation related pneumonia who are admitted to intensive care units. Methods: Descriptive case series study, conducted from January 2007 to December 2009, at the Laboratory of Microbiology and intensive care units of the Dr. Gustavo Aldereguía Lima General Hospital in Cienfuegos.  We analyzed the following variables: service that remitted patients, age, sex, cause of admission to intensive care unit, discharge status, microbiological results, isolated microorganisms, antimicrobial disks tested and antimicrobial resistance in vitro. Results: mechanical ventilation related pneumonia in intensive care units was observed mainly in male patients over 65 years old (43.1% with multiple trauma (20.9%; 20.9% were patients with cerebrovascular disease. Acinetobacter baumannii was the most frequently isolated organism in all units (41.4%, except in the Surgical Intensive Care Unit. It also reported a high mortality rate and in vitro resistance to all antimicrobials tested. Conclusions: Acinetobacter baumannii was the most isolated germen in cases of mechanical ventilation related pneumonia in intensive care units` patients. It affected mainly patients with multiple trauma and cerebrovascular disease.

  6. Value of postmortem studies in deceased neonatal and pediatric intensive care unit patients.

    Science.gov (United States)

    Widmann, Raphael; Caduff, Rosmarie; Giudici, Luca; Zhong, Qing; Vogetseder, Alexander; Arlettaz, Romaine; Frey, Bernhard; Moch, Holger; Bode, Peter K

    2017-02-01

    Worldwide, various autopsy studies have shown a decrease in the diagnostic error rate over the last years. The cause of this positive development is mainly due to the improvement of modern medicine. However, intensive care unit patients are thought to have a higher risk for diagnostic errors, which is documented in several studies in the adult population. In contrast, there is only limited information about diagnostic errors in pediatrics, particularly in pediatric and neonatal intensive care units. The aims of this study were to analyze the spectrum of childhood death, determine the prevalence and distribution of autopsy-confirmed diagnostic errors, and describe patient characteristics that might have influenced the discordance between antemortem and postmortem findings. We analyzed 143 autopsy reports from 2004 to 2013 and correlated these with clinical reports. The overall autopsy rate during this interval was 20.3%. The leading causes of death were congenital malformations (28%), diseases closely associated with perinatal disorders (25%), disorders of the cardiovascular system (18%), and infections (15%). Additional findings were obtained in 23% of the autopsies. Major diagnostic errors were found in 6%, the lowest reported value in a developed country as yet. Most cases (75%) showed complete concordance between clinical diagnoses and postmortem findings, in line with improvements in diagnostic and therapeutic processes over the last decades. In conclusion, autopsy of neonates, infants, and children represents an important tool for monitoring the quality of pediatric and neonatal medical care.

  7. Characteristics and outcomes of end-stage renal disease patients with active tuberculosis followed in intensive care units

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    Ulasli Sevinc

    2009-01-01

    Full Text Available Tuberculosis (TB remains a common problem in patients with chronic renal failure. In intensive care units, misdiagnosis or delayed diagnosis of TB is common. Therefore, a description of characteristics of active TB in patients with renal failure followed in intensive care units is important to reduce mortality and transmission of the disease. This study was performed to describe the characteristics of patients with renal failure admitted to the intensive care units and having active TB and evaluate predictive factors for in hospital mortality. The hospital records of 24 patients (11 women, 13 men having ESRD and TB between 2001-2006 were reviewed. Clinical, radiological, and laboratory data on admission were recorded. Possible parameters contributing to in-hospital mortality were obtained from the medical records. In-hospital mortality rate was 66.6%. Factors associated with mortality were decreased partial pressure of oxygen and malnutrition. Fever was reported in 8 patients and hemoptysis was reported in 3 patients. Eight patients had consolidation on chest radiograph, while 4 had normal findings Seventeen patients had pulmonary involvement, and 11 had extra pulmonary involvement. The mortality rate in TB patients followed in intensive care units is high, with 3 factors contributing to in-hospital mortality. Clinicians should consider active TB in renal failure patients being followed in the intensive care unit, even when results of a chest radiograph are normal especially in patients with unexplained poor general health or respiratory failure.

  8. Outcome of mechanically ventilated patients initially denied admission to an intensive care unit and subsequently admitted.

    Science.gov (United States)

    Naser, Wasim; Schwartz, Naama; Finkelstein, Richard; Bisharat, Naiel

    2016-11-01

    The outcome of mechanically ventilated patients initially denied admission to an intensive care unit (ICU) and subsequently admitted is unclear. We compared outcomes of patients denied ICU admission and subsequently admitted, to those of patients admitted to the ICU and to patients refused ICU admission. The medical records of all the patients who were subjected to mechanical ventilation for at least 24h over a 4year period (2010-2014) were reviewed. Of 707 patients (757 admissions), 124 (18%) were initially denied ICU admission and subsequently admitted. Multivariate stepwise logistic regression analysis showed significant association with death of: age, length of stay, nursing home residency, duration of mechanical ventilation, previous admission with mechanical ventilation, cause for mechanical ventilation, rate of failed extubations, associated morbidity (previous cerebrovascular accident, dementia, chronic renal failure), and occurrence of nosocomial bacteremia. The odds for death among patients denied ICU admission and subsequently transferred to the ICU compared to patients admitted directly to the ICU was 3.6 (95% CI: 1.9-6.7) (Padmission compared to those who were initially denied and subsequently admitted were not statistically significant (OR=1.7, 95% CI: 0.8-3.8). In conclusion, patients denied ICU admission and subsequently admitted face a considerable risk of morbidity and mortality. Their odds of death are nearly three times those admitted directly to the ICU. Late admission to the ICU does not appear to provide benefit compared to patients who remain in general medicine wards.

  9. A Comparison of Patient-Centered Care in Pharmacy Curricula in the United States and Europe.

    Science.gov (United States)

    Nunes-da-Cunha, Ines; Arguello, Blanca; Martinez, Fernando Martinez; Fernandez-Llimos, Fernando

    2016-06-25

    Objective. To compare United States and European Higher Education Area (EHEA) undergraduate pharmacy curricula in terms of patient-centered care courses. Methods. Websites from all pharmacy colleges or schools in the United States and the 41 countries in the EHEA were retrieved from the FIP Official World List of Pharmacy Schools and investigated. A random sample of schools was selected and, based on analyses of course descriptions from syllabi, each course was classified into the following categories: social/behavioral/administrative pharmacy sciences, clinical sciences, experiential, or other/basic sciences. Results. Of 147 schools of pharmacy, 59 were included (23 in US and 36 in the EHEA). Differences existed in the percentages of credits/hours in all of the four subject area categories. Conclusion. Institutions in EHEA countries maintain a greater focus on basic sciences and a lower load of clinical sciences in pharmacy curricula compared to the United States. These differences may not be in accordance with international recommendations to educate future pharmacists focused on patient care.

  10. The Effects of Scheduled Visitation on the Physiological Indices of Conscious Patients Admitted at intensive Care Units

    OpenAIRE

    2015-01-01

    Background: Visitation of patients admitted at intensive care units (ICUs) is a controversial issue in the field of health care. It is commonly believed that the presence of family members might bring about physiological changes, such as tachycardia and hypertension, in ICU patients. Aim: This study aimed to evaluate the effects of scheduled visitation on the physiological indices of conscious patients at the ICU. Method: This experimental study was conducted on 90 conscious patients admitted...

  11. Nosocomial infection and risk factors in elderly patients in intensive care units

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    Kevser Özdemir

    2015-03-01

    Full Text Available Incidence of nosocomial infections gradually increase in patients over 65 years age population. There is a significant relationship between increased age and predisposition to nosocomial infections. Predisposition to infections in this age group is a result of impaired host defense, underlying chronic diseases, long-term hospitalization, steroids and immunosuppressive therapies and malnutrition. Nevertheless there is not much data about the incidence and risk factors of nosocomial infections in elderly population. In this study we aimed to investigate the incidence and risk factors for nosocomial infections and the factors affecting mortality rates in elderly patients in the medical intensive care units. Nosocomial infection is an important factor causes increased mortality rate and length of hospital stay. Mortality rates and time interval between admission and discharge is significantly higher in nosocomially infected group than others. There are several known independent risk factors for increased mortality rates include increased age and length of hospital stay, impaired conscious levels, co-morbidities, nosocomial infections, immunsupresive conditions such as malnutrition, malignancies, mechanic ventilation and/or central venous catheter usage. As a result nosocomial infection is an important and partially preventable risk factor for mortality among patients treated in intensive care units. Mechanical ventilation, central venous and/or urinary catheterizations are such invasive interventions that may cause higher nosocomial infection rates. In terms of decreasing nosocomial infection rates; less frequently used invasive interventions can help in achieving this purpose of treatment. J Microbiol Infect Dis 2015;5(1: 38-43

  12. [Analgesia, sedation and delir – Treatment of patients in the neuro intensive care unit].

    Science.gov (United States)

    Jungk, Christine

    2015-11-01

    Analgesia and sedation of patients in the neuro intensive care unit, in particular in case of intracranial hypertension, remains a challenge even today. A goal for analgesia and sedation should be set for each individual patient (RASS -5 in case of intracranial hypertension) and should be re-evaluated repeatedly based on standardized scores (RASS plus EEG monitoring where appropriate, NCS). There are no sufficient evidence-based sedation algorithms in this patient cohort. Remifentanil, sufentanil and fentanyl have been proven safe and effective for continuous application; however, bolus application should be avoided. (S-)Ketamin can be considered safe when mechanical ventilation and sedation with GABA receptor agonists are applied. Propofol and benzodiazepines are equally safe and effective with shorter wake up times for propofol. The use of barbitarutes is restricted to intractable intracranial hypertension or status epilepicus. Evidence for alpha-2-adrenoceptoragonists and inhalative sedation is poor and requires further research.

  13. Benefits of and untoward events during intrahospital transport of pediatric intensive care unit patients

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    M M Harish

    2017-01-01

    Full Text Available Background and Aims: The transport of critically ill patients for procedures or imaging outside the Intensive Care Unit (ICU is potentially hazardous; hence, the transport process must be organized and efficient. The literature about benefits of and untoward events (UEs during intrahospital transport of pediatric critically ill patient is scarce. We, therefore, audited the UEs during and benefits of intrahospital transport of critically ill pediatric patients in our ICU. Subjects and Methods: Eighty critically ill pediatric (<18 years cancer patients, transported from the ICU for either diagnostic or therapeutic procedure over a period of 6 months, were included in the study. The data collected included the destination (computed tomography scan, intervention radiology, magnetic resonance imaging scan, and operation theater, accompanying medical personnel, UEs, and benefits obtained during transport. Results: Among eighty pediatric patients, the median age was 8 years (range 2-17 years. During the transport, four (5% patients required endotracheal intubation, three (3.75% patients required intercostal drain placement, and six (7.5% patients required cardiopulmonary resuscitation. Accidental removal of central venous catheter was reported in three (3.75% patients, drain came out in four (5% patients, and three (3.75% patients had accidental extubation. Transport indirectly led to a change in antibiotic therapy in 24 (30% patients and directly helped in change of therapy in the form of interventions in 20 (25% patients. Conclusion: Critically ill children can be transported safely with adequate pretransport preparations, which may help in avoiding major UEs and benefit the patient by change in the therapy.

  14. Utility of electroencephalogram in altered states of consciousness in intensive care unit patients

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    Kapadia F

    2005-01-01

    Full Text Available BACKGROUND: EEG is an investigative tool for assessing cerebral activity. Although certain EEG patterns may have a specific diagnostic or prognostic inference, they may not be precise for any sole etiology in majority of cases and may need clinical correlation. OBJECTIVE: Aim of this study was to assess the severity and prognosis of cerebral dysfunction in patients admitted to Intensive Care Unit (ICU and to evaluate the incidence of non-convulsive status epilepticus (NCSE. DESIGN: A prospective study, wherein we analyzed EEG characteristics in a series of 70 patients. SETTING: A tertiary care hospital in Mumbai, India. PATIENTS: EEG characteristics of 70 patients admitted in ICU over a period of 9 months were comprehensively analyzed. These patients were clinically examined and a questionnaire was completed without knowledge of the EEG findings. EEGs were requested for by neurologist or intensivist and our inclusion criteria were (i patients with altered sensorium of varying etiology, (ii unconscious patients at risk for non-convulsive status epilepticus (those with a history of epilepsy, and (iii unconscious patients with involuntary jerky eye movements. RESULTS: Of the various clinical presentations on ICU admission, there were 20 patients with seizures, 15 with metabolic disorders, 13 with infective causes, 9 with hypoxia, 9 with cerebro-vascular accident on presentation, 1 patient with alcohol/drug overdose, 2 with intra-cerebral space occupying lesion and 1 with ambiguous etiology on admission (there being an overlap among the presentation. Mean duration from presentation to performing EEG was 13 hours. 64 (91.42% patients had abnormal EEGs. 32(50% patients had EEG slowing and 4(6.25% patient had electro cerebral inactivity. Eleven (21.87% patients had epileptiform activity on the EEG of which seven did not have overt seizures (NCSE. Follow-up EEGs of these patients showed resolution of the epileptiform activity. CONCLUSIONS: EEG is useful

  15. Lumbosacral pain: Delivery of care to patients in the United Kingdom Podchufarova E.

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    E.V. Podchufarova

    2014-01-01

    Full Text Available Musculoskeletal pain syndromes are one of the most common causes of disability and referral to a medical specialist. Seven million consultations for lumbosacral pain are annually carried out in the United Kingdom.Examination of patients with back pain. Three levels of health care delivered to patients with back pain in the United Kingdom may be arbitrarily identified. Level 1 is outpatient: a general practitioner jointly with a manipulative therapist, a physiotherapist, a rehabilitation specialist, and mid-level health workers render care to patients with insignificant and mild pain syndrome; Level 2 is also outpatient, which involves the participation of a hospital or multidisciplinary team consultant, for example, in a musculoskeletal pain service or a specialized pain center; Level 3 is to deliver care at neurosurgical or orthopedic hospital, by applying invasive interventions. Acute back pain is a benign condition in the vast majority of cases; there is no need for additional instrumental and laboratory studies; but spinal X-ray study, computed tomography (СT scan, or magnetic resonance imaging (MRI, general blood and urine tests are required when marked neurological and somatic disorders are present.Management of patients with acute lumbosacral pain is to inform a patient about the benign nature of the disease; to exclude bed rest; to explain the need to maintain normal activity; to train how to correctly lift weights and to maintain normal posture; to refer for manual and exercise therapy in order to return to normal motor activity; to use proven effective medication. In most cases, acute back pain goes away spontaneously for a short period of time; an active treatment approach is considered to be optimal. Nonsteroidal anti-inflammatory drugs (NSAIDs and acetaminophen are used for analgesia if required. Patients who show no improvement after 4 weeks of treatment need rescreening for markers of potentially dangerous spinal diseases, as

  16. Cystatin C at Admission in the Intensive Care Unit Predicts Mortality among Elderly Patients.

    Science.gov (United States)

    Dalboni, Maria Aparecida; Beraldo, Daniel de Oliveira; Quinto, Beata Marie Redublo; Blaya, Rosângela; Narciso, Roberto; Oliveira, Moacir; Monte, Júlio César Martins; Durão, Marcelino de Souza; Cendoroglo, Miguel; Pavão, Oscar Fernando; Batista, Marcelo Costa

    2013-01-01

    Introduction. Cystatin C has been used in the critical care setting to evaluate renal function. Nevertheless, it has also been found to correlate with mortality, but it is not clear whether this association is due to acute kidney injury (AKI) or to other mechanism. Objective. To evaluate whether serum cystatin C at intensive care unit (ICU) entry predicts AKI and mortality in elderly patients. Materials and Methods. It was a prospective study of ICU elderly patients without AKI at admission. We evaluated 400 patients based on normality for serum cystatin C at ICU entry, of whom 234 (58%) were selected and 45 (19%) developed AKI. Results. We observed that higher serum levels of cystatin C did not predict AKI (1.05 ± 0.48 versus 0.94 ± 0.36 mg/L; P = 0.1). However, it was an independent predictor of mortality, H.R. = 6.16 (95% CI 1.46-26.00; P = 0.01), in contrast with AKI, which was not associated with death. In the ROC curves, cystatin C also provided a moderate and significant area (0.67; P = 0.03) compared to AKI (0.47; P = 0.6) to detect death. Conclusion. We demonstrated that higher cystatin C levels are an independent predictor of mortality in ICU elderly patients and may be used as a marker of poor prognosis.

  17. Focusing on patient safety in the Neonatal Intensive Care Unit environment

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    Ilias Chatziioannidis

    2017-02-01

    Full Text Available Patient safety in the Neonatal Intensive Care Unit (NICU environment is an under-researched area, but recently seems to get high priority on the healthcare quality agenda worldwide. NICU, as a highly sensitive and technological driven environment, signals the importance for awareness in causation of mistakes and accidents. Adverse events and near misses that comprise the majority of human errors, cause morbidity often with devastating results, even death. Likewise in other organizations, errors causes are multiple and complex. Other high reliability organizations, such as air force and nuclear industry, offer examples of how standardized/homogenized work and removal of systems weaknesses can minimize errors. It is widely accepted that medical errors can be explained based on personal and/or system approach. The impact/effect of medical errors can be reduced when thorough/causative identification approach is followed by detailed analysis of consequences and prevention measures. NICU’s medical and nursing staff should be familiar with patient safety language, implement best practices, and support safety culture, maximizing efforts for reducing errors. Furthermore, top management commitment and support in developing patient safety culture is essential in order to assure the achievement of the desirable organizational safety outcomes. The aim of the paper is to review patient safety issues in the NICU environment, focusing on development and implementation of strategies, enhancing high quality standards for health care.

  18. Risk assessment study of the pressure ulcers in intensive care unit patients.

    Science.gov (United States)

    Terekeci, Hakan; Kucukardali, Yasar; Top, Cihan; Onem, Yalçin; Celik, Serkan; Oktenli, Cağatay

    2009-07-01

    In this research, we studied the incidence of pressure ulcer and risk factors and screening of the patients for pressure ulcers at intensive care unit on the first day of admission in 142 patients. All patients were evaluated according to National Pressure Ulcer Advisory Panel during the ICU period strictly. Pressure ulcer risk evaluation was performed according to Norton Scale. Nutritional state was evaluated according to nutritional risk screening 2002. Age, hospitalization period, mean arterial pressure, pressure ulcer degree, hemoglobin and albumin levels, body mass index, APACHE-II scores and comorbidities were evaluated. In the following parameters, first value represents PU (+) cases, and second value represents PU (-) cases. On the admittance: 14 (9.8%) patients had PU (prevalence). NRS-2002: 5.4+/-1.9 and 4.3+/-2.1 (p0.05). Mean pressure ulcer degree was 2.15. On the discharge: first values represent new developed PU (+) patients and second values represent PU (-) cases. 25 (17.6%) patients had PU. Incidence was 7.8%. NRS-2002: 6.4 and 3.6 (p0.05). Two or more co morbidity, neurophyschiatric disorders, infections and medications were more prevalent in PU (+) group (pmalnutrition and hypoalbuminemia were significant in patients with PU; however, BMI and hemoglobin were not significant. The studies focusing on the relation between the effect of optimization of these parameters from the first day of admittance and pressure ulcer are required.

  19. Mobilization of patients in neurological Intensive Care Units of India: A survey

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    Anup Bhat

    2016-01-01

    Full Text Available Context: The rehabilitation needs of the patients in neurological Intensive Care Units (ICUs vary from that of a medical ICU patient. Early mobilization is known to improve the various neurological outcomes in patients admitted to neurological ICUs, although little is known about the practice pattern among physiotherapists. The mobilization practice pattern may vary significantly than that of developed countries due to the reasons of differences in training of professionals, availability of equipment, and financial assistance by health insurance. Aim of the Study: To study the current mobilization practices by the physiotherapists in neurological ICUs of India. Subjects and Methods: A cross-sectional survey was conducted with a content validated questionnaire about the mobilization practices. Online questionnaire was distributed to physiotherapists working in neurological ICUs of India. Descriptive statistics were used. Results: Out of 185 e-mails sent, 82 physiotherapists completed the survey (survey response rate = 44%. Eighty participants (97.6% mentioned that the patients received some form of mobilization during the day. The majority of the physiotherapists (58.5%, “always” provided bed mobility exercises to their patients when it was found appropriate for the patients. Many physiotherapists (41.5% used tilt table “sometimes” to introduce orthostatism for their patients. Conclusion: Mobilization in various forms is being practiced in the neurological ICUs of India. However, fewer mobilization sessions are conducted on weekends and night hours in Indian Neurological ICUs.

  20. The therapeutic use of music as experienced by cardiac surgery patients of an intensive care unit

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    Varshika M. Bhana

    2014-04-01

    Full Text Available Patients perceive the intensive care unit (ICU as being a stressful and anxiety-provoking environment. The physiological effects of stress and anxiety are found to be harmful and therefore should be avoided in cardiac surgery patients. The aim of the study on which this article is based was to describe cardiac surgery patients’ experiences of music as a therapeutic intervention in the ICU of a public hospital. The objectives of this article were to introduce and then expose the cardiac patients to music as part of their routine postoperative care and to explore and describe their experiences of the music intervention. The findings of the research are to be the basis for making recommendations for the inclusion of music as part of the routine postoperative care received by cardiac surgery patients in the ICU. A qualitative research methodology, using a contextual, explorative and descriptive research design, was adopted. The population of the study was cardiac surgery patients admitted to the ICU of a public hospital. An unstructured interview was conducted with each participant and content analysis and coding procedures were used to analyse the data. Four main themes were identified in the results, namely practical and operational aspects of the music sessions; participants’ experiences; discomfort due to therapeutic apparatus and the ICU environment; and the role of music and recommendations for music as a therapeutic intervention. Participants’ experiences were mainly positive. Results focused on experiences of the music and also on the participants’ experiences of the operational aspects of the therapy, as well as factors within and around the participants.

  1. Trends in admission prevalence, illness severity and survival of haematological patients treated in Dutch intensive care units

    NARCIS (Netherlands)

    Vliet, M. van; Verburg, I.W.; Boogaard, M.H.W.A. van den; Keizer, N.F. de; Peek, N.; Blijlevens, N.M.A.; Pickkers, P.

    2014-01-01

    PURPOSE: To explore trends over time in admission prevalence and (risk-adjusted) mortality of critically ill haematological patients and compare these trends to those of several subgroups of patients admitted to the medical intensive care unit (medical ICU patients). METHODS: A total of 1,741 haemat

  2. The Phase of Illness Paradigm: A Checklist Centric Model to Improve Patient Care in the Burn Intensive Care Unit

    Science.gov (United States)

    2016-04-01

    AWARD NUMBER: W81XWH-13-2-0011 TITLE: The Phase of Illness Paradigm: A Checklist Centric Model to Improve Patient Care in the Burn Intensive...2016 4. TITLE AND SUBTITLE “The Phase of Illness Paradigm: A Checklist Centric Model to 5a. CONTRACT NUMBER Improve Patient Care in the Burn...shared mental model of patient care amongst clinicians in the BICU and thus enhance distributed cognition (Hutchins 2000) and assist the work of the

  3. Ventilator versus manual hyperinflation in clearing sputum in ventilated intensive care unit patients.

    Science.gov (United States)

    Dennis, Diane; Jacob, Wendy; Budgeon, Charley

    2012-01-01

    The aim of hyperinflation in the ventilated intensive care unit patient is to increase oxygenation, reverse lung collapse and clear sputum. The efficacy and consistency of manual hyperventilation is well supported in the literature, but there is limited published evidence supporting hyperventilation utilising a ventilator. Despite this, a recent survey established that almost 40% of Australian tertiary intensive care units utilise ventilator hyperinflation. The aim of this non-inferiority cross-over study was to determine whether ventilator hyperinflation was as effective as manual hyperinflation in clearing sputum from patients receiving mechanical ventilation using a prescriptive ventilator hyperinflation protocol. Forty-six patients received two randomly ordered physiotherapy treatments on the same day by the same physiotherapist. The efficacy of the hyperinflation modes was measured by sputum wet weight. Secondary measures included compliance, tidal volume, airway pressure and PaO2/FiO2 ratio. There was no difference in wet weight of sputum cleared using ventilator hyperinflation or manual hyperinflation (mean 3.2 g, P=0.989). Further, no difference in compliance (P=0.823), tidal volume (P=0.219), heart rate (P=0.579), respiratory rate (P=0.929) or mean arterial pressure (P=0.593) was detected. A statistically significant difference was seen in mean airway pressure (P=0.002) between techniques. The effect of techniques on the PaO2/FiO2 response ratio was dependent on time (interaction P=0.024). Physiotherapy using ventilator hyperinflation cleared a comparable amount of sputum and was as safe as manual hyperinflation. This research describes a ventilator hyperinflation protocol that will serve as a platform for continued discussion, research and development of its application in ventilated patients.

  4. Nosocomial Candiduria in Critically Ill Patients Admitted to Intensive Care Units in Qazvin, Iran

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    Ghiasian

    2014-08-01

    Full Text Available Background A broad variety of fungi, especially Candida species, are becoming increasingly common causes of urinary tract infections in hospital settings. Objectives The current cross-sectional descriptive study aimed to determine the causative agents, risk factors and incidence rate of candiduria in critically ill patients, hospitalized in intensive care units (ICUs of four Iranian hospitals. Patients and Methods A total of 155 children and adult patients, admitted to ICUs of the four university educational hospitals, who demonstrated Candida-positive urine cultures, were examined. Samples were processed via mycological procedures by direct microscopy and culture. Results Candiduria was confirmed in 50 (32.26 % patients and Candida albicans was the most frequently isolated species representing 60.0% of isolates, followed by 14.0% C. glabrata, 12.0% C. parapsilosis, 10.0% C. krusei, and 4.0% C. tropicalis. Most patients were female (58% with a mean age of 46.7 years old. Generally, 39.7% and 62% of adults and children showed candiduria, respectively. The commonest predisposing factors were antibiotic therapy (98.0%, urinary catheterization (92.0%, corticotherapy (84.0%, being female (42.6 %, use of feeding tube (56%, and extended hospitalization, respectively. Conclusions The high frequency of candiduria in ICU patients can be decreased by shortening the duration of urinary catheterization, avoiding extra antibiotics and corticosteroids, as well as controlling the predisposing factors and underlying conditions.

  5. Does magnesium matter in patients of Medical Intensive Care Unit: A study in rural Central India

    Science.gov (United States)

    Kumar, Sunil; Honmode, Akshay; Jain, Shraddha; Bhagat, Vijay

    2015-01-01

    Introduction: Hypomagnesemia has been common, but mostly underdiagnosed electrolyte abnormality. Studies regarding this is lacking in India especially in rural setting. Here, we have correlated serum magnesium (Mg) level with outcome in patients of medicine Intensive Care Unit (ICU) with respect to length of ICU stay, need for mechanical ventilatory support and its duration and ultimate outcome (discharge/death). Materials and Methods: This is a prospective observational study carried out over a period of 1-year enrolling 601 patients of Medical ICU (MICU). The Chi-square test is applied to correlate hypomagnesemia with the outcome. Result and Observation: About 25% patients had admission hypomagnesemia. When compared with the normal Mg group, there was significant association of hypomagnesemia with outcome in terms of duration of MICU stay 5.46 (5.75) versus 3.93 (3.88), need for mechanical ventilation (56.86% vs. 24.33%), discharge/cured from ICU (61.43% vs. 85.26%), and death (38.56% vs. 14.73%). However, no significant difference was found in the duration of ventilation between the two groups. Conclusion: Hypomagnesemia is associated with a higher mortality rate in critically ill patients. The need for ventilatory support, but not its duration is significantly higher in hypomagnesemic patients. Hypomagnesemia is commonly associated with sepsis and diabetes mellitus. The duration of MICU stay is significantly higher in patients with low serum Mg. PMID:26180429

  6. Relationships between registered nurse staffing, processes of nursing care, and nurse-reported patient outcomes in chronic hemodialysis units.

    Science.gov (United States)

    Thomas-Hawkins, Charlotte; Flynn, Linda; Clarke, Sean P

    2008-01-01

    Little attention has been given to the effects of registered nurse (RN) staffing and processes of nursing care on patient outcomes in hemodialysis units. This research examined the effects of patient-to-RN ratios and necessary tasks left undone by RNs on the likelihood of nurse-reported frequent occurrences of adverse patient events in chronic hemodialysis units. Study findings revealed that high patient-to-RN ratios and increased numbers of tasks left undone by RNs were associated with an increased likelihood of frequent occurrences of dialysis hypotension, skipped dialysis treatments, shortened dialysis treatments, and patient complaints in hemodialysis units. These findings indicate that federal, state, and dialysis organization policies must foster staffing structures and processes of care in dialysis units that effectively utilize the invaluable skills and services of professional, registered nurses.

  7. The Effect of Live Spontaneous Harp Music on Patients in the Intensive Care Unit

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    Ann Marie Chiasson

    2013-01-01

    Full Text Available This study was performed to investigate the effect of live, spontaneous harp music on individual patients in an intensive care unit (ICU, either pre- or postoperatively. The purpose was to determine whether this intervention would serve as a relaxation or healing modality, as evidenced by the effect on patient’s pain, heart rate, respiratory rate, blood pressure, oxygen saturation, and heart rate variability. Each consenting patient was randomly assigned to receive either a live 10-minute concert of spontaneous music played by an expert harpist or a 10-minute rest period. Spontaneous harp music significantly decreased patient perception of pain by 27% but did not significantly affect heart rate, respiratory rate, oxygen saturation, blood pressure, or heart rate variability. Trends emerged, although being not statistically significant, that systolic blood pressure increased while heart rate variability decreased. These findings may invoke patient engagement, as opposed to relaxation, as the underlying mechanism of the decrease in the patients’ pain and of the healing benefit that arises from the relationship between healer, healing modality, and patient.

  8. Severe alcohol withdrawal syndrome: Evolution of care and impact of adjunctive therapy on course and complications of 171 intensive care unit patients.

    Science.gov (United States)

    Puscas, Mircea; Hasoon, Mohammed; Eechevarria, Carlos; Cooper, Tracy; Tamura, Leslie; Chebbo, Ahmad; W Carlson, Richard

    2016-01-01

    This single site retrospective observational study assessed the evolution of sedation therapy for severe alcohol withdrawal syndrome in the intensive care unit. Patient records for 2 intervals were reviewed: Interval 1, which included 87 intensive care unit patients admitted January 2005 through September 2007, for whom benzodiazedpine monotherapy was utilized; and Interval 2, January 2010 through December 2010, for whom 54 of 84 (64.3%) intensive care unit patients, including all those intubated, received adjunctive agents, including dexmedetomidine or propofol. Clinical management was similar for both intervals, as well as prevalence of alcohol withdrawal syndrome versus total adult hospital admissions and comorbid conditions. Overall, respiratory failure (53 versus 39%), seizures (36 versus 18%), and pneumonia (51 versus 38%) were less frequent during Interval 2 (all p care unit admission are excluded, the prevalence of these complications was similar (p = ns) for Interval 1 and Interval 2. Intensive care unit and hospital length of stay were not altered by adjunctive therapy, which was typically employed for more severely affected patients. High intensity sedation with adjunctive drugs led to few cardiovascular adverse events and may have facilitated management, but did not alter intensive care unit course of severe alcohol withdrawal syndrome.

  9. Intensive care unit admission in patients following rapid response team activation: call factors, patient characteristics and hospital outcomes.

    Science.gov (United States)

    Le Guen, M P; Tobin, A E; Reid, D

    2015-03-01

    Rapid Response Systems (RRSs) have been widely introduced throughout hospital health systems, yet there is limited research on the characteristics and outcomes of patients admitted to an intensive care unit (ICU) following RRS activation. Using database extraction, this study examined the factors associated with ICU admission and patient outcome in patients receiving RRS activation in a tertiary level hospital between 2009 and 2013. Of 3004 RRS activations, 392 resulted in ICU admissions. Call factors associated with ICU admission and increased hospital mortality included tachypnoea (P Medical Emergency Team call triggers breached simultaneously (P admission included young age (P admission and hospital mortality post RRS activation. This information may be useful for risk stratification of deteriorating patients and determination of appropriate escalation.

  10. Assessment of Sedation and Analgesia in Mechanically Ventilated Patients in Intensive Care Unit

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    Udita Naithani

    2008-01-01

    Full Text Available Post traumatic stress resulting from an intensive care unit(ICU stay may be prevented by adequate level of sedation and analgesia. Aims of the study were reviewing the current practices of sedation and analgesia in our ICU setup and to assess level of sedation and analgesia to know the requirement of sedative and analgesics in mechani-cally ventilated ICU patients. This prospective observational study was conducted on 50 consecutive mechanically ventilated patients in ICU over a period of 6 months. Patient′s sedation level was assessed by Ramsay Sedation Scale (RSS = 1 : Agitated; 2,3 : Comfortable; 4,5,6 : Sedated and pain intensity by Behavioural Pain Scale (BPS = 3 :No pain, to 16 : Maximum pain. BPS, mean arterial pressure(MAP and heart rate(HR were assessed before and after painful stimulus (tracheal suction. Although no patient had received sedative and analgesics, mean Ramsay score was 3.52±1.92 with 30% patients categorized as ′agitated′, 12% as ′comfortable′ and 58% as ′sedated′ because of depressed consciousness level. Mean BPS at rest was 4.30±1.28 revealing background pain that further increased to 6.18±1.88 after painful stimulus. There was significant rise in HR (10.30%, MAP (7.56% and BPS (40.86% after painful stimulus, P< 0.0001. The correlation between BPS and Ramsay Score was negative and significant (P< 0.01. We conclude that there should be regular definition of the appropriate level of sedation and analgesia as well as monitoring of the desired level, using sedation and pain scales as a part of the total care for mechanically ventilated patients.

  11. Increased rates of intensive care unit admission in patients with Mycoplasma pneumoniae: a retrospective study.

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    Khoury, T; Sviri, S; Rmeileh, A A; Nubani, A; Abutbul, A; Hoss, S; van Heerden, P V; Bayya, A E; Hidalgo-Grass, C; Moses, A E; Nir-Paz, R

    2016-08-01

    Mycoplasma pneumoniae is a leading cause of respiratory disease. In the Intensive Care Unit (ICU) setting M. pneumoniae is not considered a common pathogen. In 2010-13 an epidemic of M. pneumoniae-associated infections was reported and we observed an increase of M. pneumoniae patients admitted to ICU. We analysed the cohort of all M. pneumoniae-positive patients' admissions during 2007 to 2012 at the Hadassah-Hebrew University Medical Centre (a 1100-bed tertiary medical centre). Mycoplasma pneumoniae diagnosis was made routinely using PCR on throat swabs and other respiratory samples. Clinical parameters were retrospectively extracted. We identified 416 M. pneumoniae-infected patients; of which 68 (16.3%) were admitted to ICU. Of these, 48% (173/416) were paediatric patients with ICU admission rate of 4.6% (8/173). In the 19- to 65-year age group ICU admission rate rose to 18% (32/171), and to 38.8% (28/72) for patients older than 65 years. The mean APACHE II score on ICU admission was 20, with a median ICU stay of 7 days, and median hospital stay of 11.5 days. Of the ICU-admitted patients, 54.4% (37/68) were mechanically ventilated upon ICU admission. In 38.2% (26/68), additional pathogens were identified mostly later as secondary pathogens. A concomitant cardiac manifestation occurred in up to 36.8% (25/68) of patients. The in-hospital mortality was 29.4% (20/68) and correlated with APACHE II score. Contrary to previous reports, a substantial proportion (16.3%) of our M. pneumoniae-infected patients required ICU admission, especially in the adult population, with significant morbidity and mortality.

  12. Extracorporeal liver support therapy with Prometheus in patients with liver failure in the intensive care unit.

    Science.gov (United States)

    Oppert, Michael; Rademacher, Sibylle; Petrasch, Kathrin; Jörres, Achim

    2009-10-01

    Acute liver failure (ALF) and acute-on-chronic liver failure (AoCLF) are associated with a high mortality. In these patients an accumulation of both water-soluble and water-insoluble, protein-bound, metabolic waste products occurs. Conventional extracorporeal blood purification techniques based on diffusion and/or convection such as hemodialysis or hemofiltration may only eliminate small molecular weight, water-soluble compounds. In recent years, fractionated plasma separation and adsorption (FPSA) with the Prometheus system has been introduced for extracorporeal liver support therapy. To date, however, only limited data is available regarding the effect of this treatment on mortality and outcome of patients with advanced liver disease. Here we report on our experience with 23 patients with severe liver failure who were treated with Prometheus in our medical intensive care unit. Fourteen patients had AoCLF, and nine patients experienced ALF. The median bilirubin level at the start of Prometheus therapy was 30.5 mg/dL and the median Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 26. During 40 individual treatment sessions lasting 5-6 h, Prometheus therapy reduced serum bilirubin levels from 23.7 mg/dL to 15.0 mg/dL (median values) (P Prometheus therapy was well tolerated without relevant side-effects. In conclusion, extracorporeal liver support therapy with Prometheus is a novel and safe treatment option in patients with severe liver failure. In this series, patients with ALF showed a significantly better outcome with Prometheus therapy compared to AoCLF patients.

  13. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients.

    Science.gov (United States)

    Sessler, Curtis N; Gosnell, Mark S; Grap, Mary Jo; Brophy, Gretchen M; O'Neal, Pam V; Keane, Kimberly A; Tesoro, Eljim P; Elswick, R K

    2002-11-15

    Sedative medications are widely used in intensive care unit (ICU) patients. Structured assessment of sedation and agitation is useful to titrate sedative medications and to evaluate agitated behavior, yet existing sedation scales have limitations. We measured inter-rater reliability and validity of a new 10-level (+4 "combative" to -5 "unarousable") scale, the Richmond Agitation-Sedation Scale (RASS), in two phases. In phase 1, we demonstrated excellent (r = 0.956, lower 90% confidence limit = 0.948; kappa = 0.73, 95% confidence interval = 0.71, 0.75) inter-rater reliability among five investigators (two physicians, two nurses, and one pharmacist) in adult ICU patient encounters (n = 192). Robust inter-rater reliability (r = 0.922-0.983) (kappa = 0.64-0.82) was demonstrated for patients from medical, surgical, cardiac surgery, coronary, and neuroscience ICUs, patients with and without mechanical ventilation, and patients with and without sedative medications. In validity testing, RASS correlated highly (r = 0.93) with a visual analog scale anchored by "combative" and "unresponsive," including all patient subgroups (r = 0.84-0.98). In the second phase, after implementation of RASS in our medical ICU, inter-rater reliability between a nurse educator and 27 RASS-trained bedside nurses in 101 patient encounters was high (r = 0.964, lower 90% confidence limit = 0.950; kappa = 0.80, 95% confidence interval = 0.69, 0.90) and very good for all subgroups (r = 0.773-0.970, kappa = 0.66-0.89). Correlations between RASS and the Ramsay sedation scale (r = -0.78) and the Sedation Agitation Scale (r = 0.78) confirmed validity. Our nurses described RASS as logical, easy to administer, and readily recalled. RASS has high reliability and validity in medical and surgical, ventilated and nonventilated, and sedated and nonsedated adult ICU patients.

  14. Cumulative radiation exposure from diagnostic imaging in intensive care unit patients

    Institute of Scientific and Technical Information of China (English)

    Fiachra Moloney; Daniel Fama; Maria Twomey; Ruth O’Leary; Conor Houlihane; Kevin P Murphy; Siobhan B O’Neill; Owen J O’Connor; Dorothy Breen; Michael M Maher

    2016-01-01

    AIM:To quantify cumulative effective dose of intensive care unit(ICU)patients attributable to diagnostic imaging.METHODS:This was a prospective,interdisciplinary study conducted in the ICU of a large tertiary referral and level 1 trauma center.Demographic and clinical data including age,gender,date of ICU admission,primary reason for ICU admission,APACHE Ⅱ score,length of stay,number of days intubated,date of death or discharge,and re-admission data was collected on all patients admitted over a 1-year period.The overall radiation exposure was quantified by the cumulative effective radiation dose(CED)in millisieverts(mS v)and calculated using reference effective doses published by the United Kingdom National Radiation Protection Board.Pediatric patients were selected for subgroupanalysis.RESULTS:A total of 2737 studies were performedin 421 patients.The total CED was 1704 m Sv with a median CED of 1.5 mS v(IQR 0.04-6.6 mS v).Total CED in pediatric patients was 74.6 mS v with a median CED of 0.07 mS v(IQR 0.01-4.7 mS v).Chest radiography was the most commonly performed examination accounting for 83% of all studies but only 2.7% of total CED.Computed tomography(CT)accounted for 16% of all studies performed and contributed 97% of total CED.Trauma patients received a statistically significant higher dose [median CED 7.7 mS v(IQR 3.5-13.8 mS v)] than medical [median CED 1.4 m Sv(IQR 0.05-5.4 m Sv)] and surgical [median CED 1.6 mS v(IQR 0.04-7.5 mS v)] patients.Length of stay in ICU [OR = 1.12(95%CI:1.079-1.157)] was identified as an independent predictor of receiving a CED greater than 15 mS v.CONCLUSION:Trauma patients and patients with extended ICU admission times are at increased risk of higher CEDs.CED should be minimized where feasible,especially in young patients.

  15. Mortality Analysis of Trauma Patients in General Intensive Care Unit of a State Hospital

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    İskender Kara

    2015-08-01

    Full Text Available Objective: The aim of this study was to determine the mortality rate and factors affecting the mortality of trauma patients in general intensive care unit (ICU of a state hospital. Material and Method: Data of trauma patients hospitalized between January 2012 and March 2013 in ICU of Konya Numune Hospital were retrospectively analyzed. Demographic characteristics and clinical data of patients were recorded. Patients were divided into two groups as survivors and dead. Mortality rate and factors affectin mortality were examined. Results: A total of 108 trauma patients were included in the study. The mortality rate of overall group was 19.4%. Median age of the patients was 44.5 years and 75.9% of them were males. Median Glasgow Coma Scale of death group was lower (5 (3-8 vs. 15 (13-15, p<0.0001, median APACHE II score was higher (20 (15-26 vs. 10 (8-13, p<0.0001 and median duration of ICU stay was longer (27 (5-62,5 vs. 2 (1-5, p<0.0001 than those in the survival group. The most common etiology of trauma was traffic accidents (47.2% and 52.7% of patients had head trauma. The rate of patients with any fracture was significantly higher in the survival group (66.7% vs. 33.3%, p=0.007. The rate of erythrocyte suspension, fresh frozen plasma, trombocyte suspension and albumin were 38.9%, 27.8%, 0.9% and 8.3%, respectively in all group. The number of patients invasive mechanically ventilated was 27.8% and median length of stay of these patients were 5 (1.75-33.5 days. The rate of operated patients was 42.6%. The rate of tracheostomy, renal replacement therapy, bronchoscopy and percutaneous endoscopic gastrostomy enforcements were higher in the death group. The advanced age (p=0.016, OR: 1.054; 95% CI: 1.010-1100 and low GCS (p<0.0001, OR: 0.583; 95% CI: 0.456-0.745 were found to be independent risk factors the ICU mortality of trauma patients in logistic regression analysis. Conclusion: We believe that the determination of these risk factors affecting

  16. Evaluation of Waste Anesthetic Gas in the Postanesthesia Care Unit within the Patient Breathing Zone

    Science.gov (United States)

    Hiller, Kenneth N.; Altamirano, Alfonso V.; Cai, Chunyan; Tran, Stephanie F.; Williams, George W.

    2015-01-01

    Potential health hazards from waste anesthetic gases (WAGs) have been a concern since the introduction of inhalational anesthetics into clinical practice. The potential to exceed recommended exposure levels (RELs) in the postanesthesia care unit (PACU) exists. The aim of this pilot study was to assess sevoflurane WAG levels while accounting for factors that affect inhalational anesthetic elimination. In this pilot study, 20 adult day surgery patients were enrolled with anesthesia maintained with sevoflurane. Following extubation, exhaled WAG from the patient breathing zone was measured 8 inches from the patient's mouth in the PACU. Maximum sevoflurane WAG levels in the patient breathing zone exceeded National Institute for Occupational Safety and Health (NIOSH) RELs for every 5-minute time interval measured during PACU Phase I. Observed WAGs in our study were explained by inhalational anesthetic pharmacokinetics. Further analysis suggests that the rate of washout of sevoflurane was dependent on the duration of anesthetic exposure. This study demonstrated that clinically relevant inhalational anesthetic concentrations result in sevoflurane WAG levels that exceed current RELs. Evaluating peak and cumulative sevoflurane WAG levels in the breathing zone of PACU Phase I and Phase II providers is warranted to quantify the extent and duration of exposure. PMID:26693222

  17. Organizational culture and climate for patient safety in Intensive Care Units.

    Science.gov (United States)

    Santiago, Thaiana Helena Roma; Turrini, Ruth Natalia Teresa

    2015-02-01

    Objective To assess the perception of health professionals about patient safety climate and culture in different intensive care units (ICUs) and the relationship between scores obtained on the Hospital Survey on Patient Safety Culture (HSOPSC) and the Safety Attitudes Questionnaire (SAQ). Method A cross-sectional study conducted at a teaching hospital in the state of São Paulo, Brazil, in March and April 2014. As data gathering instruments, the HSOPSC, SAQ and a questionnaire with sociodemographic and professional information about the staff working in an adult, pediatric and neonatal ICU were used. Data analysis was conducted with descriptive statistics. Results The scales presented good reliability. Greater weaknesses in patient safety were observed in the Working conditions andPerceptions of management domains of the SAQ and in the Nonpunitive response to error domain of the HSOPSC. The strengths indicated by the SAQ wereTeamwork climate and Job satisfactionand by the HSOPC, Supervisor/manager expectations and actions promoting safety and Organizational learning-continuous improvement. Job satisfaction was higher among neonatal ICU workers when compared with the other ICUs. The adult ICU presented lower scores for most of the SAQ and HSOPSC domains. The scales presented moderate correlation between them (r=0.66). Conclusion There were differences in perception regarding patient safety among ICUs, which corroborates the existence of local microcultures. The study did not demonstrate equivalence between the SAQ and the HSOPSC.

  18. Frequency and outcome of patients with nonthyroidal illness syndrome in a medical intensive care unit.

    Science.gov (United States)

    Plikat, Katharina; Langgartner, Julia; Buettner, Roland; Bollheimer, L Cornelius; Woenckhaus, Ulrike; Schölmerich, Jürgen; Wrede, Christian E

    2007-02-01

    Acute and chronic critical conditions are associated with reduced serum levels of free triiodothyronine (FT(3)), free thyroxine FT(4), and thyrotropin, known as nonthyroidal illness syndrome (NTIS). It is still controversial whether these changes reflect a protective mechanism or a maladaptive process during prolonged illness. However, larger studies to determine the prevalence of the NTIS and its association with outcome in medical intensive care units (ICUs) are missing. Complete thyroid hormone levels from 247 of 743 patients admitted to our ICU between October 2002 and February 2004 were retrospectively evaluated. From these patients, Acute Physiology and Chronic Health II scores, ICU mortality, length of stay, mechanical ventilation, and concomitant medication were recorded. Ninety-seven patients (44.1%) had low FT(3) levels indicating an NTIS, either with normal (23.6%) or reduced (20.5%) serum thyrotropin levels. Of 97 patients with NTIS, 24 (23.3%) also showed reduced serum FT(4) levels. The NTIS was significantly associated with Acute Physiology and Chronic Health II scores, mortality, length of stay, and mechanical ventilation. In a multivariate Cox regression analysis, the combination of low FT(3) and low FT(4) was an independent risk factor for survival. Nonthyroidal illness syndrome is frequent at a medical ICU. A reduction of FT(4) together with FT(3) is associated with an increase in mortality and might reflect a maladaptive process, thereby worsening the disease.

  19. Patients with hematological disorders requiring admission to medical intensive care unit: Characteristics, survival and prognostic factors

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    Subhash H

    2003-01-01

    Full Text Available Background: This retrospective chart review assessed the characteristics and outcome of patients with hematological disorders who required admission to medical intensive care unit over a 4 year period (January 1998 to December 2001. Results: There were a total of 104 patients, 67 (64% male, 37 (36% female subjects, with a mean age of 36.3 ± 15.3 years (range 10 to 65 years. The mean duration from hospital admission to ICU transfer was 11 days. Sixty-nine (66% had malignant and 35 (34% had non-malignant conditions. Respiratory distress was the commonest reason for ICU admission 58 (56%. The other indications were hemodynamic instability 38 (36%, low sensorium 22 (21%, following cardio-pulmonary arrest 12 (11.5% and generalized tonic-clonic seizures 5 (5%. Forty-three (42% patients had absolute neutophil count (ANC less than 500, 48 (47.5% had platelet count < 20000. The mean duration of ICU stay was 4 days (range < 24 hours to 28 days. Sixty-nine (66% patients required mechanical ventilation, 61 (59% required hemodynamic support. Pneumonia or sepsis was diagnosed in 71 (68%. Twenty-five (24% survived ICU stay and 20 (19% survived to hospital discharge. ICU admission following cardio-pulmonary arrest, advanced malignancy, requirement of mechanical ventilation, vasopressor support, ANC count < 500 and platelet count < 20000 were the predictors of adverse outcome. Associated organ dysfunction further increases the mortality.

  20. Emergence of non-albicans Candida species and antifungal resistance in intensive care unit patients

    Institute of Scientific and Technical Information of China (English)

    Ravinder Kaur; Megh Singh Dhakad; Ritu Goyal; Rakesh Kumar

    2016-01-01

    Objective: To evaluate the epidemiology of candidiasis and the antifungal susceptibility profile of Candida species isolated from the intensive care unit (ICU) patients. Methods: The study used a qualitative descriptive design. Relevant samples depending on organ system involvement from 100 ICU patients were collected and processed. Identification and speciation of the isolates was conducted by the biochemical tests. Antifungal susceptibility testing was carried out as per CLSI-M27-A3 document. Results: Ninety Candida isolates were isolated from the different clinical samples:urine (43.3%), tracheal aspirate (31.1%), urinary catheter (12.2%), endotracheal tube (7.8%), abdominal drains (3.3%), sputum (2.2%). The incidence of candidiasis caused by non-albicans Candida (NAC) species (63.3%) was higher than Candida albicans (36.7%). The various NAC species were isolated as: Candida tropicalis (41.1%), Candida glab-rata (10%), Candida parapsilosis (6.7%), Candida krusei (3.3%) and Candida kefyr (2.2%). The overall isolation rate of Candida species from samples was 53.3%. Anti-fungal susceptibility indicated that 37.8%and 7.8%of the Candida isolates were resistant to fluconazole and amphotericin B, respectively. Conclusions: Predominance of NAC species in ICU patients along with the increasing resistance being recorded to fluconazole which has a major bearing on the morbidity and management of these patients and needs to be further worked upon.

  1. Tracheotomy in Pediatric Patients: In Operating Room or Intensive Care Unit?

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    Umut Kaygusuz

    2014-08-01

    Full Text Available Introduction: The morbidity and mortality rates of tracheotomy are higher in the pediatric population because the incision is small and the trachea is more prone to surgical trauma. Tracheotomy procedure is mostly performed in operating room in most institutions. The aim of the study is to compare the outcomes of tracheotomy procedures between intensive care unit (ICU and operating room (OR in terms of pitfalls, complications and family preferences. Materials and Methods: In between June 2012 and July 2013, at a single institution, 39 patients were prospectively analyzed for age, gender, primary pathology, tracheotomy indications, location of operation, the duration of family consent, perioperative complications and presence of decanulation. Results: Male/female ratio was 20/19. Mean age was 49.9±52.5 (4-204 months. Tracheotomy procedure was performed in OR in 19 patients (45% and in ICU in 20 (54.5% patients. There was no statistically significant difference between groups in terms of complications (OR-48.7%, ICU-51.3%. The time of informed consent was significantly shorter in ICU patients. Conclusions: There is no significant difference in terms of safety for tracheotomy procedure in ICU or OR. Parents give approval to a bedside invasive procedure faster. The words ‘Surgery’ and ‘Operating room’ can easily confuse the parents, extend the duration for endolaryngeal intubation, and increase the cost and labour loss.

  2. THE RELATIONSHIP BETWEEN MARKETING MIX AND PATIENT LOYALTY IN INTENSIVE CARE UNIT, ANUTAPURA PUBLIC HOSPITAL PALU

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    Muh. Ryman Napirah

    2016-09-01

    Full Text Available Background: The problem generally faced by hospital is unable to provide something really needed by the customers. One of the main factors is the poor marketing mix of hospital that impacts to low quality and influences the patients loyality. Objective: The research aims to investigate the relationship between marketing mix and patient loyalty in intensive care unit at Anutapura Public Hospital Palu. Methods: This was a cross sectional study involving 97 persons who were randomly selected without considering the level of population. The data were analyzed thought univariat and bivariat on the significance level 95% (p<0,05. The marketing mix concept of 7P (product, price, place, promotion, people, process, dan physical evidence. Was used to guide this study. Results: The result of chi-square test indicated that there was a relationship of marketing mix product (p= 0,01, price (p= 0,00, promotion (p= 0,04, people (p= 0,00; and no relationship of marketing mix place (p= 0,21, process (p= 1,00, dan physical evidence (p= 1,00 with patient loyalty. Conclusion: It is expected tht the hospital of Anutapura Palu could increase the strategy of marketing mix for the sake of keeping the patients loyalty as the profit value of the hospital, especially for marketing place, process, and physical evidence.

  3. Emergence of non-albicans Candida species and antifungal resistance in intensive care unit patients

    Institute of Scientific and Technical Information of China (English)

    Ravinder Kaur; Megh Singh Dhakad; Ritu Goyal; Rakesh Kumar

    2016-01-01

    Objective: To evaluate the epidemiology of candidiasis and the antifungal susceptibility profile of Candida species isolated from the intensive care unit(ICU) patients.Methods: The study used a qualitative descriptive design. Relevant samples depending on organ system involvement from 100 ICU patients were collected and processed.Identification and speciation of the isolates was conducted by the biochemical tests.Antifungal susceptibility testing was carried out as per CLSI-M27-A3 document.Results: Ninety Candida isolates were isolated from the different clinical samples: urine(43.3%), tracheal aspirate(31.1%), urinary catheter(12.2%), endotracheal tube(7.8%),abdominal drains(3.3%), sputum(2.2%). The incidence of candidiasis caused by nonalbicans Candida(NAC) species(63.3%) was higher than Candida albicans(36.7%).The various NAC species were isolated as: Candida tropicalis(41.1%), Candida glabrata(10%), Candida parapsilosis(6.7%), Candida krusei(3.3%) and Candida kefyr(2.2%). The overall isolation rate of Candida species from samples was 53.3%. Antifungal susceptibility indicated that 37.8% and 7.8% of the Candida isolates were resistant to fluconazole and amphotericin B, respectively.Conclusions: Predominance of NAC species in ICU patients along with the increasing resistance being recorded to fluconazole which has a major bearing on the morbidity and management of these patients and needs to be further worked upon.

  4. The prevalence and consequences of malnutrition risk in elderly Albanian intensive care unit patients

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    Shpata V

    2015-02-01

    Full Text Available Vjollca Shpata,1 Ilir Ohri,2 Tatjana Nurka,1 Xhensila Prendushi1 1Faculty of Medical Technical Sciences, 2University Hospital Center of Tirana “Mother Theresa”, Faculty of Medicine, University of Medicine in Tirana, Tirana, Albania Purpose: Many investigators have reported rising numbers of elderly patients admitted to the intensive care units (ICUs. The aim of the study was to estimate the prevalence of malnutrition risk in the ICU by comparing the prevalence of malnutrition between older adults (aged 65 years and above and adults (aged 18–64 years, and to examine the negative consequences associated with risk of malnutrition in older adults. Materials and methods: A prospective cohort study in the ICU of the University Hospital Center of Tirana, Albania, was conducted. Logistic regression analysis was used to analyze the effect of malnutrition risk on the length of ICU stay, the duration of being on the ventilator, the total complications, the infectious complications, and the mortality. Results: In this study, 963 patients participated, of whom 459 patients (47.7% were aged ≥65 years. The prevalence of malnutrition risk at the time of ICU admission of the patients aged ≥65 years old was 71.24%. Logistic regression adjusted for confounders showed that malnutrition risk was an independent risk factor of poor clinical outcome for elderly ICU patients, for 1 infections (odds ratio [OR] =4.37; 95% confidence interval [CI]: 2.61–7.31; 2 complications (OR =6.73; 95% CI: 4.26–10.62; 3 mortality (OR =2.68; 95% CI: 1.72–4.18; and 4 ICU length of stay >14 days (OR =5.18, 95% CI: 2.43–11.06. Conclusion: Malnutrition risk is highly prevalent among elderly ICU patients, especially among severely ill patients with malignancy admitted to the emergency ward. ICU elderly patients at malnutrition risk will have higher complication and infection rates, longer duration of ICU stay, and increased mortality. Efforts should be made to implement a

  5. The Effect of Increasing Meeting Time on the Physiological Indices of Patients Admitted to the Intensive Care Unit

    OpenAIRE

    2016-01-01

    Background Most hospitals have restricted visitation time in intensive care units (ICUs) for various reasons. Given the advantages of family presence and positive effect of emotional touching, talking and smiling on nervous system stimulation and vital signs of the patients. Objectives The present study aimed to determine the effect of increased visitation time on physiological indices of the patients hospitalized in ICUs. ...

  6. Longer Intestinal Persistence of Enterococcus faecalis Compared to Enterococcus faecium Clones in Intensive-Care-Unit Patients

    NARCIS (Netherlands)

    Ruiz-Garbajosa, Patricia; del Campo, Rosa; Coque, Teresa M.; Asensio, Angel; Bonten, Marc; Willems, Rob; Baquero, Fernando; Canton, Rafael

    2009-01-01

    The dynamics of intestinal colonization with enterococcal clones in intensive-care-unit (ICU) patients was evaluated. Eight patients admitted directly to the neurosurgical ICU at the Ramon y Cajal University Hospital (Madrid, Spain) from the community and with no overlapping stay during a 10-month p

  7. Evaluation of incidence and severity of postoperative hypoxemia in neurosurgical patients during transportation from operation theater to surgical intensive care unit in a tertiary care unit, Kashmir, India

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    Abdul Waheed Mir

    2012-07-01

    Full Text Available Background:Postoperative hypoxemia during transportation from operation theater to intensive care unit is common among neurosurgical patients. Methadology: Arterial oxygen saturation (Spo2 and arterial blood gas analysis was performed postoperatively before and after shifting a group of sixty patients with ASA I and ASA II status undergoing various elective neurosurgical procedures under general anesthesia at Sheri-Kashmir Institute of Medical Sciences Srinagar , Kashmir. Statistical analysis: The data was analyzed using SPSS version 13. The chi-square test was used for categorical variables and student’s t test was used for continuous variables with normal distribution. The data was collected, compiled and statistically analyzed using analysis of variance (ANOVA. The values were expressed as mean±SD and a p value <0.05 was taken as statistically significant. Results: SpO2 before and after transporting the patients to SICU in group I was 98.90±0.45 and 86.70±3.85 respectively, whereas in group II, the SpO2 values were 98.80±0.52 and 93.95±3.99 respectively. In group III the mean SpO2 before and after transportation was 97.60±1.96 and 83.95±8.64 respectively. The difference in SpO2 in all the three groups before and after transportation was statistically significant (p<0.05. Conclusion: We recommend supplemental oxygen administration in all neurosurgical patients during transportation from operation theater to intensive care unit.

  8. Acid sphingomyelinase serum activity predicts mortality in intensive care unit patients after systemic inflammation: a prospective cohort study.

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    Matthias Kott

    Full Text Available INTRODUCTION: Acid sphingomyelinase is involved in lipid signalling pathways and regulation of apoptosis by the generation of ceramide and plays an important role during the host response to infectious stimuli. It thus has the potential to be used as a novel diagnostic marker in the management of critically ill patients. The objective of our study was to evaluate acid sphingomyelinase serum activity (ASM as a diagnostic and prognostic marker in a mixed intensive care unit population before, during, and after systemic inflammation. METHODS: 40 patients admitted to the intensive care unit at risk for developing systemic inflammation (defined as systemic inflammatory response syndrome plus a significant procalcitonin [PCT] increase were included. ASM was analysed on ICU admission, before (PCT before, during (PCT peak and after (PCT low onset of SIRS. Patients undergoing elective surgery served as control (N = 8. Receiver-operating characteristics curves were computed. RESULTS: ASM significantly increased after surgery in the eight control patients. Patients from the intensive care unit had significantly higher ASM on admission than control patients after surgery. 19 out of 40 patients admitted to the intensive care unit developed systemic inflammation and 21 did not, with no differences in ASM between these two groups on admission. In patients with SIRS and PCT peak, ASM between admission and PCT before was not different, but further increased at PCT peak in non-survivors and was significantly higher at PCT low compared to survivors. Survivors exhibited decreased ASM at PCT peak and PCT low. Receiver operating curve analysis on discrimination of ICU mortality showed an area under the curve of 0.79 for ASM at PCT low. CONCLUSIONS: In summary, ASM was generally higher in patients admitted to the intensive care unit compared to patients undergoing uncomplicated surgery. ASM did not indicate onset of systemic inflammation. In contrast to PCT however

  9. SUM (Service Unit Management): An Organizational Approach To Improved Patient Care.

    Science.gov (United States)

    Jelinek, Richard C.; And Others

    To evaluate the effectiveness of Service Unit Management (SUM) in reducing costs, improving quality of care, saving professional nursing time, increasing personnel satisfaction, and setting a stage for further improvements, a national questionnaire survey identified the characteristics of SUM units, and compared the performance of a total of 55…

  10. Acute Bronchiolitis. Which Patients Should Be Admitted to Intensive Care Units?

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    Ariel Efrén Uriarte Méndez

    2014-12-01

    Full Text Available Bronchiolitis is the most common viral infection of the lower respiratory tract in childhood; it is considered the most severe respiratory condition that affects children under 2 years of age. In general, mortality from bronchiolitis is low, but it can reach up to 30% in patients at risk. Twenty children have died from this condition in the pediatric hospital of Cienfuegos in the last 30 years. Bronchiolitis-related deaths account for approximately 4 % of all deaths from 2010 to date. This fact has led to the implementation of administrative measures to reduce deaths from this cause, which have not solved the problem. The aim of this paper is to present a set of criteria for admission of bronchiolitis patients to intensive care units in order to be considered by the administrators of the institution. These criteria based on the authors’ experience and scientific evidence reflected in the literature focus on preventing overcrowding of this service with patients not showing signs of serious condition, and on the contrary, timely identifying those likely to have an unfavourable outcome.

  11. Obstetric patients in a surgical intensive care unit: prognostic factors and outcome.

    Science.gov (United States)

    Mjahed, K; Hamoudi, D; Salmi, S; Barrou, L

    2006-07-01

    The objective of this study was to assess the incidence, prognostic factors and the outcome of obstetric patients admitted in a surgical intensive care unit (SICU) during the ante-partum or postpartum period (within 6 weeks of delivery). Between 1995 and 2002, the patients transferred from the department of obstetrics were retrospectively included into the study. Demographics included: obstetric data, medical and surgical histories, diagnosis, simplified acute physiology score (SAPS II), acute physiology and chronic health evaluation system APACHE II score; and the occurrence of organ failure, therapeutic interventions, length of stay in the SICU and outcome were recorded. During the study period, 364 obstetric patients were admitted to the SICU. Obstetric admissions to the SICU represented 0.6% of all deliveries and the SICU utilisation rate was 14.96%. The main indications for admission were eclampsia (70.6%) and postpartum haemorrhage (16.2%). The overall mortality rate was 16.7% (n = 61). In a logistic regression model, risk factors for death included organ system failure (odds ratio (OR) = 3.95 confidence interval (CI) [1.84 - 8.48], bilirubin >12 mg/l (OR = 1.017 CI [1.00 - 1.03]), and prolonged prothrombin time (OR = 0.97 CI [0.95 - 0.99]). Median length of stay was longer in non- survivors (6.5 +/- 7.3 vs 5.5 +/- 4.6 days). Maternal condition on admission and associated complications are the major determinant of maternal outcome.

  12. Clinical and epidemiological study of stress hyperglycemia among medical intensive care unit patients in Central India

    Science.gov (United States)

    Sharma, Jitendra; Chittawar, Sachin; Maniram, Ram Singh; Dubey, T. N.; Singh, Ambrish

    2017-01-01

    Background: Stress hyperglycemia is common in patients presenting at the emergency medical ward and is associated with poor prognosis and increased risk of mortality. Aims and Objective: To study and determine the prevalence and factors associated with stress hyperglycemia. Materials and Methods: A cross-sectional observational study was performed on 536 nondiabetic patients presented to the Intensive Care Unit (ICU) at Gandhi Medical College and allied Hamidia Hospital, Bhopal, between March 31, 2015, and May 28, 2015. A detailed history including demographic profile, presence of chronic disease, history of hospitalization and ICU admission, surgical status, and major reason for ICU admission (i.e., predominant diagnostic category) was collected. Hematological and other parameters based on profile of study population were also analyzed. Results: Out of 536 patients, 109 (20.33%) had stress hyperglycemia. Out of 109 patients with stress hyperglycemia, 87 (16.23%) patients had glycated hemoglobin (HbA1c) <5.7% and 22 (4.10%) patients had HbA1c between 5.7% and 6.4%. Mean age of the study population was 40.27 ± 1.44 years, with male dominance. Mean random blood glucose level was 181.46 ± 3.80 mg/dl. Frequency of stress hyperglycemia was 24.13% in stroke, 19.54% in multiple organ dysfunction syndrome (MODS), 17.24% in chronic kidney disease (CKD), 12.64% in central nervous system (CNS) infection, 8.05% in chronic liver disease (CLD), and 8.05% in seizure patients. Association between stroke and stress hyperglycemia was significant (P = 0.036). Association between hospital stay more than 7 days and stress hyperglycemia was significant in stroke patients (P = 0.0029), CKD patients (P = 0.0036), CLD (P = 0.0099), and MODS patients (P = 0.0328). Conclusions: The factors associated with stress hyperglycemia were stroke, MODS, CKD, CNS infection, CLD, seizure patients, with prolonged hospital stay and expected proportion. PMID:28217513

  13. Changes in the conjunctival bacterial flora of patients hospitalized in an intensive care unit

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    Afsun Sahin

    Full Text Available ABSTRACT Purpose: To identify the changes in aerobic conjunctival bacterial flora and to correlate culture results with physical health and the duration of patients' hospitalization in an intensive care unit (ICU. Methods: Patients hospitalized in the ICU were included in this study. Conjunctival cultures from all patients were obtained using a standard technique on days 1, 3, 7, and 14. Swabs were plated on nonselective (blood agar and enriched (chocolate agar media within one hour. Visible colonies were isolated, and standard microbiological techniques were used to identify the bacteria. The frequency, identity, and correlation of culture results with patients' physical findings and the duration of hospitalization were determined. Results: We obtained 478 cultures (day 1, 270; day 3, 156; day 7, 36; and day 14, 16 from 135 patients; 288 (60.2% cultures were positive, and 331 microorganisms were isolated. The most frequently isolated microorganism from the cultures was coagulase-negative Staphylococcus species (n=210/331, 63.5%, and the others were Corynebacterium diphtheriae (n=52/331, 15.7%, S. aureus (n=26/331, 7.9%, gram-negative bacilli other than Pseudomonas (n=14/331, 4.2%, Neisseria species (n=8/331, 2.4%, Pseudomonas aeruginosa (n=6/331, 1.8%, Haemophilus influenzae (n=7/331, 2.1%, Acinetobacter species (n=6/331, 1.8%, and Streptococcus species (n=2/331, 0.6%. The frequency of positive cultures significantly increased (p<0.03 with time. Conclusions: Prolonged hospitalization significantly predisposes to bacterial colonization. The colonization rate of S. aureus and Neisseria spp. increased significantly after one week.

  14. Profile of Intravenous Admixture Compatibility in the Intensive Care Unit (ICU Patients

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    Sharly Dwijayanti

    2016-06-01

    Full Text Available which may directly impact to the outcome of treatment to the Intensive Care Unit (ICU patients. The objective of this study was to identify the profile of compatibility and incompatibility among IV admixtures given to the ICU patients. This observational research was conducted prospectively to the patients admitted in the ICU at a private hospital in Surabaya from October–December 2014. In this research, compatibility data of IV drug and its solution was compared with drug brochure and Handbook on Injectable Drugs 17th ed (2013 as references to analyze the compatibility of IV admixtures. The admixture between IV drug and its solvent was classified as compatible, incompatible, no information (NI, not applicable (NA, and not clear (NC, using a specific criteria. There were 1.186 IV drug‑solvent admixtures observed in 39 ICU patients. There were no IV drug-solvent admixtures classified as incompatible in both adult and child patients. Most of IV drugs were admixed with compatible solvents (adults: 72.31%; children: 69.84%. However, according to two of IV drugs compatibility references used in this research, there were some IV drug-solvent admixtures with unknown information about its compatibility that were classified as NI (adults: 19.68%; children: 30.16%. There were a few of IV drug-solvent admixtures classified as NA and NC, of 7.48% and 0.53%, respectively. The lack of information related to compatibility and stability of the IV admixtures emphasize the importance to continually monitor patients’ condition and drug concentration.

  15. Integrating Palliative Care into the Care of Neurocritically Ill Patients: A Report from The IPAL-ICU (Improving Palliative Care in the Intensive Care Unit) Project Advisory Board and the Center to Advance Palliative Care

    Science.gov (United States)

    Frontera, Jennifer A.; Curtis, J. Randall; Nelson, Judith E.; Campbell, Margaret; Gabriel, Michelle; Hays, Ross M.; Mosenthal, Anne C.; Mulkerin, Colleen; Puntillo, Kathleen A.; Ray, Daniel E.; Bassett, Rick; Boss, Renee D.; Lustbader, Dana R.; Brasel, Karen J.; Weiss, Stefanie P.; Weissman, David E.

    2015-01-01

    Objectives To describe unique features of neurocritical illness that are relevant to provision of high-quality palliative care; To discuss key prognostic aids and their limitations for neurocritical illnesses; To review challenges and strategies for establishing realistic goals of care for patients in the neuro-ICU; To describe elements of best practice concerning symptom management, limitation of life support, and organ donation for the neurocritically ill. Data Sources A search of Pubmed and MEDLINE was conducted from inception through January 2015 for all English-language articles using the term “palliative care,” “supportive care,” “end-of-life care,” “withdrawal of life-sustaining therapy,” “limitation of life support,” “prognosis,” or “goals of care” together with “neurocritical care,” “neurointensive care,” “neurological,” “stroke,” “subarachnoid hemorrhage,” “intracerebral hemorrhage,” or “brain injury.” Data Extraction and Synthesis We reviewed the existing literature on delivery of palliative care in the neurointensive care unit setting, focusing on challenges and strategies for establishing realistic and appropriate goals of care, symptom management, organ donation, and other considerations related to use and limitation of life-sustaining therapies for neurocritically ill patients. Based on review of these articles and the experiences of our interdisciplinary/interprofessional expert Advisory Board, this report was prepared to guide critical care staff, palliative care specialists, and others who practice in this setting. Conclusions Most neurocritically ill patients and their families face the sudden onset of devastating cognitive and functional changes that challenge clinicians to provide patient-centered palliative care within a complex and often uncertain prognostic environment. Application of palliative care principles concerning symptom relief, goal setting, and family emotional support, will

  16. In vitro sensitivity of Acinetobacter baumannii and Pseudomonas aeruginosa to carbapenems among intensive care unit patients.

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    Guzek, A; Korzeniewski, K; Nitsch-Osuch, Aneta; Rybicki, Z; Prokop, E

    2013-01-01

    Acinetobacter baumannii and Pseudomonas aeruginosa pathogens are the most common causes of fatal pneumonia among patients treated in Intensive Care Units (ICU). Carbapenems remain a group of antibiotics characterized by the highest effectiveness in treatment of heavy infections of the lower respiratory tract. This study compared in vitro sensitivity of A. baumannii and P. aeruginosa to three carbapenems: imipenem, meropenem and doripenem. The material was collected from 71 patients treated in the ICU from April 2009 to January 2010. Bronchial tree was the predominant source of samples. Fifty-four strains of A. baumannii and 17 strains of P. aeruginosa were analyzed. Sensitivity to carbapenems was interpreted in line with Clinical and Laboratory Standard Institute (CLSI) and European Committee for Antimicrobial Susceptibility Testing (EUCAST) criteria (imipenem and meropenem) or in compliance with the Food and Drug Administration (FDA) and CLSI guidelines (doripenem). We found that A. baumannii was significantly more often sensitive to imipenem than to doripenem and meropenem, but only according to the CLSI and FDA and not EUCAST criteria. The sensitivity of P. aeruginosa was higher to imipenem than to doripenem and meropenem, according to both CLSI and EUCAST criteria (64.7 %). We conclude that the EUCAST criteria demonstrate a higher rigor than those of CLSI and FDA in the determination of carbapenems sensitivity. Imipenem appears more effective than doripenem and meropenem in treatment of A. baumannii and P. aeruginosa infections.

  17. Assessment of a Hospital Palliative Care Unit (HPCU) for Cancer Patients; A Conceptual Framework

    Science.gov (United States)

    Rouhollahi, Mohammad Reza; Saghafinia, Masoud; Zandehdel, Kazem; Motlagh, Ali Ghanbari; Kazemian, Ali; Mohagheghi, Mohammad Ali; Tahmasebi, Mamak

    2015-01-01

    Introduction: The first hospital palliative care unit (HPCU) in Iran (FARS-HPCU) has been established in 2008 in the Cancer Institute, which is the largest referral cancer center in the country. We attempted to assess the performance of the HPCU based on a comprehensive conceptual framework. The main aim of this study was to develop a conceptual framework for assessment of the HPCU performances through designing a value chain in line with the goals and the main processes (core and support). Materials and Methods: We collected data from a variety of sources, including international guidelines, international best practices, and expert opinions in the country and compared them with national policies and priorities. We also took into consideration the trend of the HPCU development in the Cancer Institute of Iran. Through benchmarking the gap area with the performance standards, some recommendations for better outcome are proposed. Results: The framework for performance assessment consisted of 154 process indicators (PIs), based on which the main stakeholders of the HPCU (including staff, patients, and families) offered their scoring. The outcome revealed the state of the processes as well as the gaps Conclusion: Despite a significant improvement in many processes and indicators, more development in the comprehensive and integrative aspects of FARS-HPCU performance is required. Consideration of all supportive and palliative requirements of the patients through interdisciplinary and collaborative approaches is recommended. PMID:26600701

  18. Catheter-related infections in a northwestern São Paulo reference unit for burned patients care

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    Cláudio Penido Campos Júnior

    2010-04-01

    Full Text Available Despite improvements in care and rehabilitation of burned patients, infections still remain the main complication and death cause. Catheter-related infections are among the four most common infections and are associated with skin damage and insertion site colonization. There are few studies evaluating this kind of infection worldwide in this special group of patients. Padre Albino Hospital Burn Care Unit (PAHBCU is the only reference center in the Northwestern São Paulo for treatment of burned patients. This paper presents the results of a retrospective study aiming at describing the epidemiological and clinical features of catheter-related infections at PAHBCU.

  19. Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: Part II. Treatment.

    NARCIS (Netherlands)

    Guery, B.P.; Arendrup, M.C.; Auzinger, G.; Azoulay, E.; Borges Sa, M.; Johnson, E.M.; Muller, E.; Putensen, C.; Rotstein, C.; Sganga, G.; Venditti, M.; Zaragoza Crespo, R.; Kullberg, B.J.

    2009-01-01

    BACKGROUND: Invasive candidiasis and candidemia are frequently encountered in the nosocomial setting particularly in the intensive care unit (ICU). OBJECTIVE AND METHODS: To review the current management of invasive candidiasis and candidemia in non-neutropenic adult ICU patients based on a review o

  20. Profile of patients and physiotherapy patterns in intensive care units in public hospitals in Zimbabwe: a descriptive cross-sectional study

    OpenAIRE

    2015-01-01

    Background Physiotherapy is integral to patient management in the Intensive Care Unit. The precise role that physiotherapists play in the critical care differs significantly worldwide. The aim of the study was to describe the profile of patients and the current patterns of physiotherapy services delivered for patients admitted in the five public hospital intensive care units in Zimbabwe. Methods A prospective record review was performed and records of all consecutive patients admitted into th...

  1. [Is there a relationship between rectal colonization and nosocomial infection of patients in intensive care unit?].

    Science.gov (United States)

    Yeşilbağ, Zuhal; Çağatay, Arif Atahan; Karadeniz, Aslı; Başaran, Seniha; Orhun, Günseli; Ergin Özcan, Perihan; Özsüt, Halit; Eraksoy, Haluk

    2015-07-01

    Nosocomial infections caused by multidrug-resistant (MDR) microorganisms are a major problem in intensive care units (ICUs) with high mortality and morbidity rates and the prior colonization is an important risk factor for these infections. The aim of this study was to investigate the prevalence of rectal colonization of MDR microorganisms and the association between the microorganisms that caused colonization and infection in the patients with nosocomial infections in ICUs. Rectal swabs were obtained on the day of 0, 3, 7, 14, 21 and weekly thereafter from 80 patients over 18 years of age hospitalized in ICU for more than 48 hours, and cultured for vancomycin-resistant enterococcus (VRE), methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum β-lactamase (ESBL)- producing gram-negative bacilli (GNB) and carbapenem-resistant enteric and nonenteric bacilli. Patients whose rectal swabs were not obtained on admission (on the day of 0), were excluded even they were hospitalized more than 48 hours. Bile esculin agar containing 64 μg/mL ceftazidime and 6 μg/mL vancomycin, chromogenic MRSA agar and blood agar media, MacConkey agar containing 1 mg/L ceftazidime and ceftriaxone, and 5 mL tryptic soy broth media containing 10 µg imipenem and meropenem discs were used for identification. Identification of GNB was determined by conventional methods and ESBL production was determined by double-disc synergy test. Patients have been followed up for nosocomial infections. Bacterial identification and antibiotic susceptibility tests were performed with standard microbiological methods. In 37 (46%) of the 80 patients, at least one MDR microorganism was isolated in rectal swab cultures on the day of 0. The most common microorganisms were ESBL-positive E.coli (19%), followed by ESBL-positive K.pneumoniae (13%), carbapenem-resistant P.aeruginosa (10%), ESBL-positive K.oxytoca (3%), MRSA (1%), VRE (1%), carbapenem-resistant Acinetobacter sp. (1%) and carbapenem

  2. Accountable Care Units: A Disruptive Innovation in Acute Care Delivery.

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    Castle, Bryan W; Shapiro, Susan E

    2016-01-01

    Accountable Care Units are a disruptive innovation that has moved care on acute care units from a traditional silo model, in which each discipline works separately from all others, to one in which multiple disciplines work together with patients and their families to move patients safely through their hospital stay. This article describes the "what," "how," and "why" of the Accountable Care Units model as it has evolved in different locations across a single health system and includes the lessons learned as different units and hospitals continue working to implement the model in their complex care environments.

  3. Tilt Table Practice Improved Ventilation in a Patient with Prolonged Artificial Ventilation Support in Intensive Care Unit

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    Asiah M Hashim

    2012-03-01

    Full Text Available Patients who are on prolonged ventilator support in critical care unit present wide variety of complications, which range from reduction in oxygen uptake to various musculoskeletal impairments. Early mobilization and rehabilitation are encouraged to manage these complications effectively. Use of tilt table to motivate early mobilization in the intensive care unit for ventilator practices is not a usual practice. However, this new technique has attracted involvements of clinicians and therapists for its therapeutic benefits to the patient. Herein we describe a case of a seventy eight-year-old male patient who suffered Motor car accident, and was on ventilator support in intensive care unit for more than one month. He underwent treatment using a tilt table protocol with other routine treatment, which benefited him based on clinical as well as physiological variables. For practitioners in intensive care units, this report may offer perceptivity into the alternate practice of early mobilization using tilt table, and for investigators it may promote interest for further studies.

  4. Microbial investigation of biofilms recovered from endotracheal tubes using sonication in intensive care unit pediatric patients

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    Thiago de Oliveira Ferreira

    Full Text Available Abstract Objectives To compare cultured microorganisms identified on endotracheal tubes biofilms through sonication technique with traditional tracheal aspirate collected at extubation of pediatric intensive care unit patients. Methods Demographic and epidemiological data were analyzed to identify factors possibly related with the microbiological profile of the two collection methods. Associations between categorical and continuous variables were analyzed using the chi-square or Fisher's exact test, or Student's t test. p-Value <0.05 were considered significant. Results Thirty endotracheal tubes and tracheal aspirates samples from 27 subjects were analyzed. Only one patient presented the clinical diagnosis of ventilator-associated pneumonia. Overall, 50% of bacteria were Gram-negative bacilli, followed by Gram-positive bacteria in 37%, and fungi in 10%. No statistically significant difference on the distribution of Gram-positive or Gram-negative bacteria (p = 0.996, and fungi (p = 0.985 were observed between the collection methods. Pseudomonas spp. was the most frequent microorganism identified (23.8%, followed by Streptococcus spp. (18.5%, Acinetobacter spp. (15.9%, coagulase-negative staphylococci (11.2%, and Klebsiella spp. (8.6%. Concordant results between methods amounted to 83.3%. Pseudomonas aeruginosa and Acinetobacter baumannii showed carbapenem resistance in 50% and 43.7% of the isolates, respectively. In general, cultures after endotracheal tubes sonication (non-centrifuged sonication fluid and centrifuged sonication fluid yielded bacteria with higher rates of antimicrobial resistance compared to tracheal aspirates cultures. Additionally, in 12 subjects (40%, we observed discrepancies regarding microbiologic profiles of cultures performed using the collection methods. Conclusions Our study demonstrated that sonication technique can be applied to ET biofilms to identify microorganisms attached to their surface with a great variety of

  5. Utilization of Observation Units for the Care of Poisoned Patients: Trends from the Toxicology Investigators Consortium Case Registry.

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    Judge, Bryan S; Ouellette, Lindsey M; VandenBerg, Melissa; Riley, Brad D; Wax, Paul M

    2016-03-01

    Many poisoned patients may only require a period of observation after their exposure. There are limited data describing the use of observation units for managing poisoned adult and pediatric patients. We performed a retrospective review of all patients reported to the ToxIC Case Registry between January 1, 2012 and December 31, 2013. Eligible patients included those who received a bedside consultation by a medical toxicologist and whose care was provided in an observation unit, or those who were admitted under the care of a medical toxicologist in an observation unit. A total of 15,562 poisonings were reported to the registry during the study period, of which 340 (2.2 %) involved patients who were cared for in an observation unit. Of these patients, 22.1 % were 18 years of age or younger, and the remaining 77.9 % were greater than 18 years of age. The most common reason for exposure was the intentional ingestion of a pharmaceutical agent in both adult (30.2 %) and pediatric patients (36.0 %). Alcohols (ethanol) (24.9 %), opioids (20.0 %), and sedative-hypnotics (17.7 %) were the most common agent classes involved in adult patient exposures. The most common agent classes involved in pediatric exposures were antidepressants (12.0 %), anticonvulsants (10.7 %), and envenomations (10.7 %). In adult patients, the most common signs and symptoms involved the nervous system (52.0 %), a toxidrome (17.0 %), or a major vital sign abnormality (14.7 %). In pediatric patients, the most common signs and symptoms involved the nervous system (53.3 %), a toxidrome (21.3 %), or a major vital sign abnormality (17.3 %). The results of this study demonstrate that a wide variety of poisoned patients have been cared for in an observation unit in consultation with a board-certified medical toxicologist. Patterns for the reasons for exposure, agents responsible for the exposure, and toxicological treatments will continue to evolve. Further study is needed to identify

  6. Being a non-urgent patient in an emergency care unit--a strive to maintain personal integrity.

    Science.gov (United States)

    Nyström, Maria; Nydén, Kristoffer; Petersson, Martin

    2003-01-01

    The aim of this study was to analyse and describe experiences of being a non-urgent patient in an ECU (emergency care unit). Eleven non-urgent patients were interviewed. The research approach was inductive and interpretative. Seven tentative interpretations and an interpreted whole, i.e., an existential interpretation, revealed that the informants tried to be 'good' patients by not demanding much attention from nursing personnel, in an attempt to maintain good relations with the nurses in order to be assured of a positive reception. As health related problems jeopardize personal integrity, patients cannot afford the risk of being looked upon as inappropriate clients in the ECU.

  7. Ethical Dilemmas in Hospice and Palliative Care Units for Advanced Cancer Patients

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    Beyhan Bag

    2013-02-01

    Full Text Available Ethical dilemmas that face heathcare team members referring patients to hospice programs include the ability of clinicians to predict accurately a patient bad prognosis. They affect day-to-day patient management in palliative care programs including healthcare team members concern over the use of morphine because possible respiratory depression in the patient, the question of providing enteral or parenteral nutritional support to patients who refuse to eat and the question of providing parenteral fluids to patients who are unable to take fluids during the terminal phrases of illness. A final ethical dilemma concerns the methodology for quality of life research in palliative care. Understanding and resolving these ethical dilemmas is an important factor determining the quality of the caring for the patient. The ethical dilemmas that are discussed in the article likely to occur in this period can be prevented through his/her participation in the decisions concerning his or her treatment. [Archives Medical Review Journal 2013; 22(1.000: 65-79

  8. Currently used dosage regimens of vancomycin fail to achieve therapeutic levels in approximately 40% of intensive care unit patients

    Science.gov (United States)

    Obara, Vitor Yuzo; Zacas, Carolina Petrus; Carrilho, Claudia Maria Dantas de Maio; Delfino, Vinicius Daher Alvares

    2016-01-01

    Objective This study aimed to assess whether currently used dosages of vancomycin for treatment of serious gram-positive bacterial infections in intensive care unit patients provided initial therapeutic vancomycin trough levels and to examine possible factors associated with the presence of adequate initial vancomycin trough levels in these patients. Methods A prospective descriptive study with convenience sampling was performed. Nursing note and medical record data were collected from September 2013 to July 2014 for patients who met inclusion criteria. Eighty-three patients were included. Initial vancomycin trough levels were obtained immediately before vancomycin fourth dose. Acute kidney injury was defined as an increase of at least 0.3mg/dL in serum creatinine within 48 hours. Results Considering vancomycin trough levels recommended for serious gram-positive infection treatment (15 - 20µg/mL), patients were categorized as presenting with low, adequate, and high vancomycin trough levels (35 [42.2%], 18 [21.7%], and 30 [36.1%] patients, respectively). Acute kidney injury patients had significantly greater vancomycin trough levels (p = 0.0055, with significance for a trend, p = 0.0023). Conclusion Surprisingly, more than 40% of the patients did not reach an effective initial vancomycin trough level. Studies on pharmacokinetic and dosage regimens of vancomycin in intensive care unit patients are necessary to circumvent this high proportion of failures to obtain adequate initial vancomycin trough levels. Vancomycin use without trough serum level monitoring in critically ill patients should be discouraged. PMID:28099635

  9. Community-acquired pneumonia and survival of critically ill acute exacerbation of COPD patients in respiratory intensive care units

    Science.gov (United States)

    Lu, Zhiwei; Cheng, Yusheng; Tu, Xiongwen; Chen, Liang; Chen, Hu; Yang, Jian; Wang, Jinyan; Zhang, Liqin

    2016-01-01

    Purpose The aim of this study was to appraise the effect of community-acquired pneumonia (CAP) on inhospital mortality in critically ill acute exacerbation of COPD (AECOPD) patients admitted to a respiratory intensive care unit. Patients and methods A retrospective observational study was performed. Consecutive critically ill AECOPD patients receiving treatment in a respiratory intensive care unit were reviewed from September 1, 2012, to August 31, 2015. Categorical variables were analyzed using chi-square tests, and continuous variables were analyzed by Mann–Whitney U-test. Kaplan–Meier analysis was used to assess the association of CAP with survival of critically ill AECOPD patients for univariate analysis. Cox’s proportional hazards regression model was performed to identify risk factors for multivariate analysis. Results A total of 80 consecutive eligible individuals were reviewed. These included 38 patients with CAP and 42 patients without CAP. Patients with CAP had a higher inhospital rate of mortality than patients without CAP (42% vs 33.3%, Pcritically ill AECOPD patients (CAP: hazard ratio, 5.29; 95% CI, 1.50–18.47, Pcritically ill AECOPD patients. PMID:27563239

  10. Developing Indicators of Service Quality Provided for Cardiovascular Patients Hospitalized in Cardiac Care Unit

    Directory of Open Access Journals (Sweden)

    Saber Azami-Aghdash

    2013-03-01

    Full Text Available Introduction: Cardiovascular diseases are among the most prevalent chronic diseases leading to high degrees of mortality and morbidity worldwide and in Iran. The aim of the current study was to determine and develop appropriate indicators for evaluating provided service quality for cardiovascular patients admitted to Cardiac Care Units (CCU in Iran. Methods: In order to determine the indicators for evaluating provided service quality, a four-stage process including reviewing systematic review articles in premier bibliographic databases, interview, performing two rounds of Delphi technique, and holding experts panel by attendance of experts in different fields was adopted. Finally, after recognizing relevant indicators in resources, these indicators were finalized during various stages using ideas of 27 experts in different fields. Results: Among 2800 found articles in the text reviewing phase, 21 articles, which had completely mentioned relevant indicators, were studied and 48 related indicators were extracted. After two interviews with a cardiologist and an epidemiologist, 32 items of the indicators were omitted and replaced by 27 indicators coping with the conditions of Iranian hospitals. Finally, 43 indicators were added into the Delphi phase and after 2 rounds of Delphi with 18 specialists, 7 cases were excluded due to their low scores of applicability. In the experts’ panel stage, 6 items were also omitted and 10 new indicators were developed to replace them. Eventually, 40 indicators were finalized. Conclusion: In this study, some proper indicators for evaluating provided service quality for CCU admissions in Iran were determined. Considering the informative richness of these indicators, they can be used by managers, policy makers, health service providers, and also insurance agencies in order to improve the quality of services, decisions, and policies.

  11. Improving patient care through the prism of psychology: application of Maslow's hierarchy to sedation, delirium, and early mobility in the intensive care unit.

    Science.gov (United States)

    Jackson, James C; Santoro, Michael J; Ely, Taylor M; Boehm, Leanne; Kiehl, Amy L; Anderson, Lindsay S; Ely, E Wesley

    2014-06-01

    The intensive care unit (ICU) is not only a place where lives are saved; it is also a site of harm and iatrogenic injury for millions of people treated in this setting globally every year. Increasingly, hospitals admit only the sickest patients, and although the overall number of hospital beds remains stable in the United States, the percentage of that total devoted to ICU beds is rising. These 2 realities engender a demographic imperative to address patient safety in the critical care setting. This article addresses the medical community's resistance to adopting a culture of safety in critical care with regard to issues surrounding sedation, delirium, and early mobility. Although there is currently much research and quality improvement in this area, most of what we know from these data and published guidelines has not become reality in the day-to-day management of ICU patients. This article is not intended to provide a comprehensive review of the literature but rather a framework to rethink our currently outdated culture of critical care by employing Maslow's hierarchy of needs, along with a few novel analogies. Application of Maslow's hierarchy will help propel health care professionals toward comprehensive care of the whole person not merely for survival but toward restoration of pre-illness function of mind, body, and spirit.

  12. How does information influence hope in family members of traumatic coma patients in intensive care unit?

    NARCIS (Netherlands)

    Verhaeghe, S.T.L.; Zuuren, F.J. van; Defloor, T.; Duijnstee, M.S.H.; Grypdonck, M.H.F.

    2007-01-01

    AIMS: To assess the interplay between hope and the information provided by health care professionals. BACKGROUND: Earlier research learned that hope is crucial for relatives of traumatic coma patients. Also it has been reported that the need for information is extremely important for relatives of c

  13. Quality of life assessment in advanced cancer patients treated at home, an inpatient unit, and a day care center

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    Leppert W

    2014-05-01

    Full Text Available Wojciech Leppert,1 Mikolaj Majkowicz,2 Maria Forycka,1 Eleonora Mess,3 Agata Zdun-Ryzewska2 1Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland; 2Department of Quality of Life Research, Gdansk Medical University, Gdansk, Poland; 3Palliative Care Nursing Department, Wroclaw Medical University, Wroclaw, Poland Aim of the study: To assess quality of life (QoL in cancer patients treated at home, at an in-patient palliative care unit (PCU, and at a day care center (DCC. Patients and methods: QoL was assessed in advanced cancer patients at baseline and after 7 days of symptomatic treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care (EORTC QLQ-C15-PAL, the Edmonton Symptom Assessment System (ESAS, and the Karnofsky Performance Status (KPS scale. Results: A total of 129 patients completed the study, with 51 patients treated at home, 51 patients treated at the PCU, and 27 patients at DCC. In the EORTC QLQ-C15-PAL, improvement in functional and symptom scales was observed except in physical functioning and fatigue levels; patients at DCC had a better physical functioning, global QoL, appetite, and fatigue levels. In the ESAS, improvement in all items was found except for drowsiness levels, which was stable in patients treated at DCC and deteriorated in home and PCU patients. Higher activity, better appetite and well-being, and less drowsiness were observed in patients treated at DCC. KPS was better in DCC patients compared to those treated at home and at the PCU; the latter group deteriorated. Conclusions: QoL improved in all patient groups, with better results in DCC patients and similar scores in those staying at home and at the PCU. Along with clinical assessment, baseline age, KPS, physical and emotional functioning may be considered when assigning patients to care at a DCC, PCU, or at home. Keywords: oncology, patient care

  14. [Determination of Candida colonization and Candida score in patients in anesthesia intensive care unit].

    Science.gov (United States)

    Gökahmetoğlu, Günhan; Mutlu Sarıgüzel, Fatma; Koç, Ayşe Nedret; Behret, Orhan; Gökahmetoğlu, Selma; Atalay, Mustafa Altay; Elmalı, Ferhan; Darçın, Kamil

    2016-07-01

    The colonization rate of Candida spp. reaches up to 80% in patients who reside in intensive care units (ICUs) more than a week, and the mean rate of development of invasive disease is 10% in colonized patients. Since invasive candidiasis (IC) in ICU patients presents with septic shock and high mortality rate, rapid diagnosis and treatment are crucial. The aim of this study was to assess the relationship between invasive infection and the determination of Candida colonization index (CI) and Candida score (CS) in patients admitted to ICU who are at high risk for IC and likely to benefit from early antifungal therapy. A total of 80 patients (34 female, 46 male; age range: 12-92 years, mean age: 69.57 ± 16.30) who were in ICU over seven days or longer of Anesthesia Department of Kayseri Education and Research Hospital between April, 2014 and July, 2015 were included in the study. None of the patients were neutropenic. After admission, throat, nose, skin (axillary region), urine, rectal swab and blood cultures have been collected weekly beginning from day zero. Isolation and identification of Candida strains were performed by using conventional mycological methods. CI was calculated as the ratio of the number of culture-positive distinct body sites (except blood culture) to the total number of body sites cultured. CI> 0.2 was considered as fungal colonization, while CI≥ 0.5 as intensive colonization. CS value was calculated according to the components including total parenteral nutrition (TPN) (plus 0.908 points), surgery (plus 0.907 points), colonization in multiple areas (plus 1.112) and severe sepsis (plus 2.038 points), and cut-off value for CS was accepted as >2.5. In our study, overall 1009 cultures (mean: 13 cultures per patient) were taken from 80 patients, and yeast growth was detected in 365 (36.2%) of them. Accordingly, among 68 (85%) of 80 patients included, in at least one sample, yeast growth was determined. No yeast growth was observed in the blood

  15. Lazarus response to treatment of patients with lung cancer and oncogenic mutations in the intensive care unit

    Science.gov (United States)

    Chien, Chun-Ru

    2016-01-01

    Novel targeted therapy for patients with non-small-cell lung cancer (NSCLC) and oncogenic mutations along with poor performance status (PS) sometimes evokes a “Lazarus” response. Moreover, for critically ill patients with NSCLC and respiratory failure requiring mechanical ventilation (MV) in the intensive care unit (ICU), only a few case reports have demonstrated positive outcomes with targeted therapy. This perspective review describes in detail the most recently published data in order to highlight the findings and the main pitfalls of targeted therapy for patients with NSCLC in the ICU. PMID:28066630

  16. Positive predictive value and impact of misdiagnosis of a heart failure diagnosis in administrative registers among patients admitted to a University Hospital cardiac care unit

    DEFF Research Database (Denmark)

    Mard, Shan; Nielsen, Finn Erland

    2010-01-01

    To evaluate the positive predictive value (PPV) of a diagnosis of heart failure (HF) in the Danish National Registry of Patients (NRP) among patients admitted to a University Hospital cardiac care unit, and to evaluate the impact of misdiagnosing HF.......To evaluate the positive predictive value (PPV) of a diagnosis of heart failure (HF) in the Danish National Registry of Patients (NRP) among patients admitted to a University Hospital cardiac care unit, and to evaluate the impact of misdiagnosing HF....

  17. A survey of the domiciliary situation of urban and rural patients of a palliative care unit in south India

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    Ramu Kandasamy

    2008-01-01

    Full Text Available Aim: A demographic study was conducted to understand the social status of the urban and rural patients attending a palliative care unit in South India. Methods: Fifty rural and 50 urban patients attending the palliative care outpatient clinic of the Christian Medical College and Hospital, South India were prospectively surveyed using a structured interview and home visits. Parameters studied included age, gender, marital status, education, occupation, religion, caste, housing, economic status, diagnosis, distance to the nearest health resource personnel and hospitals. Results: Occupation, religion, caste, housing, electricity, toilet and accessibility to health care were found to be significantly different between urban and rural patients. Seventy percent of the patients were below 60 years of age. The majority were unskilled laborers or housewives. One-third had never been to school and only 3% had been educated beyond high school. Half the patients slept on the floor, 50% of the dwellings had only one or two rooms and did not have toilets or running water. Ninety-five percent had electricity. The economic status of the patients correlated significantly with age, occupation and facilities in the house such as number of rooms, availability of beds, toilets and water supply. Women and older patients were significantly less likely to have completed school education. Women were less likely to be the main decision-makers and more likely to be the main caregivers. Conclusion: Economic status was a strong predictor of the various facilities available to the patient. A significant proportion of this population lived in deprived circumstances. A knowledge and understanding of the social conditions of the palliative care patients helps provide better-tailored care.

  18. Knowledge and attitudes of Saudi intensive care unit nurses regarding oral care delivery to mechanically ventilated patients with the effect of healthcare quality accreditation

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    A K Alotaibi

    2016-01-01

    Full Text Available Introduction: Ventilator-associated pneumonia is a major morbid outcome among intensive care unit (ICU patients. Providing oral care for intubated patients is an important task by the ICU nursing staff in reducing the mortality and morbidity. The objectives of this study were to evaluate the attitudes and knowledge of ICU nurses regarding oral care delivery to critically ill patients in Saudi Arabian ICUs. The findings were further correlated to the presence of healthcare quality accreditation of the institution. Materials and Methods: The nurses′ knowledge, attitudes, and healthcare quality accreditation status of the hospital were recorded. Two hundred fifteen nurses conveniently selected from 10 random hospitals were included in this study from Riyadh city, Saudi Arabia. This is a cross-sectional study in the form of a questionnaire. Results: When comparing the knowledge of the participants to their level of education, there was no statistically significant difference between the two groups of nurses. The majority of the nurses agreed that the oral cavity is difficult to clean and that oral care delivery is a high priority for mechanically ventilated patients. Furthermore, there was no statistically significant difference in the attitudes between nurses working in accredited and nonaccredited hospitals. Conclusion: The presence of healthcare quality accreditation did not reflect any significance in attitudes or knowledge of the ICU nurses in regard to mechanically ventilated patients. Factors affecting oral care delivery should be evaluated on the personal and institutional level to achieve better understanding of them.

  19. Intensive care unit without walls: seeking patient safety by improving the efficiency of the system.

    Science.gov (United States)

    Gordo, F; Abella, A

    2014-10-01

    The term "ICU without walls" refers to innovative management in Intensive Care, based on two key elements: (1) collaboration of all medical and nursing staff involved in patient care during hospitalization and (2) technological support for severity early detection protocols by identifying patients at risk of deterioration throughout the hospital, based on the assessment of vital signs and/or laboratory test values, with the clear aim of improving critical patient safety in the hospitalization process. At present, it can be affirmed that there is important work to be done in the detection of severity and early intervention in patients at risk of organ dysfunction. Such work must be adapted to the circumstances of each center and should include training in the detection of severity, multidisciplinary work in the complete patient clinical process, and the use of technological systems allowing intervention on the basis of monitored laboratory and physiological parameters, with effective and efficient use of the information generated. Not only must information be generated, but also efficient management of such information must also be achieved. It is necessary to improve our activity through innovation in management procedures that facilitate the work of the intensivist, in collaboration with other specialists, throughout the hospital environment. Innovation is furthermore required in the efficient management of the information generated in hospitals, through intelligent and directed usage of the new available technology.

  20. Levothyroxine absorption and difficult management of hypothyroid patients in the intensive care unit: two case reports and a literature review.

    Science.gov (United States)

    Vinagre, Ana Lúcia Marinho; Souza, Marcus Vinícius Leitão de

    2011-06-01

    Levothyroxine absorption in hypothyroid patients can be influenced by several factors, particularly medications and concomitant food administration. This is especially evident in intensive care unit patients, where a continual enteral diet and the administration of multiple medications changes its absorption. Changes or adaptations in the hypothalamic-pituitary-thyroid axis, in conjunction with clinical abnormalities possibly related to under-treatment of hypothyroidism, render levothyroxine replacement therapy very challenging. Here, we report two intensive care hypothyroidism patients and their respective levothyroxine replacement management issues, focusing on a number of controversial issues, such as the optimal replacement dose, how fast the levothyroxine doses should be increased, triiodothyronine requirements, the interference of an enteral diet with absorption, and finally, the possible consequences of undertreated hypothyroidism and levothyroxine replacement monitoring useful clinical/laboratory parameters.

  1. Sleep in intensive care unit

    DEFF Research Database (Denmark)

    Boyko, Yuliya; Jennum, Poul; Nikolic, Miki

    2017-01-01

    PURPOSE: To determine if improving intensive care unit (ICU) environment would enhance sleep quality, assessed by polysomnography (PSG), in critically ill mechanically ventilated patients. MATERIALS AND METHODS: Randomized controlled trial, crossover design. The night intervention "quiet routine......" protocol was directed toward improving ICU environment between 10pm and 6am. Noise levels during control and intervention nights were recorded. Patients on mechanical ventilation and able to give consent were eligible for the study. We monitored sleep by PSG.The standard (American Association of Sleep...... Medicine) sleep scoring criteria were insufficient for the assessment of polysomnograms. Modified classification for sleep scoring in critically ill patients, suggested by Watson et al. (Crit Care Med 2013;41:1958-1967), was used. RESULTS: Sound level analysis showed insignificant effect...

  2. Evaluation of the Medical Care of Patients with Hypertension in an Emergency Department and in Ambulatory Hypertension Unit

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    Fernando Nobre

    2002-02-01

    Full Text Available OBJECTIVE: To evaluate the characteristics of the patients receiving medical care in the Ambulatory of Hypertension of the Emergency Department, Division of Cardiology, and in the Emergency Unit of the Clinical Hospital of the Ribeirão Preto Medical School. METHODS: Using a protocol, we compared the care of the same hypertensive patients in on different occasions in the 2 different places. The characteristics of 62 patients, 29 men with a mean age of 57 years, were analyzed between January 1996 and December 1997. RESULTS: The care of these patients resulted in different medical treatment regardless of their clinical features and blood pressure levels. Thus, in the Emergency Unit, 97% presented with symptoms, and 64.5% received medication to rapidly reduce blood pressure. In 50% of the cases, nifedipine SL was the elected medication. Patients who applied to the Ambulatory of Hypertension presenting with similar features, or, in some cases, presenting with similar clinically higher levels of blood pressure, were not prescribed medication for a rapid reduction of blood pressure at any of the appointments. CONCLUSION: The therapeutic approach to patients with high blood pressure levels, symptomatic or asymptomatic, was dependent on the place of treatment. In the Emergency Unit, the conduct was, in the majority of cases, to decrease blood pressure immediately, whereas in the Ambulatory of Hypertension, the same levels of blood pressure, in the same individuals, resulted in therapeutic adjustment with nonpharmacological management. These results show the need to reconsider the concept of hypertensive crises and their therapeutical implications.

  3. [Guiding patients' family members through an intensive care unit: difficulties of lack of systematization?].

    Science.gov (United States)

    Domingues, C I; Santini, L; da Silva, V E

    1999-03-01

    The purpose of this study was to analyse the problematic situation experienced by nurses at the moment of guiding the relatives of patients in an ICU. Therefore, seven (7) nurses who worked in this unit, which belonged to a general, public and training hospital in the city of São Paulo, were interviewed. The results have shown that the period of guiding brings anxiety and stress to the nurses, originated by the critical patient's condition, as well by the deficiency of conduts and in the systematization of this activity in the unit. Based on the results it was proposed the creation of na assistance plan. That includes the guiding to the family and the elaboration of a written instrument of orientation.

  4. Use of blood components in critically ill patients in the medical intensive care unit of a tertiary care hospital

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    Makroo R

    2009-01-01

    Full Text Available Background: The art of fluid administration and hemodynamic support is one of the most challenging aspects of treating critically ill patients. Transfusions of blood products continue to be an important technique for resuscitating patients in the intensive care settings. Concerns about the rate of inappropriate transfusion exist, particularly given the recognized risks of transfusions and the decreasing availability of donor blood. We investigated the current transfusion practice in the critically ill patients at our hospital. Materials and Methods: A total of 1817 consecutive critically ill patients admitted between January 2006 and December 2006 were included in this retrospective study. The blood request forms of the patients were analyzed, and their pretransfusion investigations, indications for transfusions, etc. were studied. Results: Nine hundred and eleven (50.1% critically ill patients, comprising 71.6% males and 28.4% females, received blood/blood components. About 43.8% patients were administered packed red cells (PRC, 18.27% fresh frozen plasma (FFP and 8.4% transfused platelets. Among those receiving PRC, 31.1% had a pretransfusion Hb below 7.5g%, 34.4% had Hb between 7.5 and 9g%, while 21.4% had Hb above 9g%. Among those receiving FFP, 14.5% had an international normalized ratio INR < 1.5, and 19% had a pretransfusion platelet count above 50,000/cumm. During the study, there were 7% of the patients who received red cells and FFP, 2% of the patients received red cells and platelets, 1% of the patients received platelets and FFP, and 5% of the patients had received all the three components, i.e., red cells, FFP and Platelets. The baseline investigations and/or clinical indications were not mentioned in 13.1% of patients receiving PRC, 57% receiving FFP and 49.7% receiving platelets. Conclusion: About 21.4% of PRC, 14.5% of FFP, and 19% of platelets were inappropriately indicated. Clinicians in our centre were conservative in keeping

  5. The myasthenic patient in crisis: an update of the management in Neurointensive Care Unit

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    Daniel Agustin Godoy

    2013-09-01

    Full Text Available Myasthenia gravis (MG is an autoimmune disorder affecting neuromuscular transmission leading to generalized or localized muscle weakness due most frequently to the presence of autoantibodies against acetylcholine receptors in the postsynaptic motor end-plate. Myasthenic crisis (MC is a complication of MG characterized by worsening muscle weakness, resulting in respiratory failure that requires intubation and mechanical ventilation. It also includes postsurgical patients, in whom exacerbation of muscle weakness from MG causes a delay in extubation. MC is a very important, serious, and reversible neurological emergency that affects 20–30% of the myasthenic patients, usually within the first year of illness and maybe the debut form of the disease. Most patients have a predisposing factor that triggers the crisis, generally an infection of the respiratory tract. Immunoglobulins, plasma exchange, and steroids are the cornerstones of immunotherapy. Today with the modern neurocritical care, mortality rate of MC is less than 5%.

  6. Prevalence of potential drug interactions in patients in an intensive care unit of a university hospital in Brazil

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    Adriano Max Moreira Reis

    2011-01-01

    Full Text Available OBJECTIVES: To investigate the prevalence of potential drug interactions at the intensive care unit of a university hospital in Brazil and to analyze their clinical significance. METHODS: This cross-sectional retrospective study included 299 patients who had been hospitalized in the intensive care unit of the hospital. The drugs administered during the first 24 hours of hospitalization, in the 50th length-ofstay percentile and at the time of discharge were analyzed to identify potential drug-drug and drug-enteral nutrition interactions using DRUG-REAXH software. The drugs were classified according to the anatomical therapeutic chemical classification. RESULTS: The median number of medications per patient was smaller at the time of discharge than in the 50th length-of-stay percentile and in the first 24 hours of hospitalization. There was a 70% prevalence of potential drug interactions at the intensive care unit at the studied time points of hospitalization. Most of the drug interactions were either severe or moderate, and the scientific evidence for the interactions was, in general, either good or excellent. Pharmacodynamic interactions presented a subtle predominance in relation to pharmacokinetic interactions. The occurrence of potential drug interactions was associated with the number of medications administered and the length of stay. Medications that induced cytochrome P450, drugs that prolong the QT interval and cardiovascular drugs were pharmacotherapy factors associated with potential drug interactions. CONCLUSION: The study showed that potential drug interactions were prevalent in the intensive care unit due to the complexity of the pharmacotherapies administered. The interactions were associated with the number of drugs, the length of stay and the characteristics of the administered medications.

  7. Effect of Aloe Vera mouthwash on dental plaque index in patients with endotracheal tube hospitalized in intensive care unite

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    Nasrin Mirbastegan

    2016-06-01

    Full Text Available Introduction: Oral health is an important aspect of caring for hospitalized patients in intensive care unit (ICU. Typically, 48 hours after admission to Intensive care unit, there is a change in mouth flora and dental plaque will be created subsequently. These events make an ideal environment for microbial growth. The aim of this study was to determine the effect of Aloe Vera mouthwash on dental plaque index in patients with tracheal intubation at ICU. Material and Methods: This randomized double blind trail was performed on 79 patients with Tracheal intubation at ICU. Data were gathered using purposive sampling. Participant divided in to the two groups. The experimental group received Aloe Vera mouth wash and control group received Normal Saline mouth wash. The study period was four days. O’leary Plaque index used for collecting data. Kolmogorov-Smirnov, Chi square, paired t-test and independent ttest were used for analyzing data by SPSS 20. Result: The experimental and control groups had similar characteristics except gender. The experimental dental plaque index (56.58±11.91 and Control dental plaque index (56.04±10.46 were similar. The dental plaque index had a significant decrease in experimental group (57.51±9.08 comparing to the control group (62.46±9.46. Conclusion: Aloe Vera mouth wash along with tooth brushing have a significant effect on reducing dental plaque index.

  8. Management of Sepsis in Patients with Pulmonary Arterial Hypertension in the Intensive Care Unit.

    Science.gov (United States)

    Tartavoulle, Todd M

    2017-03-01

    Pulmonary arterial hypertension is a lethal condition, and the management of sepsis in patients with pulmonary arterial hypertension is challenging. As the disease progresses, the right ventricle is susceptible to failure due to a high pulmonary vascular resistance. The limited ability of the right ventricle to increase cardiac output in septic shock makes it difficult to deliver oxygen to the organ and tissues. Intravascular volume replacement and vasoactive drugs should only be considered after a thorough assessment. Priorities of care include improving cardiac output and oxygen delivery by optimizing preload, reducing afterload, and improving contractility.

  9. Physicians′ therapeutic practice and compliance of diabetic patients attending rural primary health care units in Alexandria

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    Nahla Khamis R Ibrahim

    2010-01-01

    Full Text Available Objectives: The objectives of the study were to investigate physician′s therapeutic practice and the compliance of diabetic patients attending rural primary health units in Alexandria. Material and Methods: A cross-sectional study was conducted and a multistage stratified random sample method was used for the selection of 600 diabetic patients. Data were collected by means of an interviewing questionnaire, an observation checklist, review of prescriptions and laboratory investigations. A scoring system was made for a diabetic patient′s knowledge and skills, patient′s compliance, doctor-patient relationship, and glycemic control. Results: About 57% always took their medication as prescribed by doctor and on time, only 2.2% always complied with dietary regimen while no one reported regular compliance with exercise regimen. Complications of the regimen was the commonest cause (63.3% of noncompliance. A highly statistically significant difference was found between compliance with all regimens and patient′s knowledge of diabetes. The scores for doctor-patient relationship were all unsatisfactory. Results of glycosylated hemoglobin (HbA1c revealed that metabolic control of four-fifth of the patients was satisfactory, 12% had fair and 8% had poor metabolic control. Conclusions: Patient′s compliance with most of the diabetes regimen was low. Doctor-patient relationship and patient′s compliance should be improved by conducting educational and training programs.

  10. Thought outside the box: intensive care unit freakonomics and decision making in the intensive care unit.

    Science.gov (United States)

    Mohan, Deepika; Angus, Derek C

    2010-10-01

    Despite concerted efforts to improve the quality of care provided in the intensive care unit, inconsistency continues to characterize physician decision making. The resulting variations in care compromise outcomes and impose unnecessary decisional regret on clinicians and patients alike. Critical care is not the only arena where decisions fail to conform to the dictates of logic. Behavioral psychology uses scientific methods to analyze the influence of social, cognitive, and emotional factors on decisions. The overarching hypothesis underlying this "thought outside the box" is that the application of behavioral psychology to physician decision making in the intensive care unit will demonstrate the existence of cognitive biases associated with classic intensive care unit decisions; provide insight into novel strategies to train intensive care unit clinicians to better use data; and improve the quality of decision making in the intensive care unit as characterized by more consistent, patient-centered decisions with reduced decisional regret and work-related stress experienced by physicians.

  11. Development of a mobile HIS/PACS workstation to assist critical cardiac patients in an intensive care unit

    Science.gov (United States)

    Gutierrez, Marco A.; Cestari, Idagene A.; Hamamoto, Gina; Bacht, Simão; Rebelo, Marina S.; Silva, João E. M. M.; Lage, Silvia G.

    2008-03-01

    The current study describes the experience in the implementation of a mobile HIS/PACS workstation to assist critical cardiac patients in an Intensive Care Unit (ICU). Recently, mobile devices connected to a WiFi network were incorporated to the Hospital information System, providing the same functionalities of common desktop counterpart. However, the use of commercially devices like PDAs and Pocket PCs presented a series of problems that are more emphasized in the ICUs 1) low autonomy of the batteries, which need constant recharges; 2) low robustness of the devices; 3) insufficient display area to show medical images and vital signals; 4) data entry remains a major problem and imposes an extra time consumption to the staff; 5) high cost when fully equipped with WiFi connection, optical reader to access bar codes and memory. To address theses problems we developed a mobile workstation (MedKart) that provides access the HIS and PACS systems, with all resources and an ergonomic and practical design to be used by physicians and nurses inside the ICU. The system fulfills the requirements to assist, in the point-of-care, critical cardiac patients in Intensive Care Units.

  12. The Effects of Scheduled Visitation on the Physiological Indices of Conscious Patients Admitted at intensive Care Units

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    Hojat Rezaie

    2015-12-01

    Full Text Available Background: Visitation of patients admitted at intensive care units (ICUs is a controversial issue in the field of health care. It is commonly believed that the presence of family members might bring about physiological changes, such as tachycardia and hypertension, in ICU patients. Aim: This study aimed to evaluate the effects of scheduled visitation on the physiological indices of conscious patients at the ICU. Method: This experimental study was conducted on 90 conscious patients admitted at the ICU of Ganjavian Hospital in Dezful, Iran in 2014. Patients were randomly divided into two groups of intervention and control. In the control group, patient visits were carried out in accordance with normal procedures of the ward. In the intervention group, patients were visited by relatives and family members for 30 minutes, preferably in evening shifts. Physiological indices of the patients were recorded before, during and after scheduled visitation. Data analysis was performed in SPSS V.18 using independent T-test and one-way ANOVA with repeated measures. Results: In this study, mean age of patients in the intervention and control groups was 42.1±19.1 and 39.4±19.6 years, respectively. In the intervention group, systolic blood pressure had a more significant reduction at 10 and 30 minutes after visitation compared to the control group (independent T-test, P0.05. Implications for Practice: According to the results of this study, scheduled visitation by family members caused no significant differences in the physiological indices of ICU patients. It is recommended that future studies be conducted as to confirm this finding and revise patient visitation policies in hospitals.

  13. Acupuncture and Traditional Herbal Medicine Therapy Prevent Deliriumin Patients with Cardiovascular Disease in Intensive Care Units.

    Science.gov (United States)

    Matsumoto-Miyazaki, Jun; Ushikoshi, Hiroaki; Miyata, Shusaku; Miyazaki, Nagisa; Nawa, Takahide; Okada, Hideshi; Ojio, Shinsuke; Ogura, Shinji; Minatoguchi, Shinya

    2017-02-23

    The aim of this study was to determine the effect of combination therapy consisting of acupuncture and traditional herbal medicine (Kampo medicine) for reducing the incidence rate of delirium in patients with cardiovascular (CV) disease in ICUs. Twenty-nine patients who had been urgently admitted to the ICU in the control period were treated with conventional intensive care. Thirty patients in the treatment period received conventional therapy plus a combination therapy consisting of acupuncture and herbal medicine. Acupuncture treatment was performed once a day, and the herbal formula was administered orally three times a day during the first week of the ICU stay. The standard acupuncture points were GV20, Ex-HN3, HT7, LI4, Liv3, and KI3, and the main herbal preparation was Kamikihito. The incident rates of delirium, assessed using the confusion assessment method for ICU, in the treatment and control period were compared. The incidence rate of delirium was significantly lower in the treatment group than in the control group (6.6% vs. 37.9%, [Formula: see text]). Moreover, sedative drugs and non-pharmacological approaches against aggressive behavior of patients who were delirious were used less in the treatment group than in the control group. No serious adverse events were observed in the treatment group. Combination therapy consisting of acupuncture and herbal medicine was found to be effective in lowering the incidence of delirium in patients with CV disease in ICUs. Further studies with a large sample size and parallel randomized controlled design would be required to establish the effects of this therapy.

  14. [Use of enoximone in patients with acute and subacute heart failure in the intensive care unit].

    Science.gov (United States)

    Holubarsch, C; Pieske, B; Hasenfuss, G; Just, H

    1994-01-01

    The phosphodiesterase inhibitor enoximone has both vasodilating and positive inotropic pharmacological properties. The balance between vasodilation and positive inotropism may be different between the various types of heart failure as well as the various stages of heart failure. Therefore, we investigated the effect of intravenous application of enoximone (1 mg/kg body weight) in a cohort of patients (n = 10) suffering from acute or subacute heart failure mainly due to ischemia or hypoxia. All patients had high left ventricular filling pressure, low cardiac output and were pretreated with intravenous dobutamine. Enoximone increased cardiac output from 3.2 +/- 1.2 to 5.5 +/- 2.2 l/min, increased heart rate from 94 +/- 20 to 100 +/- 18 beats/min, decreased systemic peripheral resistance from 1770 +/- 861 to 931 +/- 340 dyn.sec.cm-5 and decreased pulmonary wedge pressure from 24 +/- 5 to 20 +/- 6 mmHg, significantly. However, systolic aortic pressure, systolic pulmonary pressure and right atrial pressure were not significantly altered. We conclude that in a selected group of patients enoximone-given intravenously and acutely in the intensive care unity-can induce beneficial effects on central hemodynamics without critical falls in perfusion pressure.

  15. Development of stress ulcers assessed by gastric electrical potential difference, pH of gastric juice, and endoscopy in patients in the intensive care unit

    DEFF Research Database (Denmark)

    Rubinstein, E; Gjørup, I; Schulze, S;

    1992-01-01

    OBJECTIVE: To assess measurement of gastric electrical potential difference, pH of gastric mucosa, and endoscopic findings in patients in intensive care units who are at risk of developing stress ulcers. DESIGN: Open comparison with age- and sex-matched control subjects. SETTING: Herlev Hospital......: Gastric electrical potential difference may be useful measurement for the assessment of stress ulceration in patients in intensive care units....

  16. Prevalence of extended spectrum β-lactamase-producing clinical isolates of Klebsiella pneumoniae in intensive care unit patients of a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Sheetal Harakuni

    2011-01-01

    Full Text Available Aim: To identify the extended-spectrum β-lactamase producing Klebsiella pneumoniae (ESBL-KP isolated from intensive care unit (ICU patients of a tertiary care hospital. Materials and Methods: Seventy Klebsiella pneumoniae clinical isolates from ICU patients were screened for ESBL production. All were confirmed for ESBL production by potentiated disc diffusion test. Minimum inhibitory concentrationby agar dilution technique was performed. Sensitivity to other group of drugs was determined by Kirby-Bauer method against ciprofloxacin, amikacin, co-trimoxazole. Results: In all, 74% of the isolates were ESBL-KP; 57% were from blood samples. Coresistance to other group of drugs ranged from 63 to 83%. Conclusion: There is a high prevalence of ESBL-KP. The prompt reporting of ESBL producing bacteria is necessary to prevent their dissemination. This alarms for strict infection control measures to be practised in hospital settings.

  17. [Feelings of relatives regarding the patient who is admitted in intensive care unit].

    Science.gov (United States)

    Almeida, Andreza Santos; Aragão, Neylor Rodrigo Oliveira; Moura, Elaine; Lima, Gabriela de Carvalho; Hora, Edilene Curvelo; Silva, Lausimary Araújo São Mateus

    2009-01-01

    This is a study with qualitative approach focusing on the relatives' feelings related to the patient who is admitted in intensive care unity. Twenty-four relatives were interviewed in a public hospital in Aracaju, SE, Brazil between July and August, 2007. The information was collected through an interview and evaluated according to content analysis. The results showed the following feelings: anxiety; worry; anguish and sadness; powerless; pain and sorrow; lost; fear and panic; stress; trust and security; insecurity; faith and hope and unexplainable feelings. Anxiety was the most common one and was related to the strange environment, the diversified procedures, fear of what will happen tomorrow and expectations of their relatives to get better.

  18. Incidence of carbapenem resistant nonfermenting gram negative bacilli from patients with respiratory infections in the intensive care units

    Directory of Open Access Journals (Sweden)

    Gladstone P

    2005-01-01

    Full Text Available Resistance to carbapenems is commonly seen in nonfermenting gram negative bacilli (NFGNB. We document herein the prevalence of carbapenem resistance in NFGNB isolated from patients with respiratory tract infections in the intensive care units (ICUs. A total of 460 NFGNB were isolated from 606 endotracheal aspirate specimens during January through December 2003, of which 56 (12.2% were found to be resistant to imipenem and meropenem. Of these, 24 (42.8% were Pseudomonas aeruginosa , 8 (14.2% were Acinetobacter spp. and 24 (42.8% were other NFGNB. Stringent protocols such as antibiotic policies and resistance surveillance programs are mandatory to curb these bacteria in ICU settings.

  19. Respiratory symptoms in patients consulting at a primary health care unit of Goiania-GO

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    José Laerte Rodrigues Silva Júnior

    2014-07-01

    Full Text Available Objective: to determine the prevalence of respiratory symptoms in subjects attending a primary healthcare unit, describing the distributions of these symptoms and of risk factors for respiratory disease. Methods: a cross-sectional study was conducted on subjects attending an outpatient primary health care unit in Goiania-GO. During one year, forty-four random observations categorized by season were made. Chi-square test, analysis of variance, correlation and univariate robust regression were used to perform the statistical analyses. Results: among the 3,354 subjects enrolled, 13.7% (458/3,354 had respiratory symptoms. Cough was the most prevalent symptom, occurring in 91% (417/458 of the cases. Among all subjects, 4.8% (161/3354 had cough for more than two weeks. The proportion of respiratory symptoms (cough, dyspnea and wheezing did not differ significantly across seasons and the prevalence of respiratory symptoms in winter, autumn, summer and spring were, respectively, 20%, 14%, 11.9% and 7.4%. The average duration of cough in the elderly was significantly longer than in the other age groups (p=0,004. Smokers, former smokers, low weight subjects and subjects reporting previous pneumonia, asthma or COPD also showed longer average duration of cough, but these differences were not statistically significant. The regression model showed that the duration of cough increased with age (r2=0,08; p=0,0001. Conclusion: subjects with respiratory diseases account for a significant proportion of the demand for healthcare. The prevalence of respiratory symptoms is higher during the winter and the average duration of cough increases with age.

  20. [Prehospital management of very elderly patients with ST segment elevation in Paris by mobile intensive care units (Samu)].

    Science.gov (United States)

    Leroy, J E; Bensouda, C; Durand, E; Greffet, A; Scemama, A; Carli, P; Danchin, N; Sauval, P

    2005-03-01

    More and more elderly people are hospitalised with myocardial infarction. Little is known on their pre-hospital management. In 2001 and 2002, 105 patients aged 80 years or more with suspected ST elevation infarction were managed by the mobile intensive care unit system of the SAMU de Paris-Necker. Diagnosis of infarction was confirmed in 92 (88%). Over 60% of the patients were women. Median time delay from symptom onset to call to the emergency service was 127 minutes, longer in nonagenarians (175 vs 101 minutes). Prehospital use of aspirin was 81% and 39% received an intravenous bolus of heparin. A reperfusion strategy was decided in only 30% (primary PCI: 23/26). One-month mortality was 21% and was related to older age, time when the call to the Samu was made, and absence of current smoking. Overall, the prehospital management of very elderly patients with suspected ST elevation infarction appears far from optimal.

  1. Profile and severity of the patients of intensive care units: prospective application of the APACHE II index.

    Science.gov (United States)

    De Freitas, Eliane Regina Ferreira Sernache

    2010-01-01

    This study aimed to understand the profile and severity of patients in physiotherapy treatment after their admission to the intensive care unit (ICU) by applying the APACHE II index. One hundred and forty six subjects, with a mean age of 60.5 +/- 19.2 years, were evaluated. The APACHE II index was applied in the first 24 hours to evaluate the severity and mortality risk score. Patients were monitored until hospital discharge or death. The mean APACHE II score was 20+/-7.3 with an estimated risk of death of 32.4% and observed mortality of 58.2%. The mean hospital stay was 27.8+/-25.2 days. The patients in physiotherapy at the institution studied were predominantly male, elderly, from the emergency service for treatment (non-surgical), and had clear severity, suggested by the APACHE II score and the observed mortality.

  2. Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency's ambulatory care unit through simulation.

    Science.gov (United States)

    Santibáñez, Pablo; Chow, Vincent S; French, John; Puterman, Martin L; Tyldesley, Scott

    2009-12-01

    We consider an ambulatory care unit (ACU) in a large cancer centre, where operational and resource utilization challenges led to overcrowding, excessive delays, and concerns regarding safety of critical patient care duties. We use simulation to analyze the simultaneous impact of operations, scheduling, and resource allocation on patient wait time, clinic overtime, and resource utilization. The impact of these factors has been studied before, but usually in isolation. Further, our model considers multiple clinics operating concurrently, and includes the extra burden of training residents and medical students during patient consults. Through scenario analyses we found that the best outcomes were obtained when not one but multiple changes were implemented simultaneously. We developed configurations that achieve a reduction of up to 70% in patient wait times and 25% in physical space requirements, with the same appointment volume. The key findings of the study are the importance of on time clinic start, the need for improved patient scheduling; and the potential improvements from allocating examination rooms flexibly and dynamically among individual clinics within each of the oncology programs. These findings are currently being evaluated for implementation by senior management.

  3. Effects of Aromatherapy on the Anxiety, Vital Signs, and Sleep Quality of Percutaneous Coronary Intervention Patients in Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Mi-Yeon Cho

    2013-01-01

    Full Text Available The purpose of this study was to investigate the effects of aromatherapy on the anxiety, sleep, and blood pressure (BP of percutaneous coronary intervention (PCI patients in an intensive care unit (ICU. Fifty-six patients with PCI in ICU were evenly allocated to either the aromatherapy or conventional nursing care. Aromatherapy essential oils were blended with lavender, roman chamomile, and neroli with a 6 : 2 : 0.5 ratio. Participants received 10 times treatment before PCI, and the same essential oils were inhaled another 10 times after PCI. Outcome measures patients' state anxiety, sleeping quality, and BP. An aromatherapy group showed significantly low anxiety (t=5.99, P<.001 and improving sleep quality (t=−3.65, P=.001 compared with conventional nursing intervention. The systolic BP of both groups did not show a significant difference by time or in a group-by-time interaction; however, a significant difference was observed between groups (F=4.63, P=.036. The diastolic BP did not show any significant difference by time or by a group-by-time interaction; however, a significant difference was observed between groups (F=6.93, P=.011. In conclusion, the aromatherapy effectively reduced the anxiety levels and increased the sleep quality of PCI patients admitted to the ICU. Aromatherapy may be used as an independent nursing intervention for reducing the anxiety levels and improving the sleep quality of PCI patients.

  4. 22q11.2 deletion syndrome in patients admitted to a cardiac pediatric intensive care unit in Brazil.

    Science.gov (United States)

    Rosa, Rafael F M; Pilla, Carlo B; Pereira, Vera L B; Flores, José A M; Golendziner, Eliete; Koshiyama, Dayane B; Hertz, Michele T; Ricachinevsky, Cláudia P; Roman, Tatiana; Varella-Garcia, Marileila; Paskulin, Giorgio A

    2008-07-01

    The 22q11.2 deletion syndrome (22q11DS) is one of the most recognizable causes of congenital heart defects (CHDs), but the frequency varies in non-selected populations. The purpose of this study was to determine the incidence and clinical features of patients with CHD and 22q11DS admitted to a pediatric cardiology intensive care unit in Brazil. In a prospective study, we evaluated a consecutive series of 207 patients with a CHD following a clinical protocol and cytogenetic analysis by high resolution karyotype and fluorescent in situ hybridization (FISH). 22q11DS was identified in four patients (2%), a frequency similar to studies that evaluated subjects with major CHDs in other countries. Despite this similarity, we believe that the low rate of prenatal identification of CHDs and the limited access of these patients to appropriate diagnosis and care, which occur in our region, could have had an influence on this frequency. It is possible that 22q11DS patients with a severe CHD could have died before having a chance to access a tertiary hospital, leading to an underestimate of its frequency.

  5. Towards a wireless patient: chronic illness, scarce care and technological innovation in the United Kingdom.

    Science.gov (United States)

    May, Carl; Finch, Tracy; Mair, Frances; Mort, Maggie

    2005-10-01

    'Modernization' is a key health policy objective in the UK. It extends across a range of public service delivery and organizational contexts, and also means there are radical changes in perspective on professional behaviour and practice. New information and communications technologies have been seen as one of the key mechanisms by which these changes can be engendered. In particular, massive investment in information technologies promises the rapid distribution and deployment of patient-centred information across internal organizational boundaries. While the National Health Service (NHS) sits on the edge of a pound sterling 6 billion investment in electronic patient records, other technologies find their status as innovative vehicles for professional behaviour change and service delivery in question. In this paper, we consider the ways that telemedicine and telehealthcare systems have been constructed first as a field of technological innovation, and more recently, as management solutions to problems around the distribution of health care. We use NHS responses to chronic illness as a medium for understanding these shifts. In particular, we draw attention to the shifting definitions of 'innovation' and to the ways that these shifts define a move away from notions of technological advance towards management control.

  6. Invasive fungal infection among hematopoietic stem cell transplantation patients with mechanical ventilation in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Hung Chen-Yiu

    2012-02-01

    Full Text Available Abstract Background Invasive fungal infection (IFI is associated with high morbidity and high mortality in hematopoietic stem cell transplantation (HSCT patientsThe purpose of this study was to assess the characteristics and outcomes of HSCT patients with IFIs who are undergoing MV at a single institution in Taiwan. Methods We performed an observational retrospective analysis of IFIs in HSCT patients undergoing mechanical ventilation (MV in an intensive care unit (ICU from the year 2000 to 2009. The characteristics of these HSCT patients and risk factors related to IFIs were evaluated. The status of discharge, length of ICU stay, date of death and cause of death were also recorded. Results There were 326 HSCT patients at the Linkou Chang-Gung Memorial Hospital (Taipei, Taiwan during the study period. Sixty of these patients (18% were transferred to the ICU and placed on mechanical ventilators. A total of 20 of these 60 patients (33% had IFIs. Multivariate analysis indicated that independent risk factors for IFI were admission to an ICU more than 40 days after HSCT, graft versus host disease (GVHD, and high dose corticosteroid (p p = 0.676. Conclusion There was a high incidence of IFIs in HSCT patients requiring MV in the ICU in our study cohort. The independent risk factors for IFI are ICU admission more than 40 days after HSCT, GVHD, and use of high-dose corticosteroid.

  7. Wireless sensor and data transmission needs and technologies for patient monitoring in the operating room and intensive care unit.

    Science.gov (United States)

    Paksuniemi, M; Sorvoja, H; Alasaarela, E; Myllyla, R

    2005-01-01

    In the intensive care unit, or during anesthesia, patients are attached to monitors by cables. These cables obstruct nursing staff and hinder the patients from moving freely in the hospital. However, rapidly developing wireless technologies are expected to solve these problems. To this end, this study revealed problem areas in current patient monitoring and established the most important medical parameters to monitor. In addition, usable wireless techniques for short-range data transmission were explored and currently employed wireless applications in the hospital environment were studied. The most important parameters measured of the patient include blood pressures, electrocardiography, respiration rate, heart rate and temperature. Currently used wireless techniques in hospitals are based on the WMTS and WLAN standards. There are no viable solutions for short-range data transmission from patient sensors to patient monitors, but potentially usable techniques in the future are based on the WPAN standards. These techniques include Bluetooth, ZigBee and UWB. Other suitable techniques might be based on capacitive or inductive coupling. The establishing of wireless techniques depends on ensuring the reliability of data transmission, eliminating disturbance by other wireless devices, ensuring patient data security and patient safety, and lowering the power consumption and price.

  8. Inspiratory muscle training facilitates weaning from mechanical ventilation among patients in the intensive care unit: a systematic review

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    Mark Elkins

    2015-07-01

    Full Text Available Question: Does inspiratory muscle training improve inspiratory muscle strength in adults receiving mechanical ventilation? Does it improve the duration or success of weaning? Does it affect length of stay, reintubation, tracheostomy, survival, or the need for post-extubation non-invasive ventilation? Is it tolerable and does it cause adverse events? Design: Systematic review of randomised trials. Participants: Adults receiving mechanical ventilation. Intervention: Inspiratory muscle training versus sham or no inspiratory muscle training. Outcome measures: Data were extracted regarding: inspiratory muscle strength and endurance; the rapid shallow breathing index; weaning success and duration; duration of mechanical ventilation; reintubation; tracheostomy; length of stay; use of non-invasive ventilation after extubation; survival; readmission; tolerability and adverse events. Results: Ten studies involving 394 participants were included. Heterogeneity within some meta-analyses was high. Random-effects meta-analyses showed that the training significantly improved maximal inspiratory pressure (MD 7 cmH2O, 95% CI 5 to 9, the rapid shallow breathing index (MD 15 breaths/min/l, 95% CI 8 to 23 and weaning success (RR 1.34, 95% CI 1.02 to 1.76. Although only assessed in individual studies, significant benefits were also reported for the time spent on non-invasive ventilation after weaning (MD 16 hours, 95% CI 13 to 18, length of stay in the intensive care unit (MD 4.5 days, 95% CI 3.6 to 5.4 and length of stay in hospital (MD 4.4 days, 95% CI 3.4 to 5.5. Weaning duration decreased in the subgroup of patients with known weaning difficulty. The other outcomes weren’t significantly affected or weren’t measured. Conclusion: Inspiratory muscle training for selected patients in the intensive care unit facilitates weaning, with potential reductions in length of stay and the duration of non-invasive ventilatory support after extubation. The heterogeneity

  9. Griggs percutaneous tracheostomy without bronchoscopic guidance is a safe method: A case series of 300 patients in a tertiary care Intensive Care Unit

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    Saroj Kumar Pattnaik

    2014-01-01

    Full Text Available Introduction: Percutaneous tracheostomy (PCT is being increasingly done by intensivists for critical care unit patients requiring either prolonged ventilation and/or for airway protection. [1] Bronchoscopic guidance considered a gold standard, [2],[3] is not always possible due to logistic reasons and ventilation issues. We share our experience of Griggs PCT technique without bronchoscopic guidance with simple modifications to ensure safe execution of the procedure. Objective: The purpose of this study was to evaluate the safety issues and complications of PCT without bronchoscopic guidance in a multi-disciplinary tertiary Intensive Care Unit (ICU. Materials and Methods: A retrospective review of consecutive PCTs performed in our ICU between August 2010 and December 2013 by Griggs guide wire dilating forceps technique without bronchoscopic guidance is being presented. It is done by withdrawing endotracheal tube with inflated cuff while monitoring expired tidal volume on ventilator and ensuring the free mobility of guide wire during each step of the procedure, thereby ensuring a safe placement of the tracheostomy tube (TT in trachea. Results: Analysis of 300 PCTs showed 26 patients (8.6% had complications including 2 (0.6% patients deteriorated neurologically and 2 (0.6% deaths observed within 24 h following procedure. The median operating time was 3.5 min (range, 2.5-8 min. There were no TT placement problems in any case. Conclusion: Percutaneous tracheostomy can be safely performed without bronchoscopic guidance by adhering to simple steps as described.

  10. Comparison the efficacy of herbal mouthwash with chlorhexidine on gingival index of intubated patients in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Sahra Rezaei

    2016-01-01

    Full Text Available Background: Intubated patients in Intensive Care Unit (ICU are not able to take care of their mouth health, so they are at risk of bacterial colonization and dental plaques formation that can lead to systemic diseases such as pneumonia and gingivitis. Aims: In randomized, double-blind clinical study, the efficacy of natural herbal mouthwash containing Salvadora persica ethanol extract and Aloe vera gel was compared with chlorhexidine on gingival index (GI of intubated patients in ICU. Materials and Methods: Seventy-six intubated patients (18–64 years old with mean age 40.35 ± 13.2 in ICU were admitted to this study. The patients were randomly divided into two groups: (1 Herbal mouthwash and (2 chlorhexidine solution. Before the intervention, the GIs was measured by modified GI device into two groups. The mouth was rinsed by mouthwashes every 2–3 h for 4 days. 2 h after the last intervention, GIs were determined. Results: Along with mechanical methods, herbal mouthwash in reducing GI was statistically significant than that of chlorhexidine (P < 0.05. Conclusion: The results of this study introduce a new botanical extract mouthwash with dominant healing effects on GI (1.5 ± 0.6 higher than that of synthetic mouthwash, chlorhexidine (2.31 ± 0.73.

  11. An unusual case of corneal perforation secondary to Pseudomonas keratitis complicating a patient's surgical/trauma intensive care unit stay.

    Science.gov (United States)

    Johnson, J L; Sagraves, S G; Feild, C J; Block, E F; Cheatham, M L

    2000-10-01

    We report a case of corneal perforation secondary to bacterial keratitis caused by Pseudomonas aeruginosa in a trauma patient in our intensive care unit. A 43-year-old man was involved in a motorcycle crash and suffered multiple injuries necessitating a prolonged intensive care unit (ICU) stay. Subsequently P. aeruginosa was cultured from his sputum, blood, and open abdomen. He developed a bacterial keratitis in his right eye, which also grew P. aeruginosa. This infection rapidly progressed to corneal perforation requiring a Gunderson conjunctival flap and lateral tarsorrhaphy in addition to aggressive antibiotic treatment. At the time of discharge from the hospital the patient had the return of vision to light only in his right eye. Corneal perforation is an unusual event in the ICU. Prevention or early detection of bacterial keratitis with aggressive antibiotic treatment is needed to prevent such complications. Pseudomonas is one of the more virulent organisms that can infect the cornea and early identification is paramount for a good outcome. Management of this complicated case is discussed and the limited amount of literature on nosocomial bacterial keratitis in the ICU is reviewed.

  12. Effects of Music Intervention on State Anxiety and Physiological Indices in Patients Undergoing Mechanical Ventilation in the Intensive Care Unit.

    Science.gov (United States)

    Lee, Chiu-Hsiang; Lee, Chien-Ying; Hsu, Ming-Yi; Lai, Chiung-Ling; Sung, Yi-Hui; Lin, Chung-Ying; Lin, Long-Yau

    2017-03-01

    Patients in intensive care units (ICUs) often experience stress and anxiety. Although stress and anxiety can be pharmacologically attenuated, some drugs cause adverse side effects such as bradycardia, immobility, and delirium. There is thus a need for an alternative treatment with no substantial adverse effects. Music intervention is a potential alternative. In the present study, we used cortisol levels, subjective questionnaires, and physiological parameters to explore the anxiety-reducing effects of music intervention in a sample of ICU patients on mechanical ventilation. Patients admitted to the ICU for ≥ 24 hr were randomly assigned to the music intervention ( n = 41) or control group ( n = 44). Music group patients individually listened to music from 4:00 to 4:30 p.m.; control group patients wore headphones but heard no music for the same 30 min. Anxiety was measured using serum cortisol levels, the Chinese Version of the State-Trait Anxiety Inventory, the Visual Analogue Scale for Anxiety, heart rate, and blood pressure. After adjusting for demographics, analysis of covariance showed that the music group had significantly better scores for all posttest measures ( p < .02) and pre-post differences ( p < .03) except for diastolic blood pressure. Because of music intervention's low cost and easy administration, clinical nurses may want to use music to reduce stress and anxiety for ICU patients. A single 30-min session might work immediately without any adverse effects. However, the duration of the effect is unclear; thus, each patient's mood should be monitored after the music intervention.

  13. The epidemiological profile of pediatric patients admitted to the general intensive care unit in an Ethiopian university hospital

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    Abebe T

    2015-01-01

    Full Text Available Teshome Abebe, Mullu Girmay, Girma G/Michael, Million Tesfaye Department of Anesthesia, Jimma University, Jimma, Ethiopia Background: In least developing countries, there are few data on children's critical care. This makes the provision of aid and improvement of outcome difficult. Objectives: To describe admission and outcome patterns of children managed in a general intensive care unit at Jimma University Specialized Hospital (JUSH, Ethiopia, over a 5-year period. Methods: A retrospective cross-sectional study design was used. All children from birth to 14 years of age who were admitted to the general ICU of the hospital from 2009–2013 were included. Patient charts and ICU documentation log were reviewed. Results: A total of 170 children were admitted to the ICU of JUSH over the study period. The greater share was taken by males (54.7%, with a male-to-female ratio of 1.2:1. The overall mortality rate was 40%. The majority of the children were in the age range of 10–14 years (38.8%. Of the total number of patients admitted, 34.7% were trauma cases, 45.8% of whom died. The highest percentage, 69.5%, of trauma patients were admitted for head injuries. Among the trauma cases, burn and polytrauma were the second and third leading causes (15.3% of admission. Postoperative patients and medical patients accounted for the rest of the admitted cases (28.2% and 27.6% of the cases respectively. Conclusion: The leading cause of admission and death was trauma. Postoperative and medical causes of admission were also significant. The mortality rate in the ICU was very high, and this could be due to various factors. Further research benchmarking and interventions are highly recommended. Keywords: trauma, critical care, pediatric, ICU, ventilation, oxygenation

  14. Nurses' Knowledge and Responsibility toward Nutritional Assessment for Patients in Intensive Care Units

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    Mahmoud Al Kalaldeh

    2014-09-01

    Full Text Available Introduction: Nutritional assessment is a prerequisite for nutritional delivery. Patients in intensive care suffer from under-nutrition and nutritional failure due to poor assessment. Nursing ability to early detect nutritional failure is the key for minimizing imparities in practice and attaining nutritional goals. Aim of this article is to examine the ability of Jordanian ICU nurses to assess the nutritional status of critically ill patients, considering biophysical and biochemical measures.Methods: This cross sectional study recruited nurses from different health sectors in Jordan. ICU nurses from the governmental sector (two hospitals and private sectors (two hospitals were surveyed using a self-administered questionnaire. Nurses' knowledge and responsibility towards nutritional assessment were examined.Results: A total of 220 nurses from both sectors have completed the questionnaire. Nurses were consistent in regard to knowledge, responsibility, and documentation of nutritional assessment. Nurses in the governmental hospitals inappropriately perceived the application of aspiration reduction measures. However, they scored higher in applying physical examination and anthropometric assessment.  Although both nurses claimed higher use of biochemical measurements, biophysical measurements were less frequently used. Older nurses with longer clinical experience exhibited better adherence to biophysical measurement than younger nurses.Conclusion: Nursing nutritional assessment is still suboptimal to attain nutritional goals. Assessment of body weight, history of nutrition intake, severity of illness, and function of gastrointestinal tract should be considered over measuring albumin and pre-albumin levels.  A well-defined evidence-based protocol as well as a multidisciplinary nutritional team for nutritional assessment is the best to minimize episodes of under-nutrition.

  15. Hyperglycemia at admission and during hospital stay are independent risk factors for mortality in high risk cardiac patients admitted to an intensive cardiac care unit

    NARCIS (Netherlands)

    J.A. Lipton (Jonathan); R. Barendse (Rj); R.T. van Domburg (Ron); A.F.L. Schinkel (Arend); H. Boersma (Eric); M.L. Simoons (Maarten); K.M. Akkerhuis (Martijn)

    2013-01-01

    textabstractAims: Hyperglycemia is associated with increased mortality in cardiac patients. However, the predictive value of admission- and average glucose levels in patients admitted to an intensive cardiac care unit (ICCU) has not been described. Methods: Observational study of patients admitted t

  16. Elevation of a patient's trunk and legs does not influence length of stay in the post-anesthesia care unit

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    Otávio Omati

    Full Text Available CONTEXT: Patient recovery time after anesthesia depends on problem-oriented monitoring and individual assessment. OBJECTIVE: To investigate the influence of patient positioning on post-anesthesia recovery time. TYPE OF STUDY: Retrospective. SETTING: Post-anesthesia care unit, Hospital das Clínicas, São Paulo. METHODS: Data were obtained from patients recovering from anesthesia in a supine horizontal position or with their trunk and legs elevated at 30 degrees. Data were recorded every 30 minutes. The start time was considered to be the admission to the unit, and the final measurement was taken when the patient reached an Aldrete-Kroulik index of 10. The length of time until discharge was recorded. RESULTS: 442 patients recovering after general (n = 274 or regional anesthesia (n = 168 were assigned to be kept in a supine position or with their trunk and legs elevated. There was no difference in the medians for non-parametric results, between supine position (75 min, n = 229 and trunk and legs elevated (70 min, n = 213; p = 0.729. Patients recovered faster from regional anesthesia with trunk and legs elevated (70 min than in the supine position (84.5 min, although not significantly (p = 0.097. There was no difference between patients recovering from general anesthesia, no matter the positioning (70 min; p = 0.493. DISCUSSION: Elevated legs may supposedly improve venous return and cardiac output since spinal anesthesia blocks sympathetic system and considering leg-raising has been shown to improve cardiac output from hipovolemia. Our findings did not support this hypothesis. Some limitations included a retrospective collection of data that did not allow randomization for recovery position and the unregistered duration of the exposure to the anesthetic drugs. CONCLUSIONS: There was no difference in anesthesia recovery time in relation to positioning patients supinely or with trunk and legs elevated.

  17. Characteristics and prognoses of patients treated by an anaesthesiologist-manned prehospital emergency care unit. A retrospective cohort study

    DEFF Research Database (Denmark)

    Mikkelsen, Søren; Lossius, Hans Morten; Toft, Palle

    2017-01-01

    public health planning, we describe the workload of a prehospital anaesthesiologist-manned mobile emergency care unit (MECU) and the total population it services in terms of factors associated with mortality. PARTICIPANTS: The study is a register-based study investigating all missions carried out......OBJECTIVE: When planning and dimensioning an emergency medical system, knowledge of the population serviced is vital. The amount of literature concerning the prehospital population is sparse. In order to add to the current body of literature regarding prehospital treatment, thus aiding future....... PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measures were number of missions and number of patient contacts. Secondary patient variables were mortality and association between mortality and age, sex, comorbidity, prior admission to hospital and response time. RESULTS: The MECU completed 41 513...

  18. SAPS 3, APACHE IV or GRACE: which score to choose for acute coronary syndrome patients in intensive care units?

    Science.gov (United States)

    Nassar Junior, Antonio Paulo; Mocelin, Amilcar Oshiro; Andrade, Fabio Moreira; Brauer, Leonardo; Giannini, Fabio Poianas; Nunes, Andre Luiz Baptiston; Dias, Carlos Augusto

    2013-01-01

    CONTEXT AND OBJECTIVE Acute coronary syndromes (ACS) are a common cause of intensive care unit (ICU) admission. Specific prognostic scores have been developed and validated for ACS patients and, among them, GRACE (Global Registry of Acute Coronary Events) has had the best performance. However, intensive care clinicians generally use prognostic scores developed from heterogeneous populations of critically ill patients, such as APACHE IV (Acute Physiologic and Chronic Health Evaluation IV) and SAPS 3 (Simplified Acute Physiology Score 3). The aim of this study was to evaluate and compare the performance of these three scores in a non-selected population of ACS cases. DESIGN AND SETTING Retrospective observational study to evaluate three prognostic scores in a population of ACS patients admitted to three general ICUs in private hospitals in São Paulo. METHODS All patients with ACS admitted from July 2008 to December 2009 were considered for inclusion in the study. Score calibration and discrimination were evaluated in relation to predicting hospital mortality. RESULTS A total of 1065 patients were included. The calibration was appropriate for APACHE IV and GRACE but not for SAPS 3. The discrimination was very good for all scores (area under curve of 0.862 for GRACE, 0.860 for APACHE IV and 0.804 for SAPS 3). CONCLUSIONS In this population of ACS patients admitted to ICUs, GRACE and APACHE IV were adequately calibrated, but SAPS 3 was not. All three scores had very good discrimination. GRACE and APACHE IV may be used for predicting mortality risk among ACS patients.

  19. SAPS 3, APACHE IV or GRACE: which score to choose for acute coronary syndrome patients in intensive care units?

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    Antonio Paulo Nassar Junior

    Full Text Available CONTEXT AND OBJECTIVE Acute coronary syndromes (ACS are a common cause of intensive care unit (ICU admission. Specific prognostic scores have been developed and validated for ACS patients and, among them, GRACE (Global Registry of Acute Coronary Events has had the best performance. However, intensive care clinicians generally use prognostic scores developed from heterogeneous populations of critically ill patients, such as APACHE IV (Acute Physiologic and Chronic Health Evaluation IV and SAPS 3 (Simplified Acute Physiology Score 3. The aim of this study was to evaluate and compare the performance of these three scores in a non-selected population of ACS cases. DESIGN AND SETTING Retrospective observational study to evaluate three prognostic scores in a population of ACS patients admitted to three general ICUs in private hospitals in São Paulo. METHODS All patients with ACS admitted from July 2008 to December 2009 were considered for inclusion in the study. Score calibration and discrimination were evaluated in relation to predicting hospital mortality. RESULTS A total of 1065 patients were included. The calibration was appropriate for APACHE IV and GRACE but not for SAPS 3. The discrimination was very good for all scores (area under curve of 0.862 for GRACE, 0.860 for APACHE IV and 0.804 for SAPS 3. CONCLUSIONS In this population of ACS patients admitted to ICUs, GRACE and APACHE IV were adequately calibrated, but SAPS 3 was not. All three scores had very good discrimination. GRACE and APACHE IV may be used for predicting mortality risk among ACS patients.

  20. Predictive value of SAPS II and APACHE II scoring systems for patient outcome in a medical intensive care unit

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    Amina Godinjak

    2016-11-01

    Full Text Available Objective. The aim is to determine SAPS II and APACHE II scores in medical intensive care unit (MICU patients, to compare them for prediction of patient outcome, and to compare with actual hospital mortality rates for different subgroups of patients. Methods. One hundred and seventy-four patients were included in this analysis over a oneyear period in the MICU, Clinical Center, University of Sarajevo. The following patient data were obtained: demographics, admission diagnosis, SAPS II, APACHE II scores and final outcome. Results. Out of 174 patients, 70 patients (40.2% died. Mean SAPS II and APACHE II scores in all patients were 48.4±17.0 and 21.6±10.3 respectively, and they were significantly different between survivors and non-survivors. SAPS II >50.5 and APACHE II >27.5 can predict the risk of mortality in these patients. There was no statistically significant difference in the clinical values of SAPS II vs APACHE II (p=0.501. A statistically significant positive correlation was established between the values of SAPS II and APACHE II (r=0.708; p=0.001. Patients with an admission diagnosis of sepsis/septic shock had the highest values of both SAPS II and APACHE II scores, and also the highest hospital mortality rate of 55.1%. Conclusion. Both APACHE II and SAPS II had an excellent ability to discriminate between survivors and non-survivors. There was no significant difference in the clinical values of SAPS II and APACHE II. A positive correlation was established between them. Sepsis/septic shock patients had the highest predicted and observed hospital mortality rate.

  1. Clinical course and spectrum of intensive care unit patients reactivating herpes simplex-1 virus: A retrospective analysis

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    Sundar Krishna

    2008-01-01

    Full Text Available Background : Herpes simplex-1 virus (HSV-1 reactivation in the respiratory tract is common in intensive care unit (ICU patients. However, susceptible ICU populations are poorly defined. Clinical recognition of HSV infection of the respiratory tract is difficult and the impact of such reactivation is not understood. Materials and Methods : A retrospective analysis of HSV-1 positive patients encountered over a 5-year period at a multispecialty ICU was carried out. HSV-1 was identified in respiratory secretions using a qualitative polymerase chain reaction (PCR technique. Patient charts were reviewed for clinical features that would typify HSV-1 respiratory involvement, and the morbidity and mortality risks found with HSV-1 respiratory involvement. Results : A review of 48 HSV-1 positive ICU patients showed that patients reactivating HSV in the respiratory tract fell into one of the three categories: (1 septic elderly patients with and without ARDS, (2 immunosuppressed patients, especially those receiving high-dose steroids, and (3 post-thoracotomy patients. Abnormalities suggestive of HSV-1 reactivation in the respiratory tract included, haemorrhagic or excessive respiratory secretions, concomitant orofacial herpes (42%, and bronchoscopic abnormalities (hemorrhagic ulcers and mucosal friability (83%. Twenty eight percent of the HSV-1 infected patients experienced postextubation stridor. HSV-1 reactivation was associated with extended ventilator stays, significant mortality (42%, and ventilator-associated pneumonias (52%. Conclusions : Identification of susceptible populations and definition of clinical features of HSV-1 related respiratory disease can enable diagnosis of HSV-1 infection in ICU patients. Although detection by a PCR technique can rapidly diagnose HSV-1 reactivation, prospective studies are required to clarify HSV disease versus mere shedding, and understand the impact of HSV-1 reactivation in hospitalized patients.

  2. Incidence, risk factors and prognostic factors of acute renal failure in patients admitted to an intensive care unit

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    S.E. Mataloun

    2006-10-01

    Full Text Available The objective of the present study was to assess the incidence, risk factors and outcome of patients who develop acute renal failure (ARF in intensive care units. In this prospective observational study, 221 patients with a 48-h minimum stay, 18-year-old minimum age and absence of overt acute or chronic renal failure were included. Exclusion criteria were organ donors and renal transplantation patients. ARF was defined as a creatinine level above 1.5 mg/dL. Statistics were performed using Pearsons' chi2 test, Student t-test, and Wilcoxon test. Multivariate analysis was run using all variables with P < 0.1 in the univariate analysis. ARF developed in 19.0% of the patients, with 76.19% resulting in death. Main risk factors (univariate analysis were: higher intra-operative hydration and bleeding, higher death risk by APACHE II score, logist organ dysfunction system on the first day, mechanical ventilation, shock due to systemic inflammatory response syndrome (SIRS/sepsis, noradrenaline use, and plasma creatinine and urea levels on admission. Heart rate on admission (OR = 1.023 (1.002-1.044, male gender (OR = 4.275 (1.340-13642, shock due to SIRS/sepsis (OR = 8.590 (2.710-27.229, higher intra-operative hydration (OR = 1.002 (1.000-1004, and plasma urea on admission (OR = 1.012 (0.980-1044 remained significant (multivariate analysis. The mortality risk factors (univariate analysis were shock due to SIRS/sepsis, mechanical ventilation, blood stream infection, potassium and bicarbonate levels. Only potassium levels remained significant (P = 0.037. In conclusion, ARF has a high incidence, morbidity and mortality when it occurs in intensive care unit. There is a very close association with hemodynamic status and multiple organ dysfunction.

  3. Designed sound and music environment in postanaesthesia care units--a multicentre study of patients and staff.

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    Thorgaard, Per; Ertmann, Ellen; Hansen, Vibeke; Noerregaard, Anni; Hansen, Vibeke; Spanggaard, Lene

    2005-08-01

    A multicentre study in five postanaesthesia care units (PACUs) was performed to investigate patient and staff opinion of a specially designed music environment (DME), related to geographical location. Patients (325) and staff (91) described their opinion by means of a questionnaire-anonymously in the case of staff. Patients were not asked beforehand for permission to play music. Amongst patients 267 (83%) found the sound environment with DME pleasant or very pleasant, 26 (6%) found it unpleasant, whereas 32 (11%) answered "no opinion". The opinion of the patients did not differ significantly with geographical location. A strong correlation (P<0.05) between a positive attitude towards DME and degree of relaxation and satisfaction with stay was found. The staff had an equally positive attitude towards the DME; but theirs varied significantly with location. The opinion of the staff was more similar concerning the beneficial effect on working conditions and distress, but varied still significantly. The opinion of the staff had no demonstrable impact on that of the patients.

  4. Continuous versus intermittent administration of piperacillin-tazobactam in intensive care unit patients with ventilator-associated pneumonia

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    Fanak Fahimi

    2012-01-01

    Full Text Available Background and Aims: Ventilator-associated pneumonia (VAP is one of the most common Intensive Care Unit (ICU-acquired infection. The aim of this study was to compare the clinical outcome of continuous and intermittent administration of piperacillin-tazobactam by serial measurements of the Clinical Pulmonary Infection Score (CPIS. Subjects and Methods: Groups were designed as parallel and the study was designed as quasi-experimental and conducted at a semi-closed ICU between September 2008 and May 2010. Patients received 3.375 g (piperacillin 3 g/tazobactam 0.375 g either through intermittent infusion every 6 h for 30 min [Intermittent Infusion (II group; n = 30] or through continuous infusion every 8 h for 4 h [Continuous Infusion (CI group; n = 31]. CPIS was used to assess the clinical diagnosis and outcome of VAP patients. Results: Sex, age, Acute Physiology and Chronic Health Evaluation II II score on ICU admission, diagnosis and underlying disease of VAP patients were not significantly different in the CI (n = 31 and II (n = 30 groups. Duration of mechanical ventilation, length of stay, total number of antibiotics used per patient and duration of piperacillin/tazobactam treatment were similar in both groups. Mortality rates of VAP patients were similar between both groups during hospitalization. Conclusion: There was no significant difference in clinical outcomes of patients receiving piperacillin-tazobactam via CI or II when measured by serial CPIS score.

  5. Searching for predictors of surgical complications in critically ill surgery patients in the intensive care unit: a review.

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    Meyer, Zainna C; Schreinemakers, Jennifer M J; de Waal, Ruud A L; van der Laan, Lijckle

    2015-09-01

    We reviewed the use of the levels of C-reactive protein, lactate and procalcitonin and/or the Sequential Organ Failure Assessment score to determine their diagnostic accuracy for predicting surgical complications in critically ill general post-surgery patients. Included were all studies published in PubMed from inception to July 2013 that met the following inclusion criteria: evaluation of the above parameters, describing their diagnostic accuracy and the risk stratification for surgical complications in surgical patients admitted to an intensive care unit. No difference in the Sequential Organ Failure Assessment scores was seen between patients with or without complications. The D-lactate levels were significantly higher in those who developed colonic ischemic complications after a ruptured abdominal aortic aneurysm. After gastro-intestinal surgery, contradictory data were reported, with both positive and negative use of C-reactive protein and procalcitonin in the diagnosis of septic complications. However, in trauma patients, the C-reactive protein levels may help to discriminate between those with and without infectious causes. We conclude that the Sequential Organ Failure Assessment score, lactate concentration and C-reactive protein level have no significant predictive value for early postoperative complications in critically ill post-surgery patients. However, procalcitonin seems to be a useful parameter for diagnosing complications in specific patient populations after surgery and/or after trauma.

  6. Admitting acute ischemic stroke patients to a stroke care monitoring unit versus a conventional stroke unit : a randomized pilot study

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    Sulter, Geert; Elting, Jan Willem; Langedijk, Marc; Maurits, Natasha M; De Keyser, Jacques

    2003-01-01

    BACKGROUND AND PURPOSE: Pathophysiological considerations and observational studies indicate that elevated body temperature, hypoxia, hypotension, and cardiac arrhythmias in the acute phase of ischemic stroke may aggravate brain damage and worsen outcome. METHODS: Both units were organized with the

  7. Neurological Sequels and Their Causes in Patients Hospitalized in the Toxicology Intensive Care Unit of Bahraloo Hospital, Tehran, Iran

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    Taghadosi Nejad

    2015-05-01

    Full Text Available Background The occurrence of neurologic complications in the intensive care units (ICUs is one of the major risks in management of patients. These sequels may be caused by structural or metabolic disorders. The same phenomenon can be seen in the toxicology ICUs, although the toxicological effects of drugs and poisons may also cause the neurological complications. Objectives This study aimed to determine the frequency of neurological sequels and their causes in patients hospitalized in the toxicology ICUs. Patients and Methods In this descriptive study, the data of patients admitted in toxicology ICU of Baharloo Hospital, Tehran, Iran, were investigated during a 2-year period (2010 ‒ 2011 and the patients with neurological sequels, based on neurological examination or brain computed tomography (CT scan findings, were included. Data recorded in questionnaires were analyzed by means of SPSS software, with a significance level at P < 0.05. Results Out of 1571 patients admitted in toxicology ICU during this period, 56 patients (3.56%, with the mean ± SD age of 36 ± 13.01 years, were included. The most common finding in neurological examination was the Babinski sign (67.9%. Ischemic encephalopathy with brain edema was the most common finding on the brain CT scans of these patients (33.9%. The mortality rate was 58.9% (33 out of 56. Thirteen patients (23.2% were discharged with vegetative state. The most common cause of neurological sequel, in this study, was hypoxia (64.3% Conclusions This study, for the first time in Iran, investigated the frequency and cause of neurological sequels in toxicology ICUs. The findings can improve the prophylaxis and diagnostic programs for the patients in this field.

  8. Epidemiological features and risk factors of sepsis-associated encephalopathy in intensive care unit patients: 2008-2011

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    ZHANG Li-na; WANG Xiao-ting; AI Yu-hang; GUO Qu-lian; HUANG Li; LIU Zhi-yong; Yao Bo

    2012-01-01

    Background Encephalopathy is a common complication of sepsis,and its onset can occur at any stage of sepsis and implies worse prognosis.However,the incidence,epidemiology,and pathogenesis of sepsis-associated encephalopathy remain controversial.The purpose of this study was to investigate the epidemiological features and risk factors for sepsis-associated encephalopathy.Methods Our retrospective study included all patients with sepsis admitted to our intensive care unit from 2008 to 2011.After excluding 91 patients,232 patients were assigned to either a sepsis-associated encephalopathy group or sepsis without encephalopathy group.Between-group differences in baseline patient data including vital signs,disease severity,pathogens,sites of infection,biochemical indicators,and time on a mechanical ventilator,intensive care unit (ICU) stay,and 28-day mortality rate were analyzed.Results The incidence of sepsis-associated encephalopathy was 17.7%.The sepsis-associated encephalopathy group had significantly higher 28-day mortality (56.1% vs.35.1%; P=0.013),spent a significantly longer time on a ventilator ((8.2±2.2) days vs.(2.9±0.4) days; P=0.021),and had a significantly longer ICU stay ((12.4±2.4) days vs.(7.1±0.6) days;P=0.042).Acute physiology and chronic health evaluation Ⅱ score,Glasgow coma scale,heart rate,blood lactate,serum sodium,platelets,serum albumin,and pH values were related to the presence of encephalopathy.Patients with biliary tract infections and intestinal infections caused by Staphylococcus aureus,Enterococcus faecium,Acinetobacter spp,Pseudomonas aeruginosa,and Stenotrophomonas maltophilia,were more prone to develop sepsis-associated encephalopathy.Conclusions Encephalopathy increases mortality rate in septic patients.Clinical intervention to reduce risk factors and thereby morbidity and mortality depends on a correct understanding of the differences between patients with sepsis and patients with both sepsis and encephalopathy.

  9. Long-term consequences of an intensive care unit stay in older critically ill patients: design of a longitudinal study

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    Hantikainen Virpi

    2011-09-01

    Full Text Available Abstract Background Modern methods in intensive care medicine often enable the survival of older critically ill patients. The short-term outcomes for patients treated in intensive care units (ICUs, such as survival to hospital discharge, are well documented. However, relatively little is known about subsequent long-term outcomes. Pain, anxiety and agitation are important stress factors for many critically ill patients. There are very few studies concerned with pain, anxiety and agitation and the consequences in older critically ill patients. The overall aim of this study is to identify how an ICU stay influences an older person's experiences later in life. More specific, this study has the following objectives: (1 to explore the relationship between pain, anxiety and agitation during ICU stays and experiences of the same symptoms in later life; and (2 to explore the associations between pain, anxiety and agitation experienced during ICU stays and their effect on subsequent health-related quality of life, use of the health care system (readmissions, doctor visits, rehabilitation, medication use, living situation, and survival after discharge and at 6 and 12 months of follow-up. Methods/Design A prospective, longitudinal study will be used for this study. A total of 150 older critically ill patients in the ICU will participate (ICU group. Pain, anxiety, agitation, morbidity, mortality, use of the health care system, and health-related quality of life will be measured at 3 intervals after a baseline assessment. Baseline measurements will be taken 48 hours after ICU admission and one week thereafter. Follow-up measurements will take place 6 months and 12 months after discharge from the ICU. To be able to interpret trends in scores on outcome variables in the ICU group, a comparison group of 150 participants, matched by age and gender, recruited from the Swiss population, will be interviewed at the same intervals as the ICU group. Discussion Little

  10. High target attainment for β-lactam antibiotics in intensive care unit patients when actual minimum inhibitory concentrations are applied.

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    Woksepp, H; Hällgren, A; Borgström, S; Kullberg, F; Wimmerstedt, A; Oscarsson, A; Nordlund, P; Lindholm, M-L; Bonnedahl, J; Brudin, L; Carlsson, B; Schön, T

    2017-03-01

    Patients in the intensive care unit (ICU) are at risk for suboptimal levels of β-lactam antibiotics, possibly leading to poor efficacy. Our aim was to investigate whether the actual minimum inhibitory concentration (MIC) compared to the more commonly used arbitrary epidemiological cut-off values (ECOFFs) would affect target attainment in ICU patients on empirical treatment with broad-spectrum β-lactam antibiotics and to identify risk factors for not reaching target. In a prospective, multicenter study, ICU patients ≥18 years old and treated with piperacillin/tazobactam, meropenem, or cefotaxime were included. Clinical and laboratory data were recorded. Serum trough antibiotic levels from three consecutive days were analyzed by liquid chromatography-mass spectrometry (LC-MS). The target was defined as the free trough concentration above the MIC (100% fT>MIC). MICECOFF was used as the target and, when available, the actual MIC (MICACTUAL) was applied. The median age of the patients was 70 years old, 52% (58/111) were males, and the median estimated glomerular filtration rate (eGFR) was 48.0 mL/min/1.73 m(2). The rate of patients reaching 100% fT > MICACTUAL was higher (89%, 31/35) compared to the same patients using MICECOFF (60%, p = 0.002). In total, 55% (61/111) reached 100% fT > MICECOFF. Increased renal clearance was independently associated to not reaching 100% fT > MICECOFF. On repeated sampling, >77% of patients had stable serum drug levels around the MICECOFF. Serum concentrations of β-lactam antibiotics vary extensively between ICU patients. The rate of patients not reaching target was markedly lower for the actual MIC than when the arbitrary MIC based on the ECOFF was used, which is important to consider in future studies.

  11. Value of abdominal CT in patients of the surgical intensive care unit; Stellenwert der abdominellen CT bei chirurgischen Intensivpatienten

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    Rieger, J. [Abt. fuer Radiologie, Klinikum Innenstadt, Ludwig-Maximilians-Universitaet, Muenchen (Germany); Kerner, T. [Abt. fuer Chirurgie, Klinikum Innenstadt, Ludwig-Maximilians-Universitaet, Muenchen (Germany); Waydhas, C. [Abt. fuer Chirurgie, Klinikum Innenstadt, Ludwig-Maximilians-Universitaet, Muenchen (Germany); Schenk, F. [Abt. fuer Radiologie, Klinikum Innenstadt, Ludwig-Maximilians-Universitaet, Muenchen (Germany); Pfeifer, K.J. [Abt. fuer Radiologie, Klinikum Innenstadt, Ludwig-Maximilians-Universitaet, Muenchen (Germany)

    1996-09-01

    The purpose of the retrospective study reported was to examine the indications, findings and therapeutic consequences of 88 consecutive CT examinations of the abdomen of 62 patients of a surgical intensive care unit. The CT examinations were performed within 12 hours following indication. The most frequent indications were sepsis with suspected intra-abdominal foci (72.7%), suspected lesion of intra-abdominal organs due to a serious accident (13.6%), and acutely necrotising pancreatitis (11.4%). Clinically relevant findings were obtained in 71.6% of the patients, in 43.2% the decision was for invasive treatment (of 38 patients, 28 treated by surgery, and 10 by other interventional measures) within 48 hours, which meant an essential modification of hitherto planned treatment. Patients with a high MOF score (>5) exhibited a significantly higher rate of pathologic findings than patients with a low MOF score (0-2). In the cases of suspected organ lesions, CT did not add any further information. (orig./MG)

  12. Psychometric properties of the patient assessment of chronic illness care measure: acceptability, reliability and validity in United Kingdom patients with long-term conditions

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    Rick Jo

    2012-08-01

    Full Text Available Abstract Background The Patient Assessment of Chronic Illness Care (PACIC is a US measure of chronic illness quality of care, based on the influential Chronic Care Model (CCM. It measures a number of aspects of care, including patient activation; delivery system design and decision support; goal setting and tailoring; problem-solving and contextual counselling; follow-up and coordination. Although there is developing evidence of the utility of the scale, there is little evidence about its performance in the United Kingdom (UK. We present preliminary data on the psychometric performance of the PACIC in a large sample of UK patients with long-term conditions. Method We collected PACIC, demographic, clinical and quality of care data from patients with long-term conditions across 38 general practices, as part of a wider longitudinal study. We assess rates of missing data, present descriptive and distributional data, assess internal consistency, and test validity through confirmatory factor analysis, and through associations between PACIC scores, patient characteristics and related measures. Results There was evidence that rates of missing data were high on PACIC (9.6% - 15.9%, and higher than on other scales used in the same survey. Most PACIC sub-scales showed reasonable levels of internal consistency (alpha = 0.68 – 0.94, responses did not demonstrate high skewness levels, and floor effects were more frequent (up to 30.4% on the follow up and co-ordination subscale than ceiling effects (generally Conclusion The importance of improving care for long-term conditions means that the development and validation of measures is a priority. The PACIC scale has demonstrated potential utility in this regard, but further assessment is required to assess low levels of completion of the scale, and to explore the performance of the scale in predicting outcomes and assessing the effects of interventions.

  13. An antibiotic decision-making tool for patients with pneumonia admitted to a medical intensive care unit.

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    Huang, Sheng-Feng; Chang, Jung-San; Sheu, Chau-Chyun; Liu, Yu-Ting; Lin, Ying-Chi

    2016-09-01

    Pneumonia is a leading cause of death in medical intensive care units (MICUs). Delayed or inappropriate antibiotic therapy largely increases morbidity and mortality. Multidrug-resistant (MDR) micro-organisms are major reasons for inappropriate antibiotic use. Currently there is no good antibiotic decision-making tool designed for critically ill patients. The objective of this study was to develop a convenient MDR prediction scoring system for patients admitted to MICUs with pneumonia. A retrospective cohort study was conducted using databases and chart reviews of pneumonia patients admitted to a 30-bed MICU from 2012 to 2013. Forward logistic regression was applied to identify independent MDR risk factors for prediction tool development. A total of 283 pneumonia episodes from 263 patients with positive cultures from blood or respiratory secretions were recruited, of which 154 (54.4%) were MDR episodes. Long-term ventilation (OR = 11.09; P = 0.026), residence in a long-term care facility (OR = 2.50; P = 0.005), MDR infection/colonisation during the preceding 90 days (OR = 2.08; P = 0.041), current hospitalisation ≥2 days (OR = 1.98; P = 0.019) and stroke (OR = 1.81; P = 0.035) were identified as independent predictors for MDR pneumonia. The area under the ROC curve of this prediction tool was much higher than that of ATS/IDSA classification (0.69 vs. 0.54; P <0.001). The prediction accuracy of this tool with risk score ≥1 for MDR infections was 63.7%. This simple five-item, one-step scoring tool for critically ill patients admitted to the MICU could help physicians provide timely appropriate empirical antibiotics.

  14. CLINICAL PRESENTATION, RADIOLOGICAL FEATURES AND COURSE OF THE DISEASE IN SWINE FLU POSITIVE PATIENTS ADMITTED IN THE RESPIRATORY INTENSIVE CARE UNIT OF A TERTIARY CARE HOSPITAL

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    Aruna

    2015-06-01

    Full Text Available BACKGROUND : Since the 2009 pandemic of H1N1 or Swine Flu influenza , there have been respiratory emergencies every year throughout India , but in the early part of this year that is between January and April 2015 an explosion of cases was seen throughout the country , and so also in our state , Andhra Pradesh. The study of clinical presentation , radiological features and course of the disease helps in early suspicion , isolation , detection and institution of treatment in swine flu positive patients so that further spread of the disease can be co ntrolled and the patients saved . MATERIAL AND METHODS : This is a cross - sectional study conducted at the Department of Pulmonary Medicine , S.V.R.R. Govt. General Hospital , Tirupathi , between January 2015 and April 2015. Study sample was the total number of swine flu suspects who were admitted in the Respiratory Intensive Care Unit and swine flu wards of the Department of Pulmonary Medicine. SUMMARY : Out of 32 suspects admitted , 13 tested positive for swine flu. 8 of the 13 were females (61% and 5 were males (39%. Cold , cough and breathlessness were present in all the patients (100%. Sore throat was present in only 4 patients (30%. 11 out of the 13 patients were in respiratory failure (85%. 9 out of the 13 had comorbidities like diabetes , bronchial asthma and chronic kidney disease (70%. Chest X - ray and CT chest showed ARDS like pic ture and pneumonia in 11 out of the 13 patients (85%.

  15. Clinical factors associated with a Candida albicans Germ Tube Antibody positive test in Intensive Care Unit patients

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    Martín-Mazuelos Estrella

    2011-03-01

    Full Text Available Abstract Background Poor outcomes of invasive candidiasis (IC are associated with the difficulty in establishing the microbiological diagnosis at an early stage. New scores and laboratory tests have been developed in order to make an early therapeutic intervention in an attempt to reduce the high mortality associated with invasive fungal infections. Candida albicans IFA IgG has been recently commercialized for germ tube antibody detection (CAGTA. This test provides a rapid and simple diagnosis of IC (84.4% sensitivity and 94.7% specificity. The aim of this study is to identify the patients who could be benefited by the use of CAGTA test in critical care setting. Methods A prospective, cohort, observational multicentre study was carried out in six medical/surgical Intensive care units (ICU of tertiary-care Spanish hospitals. Candida albicans Germ Tube Antibody test was performed twice a week if predetermined risk factors were present, and serologically demonstrated candidiasis was considered if the testing serum dilution was ≥ 1:160 in at least one sample and no other microbiological evidence of invasive candidiasis was found. Results Fifty-three critically ill non-neutropenic patients (37.7% post surgery were included. Twenty-two patients (41.5% had CAGTA-positive results, none of them with positive blood culture for Candida. Neither corrected colonization index nor antifungal treatment had influence on CAGTA results. This finding could corroborate that the CAGTA may be an important biomarker to distinguish between colonization and infection in these patients. The presence of acute renal failure at the beginning of the study was more frequent in CAGTA-negative patients. Previous surgery was statistically more frequent in CAGTA-positive patients. Conclusions This study identified previous surgery as the principal clinical factor associated with CAGTA-positive results and emphasises the utility of this promising technique, which was not

  16. Improving Resident Communication in the Intensive Care Unit. The Proceduralization of Physician Communication with Patients and Their Surrogates.

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    Miller, David C; McSparron, Jakob I; Clardy, Peter F; Sullivan, Amy M; Hayes, Margaret M

    2016-09-01

    Effective communication between providers and patients and their surrogates in the intensive care unit (ICU) is crucial for delivery of high-quality care. Despite the identification of communication as a key education focus by the American Board of Internal Medicine, little emphasis is placed on teaching trainees how to effectively communicate in the ICU. Data are conflicting on the best way to teach residents, and institutions vary on their emphasis of communication as a key skill. There needs to be a cultural shift surrounding the education of medical residents in the ICU: communication must be treated with the same emphasis, precision, and importance as placing a central venous catheter in the ICU. We propose that high-stakes communications between physicians and patients or their surrogates must be viewed as a medical procedure that can be taught, assessed, and quality controlled. Medical residents require training, observation, and feedback in specific communication skill sets with the goal of achieving mastery. It is only through supervised training, practice in real time, observation, and feedback that medical residents can become skillful practitioners of communication in the ICU.

  17. Postoperative nutrition practices in abdominal surgery patients in a tertiary referral hospital Intensive Care Unit: A prospective analysis

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    Tejaswini Arunachala Murthy

    2016-01-01

    Full Text Available Background: Benefit of early enteral feeds in surgical patients admitted to Intensive Care Units (ICUs has been emphasized by several studies. Apprehensions about anastomotic leaks in gastrointestinal surgical patients prevent initiation of early enteral nutrition (EN. The impact of these practices on outcome in Indian scenario is less studied. Aims: This study compares the impact of early EN (within 48 h after surgery with late EN (48 h postsurgery on outcomes in abdominal surgical ICU patients. Settings and Design: Postabdominal surgery patients admitted to a tertiary referral hospital ICU over a 2-year period were analyzed. Methods: Only patients directly admitted to ICU after abdominal surgery were included in this study. ICU stay>3 days was considered as prolonged; with average ICU length of stay (LOS for this ICU being 3 days. The primary outcome was in-patient mortality. ICU LOS, hospital LOS, infection rates, and ventilator days were secondary outcome measures. Acute Physiology and Chronic Health Evaluation II scores were calculated. SPSS and Microsoft Excel were used for analysis. Results: Of 91 ICU patients included, 58 received early EN and 33 late EN. Hospital LOS and infection rates were less in early EN group. Use of parenteral nutrition (odds ratio [OR] 5.25, 95% confidence interval (CI; P = 0.003 and number of nil-per-oral days (OR 8.25, 95% CI; P ≤ 0.001 were other predictors of prolonged LOS. Conclusions: Early EN in postabdominal surgery ICU patients was associated with reduced hospital LOS and infection rates. ICU LOS, duration of mechanical ventilation and mortality rates did not vary.

  18. Study of sleep – Related breathing disorders in patients admitted to respiratory intensive care unit

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    Mahmoud Ibrahim Mahmoud

    2016-01-01

    Conclusion: In ICU patients, SRBDs are common coexistent findings and every physician should systematically search for them. Type II respiratory failure is the main cause of ICU admission in patients with SRBDs. Quality of sleep in ICU is very disturbed. Most ICU patients with SRBDs have concomitant SHVS mostly due to OHS. Important comorbidities coexist in patients with SRBDs; both influence each other and should be identified and managed properly for the wellbeing of the patient. BiPAP therapy is the cardinal mode of ventilation used in patients with respiratory failure and SRBDs.

  19. Correlation of American Burn Association Sepsis Criteria With the Presence of Bacteremia in Burned Patients Admitted to the Intensive Care Unit

    Science.gov (United States)

    2012-06-01

    documentation by the physi- cians and nurses who took care of the patients. There was also no clear guidance on ventilator modes such as HFPV and how their...Presence of Bacteremia in Burned Patients Admitted to the Intensive Care Unit Brian K. Hogan, MD,*†‡ Steven E. Wolf, MD,*‡§ Duane R. Hospenthal, MD...criteria’s correlation with bacteremia because bacteremia is not associated with inherent issues of diagnosis as occurs with pneumonia or soft tissue

  20. Sleep in acute care units.

    Science.gov (United States)

    BaHammam, Ahmed

    2006-03-01

    Patients in the acute care units (ACU) are usually critically ill, making them more susceptible to the unfavorable atmosphere in the hospital. One of these unfavorable factors is sleep disruption and deprivation. Many factors may affect sleep in the ACU, including therapeutic interventions, diagnostic procedures, medications, the underlying disease process, and noise generated in the ACU environment. Many detrimental physiological effects can occur secondary to noise and sleep deprivation, including cardiovascular stimulation, increased gastric secretion, pituitary and adrenal stimulation, suppression of the immune system and wound healing, and possible contribution to delirium. Over the past few years, many studies have endeavored to objectively assess sleep in the ACUs, as well as the effect of mechanical ventilation and circadian rhythm changes critically ill patients. At this time, therefore, it is important to review published data regarding sleep in ACUs, in order to improve the knowledge and recognition of this problem by health care professionals. We have therefore reviewed the methods used to assess sleep in ACUs, factors that may affect sleep in the ACU environment, and the clinical implications of sleep disruption in the ACU.

  1. Exploitation of resources and cardiovascular outcomes in low-risk patients with chest pain hospitalized in coronary care units

    Directory of Open Access Journals (Sweden)

    Saadat H

    2011-10-01

    Full Text Available Habibollah Saadat¹, Hossein Shiri², Zahra Salarpour², Tahereh Ashktorab² , Hamid Alavi Majd², Zahra Saadat¹, Hosein Vakili¹ 1Cardiovascular Research Center, Modarres Hospital, Shaheed Beheshti University of Medical Sciences, Tehran; 2Nursing School, Shaheed Beheshti University of Medical Sciences, Tehran, Iran Background: Most patients who present to medical centers due to chest pain do not suffer from acute coronary syndromes and do not need to be hospitalized in coronary care units (CCUs. This study was done to determine exploitation of resources and cardiovascular outcomes in low-risk patients with chest pain hospitalized in CCUs of educational hospitals affiliated with a major medical university. Methods: Over a 4-month period, 550 patients with chest pain who were hospitalized in the CCUs belonging to six hospitals affiliated to the authors' medical university were recruited by census method. Using Thrombolysis in Myocardial Infarction risk score, 95 patients (17.27% were categorized as low-risk patients. This group was evaluated with respect to demographics, bed occupancy rate, mean hospitalization period, expenses during admission, and cardiovascular outcomes in the 30-day period postdischarge. Results: Mean (± standard deviation hospitalization duration was 3.04 (±0.71 days. No significant difference was seen between the six surveyed hospitals regarding hospitalization duration (P = 0.602. The highest bed occupancy rate was seen in Taleghani and Shohada Tajrish hospitals and the lowest was in Modarres Hospital. The mean paid treatment expenses by low-risk patients was IRR 2,050,000 (US$205. Mean total hospitalization expenses was US$205. No significant difference was seen between the six surveyed hospitals (P = 0.699. Of the patients studied, 89.5% did not show any cardiovascular complications in 1 month and no deaths occurred. Conclusion: Given the high bed-occupancy rate by low-risk patients, associated high hospitalization

  2. Emergence of non-albicans Candida species and antifungal resistance in intensive care unit patients

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    Ravinder Kaur

    2016-05-01

    Conclusions: Predominance of NAC species in ICU patients along with the increasing resistance being recorded to fluconazole which has a major bearing on the morbidity and management of these patients and needs to be further worked upon.

  3. Novel predictors of sepsis outperform the American Burn Association sepsis criteria in the burn intensive care unit patient.

    Science.gov (United States)

    Mann-Salinas, Elizabeth A; Baun, Mara M; Meininger, Janet C; Murray, Clinton K; Aden, James K; Wolf, Steven E; Wade, Charles E

    2013-01-01

    The purpose of this study was to determine whether systemic inflammatory response syndrome (SIRS) and American Burn Association (ABA) criteria predict sepsis in the burn patient and develop a model representing the best combination of novel clinical sepsis predictors. A retrospective, case-controlled, within-patient comparison of burn patients admitted to a single intensive care unit from January 2005 to September 2010 was made. Blood culture results were paired with documented sepsis: positive-sick, negative-sick (collectively defined as sick), and negative-not sick. Data for all predictors were collected for the 72 hours before blood culture. Variables were evaluated using regression and area under the curve (AUC) analyses. Fifty-nine subjects represented 177 culture periods. SIRS criteria were not discriminative: 98% of the subjects met criteria. ABA sepsis criteria were different on the day before (P = .004). The six best-fit variables identified for the model included heart rate > 130 beats per min, mean arterial pressure 150 mg/dl. The model was significant in predicting positive-sick and sick, with an AUC of 0.775 (P burn patient.

  4. Invasive Candida infections in surgical patients in intensive care units: a prospective, multicentre survey initiated by the European Confederation of Medical Mycology (ECMM) (2006-2008)

    NARCIS (Netherlands)

    Klingspor, L.; Tortorano, A.M.; Peman, J.; Willinger, B.; Hamal, P.; Sendid, B.; Velegraki, A.; Kibbler, C.; Meis, J.F.G.M.; Sabino, R.; Ruhnke, M.; Arikan-Akdagli, S.; Salonen, J.; Doczi, I.

    2015-01-01

    A prospective, observational, multicentre study of invasive candidosis (IC) in surgical patients in intensive care units (ICUs) was conducted from 2006 to 2008 in 72 ICUs in 14 European countries. A total of 779 patients (62.5% males, median age 63 years) with IC were included. The median rate of ca

  5. Sedation in neurological intensive care unit

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    Birinder S Paul

    2013-01-01

    Full Text Available Analgesia and sedation has been widely used in intensive care units where iatrogenic discomfort often complicates patient management. In neurological patients maximal comfort without diminishing patient responsiveness is desirable. In these patients successful management of sedation and analgesia incorporates a patient based approach that includes detection and management of predisposing and causative factors, including delirium, monitoring using sedation scales, proper medication selection, emphasis on analgesia based drugs and incorporation of protocols or algorithms. So, to optimize care clinician should be familiar with the pharmacokinetic and pharmacodynamic variables that can affect the safety and efficacy of analgesics and sedatives.

  6. FACTORS ASSOCIATED WITH MORTALITY AMONG PATIENTS WITH CENTRAL VENOUS CATHETER-RELATED BLOODSTREAM INFECTION IN AN INTENSIVE CARE UNIT

    Directory of Open Access Journals (Sweden)

    Priscilla Roberta Silva Rocha

    2012-01-01

    Full Text Available Central venous catheterization is a common practice in the management of critically ill patients and is associated with various complications, such as Bloodstream Infections (BSI, which are major determinants of increased morbidity, mortality and healthcare expenses. Few studies have addressed factors that predict mortality in patients with this complication. The aim of this study was to investigate factors associated with mortality in patients with Central Venous Catheter (CVC-related BSI in an intensive care unit of a tertiary care hospital in the Federal District, Brazil. This was a retrospective and observational study, in which all CVC-related BSI that occurred between January 2008 and December 2010 were reviewed. We obtained demographic, clinical, biochemical and microbiological data from medical records and investigated its association with mortality during ICU stay. There were 4,504 ICU admissions during the study period and 68 were complicated by CVC-related BSI (4.09 per 1000 catheter-days, most due to gram-negative organisms (45.6%. Overall mortality was 59.7%. Death risk was significantly associated with mechanical ventilation (OR 27.8, 95% CI 3.28-250, p-1 in survivors vs. 73.9 mg dL-1 in non-survivors, p = 0.001. Mortality was not associated with other clinical or biochemical features, neither with microbiological variables, although lethality was high among patients with gram-positive infections (77% Vs 58.33% for fungi and 54.83% for gram-negative. CVC-related BSI was associated with high absolute mortality, which was predicted by mechanical ventilation and a higher number of invasive devices other than the CVC. Knowledge of local factors predictive of mortality is critical for planning strategies to reduce death risk associated with this complication.

  7. The Phase of Illness Paradigm: A Checklist Centric Model to Improve Patient Care in the Burn Intensive Care Unit

    Science.gov (United States)

    2015-04-01

    1. Although definitions for patient “goals,” healthcare team “objectives,” and clinicians “tasks” were provided, clinicians have difficulty phrasing...Concentration Goal Goal: Optimal Wound Healing Goal Goal: Organ Suppoprt with Hemodialysis Goal Goal: Organ Support Goal Goal: Organ support (renal) Goal...Objective: Post operative recovery/management Obje Objective: Prepare for surgery Obje Objective: Prepare patient for hemodialysis Obje Objective

  8. Selective decontamination of the digestive tract and selective oropharyngeal decontamination in intensive care unit patients : a cost-effectiveness analysis

    NARCIS (Netherlands)

    Oostdijk, Evelien A. N.; de Wit, G. A.; Bakker, Marina; de Smet, Anne-Marie; Bonten, M. J. M.

    2013-01-01

    Objective: To determine costs and effects of selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) as compared with standard care (ie, no SDD/SOD (SC)) from a healthcare perspective in Dutch Intensive Care Units (ICUs). Design: A post hoc analysis of a pre

  9. Cervical collar-related pressure ulcers in trauma patients in intensive care unit

    NARCIS (Netherlands)

    Ham, H.W.; Schoonhoven, L.; Galer, A.A.; Shortridge-Baggett, L.L.

    2014-01-01

    INTRODUCTION: The application of a cervical collar (C-collar) in trauma patients can be life-saving. Previous studies, however, describe development of pressure ulcers related to C-collars. OBJECTIVE: To retrospectively compare collar-related pressure ulcers (CRPUs) occurring in trauma patients admi

  10. Sleep and delirium in unsedated patients in the intensive care unit

    DEFF Research Database (Denmark)

    Boesen, H C; Andersen, J H; Bendtsen, A O

    2016-01-01

    BACKGROUND: Sleep deprivation and delirium are major problems in the ICU. We aimed to assess the sleep quality by polysomnography (PSG) in relation to delirium in mechanically ventilated non-sedated ICU patients. METHODS: Interpretation of 24-h PSG and clinical sleep assessment in 14 patients...

  11. Effect of propofol and dexmedetomidine on pulmonary mechanics in intensive care unit patients

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    Mediha Turktan

    2017-03-01

    Conclusions: Dexmedetomidine causes minimal respiratory depression altough propofol has better ventilator-patient conflict. Therefore dexmedetomidine may preferred during weaning period in ICUs patients. Further studies with larger simple size are warranted to reveal a significant difference in terms of pulmonary compliance between propofol and dexmedetomidine. [Cukurova Med J 2017; 42(1.000: 34-40

  12. Relationship between glycated hemoglobin, Intensive Care Unit admission blood sugar and glucose control with ICU mortality in critically ill patients

    Science.gov (United States)

    Mahmoodpoor, Ata; Hamishehkar, Hadi; Shadvar, Kamran; Beigmohammadi, Mohammadtaghi; Iranpour, Afshin; Sanaie, Sarvin

    2016-01-01

    Background and Aims: The association between hyperglycemia and mortality is believed to be influenced by the presence of diabetes mellitus (DM). In this study, we evaluated the effect of preexisting hyperglycemia on the association between acute blood glucose management and mortality in critically ill patients. The primary objective of the study was the relationship between HbA1c and mortality in critically ill patients. Secondary objectives of the study were relationship between Intensive Care Unit (ICU) admission blood glucose and glucose control during ICU stay with mortality in critically ill patients. Materials and Methods: Five hundred patients admitted to two ICUs were enrolled. Blood sugar and hemoglobin A1c (HbA1c) concentrations on ICU admission were measured. Age, sex, history of DM, comorbidities, Acute Physiology and Chronic Health Evaluation II score, sequential organ failure assessment score, hypoglycemic episodes, drug history, mortality, and development of acute kidney injury and liver failure were noted for all patients. Results: Without considering the history of diabetes, nonsurvivors had significantly higher HbA1c values compared to survivors (7.25 ± 1.87 vs. 6.05 ± 1.22, respectively, P < 0.001). Blood glucose levels in ICU admission showed a significant correlation with risk of death (P < 0.006, confidence interval [CI]: 1.004–1.02, relative risk [RR]: 1.01). Logistic regression analysis revealed that HbA1c increased the risk of death; with each increase in HbA1c level, the risk of death doubled. However, this relationship was not statistically significant (P: 0.161, CI: 0.933–1.58, RR: 1.2). Conclusions: Acute hyperglycemia significantly affects mortality in the critically ill patients; this relation is also influenced by chronic hyperglycemia. PMID:27076705

  13. Contribution of cholescintigraphy to the early diagnosis of acute acalculous cholecystitis in intensive-care-unit patients

    Energy Technology Data Exchange (ETDEWEB)

    Prevot, N.; Granjon, D.; Dubois, F. [Dept. of Nuclear Medicine, Service de Medecine Nucleaire, Hopital Nord, CHRU Saint-Etienne (France); Mariat, G.; Mahul, P.; Jospe, R.; Auboyer, C. [Department of Intensive Care, Hospital Nord, CHRU Saint-Etienne (France); Cuilleron, M. [Department of Radiology, Hospital Nord, CHRU Saint-Etienne (France); Tiffet, O. [Department of Surgery, Hospital Nord, CHRU Saint-Etienne (France); De Filipis, J.-P. [Department of Nephrology, Hospital Nord, CHRU Saint-Etienne (France)

    1999-10-01

    Thirty-two intensive care unit patients (78% on long-term total parenteral nutrition) suspected of having acute acalculous cholecystitis (AAC) were studied prospectively. All of these patients underwent abdominal ultrasonography and cholescintigraphy with technetium-99m mebrofenin. Morphine sulphate (0.04 mg/kg) was administered only if the gallbladder was not visualised after 1 h (16 patients). The final diagnosis was reached after clinical improvement, or upon the discovery of another aetiology for the symptoms presented, or on the basis of histopathology following cholecystectomy (when this was performed). We analysed the contribution of individual cholescintigraphic findings (I: non-visualisation of the gallbladder during the first 60 min of the examination; II: persistent non-visualisation of the gallbladder 30 min following morphine administration; III: non-visualisation of the small bowel for at least 90 min) and their various combinations. We obtained a sensitivity of 79% and a specificity rate 100% using the interpretative criteria ''I and II or III''. Excluding obstructive syndrome (''I and II''), the sensitivity and specificity figures were 70% and 100% respectively (28 patients). We had no false-positive results in our patient population. Cholescintigraphy was found to complement ultrasonography, which had either good sensitivity (93%) and poor specificity (17%), when at least two of the three major signs were present (sludge, thickened wall, gallbladder distension), or poor sensitivity (36%) and good specificity (89%) when all three signs were present. We conclude that cholescintigraphy is a useful tool for early diagnosis of AAC in critically ill patients, in whom ultrasonography alone does not provide enough information to permit a sufficiently early decision regarding the use of surgery. (orig.)

  14. Acute kidney injury in a tropical country: a cohort study of 253 patients in an infectious diseases intensive care unit

    Directory of Open Access Journals (Sweden)

    Elizabeth De Fransceco Daher

    2014-01-01

    Full Text Available Introduction: Acute kidney injury (AKI is a frequent and potentially fatal complication in infectious diseases. The aim of this study was to investigate the clinical aspects of AKI associated with infectious diseases and the factors associated with mortality. Methods: This retrospective study was conducted in patients with AKI who were admitted to the intensive care unit (ICU of a tertiary infectious diseases hospital from January 2003 to January 2012. The major underlying diseases and clinical and laboratory findings were evaluated. Results: A total of 253 cases were included. The mean age was 46±16 years, and 72% of the patients were male. The main diseases were human immunodeficiency virus (HIV infection, HIV/acquired immunodeficiency syndrome (AIDS (30%, tuberculosis (12%, leptospirosis (11% and dengue (4%. Dialysis was performed in 70 cases (27.6%. The patients were classified as risk (4.4%, injury (63.6% or failure (32%. The time between AKI diagnosis and dialysis was 3.6±4.7 days. Oliguria was observed in 112 cases (45.7%. The Acute Physiology and Chronic Health Evaluation (APACHE II scores were higher in patients with HIV/AIDS (57±20, p-value=0.01 and dengue (68±11, p-value=0.01. Death occurred in 159 cases (62.8%. Mortality was higher in patients with HIV/AIDS (76.6%, p-value=0.02. A multivariate analysis identified the following independent risk factors for death: oliguria, metabolic acidosis, sepsis, hypovolemia, the need for vasoactive drugs, the need for mechanical ventilation and the APACHE II score. Conclusions: AKI is a common complication in infectious diseases, with high mortality. Mortality was higher in patients with HIV/AIDS, most likely due to the severity of immunosuppression and opportunistic diseases.

  15. Relationship between glycated hemoglobin, Intensive Care Unit admission blood sugar and glucose control with ICU mortality in critically ill patients

    Directory of Open Access Journals (Sweden)

    Ata Mahmoodpoor

    2016-01-01

    Full Text Available Background and Aims: The association between hyperglycemia and mortality is believed to be influenced by the presence of diabetes mellitus (DM. In this study, we evaluated the effect of preexisting hyperglycemia on the association between acute blood glucose management and mortality in critically ill patients. The primary objective of the study was the relationship between HbA1c and mortality in critically ill patients. Secondary objectives of the study were relationship between Intensive Care Unit (ICU admission blood glucose and glucose control during ICU stay with mortality in critically ill patients. Materials and Methods: Five hundred patients admitted to two ICUs were enrolled. Blood sugar and hemoglobin A1c (HbA1c concentrations on ICU admission were measured. Age, sex, history of DM, comorbidities, Acute Physiology and Chronic Health Evaluation II score, sequential organ failure assessment score, hypoglycemic episodes, drug history, mortality, and development of acute kidney injury and liver failure were noted for all patients. Results: Without considering the history of diabetes, nonsurvivors had significantly higher HbA1c values compared to survivors (7.25 ± 1.87 vs. 6.05 ± 1.22, respectively, P < 0.001. Blood glucose levels in ICU admission showed a significant correlation with risk of death (P < 0.006, confidence interval [CI]: 1.004–1.02, relative risk [RR]: 1.01. Logistic regression analysis revealed that HbA1c increased the risk of death; with each increase in HbA1c level, the risk of death doubled. However, this relationship was not statistically significant (P: 0.161, CI: 0.933–1.58, RR: 1.2. Conclusions: Acute hyperglycemia significantly affects mortality in the critically ill patients; this relation is also influenced by chronic hyperglycemia.

  16. Risk factors for multi-drug resistant Acinetobacter baumannii bacteremia in patients with colonization in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Kim Se

    2010-07-01

    Full Text Available Abstract Background Epidemic outbreaks of multi-drug resistant (MDR Acinetobacter baumannii (AB in intensive care units (ICUs are increasing. The incidence of MDR AB bacteremia, which develops as a result of colonization, is increasing through widespread dissemination of the pathogen, and further colonization. We sought to determine risk factors for MDR AB bacteremia in patients colonized with MDR AB in the ICU. Methods We conducted a retrospective, observational study of 200 patients colonized with MDR AB in the ICU at Severance Hospital, South Korea during the outbreak period between January 2008 and December 2009. Results Of the 200 patients colonized with MDR AB, 108 developed MDR AB bacteremia, and 92 did not. APACHE II scores were higher in bacteremic than non-bacteremic patients at the time of ICU admission and colonization (24.0 vs. 21.6; P = 0.035, 22.9 vs. 16.8; P P = 0.923, but the duration of time at risk was shorter in bacteremic patients (12.1 vs. 6.0 days; P = 0.016. A recent invasive procedure was a significant risk factor for development of bacteremia (odds ratio = 3.85; 95% CI 1.45-10.24; P = 0.007. Multivariate analysis indicated infection and respiratory failure at the time of ICU admission, maintenance of mechanical ventilation, maintenance of endotracheal tube instead of switching to a tracheostomy, recent central venous catheter insertion, bacteremia caused by other microorganism after colonization by MDR AB, and prior antimicrobial therapy, were significant risk factors for MDR AB bacteremia. Conclusions Patients in the ICU, colonized with MDR AB, should be considered for minimizing invasive procedures and early removal of the invasive devices to prevent development of MDR AB bacteremia.

  17. Risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) by trauma patients in the intensive care unit.

    Science.gov (United States)

    Marshall, C; Wolfe, R; Kossmann, T; Wesselingh, S; Harrington, G; Spelman, D

    2004-07-01

    In a previous study in the intensive care unit (ICU) of the Alfred Hospital, Melbourne, Australia, it was demonstrated that trauma patients were at particular risk of becoming colonized by methicillin-resistant Staphylococcus aureus (MRSA). We examined risk factors for MRSA acquisition in these patients using a cohort study comparing the 31 patients who acquired MRSA with 65 who did not. Data collected included ICU length of stay (LOS), mechanism of trauma, site of injury, type of surgery, trauma severity and antibiotic usage. Odds ratios (OR) were determined and adjusted for LOS. LOS in the ICU was a significant univariate predictor of MRSA acquisition (OR 13.7). When adjusted for LOS, mechanism of trauma (OR 10.4), laparotomy (OR 6.3) and administration of ticarcillin/clavulanic acid (OR 4.5) or glycopeptides (OR 5.9) remained significant. We confirmed our previous finding that LOS was associated with MRSA acquisition. Receipt of antibiotics correlated with reported literature. Novel associations were road trauma as a mechanism and laparotomy.

  18. Hyperglycemia in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Rainer Lenhardt

    2014-12-01

    Full Text Available Hyperglycemia is frequently encountered in the intensive care unit. In this disease, after severe injury and during diabetes mellitus homeostasis is impaired; hyperglycemia, hypoglycemia and glycemic variability may ensue. These three states have been shown to independently increase mortality and morbidity. Patients with diabetics admitted to the intensive care unit tolerate higher blood glucose values without increase of mortality. Stress hyperglycemia may occur in patients with or without diabetes and has a strong association with increased mortality in the intensive care unit patients. Insulin is the drug of choice to treat hyperglycemia in the intensive care unit. In patients with moderate hyperglycemia a basal–bolus insulin concept can be used. Close glucose monitoring is of paramount importance throughout the intensive care unit stay of the patient. In the guidelines for glycemic control based on meta-analyses it was shown that a tight glycemic control does not have a significant mortality advantage over conventional treatment. Given the controversy about optimal blood glucose goals in the intensive care unit setting, it seems reasonable to target a blood glucose level around 140 mg/dL to avoid episodes of hypoglycemia and minimize glycemic variability. The closed loop system with continuous glucose monitoring and algorithm based insulin application by an infusion pump is a promising new concept with the potential to further reduce mortality and morbidity due to hyperglycemia, hypoglycemia and glycemic variability. The goal of this review was to give a brief overview about pathophysiology of hyperglycemia and to summarize current guidelines for glycemic control in critically ill patients.

  19. Imported and intensive care unit-born Acinetobacter baumannii clonal complexes: one-year prospective cohort study in intensive care patients.

    Science.gov (United States)

    Martins, Natacha; Martins, Ianick Souto; de Freitas, Wania Vasconcelos; de Matos, Juliana Arruda; Girão, Valeria Brígido de Carvalho; Coelho-Souza, Talita; Maralhães, Ana Cristina de Gouveia; Cacci, Luciana Camila; de Figueiredo, Miriam Perez; Dias, Rubens Clayton Silva; Costa-Lourenço, Ana Paula Ramalho; Ferreira, Adriana Lúcia Pires; Dalla-Costa, Libera; Nouér, Simone Aranha; Santoro-Lopes, Guilherme; Riley, Lee W; Moreira, Beatriz Meurer

    2013-06-01

    The main objective of this study was to assess the frequency and possible sources of colonization and infection by Acinetobacter in the intensive care unit (ICU) of a university hospital in Rio de Janeiro, Brazil, and characterize the isolates for relatedness to internationally and locally disseminated lineages. Patients consecutively admitted to the ICU from April 2007 to April 2008 were screened for colonization and infection. Species were identified by rpoB sequencing. The presence of acquired and intrinsic carbapenemase genes was assessed by polymerase chain reaction (PCR). Strains were typed by random amplification of polymorphic DNA (RAPD)-PCR, pulsed-field gel electrophoresis, and multilocus sequence typing (MLST) using the schemes hosted at the University of Oxford (UO) and Institut Pasteur (IP). Of 234 patients, 98 (42%) had at least one specimen positive for the Acinetobacter isolate, and 24 (10%) had infection. A total of 22 (92%) infections were caused by Acinetobacter baumannii and one each (4%) by Acinetobacter nosocomialis and Acinetobacter berezinae. A. baumannii isolates from 60 patients belonged to RAPD types that corresponded to MLST clonal complexes (CCs) 109/1 (UO/IP scheme, known as International Clone I), CC 110/110 (UO/IP), CC 113/79 (UO/IP), and CC 104/15 (UO/IP). Most CCs were carbapenem resistant and carried the bla(OXA-23)-like gene. Strains were introduced by patients transferred from other wards of the same hospital (11 patients, 18%) or acquired from cross-transmission within the ICU (49 patients, 82%). A. nosocomialis lineage sequence type 260 colonized 10% of the whole study population. A. baumannii have become established in this hospital as a part of a global epidemic of successful clones. Once introduced into the hospital, such clones have become entrenched among patients in the ICU.

  20. Aspergillosis in Intensive Care Unit (ICU patients: epidemiology and economic outcomes

    Directory of Open Access Journals (Sweden)

    Baddley John W

    2013-01-01

    Full Text Available Abstract Background Few data are available regarding the epidemiology of invasive aspergillosis (IA in ICU patients. The aim of this study was to examine epidemiology and economic outcomes (length of stay, hospital costs among ICU patients with IA who lack traditional risk factors for IA, such as cancer, transplants, neutropenia or HIV infection. Methods Retrospective cohort study using Premier Inc. Perspective™ US administrative hospital database (2005–2008. Adults with ICU stays and aspergillosis (ICD-9 117.3 plus 484.6 who received initial antifungal therapy (AF in the ICU were included. Patients with traditional risk factors (cancer, transplant, neutropenia, HIV/AIDS were excluded. The relationship of antifungal therapy and co-morbidities to economic outcomes were examined using Generalized linear models. Results From 6,424 aspergillosis patients in the database, 412 (6.4% ICU patients with IA were identified. Mean age was 63.9 years and 53% were male. Frequent co-morbidities included steroid use (77%, acute respiratory failure (76% and acute renal failure (41%. In-hospital mortality was 46%. The most frequently used AF was voriconazole (71% received at least once. Mean length of stay (LOS was 26.9 days and mean total hospital cost was $76,235. Each 1 day lag before initiating AF therapy was associated with 1.28 days longer hospital stay and 3.5% increase in costs (p  Conclusions Invasive aspergillosis in ICU patients is associated with high mortality and hospital costs. Antifungal timing impacts economic outcomes. These findings underscore the importance of timely diagnosis, appropriate treatment, and consideration of Aspergillus as a potential etiology in ICU patients.

  1. Study of Characteristics, risk factors and outcome for Ventilator Associated Pneumonia in Neonatal Intensive Care Unit patient

    Directory of Open Access Journals (Sweden)

    Mehdi Moradi

    2013-09-01

    Full Text Available Background: Ventilator Associated Pneumonia (VAP, developing in mechanically ventilated patients after 48 hours of mechanical ventilation, is the second most common nosocomial infection. Therefore, there is a vital need to study the etiology and risk factors associated with VAP in neonates.Methods: Neonates admitted to neonatal intensive care unit (NICU, over a period of one year and who required mechanical ventilation for more than 48 hours were enrolled consecutively into the study. Semi-quantitative assay of endotracheal aspirate was used for microbiological diagnoses of VAP. 105CFU/ml was taken as the cut off between evidence of pathological infection and colonization. The primary outcome measure was the development of VAP. Secondary outcome measures were length of mechanical ventilation, NICU length of stay, hospital cost, and death.Results: Thirty eight patients were enrolled (58% were boys and 42% were girls. 42% of neonates developed VAP. The most common VAP organisms identified were Acinetobacter baumanni (43%. On multiple regression analysis, duration of mechanical ventilation was associated with VAP (P=0.00. Patients with VAP had greater need for mechanical ventilation (18.7 vs 6 median days, longer NICU length of stay (39 vs 21.5 median days and higher total median hospital costs (79.5 vs 52 million rials than those without VAP. The mortality rate was not different between two groups.Conclusion: In mechanically ventilated neonates, those with VAP had a prolonged need for mechanical ventilation, a longer NICU stay, and a higher hospital costs. Longer mechanical ventilation was associated with an increased risk of developing VAP in these patients. Developing of VAP didn’t increase mortality in patients.

  2. Predicting Calcium Values for Gastrointestinal Bleeding Patients in Intensive Care Unit Using Clinical Variables and Fuzzy Modeling

    Directory of Open Access Journals (Sweden)

    G Khalili-Zadeh-Mahani

    2016-07-01

    Full Text Available Introduction: Reducing unnecessary laboratory tests is an essential issue in the Intensive Care Unit. One solution for this issue is to predict the value of a laboratory test to specify the necessity of ordering the tests. The aim of this paper was to propose a clinical decision support system for predicting laboratory tests values. Calcium laboratory tests of three categories of patients, including upper and lower gastrointestinal bleeding, and unspecified hemorrhage of gastrointestinal tract, have been selected as the case studies for this research. Method: In this research, the data have been collected from MIMIC-II database. For predicting calcium laboratory values, a Fuzzy Takagi-Sugeno model is used and the input variables of the model are heart rate and previous value of calcium laboratory test. Results: The results showed that the values of calcium laboratory test for the understudy patients were predictable with an acceptable accuracy. In average, the mean absolute errors of the system for the three categories of the patients are 0.27, 0.29, and 0.28, respectively. Conclusion: In this research, using fuzzy modeling and two variables of heart rate and previous calcium laboratory values, a clinical decision support system was proposed for predicting laboratory values of three categories of patients with gastrointestinal bleeding. Using these two clinical values as input variables, the obtained results were acceptable and showed the capability of the proposed system in predicting calcium laboratory values. For achieving better results, the impact of more input variables should be studied. Since, the proposed system predicts the laboratory values instead of just predicting the necessity of the laboratory tests; it was more generalized than previous studies. So, the proposed method let the specialists make the decision depending on the condition of each patient.

  3. Performance assessment of the SOFA, APACHE II scoring system, and SAPS II in intensive care unit organophosphate poisoned patients.

    Science.gov (United States)

    Kim, Yong Hwan; Yeo, Jung Hoon; Kang, Mun Ju; Lee, Jun Ho; Cho, Kwang Won; Hwang, SeongYoun; Hong, Chong Kun; Lee, Young Hwan; Kim, Yang Weon

    2013-12-01

    This study assessed the ability of the Sequential Organ Failure Assessment (SOFA) and Acute Physiology, Chronic Health Evaluation (APACHE) II scoring systems, as well as the Simplified Acute Physiology Score (SAPS) II method to predict group mortality in intensive care unit (ICU) patients who were poisoned with organophosphate. The medical records of 149 organophosphate poisoned patients admitted to the ICU from September 2006 to December 2012 were retrospectively examined. The SOFA, APACHE II, and SAPS II were calculated based on initial laboratory data in the Emergency Department, and during the first 24 hr of ICU admission. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and SAPS II equations. The ability to predict group mortality by the SOFA score, APACHE II score, and SAPS II method was assessed using two by two decision matrices and receiver operating characteristic (ROC) curve analysis. A total of 131 patients (mean age, 61 yr) were enrolled. The sensitivities, specificities, and accuracies were 86.2%, 82.4%, and 83.2% for the SOFA score, respectively; 65.5%, 68.6%, and 67.9% for the APACHE II scoring system, respectively; and 86.2%, 77.5%, and 79.4% for the SAPS II, respectively. The areas under the curve in the ROC curve analysis for the SOFA score, APACHE II scoring system, and SAPS II were 0.896, 0.716, and 0.852, respectively. In conclusion, the SOFA, APACHE II, and SAPS II have different capability to discriminate and estimate early in-hospital mortality of organophosphate poisoned patients. The SOFA score is more useful in predicting mortality, and easier and simpler than the APACHE II and SAPS II.

  4. Comparative Study of Plasma Endotoxin with Procalcitonin Levels in Diagnosis of Bacteremia in Intensive Care Unit Patients

    Institute of Scientific and Technical Information of China (English)

    Tao Wang; Yun-Liang Cui; Zhao-Fen Lin; De-Chang Chen

    2016-01-01

    Background: Both procalcitonin (PCT) and plasma endotoxin levels cannot be solely used for a definite diagnosis ofbacteremia or sepsis, and there has been few study comparing the values of the two biomarkers for the diagnosis of bacteremia.The aim of this study was to identify bacteria causing bacteremia and evaluate the role of the two biomarkers in the diagnosis ofbacteremia in Intensive Care Unit (ICU).Methods: The medical records of 420 patients in ICU were retrospectively reviewed.Patients (n =241) who met the inclusion criteria were subjected to blood culture (BC) for the analysis of the endotoxin or PCT levels.The exclusion criteria included the presence of infection with human immunodeficiency virus and/or AIDS, neutropenia without sepsis, pregnancy, treatment with immunosuppressive therapies, or blood diseases such as hematological tumors.Patients' BC episodes were divided into BC negative, Gram-negative (GN) bacteria, Gram-positive bacteria, and fungi groups.The PCT and plasma endotoxin levels were compared in the different groups.Results: A total of 241 patients with 505 episodes of BC were analyzed.The GN bacteria group showed higher levels of PCT and endotoxin than the BC negative, Gram-positive bacteria, and fungi groups.GN bacteremia was more prevalent than Gram-positive bacteremia.The GN bacteremia caused by non-Enterobacteriaceae infection presented higher endotoxin level than that by Enterobacteriaceae, but no significant difference in PCT levels was observed between the two groups.The plasma endotoxin significantly differed among different groups and was bacterial species dependent.Conclusions: Plasma endotoxin was more related to GN than to Gram-positive bacteremia, and that endotoxin level was species dependent, but PCT level remained relatively more stable within the GN bacteria caused bacteremia.Both GN and positive bacteria caused bacteremia in the ICU patients in different regions of China.And PCT is a more valuable biomarker than endotoxin

  5. In Vivo Microdialysis To Determine Subcutaneous Interstitial Fluid Penetration and Pharmacokinetics of Fluconazole in Intensive Care Unit Patients with Sepsis.

    Science.gov (United States)

    Sinnollareddy, Mahipal G; Roberts, Michael S; Lipman, Jeffrey; Lassig-Smith, Melissa; Starr, Therese; Robertson, Thomas; Peake, Sandra L; Roberts, Jason A

    2016-02-01

    The objective of the study was to describe the subcutaneous interstitial fluid (ISF) pharmacokinetics of fluconazole in critically ill patients with sepsis. This prospective observational study was conducted at two tertiary intensive care units in Australia. Serial fluconazole concentrations were measured over 24 h in plasma and subcutaneous ISF using microdialysis. The concentrations in plasma and microdialysate were measured using a validated high-performance liquid chromatography system with electrospray mass spectrometer detector method. Noncompartmental pharmacokinetic analysis was performed. Twelve critically ill patients with sepsis were enrolled. The mean in vivo fluconazole recovery rates ± standard deviation (SD) for microdialysis were 51.4% ± 16.1% with a mean (±SD) fluconazole ISF penetration ratio of 0.52 ± 0.30 (coefficient of variation, 58%). The median free plasma area under the concentration-time curve from 0 to 24 h (AUC0-24) was significantly higher than the median ISF AUC0-24 (340.4 versus 141.1 mg · h/liter; P = 0.004). There was no statistical difference in median fluconazole ISF penetration between patients receiving and not receiving vasopressors (median, 0.28 versus 0.78; P = 0.106). Both minimum and the maximum concentrations of drug in serum (Cmax and Cmin) showed a significant correlation with the fluconazole plasma exposure (Cmax, R(2) = 0.86, P fluconazole was distributed variably, but incompletely, from plasma into subcutaneous interstitial fluid in this cohort of critically ill patients with sepsis. Given the variability of fluconazole interstitial fluid exposures and lack of clinically identifiable factors by which to recognize patients with reduced distribution/exposure, we suggest higher than standard doses to ensure that drug exposure is adequate at the site of infection.

  6. Association between heat shock protein 70 gene polymorphisms and clinical outcomes in intensive care unit patients with sepsis

    Directory of Open Access Journals (Sweden)

    Kartik Ramakrishna

    2014-01-01

    Full Text Available Objective: The objective of the following study is to evaluate the associations between single nucleotide polymorphisms (SNPs in the Heat Shock Protein 70 (HSP70 gene, gene expression of interleukin-6 (IL-6 and tumor necrosis factor-alpha (TNF- and medical intensive care unit (MICU stay and organ failure in sepsis. Materials and Methods: MICU patients with sepsis were genotyped for rs1061581, rs2227956, rs1008438 and rs1043618 polymorphisms in HSP70 gene using polymerase chain reaction (PCR-restriction fragment length polymorphism analysis or allele-specific PCR. Messenger ribonucleic acid (mRNA expression of IL-6 and TNF- were quantitated in peripheral blood lymphocytes. Outcomes were recorded. Results: 108 patients (48 male aged 40.7 ± 16.0 (mean ± standard deviation years included H1N1 infection (36, scrub typhus (29 and urosepsis (12. Seventy-one (65.7% had dysfunction of three or more organ systems, 66 patients (61.1% were treated by mechanical ventilation, 21 (19.4% needed dialysis. ICU stay was 9.3 ± 7.3 days. Mortality was 38.9%. One or more SNPs were noted in 101/108 (93.5% and organ failure was noted in only 1/7 patients without a single SNP. The A allelotypes of rs1061581 and rs1008438 were associated with hematological dysfunction (P = 0.03 and 0.07 and longer ICU stay (P = 0.05 and 0.04, whereas IL-6 and TNF- mRNA levels were associated with central nervous system dysfunction. Conclusions: HSP70 genotypes may determine some adverse outcomes in patients with sepsis.

  7. Intermediate Care Unit - defining substituyable admissions

    DEFF Research Database (Denmark)

    Nygaard, Hanne; Ekmann, Anette Addy

    Background: Elderly patients have excess risk of functional decline and development of delirium. Studies have shown that 14-27 % of hospitalizations among elderly patients are substitutable. To lower the risk of unwanted consequences of hospitalizations, we implemented an Intermediate Care Unit...... (TUE). TUE was established in collaboration between Bispebjerg Hospital and the City of Copenhagen and took in patients whose hospitalization was regarded as substitutable. TUE offered a quick diagnostic assessment by a cross sectoral team of hospital doctors and community nurses. Home care was offered...... Care Unit.' Methods: From September 17, 2012 - June 24, 2014, 969 patients were treated at TUE. We registered both demographic-, treatment- and medical data and furthermore functional related variables. We used logistic regression to test the association between a combined graded variable of EWS...

  8. Fast Hugs with Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Nimet Şenoğlu

    2014-12-01

    Full Text Available Mnemonics are commonly used in medical procedures as cognitive aids to guide clinicians all over the world. The mnemonic ‘FAST HUG’ (Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glycemic control was proposed almost ten years ago for patient care in intensive care units and have been commonly used worldwide. Beside this, new mnemonics were also determined for improving routine care of the critically ill patients. But none of this was accepted as much as “FAST HUGS”. In our clinical practice we delivered an another mnemonic as FAST HUGS with ICU (Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, Stress ulcer prevention, and Glucose control, Water balance, Investigation and Results, Therapy, Hypo-hyper delirium, Invasive devices, Check the daily infection parameters, Use a checklist for checking some of the key aspects in the general care of intensive care patients. In this review we summarized these mnemonics.

  9. Evaluation of a vancomycin dosing protocol for intensive care unit patients

    NARCIS (Netherlands)

    Brinkman, I.; Verstappen, G.; Veeger, N.; Boerma, E. C.; Buter, H.

    2015-01-01

    Vancomycin is a glycopeptide antibiotic that needs to be dosed to achieve target trough levels of 15-20 mg/l. Dosing can be challenging in ICU patients. To optimise therapy, in ICU-pharmacy collaboration, a dosing protocol was introduced on the ICU of the Medical Center Leeuwarden, the Netherlands.

  10. Tracheostomy care and complications in the intensive care unit.

    Science.gov (United States)

    Morris, Linda L; Whitmer, Andrea; McIntosh, Erik

    2013-10-01

    Tracheotomy is a common procedure in intensive care units, and nurses must provide proper care to tracheostomy patients to prevent complications. One of the most important considerations is effective mobilization of secretions, and a suction catheter is the most important tool for that purpose. Each bedside should be equipped with a functional suctioning system, an oxygen source, a manual resuscitation bag, and a complete tracheostomy kit, which should accompany patients wherever they go in the hospital. Complications include infection, tracheomalacia, skin breakdown, and tracheoesophageal fistula. Tracheostomy emergencies include hemorrhage, tube dislodgement and loss of airway, and tube obstruction; such emergencies are managed more effectively when all necessary supplies are readily available at the bedside. This article describes how to provide proper care in the intensive care unit, strategies for preventing complications, and management of tracheostomy emergencies.

  11. Nosocomial infection and risk factors in elderly patients in intensive care units

    OpenAIRE

    2015-01-01

    Incidence of nosocomial infections gradually increase in patients over 65 years age population. There is a significant relationship between increased age and predisposition to nosocomial infections. Predisposition to infections in this age group is a result of impaired host defense, underlying chronic diseases, long-term hospitalization, steroids and immunosuppressive therapies and malnutrition. Nevertheless there is not much data about the incidence and risk factors of nosocomial infectio...

  12. Managing Potential Laboratory Exposure to Ebola Virus by Using a Patient Biocontainment Care Unit

    Science.gov (United States)

    2008-06-01

    et al. (8) with permission. †JEB, Japanese encephalitis virus B; Ebola/ Lassa , potential exposure to these viruses . ‡IP, immune plasma from...expo- sure to BSL-4 viruses , 8 involved percutaneous injury and 6 involved potential aerosol exposure. Eight persons (5 evaluated for exposure to Lassa ...potentially exposed to Lassa virus also received intrave- nous ribavirin. No patient developed disease or serocon- verted. From 1985 through 2003, no

  13. Mechanical ventilation strategies for intensive care unit patients without acute lung injury or acute respiratory distress syndrome: a systematic review and network meta-analysis

    OpenAIRE

    Guo, Lei; Wang, Weiwei; Zhao, Nana; Guo, Libo; Chi, Chunjie; Hou, Wei; Wu, Anqi; Tong, Hongshuang; Wang, Yue; Wang, Changsong; Li, Enyou

    2016-01-01

    Background It has been shown that the application of a lung-protective mechanical ventilation strategy can improve the prognosis of patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). However, the optimal mechanical ventilation strategy for intensive care unit (ICU) patients without ALI or ARDS is uncertain. Therefore, we performed a network meta-analysis to identify the optimal mechanical ventilation strategy for these patients. Methods We searched the Cochra...

  14. Comfort of the patient's family in an Intensive Care Unit related to welcoming

    Directory of Open Access Journals (Sweden)

    Mariana de Almeida Moraes Gibaut

    2013-10-01

    Full Text Available This study aimed to identify the level of comfort of families of patients in a critical health condition related to the welcoming practices performed by the hospital staff. Interviews were conducted with 250 relatives in hospitals of the state Bahia, using a Likert scale. Data were analyzed as percentages and quartiles. For nine of the 12 statements of the scale, most relatives scored their comfort level between very and totally comfortable, median of 4,revealing kindness, tranquility and friendly communication with family members. More than half of the sample scored its level as not at all to more or less comfortable, median of 3, for statements about demonstration of interest towards the relative by the staff and flexible visiting of the patient. The necessity of greater interest of the team in the condition and needs of the family was observed. Promoting comfort from the dimension of welcoming demands interdisciplinary actions grounded in humanistic philosophy, in which the nurse has an important role to play.

  15. Early changes of procalcitonin predict bacteremia in patients with intensive care unit-acquired new fever

    Institute of Scientific and Technical Information of China (English)

    SHI Yan; DU Bin; XU Ying-chun; RUI Xi; DU Wei; WANG Yao

    2013-01-01

    Background Rapid detection of bacteremia is important for critically ill patients.Procalcitonin (PCT) has emerged as a marker of sepsis,but its characterization for predicting bacteremia is still unclear.This study aimed to investigate the role of change of PCT within 6 to 12 hours after new fever in predicting bacteremia.Methods An observational study was conducted in the ICU of our hospital from January 2009 to March 2010.Adult patients with new fever were included and grouped as bacteremia and non bacteremia group.Serum PCT concentration was measured at admission and within 6 to12 hours after new fever (designated PCT0 and PCT1).Other results of laboratory tests and therapeutic interventions were recorded.Multivariate Logistic regression analysis was used to identify the risk factors of bacteremia.The area under the ROC curve (AUC) was constructed to evaluate the discriminative power of variables to predict bacteremia.Results Totally 106 patients were enrolled,60 of whom had bacteremia and 46 did not have bacteremia,.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) scores were 13.1±7.8 and 5.0±2.2 at admission,respectively.There was no significant difference in PCT0 between the bacteremia group and nonbacteremia group; 1.27μg/L (range,0.10-33.3) vs.0.98μg/L (range,0.08-25.7),(P=-0.157).However,the PCT1 and the rate of change of PCT were significantly higher in bacteremia group; PCT1 was 6.73μg/L (1.13-120.10)vs.1.17μg/L (0.10-12.10) (P=0.001),and the rate of change was 5.62 times (1.05-120.6) vs.0.07 times (-0.03-0.18)(P<0.001).The area under the ROC curve (AUC; 95% confidence interval) of the rate of change of PCT was better for predicting bacteremia than that of PCT1; 0.864 (range,0.801-0.927) vs.0.715 (range,0.628-0.801),(P<0.05).The AUCs of PCT0 and other parameters (such as WBC count,granulocyte percentage and temperature) were not significantly different (all P>0

  16. Exploring measurement biases associated with esophageal Doppler monitoring in critically ill patients in intensive care unit

    Directory of Open Access Journals (Sweden)

    Stawicki Peter

    2007-01-01

    Full Text Available Background : Esophageal Doppler monitoring (EDM is utilized in numerous clinical settings. This study examines the relationship between pulmonary artery catheter (PAC and EDM-derived hemodynamic parameters, concentrating on gender- and age-related EDM measurement biases. Materials and Methods : Prospective study of EDM use in ventilated surgical ICU patients. Parameters examined included demographics, diagnosis, resuscitation endpoints, cardiac output (CO and stroke volume from both devices, number of personnel and time needed to place equipment, time to data acquisition, duration of use, complications of placement. Results : Fifteen patients (11 men, 4 women, mean age 47 years were included. Most common diagnoses included trauma (7/15 and sepsis (4/15. Insertion time and time to data acquisition were shorter for EDM than for PAC ( P < 0.001. The EDM required an average of 1.1 persons to place (2.4 for PAC, P =0.002. Mean EDM utilization time was 12.4 h. There was a fair CO correlation between EDM and PAC (r = 0.647, P < 0.001. Overall, the EDM underestimated CO relative to PAC (bias -1.42 ± 2.08, 95% CI: -5.58-2.74, with more underestimation in women (mean bias difference of -1.16, P < 0.001. No significant age-related measurement bias differences between PAC and EDM were noted. Significant reductions in lactate and norepinephrine requirement were noted following EDM monitoring periods. Conclusions : This study found that the EDM significantly underestimated cardiac output in women when compared to PAC. Clinicians should be aware of this measurement bias when making therapeutic decision based on EDM data. Significant reductions in lactate and norepinephrine requirement during EDM monitoring periods support the clinical usefulness of EDM technology.

  17. A preliminary study on the relationships between diurnal melatonin secretion profile and sleep variables in patients emergently admitted to the coronary care unit.

    Science.gov (United States)

    Takaesu, Yoshikazu; Futenma, Kunihiro; Kobayashi, Mina; Komada, Yoko; Tanaka, Nobuhiro; Yamashina, Akira; Inoue, Yuichi

    2015-01-01

    To clarify the significance of melatonin secretion under intensive care conditions, we investigated melatonin secretion profiles and sleep parameters of 23 patients just after admission to the coronary care unit (CCU) and 19 age-matched controls. Sleep parameters were evaluated by actigraphy, and melatonin secretion was assessed by measuring the urinary 6-sulphatoxy melatonin (6-SMT). 6-SMT secretion was lower and nocturnal sleep parameters were less satisfactory in the subjects than those in the controls, and there were positive correlations between these variables, particularly in the subject patients. The lowered melatonin secretion might be involved in the mechanism of insomnia in CCU patients.

  18. Dermatomyositis and Polymyositis in the Intensive Care Unit: A Single-Center Retrospective Cohort Study of 102 Patients.

    Directory of Open Access Journals (Sweden)

    Jin-Min Peng

    Full Text Available Patients with idiopathic inflammatory myopathies (IIMs are sometimes complicated with life-threatening conditions requiring intensive care unit (ICU admission. In the past, owing to the low incidence of IIM, little was known about such patients. Our aim was to investigate the clinical features and outcomes of these patients and identify their risk factors for mortality.A retrospective study was performed of IIM patients admitted over an 8-year period to the medical ICU of a tertiary referral center in China. We collected data regarding demographic features, IIM-related clinical characteristics, reasons for admission, organ dysfunction, and outcomes. Independent predictors of ICU mortality were identified through multivariate logistic regression analysis.Of the 102 patients in our cohort, polymyositis (PM, dermatomyositis (DM, and clinically amyopathic dermatomyositis (CADM accounted for 23.5%, 64.7%, and 11.7% respectively. The median duration from the onset of IIM to ICU admission was 4.3 months (interquartile range [IQR], 2.6-9.4 months. Reasons for ICU admission were infection alone (39.2%, acute exacerbation of IIM alone (27.5%, the coexistence of both (27.5%, or other reasons (5.8%. Pneumonia accounted for 97% of the infections; 63.2% of infections with documented pathogens were caused by opportunistic agents. Rapid progressive interstitial lung disease (RP-ILD was responsible for 87.5% of acute exacerbation of IIM. The median Acute Physiology and Chronic Health Evaluation II (APACHE II score on ICU day 1 was 17 (IQR 14-20. On ICU admission, acute respiratory failure (ARF was the most common type (80.4% of organ failure. The mortality rate in the ICU was 79.4%. Factors associated with increased ICU mortality included a diagnosis of DM (including CADM, a high APACHE II score, the presence of ARF, a decreased PaO2/FiO2 ratio, and a low lymphocyte count at the time of ICU admission.The outcome of IIM patients admitted to the ICU was extremely

  19. Time to wean after tracheotomy differs among subgroups of critically ill patients: Retrospective analysis in a mixed medical/surgical intensive care unit

    NARCIS (Netherlands)

    A.J.W.J. van der Lely; D.P. Veelo; D.A. Dongelmans; J.C. Korevaar; M.B. Vroom; M.J. Schultz

    2006-01-01

    OBJECTIVE: To determine the time to wean from mechanical ventilation and time spent off the ventilator per day after tracheotomy in critically ill patients in a 28-bed mixed medical and surgical intensive care unit (ICU) in Amsterdam, Netherlands. METHODS: We conducted a retrospective analysis of co

  20. The influence of volume and intensive care unit organization on hospital mortality in patients admitted with severe sepsis: a retrospective multicentre cohort study.

    NARCIS (Netherlands)

    Peelen, L.; Keizer, N.F. de; Peek, N.; Scheffer, G.J.; Voort, P.H. van der; Jonge, E. de

    2007-01-01

    INTRODUCTION: The aim of the study was to assess the influence of annual volume and factors related to intensive care unit (ICU) organization on in-hospital mortality among patients admitted to the ICU with severe sepsis. METHODS: A retrospective cohort study was conducted using the database of the

  1. [Intermediate care units and noninvasive ventilation].

    Science.gov (United States)

    Becker, Heinrich F; Schönhofer, Bernd; Vogelmeier, Claus

    2006-04-15

    Intermediate care units (IMC) have been introduced to provide optimal patient management according to disease severity and to bridge the gap between intensive care (ICU) and general wards. Most patients that are referred to an IMC need monitoring and intensive analgetic treatment. Over the past years noninvasive ventilation (NIV) and weaning have emerged as important new forms of active treatment in the IMC. Most studies that have been published so far demonstrate that an IMC improves patient outcome and lowers costs, although randomized controlled trials are missing. NIV reduces mortality, the need for intubation as well as ICU and hospital length of stay in patients with chronic obstructive pulmonary disease (COPD) and other disorders that cause respiratory failure. In many cases NIV can be performed in the IMC, a fact that reduces the number of ICU admissions, lowers costs and improves patient care. The high prevalence of pulmonary diseases and NIV emphasizes the importance of pneumologists as directors of both ICU and IMC.

  2. Clinical Effectiveness of Modified SOFA (MSOFA scoring system for predicting mortality and length of stay in patients hospitalized in intensive care unit

    Directory of Open Access Journals (Sweden)

    Hassan Babamohamadi

    2016-10-01

    Full Text Available Background: The ability to recognize the severity of the disease in those who their survival depend entirely on admission to the intensive care unit, is very valuable clinically. This study aimed to evaluate the clinical effectiveness of MSOFA scale to predict mortality and length of stay in ICU patients respectively. Methods: This was a retrospective cross-sectional study conducted on hospital records of patients admitted to the intensive care unit of Kowsar Hospital of Semnan. The data collection tool was a demographic questionnaire and MSOFA scale. Finally, data were analyzed using SPSS version 16 by logistic regression and ROC curve. Results: The study of 105 patients' records of the intensive care unit in 2015 showed that 45/7% of patients were died, 15/2% and 39% were discharged and moved to other wards respectively. The results of logistic regression analysis and ROC curve showed that this criterion had moderate sensitivity and specificity for prediction of mortality and length of stay in ICU patients (Area=0/635, CI= 0/527-0/743( and each unit increase in MSOFA score is accompanied by increasing 32 percent chance of death (OR=1.325; 95% CI:1.129,1.555; P=0.001(. Also each unit increase in MSOFA score accompanied by increasing 19% length of stay in ICU (OR=1.191; 95% CI: 1.034, 1.371; P=0.015(. Conclusion: The results of this study showed that the MSOFA scale is not useful tool to predict the length of stay and mortality of patients admitted to the intensive care unit.

  3. Mortality in very long-stay pediatric intensive care unit patients and incidence of withdrawal of treatment

    NARCIS (Netherlands)

    S. Naghib (Sara); C. van der Starre (Cynthia); S.J. Gischler (Saskia); K.F.M. Joosten (Koen); D. Tibboel (Dick)

    2010-01-01

    textabstractBackground: The mortality for children with prolonged stay in pediatric intensive care units (PICU) is much higher than overall mortality. The incidence of withdrawal or limitation of therapy in this group is unknown. Purpose: To assess mortality and characteristics of children admitted

  4. Developing an App by Exploiting Web-Based Mobile Technology to Inspect Controlled Substances in Patient Care Units

    Directory of Open Access Journals (Sweden)

    Ying-Hao Lu

    2017-01-01

    Full Text Available We selected iOS in this study as the App operation system, Objective-C as the programming language, and Oracle as the database to develop an App to inspect controlled substances in patient care units. Using a web-enabled smartphone, pharmacist inspection can be performed on site and the inspection result can be directly recorded into HIS through the Internet, so human error of data translation can be minimized and the work efficiency and data processing can be improved. This system not only is fast and convenient compared to the conventional paperwork, but also provides data security and accuracy. In addition, there are several features to increase inspecting quality: (1 accuracy of drug appearance, (2 foolproof mechanism to avoid input errors or miss, (3 automatic data conversion without human judgments, (4 online alarm of expiry date, and (5 instant inspection result to show not meted items. This study has successfully turned paper-based medication inspection into inspection using a web-based mobile device.

  5. Developing an App by Exploiting Web-Based Mobile Technology to Inspect Controlled Substances in Patient Care Units

    Science.gov (United States)

    2017-01-01

    We selected iOS in this study as the App operation system, Objective-C as the programming language, and Oracle as the database to develop an App to inspect controlled substances in patient care units. Using a web-enabled smartphone, pharmacist inspection can be performed on site and the inspection result can be directly recorded into HIS through the Internet, so human error of data translation can be minimized and the work efficiency and data processing can be improved. This system not only is fast and convenient compared to the conventional paperwork, but also provides data security and accuracy. In addition, there are several features to increase inspecting quality: (1) accuracy of drug appearance, (2) foolproof mechanism to avoid input errors or miss, (3) automatic data conversion without human judgments, (4) online alarm of expiry date, and (5) instant inspection result to show not meted items. This study has successfully turned paper-based medication inspection into inspection using a web-based mobile device. PMID:28286761

  6. Developing an App by Exploiting Web-Based Mobile Technology to Inspect Controlled Substances in Patient Care Units.

    Science.gov (United States)

    Lu, Ying-Hao; Lee, Li-Yao; Chen, Ying-Lan; Cheng, Hsing-I; Tsai, Wen-Tsung; Kuo, Chen-Chun; Chen, Chung-Yu; Huang, Yaw-Bin

    2017-01-01

    We selected iOS in this study as the App operation system, Objective-C as the programming language, and Oracle as the database to develop an App to inspect controlled substances in patient care units. Using a web-enabled smartphone, pharmacist inspection can be performed on site and the inspection result can be directly recorded into HIS through the Internet, so human error of data translation can be minimized and the work efficiency and data processing can be improved. This system not only is fast and convenient compared to the conventional paperwork, but also provides data security and accuracy. In addition, there are several features to increase inspecting quality: (1) accuracy of drug appearance, (2) foolproof mechanism to avoid input errors or miss, (3) automatic data conversion without human judgments, (4) online alarm of expiry date, and (5) instant inspection result to show not meted items. This study has successfully turned paper-based medication inspection into inspection using a web-based mobile device.

  7. [Capacity problems in Danish intensive care units?].

    Science.gov (United States)

    Espersen, Kurt; Antonsen, Kristian; Joensen, Henning

    2007-02-19

    There are documented capacity problems in Danish ICUs. The indications for intensive care have increased in the last decade without any increase in the number of ICU beds. The result is massive pressure on many ICUs and many negative consequences in relation to healthcare, healthcare economics and patient comfort. Possible solutions: 1) an increase in the number of ICU beds, 2) re-organization of Danish ICUs into larger units and 3) creation of "step-down"-units. Intensive care is a costly area in the healthcare system, where there must be distinct guidelines for visitation and use of expensive medicine and advanced technology.

  8. Antibiotic Policies in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Nese Saltoglu

    2003-08-01

    Full Text Available The antimicrobial management of patients in the Intensive Care Units are complex. Antimicrobial resistance is an increasing problem. Effective strategies for the prevention of antimicrobial resistance in ICUs have focused on limiting the unnecessary use of antibiotics and increasing compliance with infection control practices. Antibiotic policies have been implemented to modify antibiotic use, including national or regional formulary manipulations, antibiotic restriction forms, care plans, antibiotic cycling and computer assigned antimicrobial therapy. Moreover, infectious diseases consultation is a simple way to limit antibiotic use in ICU units. To improve rational antimicrobial using a multidisiplinary approach is suggested. [Archives Medical Review Journal 2003; 12(4.000: 299-309

  9. Safety Management of a Clinical Process Using Failure Mode and Effect Analysis: Continuous Renal Replacement Therapies in Intensive Care Unit Patients.

    Science.gov (United States)

    Sanchez-Izquierdo-Riera, Jose Angel; Molano-Alvarez, Esteban; Saez-de la Fuente, Ignacio; Maynar-Moliner, Javier; Marín-Mateos, Helena; Chacón-Alves, Silvia

    2016-01-01

    The failure mode and effect analysis (FMEA) may improve the safety of the continuous renal replacement therapies (CRRT) in the intensive care unit. We use this tool in three phases: 1) Retrospective observational study. 2) A process FMEA, with implementation of the improvement measures identified. 3) Cohort study after FMEA. We included 54 patients in the pre-FMEA group and 72 patients in the post-FMEA group. Comparing the risks frequencies per patient in both groups, we got less cases of under 24 hours of filter survival time in the post-FMEA group (31 patients 57.4% vs. 21 patients 29.6%; p < 0.05); less patients suffered circuit coagulation with inability to return the blood to the patient (25 patients [46.3%] vs. 16 patients [22.2%]; p < 0.05); 54 patients (100%) versus 5 (6.94%) did not get phosphorus levels monitoring (p < 0.05); in 14 patients (25.9%) versus 0 (0%), the CRRT prescription did not appear on medical orders. As a measure of improvement, we adopt a dynamic dosage management. After the process FMEA, there were several improvements in the management of intensive care unit patients receiving CRRT, and we consider it a useful tool for improving the safety of critically ill patients.

  10. Physical functional outcome assessment of patients with major burns admitted to a UK Burn Intensive Care Unit.

    Science.gov (United States)

    Smailes, Sarah T; Engelsman, Kayleen; Dziewulski, Peter

    2013-02-01

    Determining the discharge outcome of burn patients can be challenging and therefore a validated objective measure of functional independence would assist with this process. We developed the Functional Assessment for Burns (FAB) score to measure burn patients' functional independence. FAB scores were taken on discharge from ICU (FAB 1) and on discharge from inpatient burn care (FAB 2) in 56 patients meeting the American Burn Association criteria for major burn. We retrospectively analysed prospectively collected data to measure the progress of patients' physical functional outcomes and to evaluate the predictive validity of the FAB score for discharge outcome. Mean age was 38.6 years and median burn size 35%. Significant improvements were made in the physical functional outcomes between FAB 1 and FAB 2 scores (ppatients were discharged home, 8 of these with social care. 8 patients were transferred to another hospital for further inpatient rehabilitation. FAB 1 score (≤ 9) is strongly associated with discharge outcome (pburn patients.

  11. The issue of penal and legal protection of the intensive care unit physician within the context of patient's consent to treatment. Part II: unconscious patient.

    Science.gov (United States)

    Siewiera, Jacek; Kübler, Andrzej; Filipowska, Monika; Trnka, Jakub; Zamaro-Michalska, Aleksandra

    2014-01-01

    Cultural changes in Western societies, as well as the rapid development of medical technology during the last quarter of a century, have led to many changes in the relationship between a physician and a patient. During this period, the patient's consent to treatment has proven to be an essential component of any decision relating to the patient's health. The patient's will component, as an essential element of the legality of the treatment process, is also reflected in the Polish legislation. The correct interpretation of the legal regulations and the role the patient's will plays in the therapeutic decision-making process within the Intensive Care Unit (ICU) requires the consideration of both the good of the patient and the physician's safety in terms of his criminal responsibility. Clinical experience indicates that the physicians' decisions result in the choice of the best treatment strategy for a patient only if they are based on current medical knowledge and an assessment of therapeutic opportunities. The good of the patient must be the sole objective of the physician's actions, and as a result of the current state of medical knowledge and the medical prognosis, all the conditions of the legal safety of a physician taking decisions must be met. In this paper, the authors have set out how to obtain consent (substantive consent) to treat an unconscious patient in the ICU in light of the current Polish law, as well as a physician's daily practice. The solutions proposed in the text of the publication are aimed at increasing the legal safety of the ICU physicians when making key decisions relating to the strategy of the treatment of ICU patients.

  12. Rapid detection of Vancomycin-Resistant Enterococci (VRE in rectal samples from patients admitted to intensive care units

    Directory of Open Access Journals (Sweden)

    Pedro Alves d'Azevedo

    2009-08-01

    Full Text Available The reduction in time required to identify vancomycin-resistant enterococci (VRE has gained increased importance during hospital outbreaks. In the present study, we implemented a laboratory protocol to speed up the VRE screening from rectal samples. The protocol combines a medium for selective VRE isolation (VREBAC®, Probac, São Paulo and a multiplex PCR for detection and identification of vanA and vanB resistance genes. The screening performance was analyzed in 114 specimens collected from four intensive care units. The swabs were collected at two periods: (1 during a VRE outbreak (February 2006, n=83 patients and (2 at the post-outbreak period, after adoption of infection control measures (June 2006, n=31 patients. Forty-one/83 VRE (49.4% and 3/31(9.7% VRE were found at the first and second period, respectively. All isolates harbored the vanA gene. In both periods, detection of the gene vanA parallels to the minimum inhibitory concentration values of >256 µg/mL and >48 µg/mL for vancomycin and teicoplanin, respectively. Multiplex PCR and conventional methods agreed in 90.2% for enterococci identification. Besides this accuracy, we also found a remarkable reduction in time to obtain results. Detection of enterococcal species and identification of vancomycin resistance genes were ready in 29.5 hours, in comparison to 72 hours needed by the conventional methods. In conclusion, our protocol identified properly and rapidly enterococci species and vancomycin-resistance genes. The results strongly encourage its adoption by microbiology laboratories for VRE screenning in rectal samples.

  13. Intensive Care Unit death and factors influencing family satisfaction of Intensive Care Unit care

    Science.gov (United States)

    Salins, Naveen; Deodhar, Jayita; Muckaden, Mary Ann

    2016-01-01

    Introduction: Family satisfaction of Intensive Care Unit (FS-ICU) care is believed to be associated with ICU survival and ICU outcomes. A review of literature was done to determine factors influencing FS-ICU care in ICU deaths. Results: Factors that positively influenced FS-ICU care were (a) communication: Honesty, accuracy, active listening, emphatic statements, consistency, and clarity; (b) family support: Respect, compassion, courtesy, considering family needs and wishes, and emotional and spiritual support; (c) family meetings: Meaningful explanation and frequency of meetings; (d) decision-making: Shared decision-making; (e) end of life care support: Support during foregoing life-sustaining interventions and staggered withdrawal of life support; (f) ICU environment: Flexibility of visiting hours and safe hospital environment; and (g) other factors: Control of pain and physical symptoms, palliative care consultation, and family-centered care. Factors that negatively influenced FS-ICU care were (a) communication: Incomplete information and unable to interpret information provided; (b) family support: Lack of emotional and spiritual support; (c) family meetings: Conflicts and short family meetings; (d) end of life care support: Resuscitation at end of life, mechanical ventilation on day of death, ICU death of an elderly, prolonged use of life-sustaining treatment, and unfamiliar technology; and (e) ICU environment: Restrictive visitation policies and families denied access to see the dying loved ones. Conclusion: Families of the patients admitted to ICU value respect, compassion, empathy, communication, involvement in decision-making, pain and symptom relief, avoiding futile medical interventions, and dignified end of life care. PMID:27076710

  14. Intensive Care Unit death and factors influencing family satisfaction of Intensive Care Unit care

    Directory of Open Access Journals (Sweden)

    Naveen Salins

    2016-01-01

    Full Text Available Introduction: Family satisfaction of Intensive Care Unit (FS-ICU care is believed to be associated with ICU survival and ICU outcomes. A review of literature was done to determine factors influencing FS-ICU care in ICU deaths. Results: Factors that positively influenced FS-ICU care were (a communication: Honesty, accuracy, active listening, emphatic statements, consistency, and clarity; (b family support: Respect, compassion, courtesy, considering family needs and wishes, and emotional and spiritual support; (c family meetings: Meaningful explanation and frequency of meetings; (d decision-making: Shared decision-making; (e end of life care support: Support during foregoing life-sustaining interventions and staggered withdrawal of life support; (f ICU environment: Flexibility of visiting hours and safe hospital environment; and (g other factors: Control of pain and physical symptoms, palliative care consultation, and family-centered care. Factors that negatively influenced FS-ICU care were (a communication: Incomplete information and unable to interpret information provided; (b family support: Lack of emotional and spiritual support; (c family meetings: Conflicts and short family meetings; (d end of life care support: Resuscitation at end of life, mechanical ventilation on day of death, ICU death of an elderly, prolonged use of life-sustaining treatment, and unfamiliar technology; and (e ICU environment: Restrictive visitation policies and families denied access to see the dying loved ones. Conclusion: Families of the patients admitted to ICU value respect, compassion, empathy, communication, involvement in decision-making, pain and symptom relief, avoiding futile medical interventions, and dignified end of life care.

  15. A qualitative study of the experiences and expectations of women receiving in-patient postnatal care in one English maternity unit

    Directory of Open Access Journals (Sweden)

    Bick Debra

    2010-10-01

    Full Text Available Abstract Background Studies consistently highlight in-patient postnatal care as the area of maternity care women are least satisfied with. As part of a quality improvement study to promote a continuum of care from the birthing room to discharge home from hospital, we explored women's expectations and experiences of current in-patient care. Methods For this part of the study, qualitative data from semi-structured interviews were transcribed and analysed using content analyses to identify issues and concepts. Women were recruited from two postnatal wards in one large maternity unit in the South of England, with around 6,000 births a year. Results Twenty women, who had a vaginal or caesarean birth, were interviewed on the postnatal ward. Identified themes included; the impact of the ward environment; the impact of the attitude of staff; quality and level of support for breastfeeding; unmet information needs; and women's low expectations of hospital based postnatal care. Findings informed revision to the content and planning of in-patient postnatal care, results of which will be reported elsewhere. Conclusions Women's responses highlighted several areas where changes could be implemented. Staff should be aware that how they inter-act with women could make a difference to care as a positive or negative experience. The lack of support and inconsistent advice on breastfeeding highlights that units need to consider how individual staff communicate information to women. Units need to address how and when information on practical aspects of infant care is provided if women and their partners are to feel confident on the woman's transfer home from hospital.

  16. Comparison the effect of two ways of tube feeding including bolus and continuous infusion on gastric residual volume and diarrhea in patients hospitalized in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Shahriari M

    2015-05-01

    Full Text Available Background and Objective: Proper nutritional support is one of the important caring aspects in patients who were hospitalized in Intensive Care Unit. Although the several studies have been done concerning the selection of proper nutrition method for patients, but there is no agreement on this issue. The aim of current study was the compare the effect of two ways of tube feeding including bolus and continuous infusion on gastric residual volume and diarrhea in patients hospitalized in Intensive Care Unit.  Materials and Method: The current clinical trial was conducted on patients who were hospitalized in intensive care unit in Alzahra hospital in Isfahan, 2013. Fifty patients were selected through convenient sampling and were randomly assigned into two groups of 25 people of intervention and control. Nutrition was done through infusion pump in intervention group and by bolus in control group. Gastric residual volume and diarrhea was assessed each four hours for four days. Data were gathered through checklist and were analyzed by SPSS18 using descriptive and inferential statistics including independent T-test, Fisher's exact test and repeated measures ANOVA.  Results: The results showed that the mean of gastric residual volume in control group was more than the intervention group on the third day (p=0.04. Also, the mean of gastric residual volume did not show significant difference at different times in intervention group, but the mean of gastric residual volume was significantly increased in control group at different times (p=0.04. Fisher's exact test showed no significant difference between two groups concerning the diarrhea frequency.  Conclusion: In nutritional support with continuous infusion method, gastric residual volume was not increased and gastric emptying rate was not diminished. Therefore, this method can be used as an appropriate nutritional support in intensive care unit.

  17. The impact of a pre-hospital medical response unit on patient care and emergency department attendances.

    LENUS (Irish Health Repository)

    Deasy, C

    2012-02-03

    A rapid response team was instigated in Cork to improve prehospital care and reduce unnecessary Emergency Department (ED) visits. This consisted of a Specialist Registrar (SpR) in Emergency Medicine and a Paramedic who attended all "999" calls in a designated rapid response vehicle on the allotted study days. Two hundred and sixty-three patients were seen on designated days between Jan 2004 and March 2006. Presentations seen included; road traffic accident (23%) collapse (12%), fall (10%) and seizure (8%). The majority of calls were to houses (36%). The most common medical intervention was intravenous cannulation (25%). Intravenous medications were administered in 21% of these patients--morphine sulphate was the most common drug given. It was possible to safely discharge 31% of patients on scene. In our experience skilled Emergency Medicine doctors attending at scene could provide advanced care and reduce ambulance transportation and patient attendance.

  18. Rehabilitation starts in the intensive care unit.

    Science.gov (United States)

    Rozeboom, Nathan; Parenteau, Kathy; Carratturo, Daniel

    2012-01-01

    Each year between 10 000 and 12 000 spinal cord injuries occur in the United States. Once injured, many of these patients will receive a portion of their care in an intensive care unit (ICU), where their treatment will begin. Harborview Medical Center in Seattle, Washington, provides comprehensive care to approximately 60 to 70 cervical spinal cord injuries each year. Because of many factors such as hemodynamic instability, pulmonary complications, and risk of infection, patients with cervical spinal cord injuries can spend up to 2 or more weeks in the ICU before they transfer to a rehabilitation unit. To achieve optimal outcomes, it is imperative that members of the interdisciplinary team work together in a consistent, goal-oriented, collaborative manner. This team includes physicians, nurses, respiratory therapists, physical and occupational therapists, speech pathologists, dieticians, and rehabilitation psychologists. An individual plan is developed for each patient and rehabilitation starts in the ICU as soon as the patient is medically stable. This article will highlight the management strategies used in the neuroscience ICU at Harborview Medical Center and will include a case study as an example of the typical experience for our patients with high cervical cord injury.

  19. The Effect of Increasing Meeting Time on the Physiological Indices of Patients Admitted to the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Mahmoudi

    2016-04-01

    Full Text Available Background Most hospitals have restricted visitation time in intensive care units (ICUs for various reasons. Given the advantages of family presence and positive effect of emotional touching, talking and smiling on nervous system stimulation and vital signs of the patients. Objectives The present study aimed to determine the effect of increased visitation time on physiological indices of the patients hospitalized in ICUs. Materials and Methods This clinical trial study was conducted in the ICUs of Vail-e-Asr hospital in Arak city, Iran. A total of 60 subjects were randomly assigned to the intervention and control groups with visitation time for 10 minutes 3 times a day and 10 minutes once a day, respectively. Then, the patients’ physiological indices were measured before, during, and 10 and 30 minutes after the hospital visiting hours. Data were analyzed using SPSS version 20. Results Findings showed no statistically significant differences among mean values of all physiological indices in measurement stages before, during, and 10 and 30 minutes after the visitation times in the control group (P > 0.05. While, in the intervention group, systolic blood pressure (SBP measurements at 9 (previous mean: 126.9, 30 minutes later: 111.9, 12:00 PM (previous mean: 126.9, 30 minutes later: 114.9, and 3:00 PM (previous mean: 125.2, 30 minutes later: 105.8, diastolic blood pressure (DBP measurements at 9:00 AM (previous mean: 87.4, 30 minutes later: 83.2, 12:00 PM (previous mean: 86.6, 30 minutes later: 81.7, and 3:00 PM (previous mean: 87.1, 30 minutes later: 85.0, heart rate (HR measurements at 9:00 AM (previous mean: 90, 30 minutes later: 78.4, 12:00 PM (previous mean: 89.8, 30 minutes later: 78.6, and 3:00 PM (previous mean: 89.3, 30 minutes later: 78.3, repertory rate (RR measurements at 9:00 AM (previous mean: 20.9, 30 minutes later: 15.0, 12:00 PM (previous mean: 20.6, 30 minutes later: 15.4, and 3:00 PM (previous mean: 21.0, 30 minutes later: 15

  20. Healthcare reform and the next generation: United States medical student attitudes toward the Patient Protection and Affordable Care Act.

    Directory of Open Access Journals (Sweden)

    Kristin M Huntoon

    Full Text Available CONTEXT: Over one year after passage of the Patient Protection and Affordable Care Act (PPACA, legislators, healthcare experts, physicians, and the general public continue to debate the implications of the law and its repeal. The PPACA will have a significant impact on future physicians, yet medical student perspectives on the legislation have not been well documented. OBJECTIVE: To evaluate medical students' understanding of and attitudes toward healthcare reform and the PPACA including issues of quality, access and cost. DESIGN, SETTING, AND PARTICIPANTS: An anonymous electronic survey was sent to medical students at 10 medical schools (total of 6982 students between October-December 2010, with 1232 students responding and a response rate of 18%. MAIN OUTCOME MEASURES: Medical students' views and attitudes regarding the PPACA and related topics, measured with Likert scale and open response items. RESULTS: Of medical students surveyed, 94.8% agreed that the existing United States healthcare system needs to be reformed, 31.4% believed the PPACA will improve healthcare quality, while 20.9% disagreed and almost half (47.7% were unsure if quality will be improved. Two thirds (67.6% believed that the PPACA will increase access, 6.5% disagreed and the remaining 25.9% were unsure. With regard to containing healthcare costs, 45.4% of participants indicated that they are unsure if the provisions of the PPACA will do so. Overall, 80.1% of respondents indicated that they support the PPACA, and 78.3% also indicated that they did not feel that reform efforts had gone far enough. A majority of respondents (58.8% opposed repeal of the PPACA, while 15.0% supported repeal, and 26.1% were undecided. CONCLUSION: The overwhelming majority of medical students recognized healthcare reform is needed and expressed support for the PPACA but echoed concerns about whether it will address issues of quality or cost containment.

  1. [The coma awakening unit, between intensive care and rehabilitation].

    Science.gov (United States)

    Mimouni, Arnaud

    2015-01-01

    After intensive care and before classic neurological rehabilitation is possible, patients in an altered state of consciousness are cared for at early stages in so-called coma awakening units. The care involves, on the one hand, the complex support of the patient's awakening from coma as a neurological and existential process, and on the other, support for their families.

  2. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States.

    NARCIS (Netherlands)

    Aiken, L.H.; Sermeus, W.; Heede, K. Van den; Sloane, D.M.; Busse, R.; McKee, M.; Bruyneel, L.; Rafferty, A.M.; Griffiths, P.; Moreno-Casbas, M.T.; Tishelman, C.; Scott, A.; Brzostek, T.; Kinnunen, J.; Schwendimann, R.; Heinen, M.M.; Zikos, D.; Sjetne, I.S.; Smith, H.L.; Kutney-Lee, A.

    2012-01-01

    OBJECTIVE: To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. DESIGN: Cross sectional surveys of patients and nurses. SETTING: Nurses were surveyed in gen

  3. On the palliative care unit.

    Science.gov (United States)

    Selwyn, Peter A

    2016-06-01

    As a physician working in palliative care, the author is often privileged to share special moments with patients and their families at the end of life. This haiku poem recalls one such moment in that precious space between life and death, as an elderly woman, surrounded by her adult daughters, takes her last breath. (PsycINFO Database Record

  4. Intensive care of haematological patients

    DEFF Research Database (Denmark)

    Magid, Tobias; Haase, Nicolai; Andersen, Jakob Steen

    2012-01-01

    This article presents the treatment results of 320 consecutive patients with malignant haematological diagnoses admitted to a tertiary intensive care unit at a Danish University hospital over a six-year period (2005-2010). With reference to international publications, we describe the development...

  5. Patients admitted in an Intensive Care Unit with severe clinical manifestations of Influenza, october-december 2009

    Directory of Open Access Journals (Sweden)

    Yenisey Quintero Mendez

    2011-04-01

    Full Text Available A descriptive study of a series of cases was carried out, where 109 patients with the presumptive diagnosis of severe clinical pictures of Influenza were included, the total of them admitted in one of our Intensive Care Units (ICU, prepared for that purpose during the recent pandemic, during the period comprised between October 1 and December 31, 2009. There were 62 women (56,9%, of which 19 were pregnant or postpartum women (17,4%. The mean age of the sick persons of this serie was of 52,53 ± 22,54 years. The beginning of symptoms before the time of admission revealed an average of 4,90 ± 4,37 days. The predominant symptoms were: cough in 93 patients (85,3%, dyspnea in 86 (78,9%, fever in 76 (68,8% and general symptoms of asthenia and anorexia in 76 (68,8%. In the physical exam, the most frequent signs were: polypnea in 86 (78,9% and wet rales in 65 (59,6%. Personal antecedents were informed by patients suffering arterial hypertension in 31 (28,4%, bronchial asthma and chronic obstructive lung disease in 26 (23,9%, diabetes in 19 (17,4%, ischemic heart disease in 19 (17,4%, alcoholism in 5 (4,6% and valvulopathies in 4 (3,7%. Among the signs found in the thorax´s radiographies at the moment of admission, it prevailed the pattern of radiopacity diffuse hilar and bilateral parahilar in 31 patients (28,4%, followed by bilateral diffuse opacities toward medial and inferiors lobes in 16 (14,7%, unilateral diffuse radiopacity in 12 (11,0%, increment in the broncovascular network in 13 (11,9%, lobar consolidation in 7 (6,4% and pleural esfusion in 5 (4,6%. In 25 cases the initial X-ray films were normal. In electrocardiograms, alterations were verified of ST-T in 12 sick persons (11,0%, sinusal tachicardia in 12 (11,0%, supraventricular arrhythmias (that included acute auricular fibrillation and supraventricular paroxysmal tachicardia in 7 (6,4% and ventricular arrhythmias in 2 (1,8%. The complications verified with more frequency were the

  6. Determination of prevalence and causes of hyponatremia in patient's admitted in pediatric intensive care unit of the Children's Hospital Medical Center

    Directory of Open Access Journals (Sweden)

    Kadivar M

    1999-06-01

    Full Text Available Among the 708 patients who were admitted in the pediatric intensive care unit (PICU of the children's hospital medical center, there were 100 patients with hyponatermia (Na<130 mEq/L. 62% of these patients had hyponatermia at the beginning of admission and 38% during hospitalization in PICU. According to the classification of hyponatermia in comparison to body fluid, this study revealed 7% pseudohyponatermia, 40% euvolemic hyponatermia, 34% hypovolemic hyponatermia and 10% hypovolemic hyponatermia. In conclusion, the most perevalent causes of hyponatermia in this study were syndrome of inappropriate antidiuretic hormone secretion (SIADH (27%, water intoxication (22% and extrarenal losses (20%

  7. Families' experiences of intensive care unit quality of care

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene; Gerritsen, Rik T; Koopmans, Matty

    2015-01-01

    PURPOSE: The purpose of the study is to adapt and provide preliminary validation for questionnaires evaluating families' experiences of quality of care for critically ill patients in the intensive care unit (ICU). MATERIALS AND METHODS: This study took place in 2 European ICUs. Based on literature......-retest reliability showed a median weighted κ of 0.69 (0.53-0.83). Validation showed significant correlation between total scores and key questions. CONCLUSIONS: The questions were assessed as relevant and understandable, providing high face and content validity. Ceiling effects were comparable to similar...

  8. The patient experience of intensive care

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Bergbom, Ingegerd; Lindahl, Berit

    2015-01-01

    countries have been particularly close to goals of lighter or no sedation and a more humane approach to intensive care. OBJECTIVES: The aim of our study was to systematically review and reinterpret newer Nordic studies of the patient experience of intensive care to obtain a contemporary description of human......: Nordic intensive care units. PARTICIPANTS: Patients in Nordic intensive care units. METHODS: We performed a literature search of qualitative studies of the patient experience of intensive care based on Nordic publications in 2000-2013. We searched the following databases: PubMed, CINAHL, Scopus, and Psyc......BACKGROUND: Sedation practices in the intensive care unit have evolved from deep sedation and paralysis toward lighter sedation and better pain management. The new paradigm of sedation has enabled early mobilization and optimized mechanical ventilator weaning. Intensive care units in the Nordic...

  9. The performance of customised APACHE II and SAPS II in predicting mortality of mixed critically ill patients in a Thai medical intensive care unit.

    Science.gov (United States)

    Khwannimit, B; Bhurayanontachai, R

    2009-09-01

    The aim of this study was to evaluate and compare the performance of customised Acute Physiology and Chronic Health Evaluation HII (APACHE II) and Simplified Acute Physiology Score HII (SAPS II) in predicting hospital mortality of mixed critically ill Thai patients in a medical intensive care unit. A prospective cohort study was conducted over a four-year period. The subjects were randomly divided into calibration and validation groups. Logistic regression analysis was used for customisation. The performance of the scores was evaluated by the discrimination, calibration and overall fit in the overall group and across subgroups in the validation group. Two thousand and forty consecutive intensive care unit admissions during the study period were split into two groups. Both customised models showed excellent discrimination. The area under the receiver operating characteristic curve of the customised APACHE II was greater than the customised SAPS II (0.925 and 0.892, P APACHE II in overall populations and various subgroups but insufficient calibration for the customised SAPS II. The customised SAPS II showed good calibration in only the younger, postoperative and sepsis patients subgroups. The overall performance of the customised APACHE II was better than the customised SAPS II (Brier score 0.089 and 0.109, respectively). Our results indicate that the customised APACHE II shows better performance than the customised SAPS II in predicting hospital mortality and could be used to predict mortality and quality assessment in our unit or other intensive care units with a similar case mix.

  10. Development of Delirium in the Intensive Care Unit in Patients after Endovascular Aortic Repair: A Retrospective Evaluation of the Prevalence and Risk Factors

    Directory of Open Access Journals (Sweden)

    Yohei Kawatani

    2015-01-01

    Full Text Available Delirium is an acute form of nervous system dysfunction often observed in patients in the intensive care unit. Endovascular aortic repair (EVAR is considered a minimally invasive surgical treatment for abdominal aortic aneurysm. Although the operation method is widely used, there are few investigations of the rate and risk factors of delirium development after the operation. In this study, we retrospectively examined the rate of delirium development in the intensive care unit (ICU after EVAR, as well as the associated preoperative risk factors and effects on the lengths of ICU and hospital stays. We examined the 81 consecutive patients who underwent elective EVAR between November 2013 and August 2014. The Intensive Care Delirium Screening Checklist was used to diagnose delirium. Twenty patients (24.7% were diagnosed with delirium in this study. The ICU and hospital length of stays of patients with delirium were 3.3 ± 2.4 days and 14.5 ± 11.9 days, respectively, the latter of which was significantly longer than that of patients without delirium (p= 0.019. Additionally, renal dysfunction, preoperative benzodiazepine use, and intraoperative transfusion were found to be risk factors for the development of delirium after elective EVAR.

  11. Music Inside an Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Ana Maria Loureiro De Souza Delabary

    2004-07-01

    Full Text Available This paper reports on the music therapy work performed in the intensive care unit of a university hospital. Clinical practice is inserted with in the hospital psychology department and acts jointly with some of the other health departments in the same hospital. The text presents the employed methodology, techniques, and repertoire, along with some considerations, comments, and observations on the practical side of the treatment. Music therapy imposes itself as a valuable element for the health area and becomes particularly meaningful as a part of the hospital's humanization program which is being developed in the institution. Striving for care quality, all the while it helps integrating all involved personnel interacting with the patients, music can be a powerful stimulus for the improvement of health care, particularly in the reception and support of the difficult situations terminal patients are faced with.

  12. [Molecular epidemiology and antifungal susceptibility of Candida species isolated from urine samples of patients in intensive care unit].

    Science.gov (United States)

    Yüksekkaya, Serife; Fındık, Duygu; Arslan, Uğur

    2011-01-01

    The aims of this study were to analyse the amphotericin B and fluconazole susceptibility and molecular epidemiology of Candida strains (Candida albicans, Candida tropicalis and Candida glabrata) isolated from the urine samples of patients hospitalized in the intensive care unit. Identification of the isolates was done according to microscopic morphology (chlamydospor, blastospor, pseudohyphae and true hyphae) on cornmeal agar, germ tube formation and carbohydrate assimilation patterns (API ID 32C bioMérieux, France). Antifungal susceptibilities of the isolates were determined by in vitro broth microdilution method recommended by Clinical and Laboratory Standards Institute (CLSI). To investigate the clonal relationship of the isolates, randomly amplified polymorphic DNA (RAPD) analysis was performed by using Cnd3 primer. Of the 56 Candida isolates minimum inhibitory concentration (MIC) ranges, MIC50 and MIC90 values for amphotericin B were 0.125-1 µg/ml, 0.125 and 0.5 µg/ml for C.albicans, 0.125-1 µg/ml, 0.25 and 1 µg/ml for C.tropicalis and 0.125-1 µg/ml, 0.25 and 1 µg/ml for C.glabrata, respectively. Fluconazole MIC ranges, MIC50 and MIC90 values were 0.25-4 µg/ml, 0.25 and 0.5 µg/ml for C.albicans, 0.25-16 µg/ml, 0.5 and 1 µg/ml for C.tropicalis and 0.5-64 µg/ml, 8 and 16 µg/ml for C.glabrata, respectively. For amphotericin B, none of the isolates had high MIC values (MIC > 1 µg/ml). While one of the C.glabrata isolates was resistant to fluconazole (MIC ≥ 64 µg/ml), one C.tropicalis and two C.glabrata isolates were dose-dependent susceptible (MIC: 16-32 µg/ml). The results of RAPD analysis indicated an exogenous spread from two clones for C.albicans, one clone for C.glabrata and one clone for C.tropicalis. This study underlines the importance of molecular epidemiological analysis of clinical samples together with hospital environmental samples in terms of Candida spp. To determine the exogenous origin for the related strains and to prevent

  13. Orthogeriatric care: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Tarazona-Santabalbina FJ

    2016-06-01

    Full Text Available Francisco José Tarazona-Santabalbina,1,2 Ángel Belenguer-Varea,1,2 Eduardo Rovira,1,2 David Cuesta-Peredó1,21Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera, 2Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, SpainAbstract: Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard. Keywords: hip fractures, geriatric assessment, orthogeriatric care, recovery of function, mortality

  14. [Primary care in the United Kingdom].

    Science.gov (United States)

    Sánchez-Sagrado, T

    2016-03-01

    The inadequate planning of health professionals in Spain has boosted the way out of doctors overseas. The United Kingdom is one of the countries chosen by Spanish doctors to develop their job. The National Health Service is a health system similar to the Spanish one. Health care services are financing mainly through taxes. The right to health care is linked to the citizen condition. The provision of health care is a mix-up of public and private enterprises. Primary Care is much closed to Spanish Primary Care. Doctors are "self-employed like" professionals. They can set their surgeries in a free area previously designed by the government. They have the right to make their own team and to manage their own budget. Medical salary is linked to professional capability and curriculum vitae. The main role of a General Practitioner is the prevention. Team work and coordination within primary and specialised care is more developed than in Spain. The access to diagnostic tests and to the specialist is controlled through waiting lists. General Practitioners work as gate-keepers. Patients may choose freely their doctor and consultations and hospital care are free at the point of use. Within the United Kingdom there are also health regions with problems due to inequalities to access and to treatment. There is a training path and the access to it is by Curricula. The number of training jobs is regulated by the local needs. Continuing education is compulsory and strictly regulated local and nationally. The National Health Service was the example for the Spanish health reform in 1986. While Spanish Primary health care is of quality, the efficiency of the health system would improve if staff in Primary Care settings were managed in a similar way to the British's.

  15. [Evaluation of the status of patients with severe infection, criteria for intensive care unit admittance. Spanish Society for Infectious Diseases and Clinical Microbiology. Spanish Society of Intensive and Critical Medicine and Coronary Units].

    Science.gov (United States)

    Olaechea, Pedro M; Alvarez-Lerma, Francisco; Sánchez, Miguel; Torres, Antonio; Palomar, Mercedes; Fernández, Pedro; Miró, José M; Cisneros, José Miguel; Torres, Manuel

    2009-06-01

    Recent studies have shown that early attention in patients with serious infections is associated with a better outcome. Assistance in intensive care units (ICU) can effectively provide this attention; hence patients should be admitted to the ICU as soon as possible, before clinical deterioration becomes irreversible. The objective of this article is to compile the recommendations for evaluating disease severity in patients with infections and describe the criteria for ICU admission, updating the criteria published 10 years ago. A literature review was carried out, compiling the opinions of experts from the Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC, Spanish Society for Infectious Diseases and Clinical Microbiology) and the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC, Spanish Society for Intensive Medicine, Critical Care and Coronary Units) as well as the working groups for infections in critically ill patients (GEIPC-SEIMC and GTEI-SEMICYUC). We describe the specific recommendations for ICU admission related to the most common infections affecting patients, who will potentially benefit from critical care. Assessment of the severity of the patient's condition to enable early intensive care is stressed.

  16. The impact of chronic obstructive pulmonary disease on intensive care unit admission and 30-day mortality in patients undergoing colorectal cancer surgery

    DEFF Research Database (Denmark)

    Platon, Anna Maria; Erichsen, Rune; Christiansen, Christian Fynbo;

    2014-01-01

    all patients undergoing CRC surgery in the period 2005-2011, identified through medical databases. We categorised the patients according to the history of COPD. We assessed the rate of complications within 30 days. We computed 30-day mortality among patients with/without COPD using the Kaplan......-Meier method. We used Cox regression to compute HRs for death, controlling for age, gender, type of admission, cancer stage, hospital volume, alcohol-related diseases, obesity and Charlson comorbidity score. RESULTS: We identified 18 302 CRC surgery patients. Of these, 7.9% had a prior diagnosis of COPD. Among...... patients with COPD, 16.1% were admitted postoperatively to the intensive care unit, 1.9% were treated with mechanical ventilation, and 3.6% were treated with non-invasive ventilation. In patients without COPD, the corresponding proportions were 9.7%, 1.1% and 1.1%. The reoperation rate was 10.6% among...

  17. Delirium in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Suresh Arumugam

    2017-01-01

    Full Text Available Delirium is characterized by impaired cognition with nonspecific manifestations. In critically ill patients, it may develop secondary to multiple precipitating or predisposing causes. Although it can be a transient and reversible syndrome, its occurrence in Intensive Care Unit (ICU patients may be associated with long-term cognitive dysfunction. This condition is often under-recognized by treating physicians, leading to inappropriate management. For appropriate management of delirium, early identification and risk factor assessment are key factors. Multidisciplinary collaboration and standardized care can enhance the recognition of delirium. Interdisciplinary team working, together with updated guideline implementation, demonstrates proven success in minimizing delirium in the ICU. Moreover, should the use of physical restraint be necessary to prevent harm among mechanically ventilated patients, ethical clinical practice methodology must be employed. This traditional narrative review aims to address the presentation, risk factors, management, and ethical considerations in the management of delirium in ICU settings.

  18. Delirium in the Intensive Care Unit

    Science.gov (United States)

    Arumugam, Suresh; El-Menyar, Ayman; Al-Hassani, Ammar; Strandvik, Gustav; Asim, Mohammad; Mekkodithal, Ahammed; Mudali, Insolvisagan; Al-Thani, Hassan

    2017-01-01

    Delirium is characterized by impaired cognition with nonspecific manifestations. In critically ill patients, it may develop secondary to multiple precipitating or predisposing causes. Although it can be a transient and reversible syndrome, its occurrence in Intensive Care Unit (ICU) patients may be associated with long-term cognitive dysfunction. This condition is often under-recognized by treating physicians, leading to inappropriate management. For appropriate management of delirium, early identification and risk factor assessment are key factors. Multidisciplinary collaboration and standardized care can enhance the recognition of delirium. Interdisciplinary team working, together with updated guideline implementation, demonstrates proven success in minimizing delirium in the ICU. Moreover, should the use of physical restraint be necessary to prevent harm among mechanically ventilated patients, ethical clinical practice methodology must be employed. This traditional narrative review aims to address the presentation, risk factors, management, and ethical considerations in the management of delirium in ICU settings.

  19. Rehabilitation in the intensive care unit.

    Science.gov (United States)

    Rochester, Carolyn L

    2009-12-01

    Critical illness has many devastating sequelae, including profound neuromuscular weakness and psychological and cognitive disturbances that frequently result in long-term functional impairments. Early rehabilitation begun in the intensive care unit (ICU) is emerging as an important strategy both to prevent and to treat ICU-acquired weakness, in an effort to facilitate and improve long-term recovery. Rehabilitation may begin with range of motion and bed mobility exercise, then may progress when the patient is fully alert and able to participate actively to include sitting and posture-based exercise, bed to chair transfers, strength and endurance exercises, and ambulation. Electrical muscle stimulation and inspiratory muscle training are additional techniques that may be employed. Studies conducted to date suggest that such ICU-based rehabilitation is feasible, safe, and effective for carefully selected patients. Further research is needed to identify the optimal patient candidates and procedures and for providing rehabilitation in the ICU.

  20. Impact of different sedation protocols and perioperative procedures on patients admitted to the intensive care unit after maxillofacial tumor surgery of the lower jaw: A retrospective study.

    Science.gov (United States)

    Lebherz-Eichinger, Diana; Tudor, Bianca; Krenn, Claus G; Roth, Georg A; Seemann, Rudolf

    2016-04-01

    Maxillofacial tumor surgery often necessitates prolonged invasive ventilation to prevent blockage of the respiratory tract. To tolerate ventilation, continuously administered sedatives are recommended. Half-time of sedative or analgesic medication is an important characteristic by which narcotic drugs are chosen, due to the fact that weaning period increases with half-time. The aim of our study was to investigate whether a change in sedation regimen would affect the length of invasive ventilation or intensive care unit stay and medical costs. Additionally, the impact of various surgical procedures was analyzed. Data of 157 patients after mandibular surgery were retrospectively analyzed over 5 years in count regression models. Of those patients, 84 received a sedation regimen with sufentanil and midazolam and 73 with remifentanil and propofol. The impact of the surgical procedures (tracheostomy, tumor resection, neck dissection and length of operation) and the patient age and sex were analyzed with respect to length of ventilation and ICU days. Cost savings were calculated. Our data show that patients receiving remifentanil/propofol had fewer ventilation days (2.5 ± 2.5 versus 6.1 ± 4.6 days, P < 0.001) and were discharged earlier from the intensive care unit than patients receiving sufentanil/midazolam (5.1 ± 3.8 versus 9.2 ± 6.2 days, P < 0.001), leading to calculated cost savings of about 8000 Euro per patient. Length of operation negatively influenced length of ICU stay (P < 0.001). In conclusion, short-acting drugs such as remifentanil/propofol, as well as tracheostoma and shortened surgery duration may reduce the postoperative need for invasive ventilation and length of intensive care unit stay.

  1. Severe encephalopathy after ingestion of star fruit juice in a patient with chronic renal failure admitted to the intensive care unit.

    Science.gov (United States)

    Auxiliadora-Martins, Maria; Alkmin Teixeira, Gil Cezar; da Silva, Graciana Soares; Viana, Jaciara Machado; Nicolini, Edson Antônio; Martins-Filho, Olindo Assis; Basile-Filho, Anibal

    2010-01-01

    Star fruit (Averrhoa carambola) is a popular tropical fruit that is usually consumed as fresh fruit or fruit juice. Consumption of star fruit by patients with chronic renal failure can lead to neurologic symptoms. The present report describes the clinical course, management, and outcome of a patient with chronic renal failure admitted to an intensive care unit after ingestion of star fruit juice 2 days before hospital admission. A case of nausea, vomiting, intractable hiccups, and severe encephalopathy along with mental confusion, disorientation, agitation, and seizures in a 53-year-old woman is presented. The patient's ventilatory pattern worsened, with development of dyspnea and tachypnea, which resulted in her transfer to an intensive care unit. Although hemodialysis was performed and the septic shock was adequately treated, the patient died on the fifth day after hospital admission. The susceptibility of patients with chronic renal failure to star fruit and the severity of intoxication are poorly known by intensivists. This case demonstrates that star fruit consumption should be considered as a cause of rapid deterioration in the renal function of patients with underlying chronic renal failure, potentially resulting in a fatal outcome.

  2. Intensive care unit audit: invasive procedure surveillance

    Directory of Open Access Journals (Sweden)

    Mariama Amaral Michels

    2013-06-01

    Full Text Available Rationale and objective: currently, Healthcare-associated Infections (HAIs constitute a serious public health problem. It is estimated that for every ten hospitalized patients, one will have infection after admission, generating high costs resulting from increased length of hospitalization, additional diagnostic and therapeutic interventions. The intensive care unit (ICU, due to its characteristics, is one of the most complex units of the hospital environment, a result of the equipment, the available technology, the severity of inpatients and the invasive procedures the latter are submitted to. The aim of the study was to evaluate the adherence to specifi c HAI prevention measures in invasive ICU procedures. Methods: This study had a quantitative, descriptive and exploratory approach. Among the risk factors for HAIs are the presence of central venous access, indwelling vesical catheter and mechanical ventilation, and, therefore, the indicators were calculated for patients undergoing these invasive procedures, through a questionnaire standardized by the Hospital Infection Control Commission (HICC. Results: For every 1,000 patients, 15 had catheter-related bloodstream infection, 6.85 had urinary tract infection associated with indwelling catheter in the fi rst half of 2010. Conclusion: most HAIs cannot be prevented, for reasons inherent to invasive procedures and the patients. However, their incidence can be reduced and controlled. The implementation of preventive measures based on scientifi c evidence can reduce HAIs signifi cantly and sustainably, resulting in safer health care services and reduced costs. The main means of prevention include the cleaning of hands, use of epidemiological block measures, when necessary, and specifi c care for each infection site. KEYWORDS Nosocomial infection. Intensive care units.

  3. Atrial Fibrillation on Intensive Care Unit Admission Independently Increases the Risk of Weaning Failure in Nonheart Failure Mechanically Ventilated Patients in a Medical Intensive Care Unit: A Retrospective Case-Control Study.

    Science.gov (United States)

    Tseng, Yen-Han; Ko, Hsin-Kuo; Tseng, Yen-Chiang; Lin, Yi-Hsuan; Kou, Yu Ru

    2016-05-01

    Atrial fibrillation (AF) is one of the most frequent arrhythmias in clinical practice. Previous studies have reported the influence of AF on patients with heart failure (HF). The effect of AF on the non-HF critically ill patients in a medical intensive care unit (ICU) remains largely unclear. The study aimed to investigate the impact of AF presenting on ICU admission on the weaning outcome of non-HF mechanically ventilated patients in a medical ICU.A retrospective observational case-control study was conducted over a 1-year period in a medical ICU at Taipei Veterans General Hospital, a tertiary medical center in north Taiwan. Non-HF mechanically ventilated patients who were successful in their spontaneous breathing trial and underwent ventilator discontinuation were enrolled. The primary outcome measure was the ventilator status after the first episode of ventilator discontinuation.A total of 285 non-HF patients enrolled were divided into AF (n = 62) and non-AF (n = 223) groups. Compared with the non-AF patients, the AF patients were significantly associated with old age (P = 0.002), a higher rate of acute respiratory distress syndrome causing respiratory failure (P = 0.015), a higher percentage of sepsis before liberation from mechanical ventilation (MV) (P = 0.004), and a higher serum level of blood urea nitrogen on the day of liberation from MV (P = 0.003). Multivariate logistic regression analysis demonstrated that AF independently increased the risk of weaning failure [adjusted odds ratio (AOR), 3.268; 95% confidence interval (CI), 1.254-8.517; P = 0.015]. Furthermore, the AF patients were found to be independently associated with a high rate of ventilator dependence (log rank test, P = 0.026), prolonged total ventilator use (AOR, 1.979; 95% CI, 1.032-3.794; P = 0.040), increased length of ICU stay (AOR, 2.256; 95% CI, 1.049-4.849; P = 0.037), increased length of hospital stay (AOR, 2.921; 95% CI, 1.363-6.260; P = 0

  4. "Patient care in radiology"

    DEFF Research Database (Denmark)

    Bro Brask, Kirsten; Birkelund, Regner

    2014-01-01

    The aim of this study was to research how the staff experience care expressed during the brief encounter with the patients in a diagnostic imaging department. This was a qualitative study with a phenomenological and hermeneutical frame of reference. The data were collected using field observations...... and semistructured interviews and analyzed according to the guidelines for meaning condensation by Giorgi. The imaging staff found that care is expressed in an administrative, an instrumental, and a compassionate sense. The imaging staff perceived care in a way that clearly differs from the traditional perception...... of care understood as the close relations between people. In their self-understanding, the staff found that care not only comprised the relational aspect but also that it was already delivered during the preparatory phases before the actual meeting with the patient and up until the image...

  5. Factors influencing nursing care in a surgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Raj John

    2006-01-01

    Full Text Available Context: The total time spent in nursing care depends on the type of patient and the patient′s condition. We analysed factors that influenced the time spent in nursing a patient. Aims : To analyse the factors in a patient′s condition that influenced time spent in nursing a patient. Materials and Methods: This study was performed in the Surgical Intensive Care Unit of a tertiary referral centre, over a period of one month. The total time spent on a patient in nursing care for the first 24 hours of admission, was recorded. This time was divided into time for routine nursing care, time for interventions, time for monitoring and time for administering medications. Statistical analysis used: A backward stepwise linear regression analysis using the age, sex, diagnosis, type of admission and ventilatory status as variables, was done. Results: Patients admitted after elective surgery required less time (852.4 ± 234.1 minutes, than those admitted after either emergency surgery (1069.5 ± 187.3 minutes, or directly from the ward or the emergency room (1253.7 ± 42.1 minutes. Patients who were ventilated required more time (1111.5 ± 132.5 minutes, than those brought on a T-piece (732.2 ± 134.8 minutes or extubated (639.5 ± 155.6 minutes. The regression analysis showed that only the type of admission and the ventilatory status significantly affected the time. Conclusions : This study showed that the type of admission and ventilatory status significantly influenced the time spent in nursing care. This will help optimal utilization of nursing resources.

  6. [Risky alcohol drinking surveyed at a GP unit. Secondary prevention of alcohol problems in primary care patients].

    Science.gov (United States)

    Eriksson, G; Spak, F; Andersson, C

    2000-03-08

    This article describes an implementation of secondary prevention of alcohol abuse at a GP unit in southern Gothenburg, Sweden. During several periods between 1994 and 1996, screening for alcohol problems was performed using either AUDIT or a 4-item instrument called SWAG. In one part of the study, screening was simultaneously carried out using gamma-GT and MCV. The main object of screening efforts was to stimulate interest for alcohol-related conditions, and this goal was reached. The staff was trained in treatment techniques such as motivational interviewing (MI), bio-feedback using gamma-GT and delivery of concise information. Simple methods to determine level of motivation were used for treatment stratification. Some doctors reported that they had insufficient time for adequate MI treatment, and therefore a condensed model was sometimes used. A nurse-staffed treatment unit was started and successfully promoted work with alcohol problem. Attempts were made to spread these methods to other GP units in the region and this was partially successful, although support from the central primary care administration was not secured.

  7. Positive predictive value and impact of misdiagnosis of a heart failure diagnosis in administrative registers among patients admitted to a University Hospital cardiac care unit

    DEFF Research Database (Denmark)

    Mard, Shan; Nielsen, Finn Erland

    2010-01-01

    patients with heart failure from July 1, 2005 to June 30, 2007. Heart failure was defined in accordance with European Society of Cardiology (ESC) guidelines. The recorded diagnoses from the NRP were compared with clinical data from the medical records. RESULTS: We identified 758 patients with a diagnosis......OBJECTIVE: To evaluate the positive predictive value (PPV) of a diagnosis of heart failure (HF) in the Danish National Registry of Patients (NRP) among patients admitted to a University Hospital cardiac care unit, and to evaluate the impact of misdiagnosing HF. DESIGN: The NRP was used to identify...... of heart failure in the NRP. The PPV of a heart failure discharge diagnosis was 84.0% (95% confidence interval: 81.2-86.6). Patients with a discharge diagnosis of HF in the NRP without fulfilling the ESC criteria for HF had a better survival rate, a lower rate of rehospitalization, none were followed...

  8. Prevalence of Undiagnosed Diabetes and Quality of Care in Diabetic Patients Followed at Primary and Tertiary Clinics in Abu Dhabi, United Arab Emirates

    Science.gov (United States)

    Saadi, Hussein; Al-Kaabi, Jumaa; Benbarka, Mahmoud; Khalili, Ali; Almahmeed, Wael; Nagelkerke, Nicolaas; Abdel-Wareth, Laila; Al Essa, Awad; Yasin, Javed; Al-Dabbagh, Bayan; Kazam, Elsadig

    2010-01-01

    AIMS: To investigate the prevalence of undiagnosed type 2 diabetes (T2D) at primary health care (PHC) clinics, and to assess the quality of care of diabetic patients followed at a tertiary hospital diabetes center in Abu Dhabi, United Arab Emirates (UAE). METHODS: Between May 2009 and October 2010, adult patients attending two PHC clinics, and adult diabetic patients attending the diabetes center, were invited to participate in the study. After overnight fast, participants returned for interview and laboratory tests. Undiagnosed T2D was defined by FPG ≥ 7.0 mmol/l or HbA1c ≥ 6.5%. Quality of care was assessed by reported care practices and achievement of internationally recognized targets. RESULTS: Out of 239 patients at PHC clinics without history of T2D, 14.6% had undiagnosed T2D, and 31% had increased risk of diabetes (FPG 5.6-7.0 mmol/l or HbA1c 5.7-6.5%). The independent predictors of undiagnosed T2D were age (adjusted OR per year 1.07, 95% CI 1.04-1.11, p < 0.001) and BMI ≥ 25 (adjusted OR 4.2, 95% CI 0.91-19.7, p = 0.033). Amongst all 275 diagnosed T2D patients, including those attending PHC clinics and those followed at the diabetes center, it was found that 40.1% followed dietary recommendations, 12% reported visiting a diabetes educator, 28.2% walked for exercise, and 13.5% attained recognized targets of HbA1c < 7%, blood pressure < 130/80 mmHg, and LDL cholesterol < 2.6 mmol/l. CONCLUSIONS: Almost half of the adult patients attending PHC clinics had undiagnosed T2D, or increased diabetes risk. Care practices, and achievement of treatment targets, were suboptimal. PMID:21713317

  9. Intensive Care Unit death and factors influencing family satisfaction of Intensive Care Unit care

    OpenAIRE

    2016-01-01

    Introduction: Family satisfaction of Intensive Care Unit (FS-ICU) care is believed to be associated with ICU survival and ICU outcomes. A review of literature was done to determine factors influencing FS-ICU care in ICU deaths. Results: Factors that positively influenced FS-ICU care were (a) communication: Honesty, accuracy, active listening, emphatic statements, consistency, and clarity; (b) family support: Respect, compassion, courtesy, considering family needs and wishes, and emotional and...

  10. What are the highly important and desirable patient engagement actions for self-care as perceived by individuals living in the southern United States?

    Science.gov (United States)

    Tzeng, Huey-Ming; Pierson, James Marcus

    2017-01-01

    Aim This exploratory survey study aimed to identify patient engagement actions that are the most frequently named as being highly important (top 30 by importance) or ones that they want to do (top 30 by desire) for community-dwelling adult patients living in the southern United States. Items not making the list of the top 30 by ability were also identified. Background Patient engagement is still an ambiguous term among population health and health care professionals in the United States as we lack a clear understanding of what it entails. Methods This 2015–2016 study used convenience sampling to recruit subjects in a university’s student health service department and in eight senior centers. Two hundred and fifty adult patients older than 18 years in the Upper Cumberland region of Tennessee participated in the study (82% response rate). A 57-item inventory, “The Patient Action Inventory for Self-Care,” was developed and used to ascertain patients’ self-designated preferences and capabilities in order to understand their needs for education and support. Results Respondents included 159 (63.6%) women, 62 (24.8%) men, and 29 (11.6%) who did not indicate their gender. Combining the list of the top 30 importance items and the list of the top 30 desired items yielded a list of 35 items; noteworthy is the fact that the list of the top 30 ability actions contained nine items that were not found in a previously mentioned list of 35 high-ranking importance and desired items. This study validated the necessity of analyzing patient engagement actions by importance, desirability, and ability to accomplish it. These three levels are distinct from each other. Conclusion Nurses may use future versions of the inventory to assist patients in identifying self-care actions to engage in. Use of the inventory will demonstrate respect for patients’ preferences and may thus improve engagement.

  11. Meeting standards of high-quality intensive care unit palliative care: Clinical performance and predictors

    Science.gov (United States)

    Penrod, Joan D.; Pronovost, Peter J.; Livote, Elayne E.; Puntillo, Kathleen A.; Walker, Amy S.; Wallenstein, Sylvan; Mercado, Alice F.; Swoboda, Sandra M.; Ilaoa, Debra; Thompson, David A.; Nelson, Judith E.

    2012-01-01

    Objectives High-quality care for intensive care unit patients and families includes palliative care. To promote performance improvement, the Agency for Healthcare Research and Quality’s National Quality Measures Clearinghouse identified nine evidence-based processes of intensive care unit palliative care (Care and Communication Bundle) that are measured through review of medical record documentation. We conducted this study to examine how frequently the Care and Communication Bundle processes were performed in diverse intensive care units and to understand patient factors that are associated with such performance. Design Prospective, multisite, observational study of performance of key intensive care unit palliative care processes. Settings A surgical intensive care unit and a medical intensive care unit in two different large academic health centers and a medical-surgical intensive care unit in a medium-sized community hospital. Patients Consecutive adult patients with length of intensive care unit stay ≥5 days. Interventions None. Measurements and Main Results Between November 2007 and December 2009, we measured performance by specified day after intensive care unit admission on nine care process measures: identify medical decision-maker, advance directive and resuscitation preference, distribute family information leaflet, assess and manage pain, offer social work and spiritual support, and conduct interdisciplinary family meeting. Multivariable regression analysis was used to determine predictors of performance of five care processes. We enrolled 518 (94.9%) patients and 336 (83.6%) family members. Performances on pain assessment and management measures were high. In contrast, interdisciplinary family meetings were documented for <20% of patients by intensive care unit day 5. Performance on other measures ranged from 8% to 43%, with substantial variation across and within sites. Chronic comorbidity burden and site were the most consistent predictors of care

  12. The Definition of a Prolonged Intensive Care Unit Stay for Spontaneous Intracerebral Hemorrhage Patients: An Application with National Health Insurance Research Database

    Directory of Open Access Journals (Sweden)

    Chien-Lung Chan

    2014-01-01

    Full Text Available Introduction. Length of stay (LOS in the intensive care unit (ICU of spontaneous intracerebral hemorrhage (sICH patients is one of the most important issues. The disease severity, psychosocial factors, and institutional factors will influence the length of ICU stay. This study is used in the Taiwan National Health Insurance Research Database (NHIRD to define the threshold of a prolonged ICU stay in sICH patients. Methods. This research collected the demographic data of sICH patients in the NHIRD from 2005 to 2009. The threshold of prolonged ICU stay was calculated using change point analysis. Results. There were 1599 sICH patients included. A prolonged ICU stay was defined as being equal to or longer than 10 days. There were 436 prolonged ICU stay cases and 1163 nonprolonged cases. Conclusion. This study showed that the threshold of a prolonged ICU stay is a good indicator of hospital utilization in ICH patients. Different hospitals have their own different care strategies that can be identified with a prolonged ICU stay. This indicator can be improved using quality control methods such as complications prevention and efficiency of ICU bed management. Patients’ stay in ICUs and in hospitals will be shorter if integrated care systems are established.

  13. Nutrition in the neurocritical care unit

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    Swagata Tripathy

    2015-01-01

    Full Text Available The aim of intensive care is to support the physiology of the body till the treatment or the reparative process of the body kicks in to the rescue. Maintaining an adequate nutrition during this period is of vital importance to counteract the catabolic effect of the critical disease process. The guidelines for nutritional care in the neuro intensive care unit (ICU are sparse. This article collates the current evidence and best practice recommendations as applicable to the critically ill patient in the neuro ICU. The use of screening tests to identify patients at a risk of malnutrition and related complications is presently recommended for all patients with an emphasis on early initiation of caloric support. Over-aggressive feeding in an attempt to revert the catabolic effects of critical illness have not proven beneficial, just as the attempts to improve patient outcomes by altering the routes of nutrition administration. Special patient population such as traumatic brain injury, stroke, subarachnoid haemorrhage or spinal cord injury may have varying nutritional requirements; individualised approach in the neurocritical ICU with the help of the intensivist, nutritionist and pharmacology team may be of benefit.

  14. INTRATRACHEAL SUCTION: STUDY IN PATIENTS OF AN EMERGENCY AND INTENSIVE CARE UNIT IN A HOSPITAL OF THE METROPOLITAN REGION OF NATAL CITY – RN

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    Glaucea Maciel de Farias

    2006-04-01

    Full Text Available ABSTRACT: Intratracheal suction is a simple and important mechanical procedure on hospital routine. It’s largely used on patients in Intensive Care Units (ICU, under mechanical ventilation or not. This study seeks to characterize the professionals that perform the procedure of upper air tracts aspiration and identify how this procedure is being performed. The research is of the descriptive exploratory type with prospective data and quantitative approach, performed on the Emergency Room and ICU of a hospital in the greater Natal-RN. The population is comprised of 14 nurses, 22 nursing technicians, 14 nursing auxiliaries, 03 physicians and 07 physiotherapists. The structure observation technique was employed in the data collection. The instrument was comprised of a suction protocol based on the directives of the Agência Nacional de Vigilância Sanitária, Ministério da Saúde, and of the Guidelines for Prevention of Nosocomial Pneumonia of the Center for Disease Control (CDC, 1997. We’ve discovered that the guidelines for this procedure were not taken into consideration in almost every step of this care. The most outstanding discovery was the absence of hand washing before (92,81% and after (50,29% this care. The small participation of the nurse (3,59% on this activity is also considered a point of extreme relevance, since it’s a unit for care of extreme complexity. The data indicate the need to intensify the educating activities that promote a change of behavior on these professionals, thus improving the quality of assistance and prevention of nosocomial infections. KEYWORDS: Intensive Care; Quality of Health Care; Nursing Care.

  15. Diabetic patients with severe sepsis admitted to intensive care unit do not fare worse than non-diabetic patients: a nationwide population-based cohort study.

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    Cheng-Wei Chang

    Full Text Available BACKGROUND: We sought to examine whether type 2 diabetes increases the risk of acute organ dysfunction and of hospital mortality following severe sepsis that requires admission to an intensive care unit (ICU. METHODS: Nationwide population-based retrospective cohort study of 16,497 subjects with severe sepsis who had been admitted for the first time to an ICU during the period of 1998-2008. A diabetic cohort (n = 4573 and a non-diabetic cohort (n = 11924 were then created. Relative risk (RR of organ dysfunctions, length of hospital stay (LOS, 90-days hospital mortality, ICU resource utilization and hazard ratio (HR of mortality adjusted for age, gender, Charlson-Deyo comorbidity index score, surgical condition and number of acute organ dysfunction, were compared across patients with severe sepsis with or without diabetes. RESULTS: Diabetic patients with sepsis had a higher risk of developing acute kidney injury (RR, 1.54; 95% confidence interval (CI, 1.44-1.63 and were more likely to be undergoing hemodialysis (15.55% vs. 7.24% in the ICU. However, the diabetic cohort had a lower risk of developing acute respiratory dysfunction (RR = 0.96, 0.94-0.97, hematological dysfunction (RR = 0.70, 0.56-0.89, and hepatic dysfunction (RR = 0.77, 0.63-0.93. In terms of adjusted HR for 90-days hospital mortality, the diabetic patients with severe sepsis did not fare significantly worse when afflicted with cardiovascular, respiratory, hepatic, renal and/or neurologic organ dysfunction and by numbers of organ dysfunction. There was no statistically significant difference in LOS between the two cohorts (median 17 vs. 16 days, interquartile range (IQR 8-30 days, p = 0.11. Multiple logistic regression analysis to predict the occurrence of mortality shows that being diabetic was not a predictive factor with an odds ratio of 0.972, 95% CI 0.890-1.061, p = 0.5203. INTERPRETATION: This large nationwide population-based cohort study suggests

  16. Respiratory virology and microbiology in intensive care units

    DEFF Research Database (Denmark)

    Østby, Anne-Cathrine; Gubbels, Sophie; Baake, Gerben

    2013-01-01

    Our aim was to determine the frequency of 12 common respiratory viruses in patients admitted to intensive care units with respiratory symptoms, evaluate the clinical characteristics and to compare the results to routine microbiological diagnostics. Throat swabs from 122 intensive care-patients >18...

  17. General care plan in a Paediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Mª Teresa Martín Alonso

    2011-07-01

    Full Text Available The care plan we expose is a general one applicable to all the children who are admitted in the unit, no matter what pathology they present/display, their physiopathological situation or their age. We present the common nursing actions which are applied to all the patients at the time of their admittance. The factor related to the studied problems is the hospitalization and what it has associate, from separation of the parents and rupture familiar ties, up to immobilization, the use of bloody devices and the generally hostile and stranger background.The protocol is based on the NANDA, the nursing outcomes classification NOC and the nursing intervention classification NIC. It is part of the nursing process and promotes systematized, humanistic and effective care, focuses on the child and his parents.We have selected the most relevant problems, ordered according to the deficits in the different selfcare requirements of Dorotea E. Orem. Each problem has its definition, the outcomes we pretend to reach with our care and the interventions to get the outcomes (these two last topics have the corresponding codification. In them all the most important factor is hospitalization in a unit of intensive care and the separation of the child from his habitual environment.

  18. Radiology clinical synopsis: a simple solution for obtaining an adequate clinical history for the accurate reporting of imaging studies on patients in intensive care units

    Energy Technology Data Exchange (ETDEWEB)

    Cohen, Mervyn D. [Riley Hospital for Children, Indianapolis, IN (United States); Alam, Khurshaid [Indiana University, School of Medicine, Indianapolis, IN (United States)

    2005-09-01

    Lack of clinical history on radiology requisitions is a universal problem. We describe a simple Web-based system that readily provides radiology-relevant clinical history to the radiologist reading radiographs of intensive care unit (ICU) patients. Along with the relevant history, which includes primary and secondary diagnoses, disease progression and complications, the system provides the patient's name, record number and hospital location. This information is immediately available to reporting radiologists. New clinical information is immediately entered on-line by the radiologists as they are reviewing images. After patient discharge, the data are stored and immediately available if the patient is readmitted. The system has been in routine clinical use in our hospital for nearly 2 years. (orig.)

  19. Medication administration errors in an intensive care unit in Ethiopia

    OpenAIRE

    2012-01-01

    Background Medication administration errors in patient care have been shown to be frequent and serious. Such errors are particularly prevalent in highly technical specialties such as the intensive care unit (ICU). In Ethiopia, the prevalence of medication administration errors in the ICU is not studied. Objective To assess medication administration errors in the intensive care unit of Jimma University Specialized Hospital (JUSH), Southwest Ethiopia. Methods Prospective observation based cross...

  20. Nosocomial diarrhea in the intensive care unit

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    Ana Paula Marcon

    2006-12-01

    Full Text Available We made an epidemiological case-control study to examine risk factors for the development of diarrhea in the intensive care unit (ICU of a public hospital in Santo André, SP, from January to October 2002. Forty-nine patients with diarrhea (cases and 49 patients without diarrhea (controls, matched for age and gender, were included in the study. A stool culture and enzyme immunoassays for Clostridium difficile toxins A and B were performed on fecal specimens from diarrhea patients. Fourteen of them presented positive cultures for Pseudomonas aeruginosa and 22 patients presented positive ELISA for Clostridium diffícile. Nosocomial diarrhea was associated with several factors, including use of antibiotics (P=0.001, use of ceftriaxone (P=0.001, presence of infection (P=0.010 and length of hospital stay (P=0.0001.

  1. [Nosocomial infections in intensive care units].

    Science.gov (United States)

    Zaragoza, Rafael; Ramírez, Paula; López-Pueyo, María Jesús

    2014-05-01

    Nosocomial infections (NI) still have a high incidence in intensive care units (ICUs), and are becoming one of the most important problems in these units. It is well known that these infections are a major cause of morbidity and mortality in critically ill patients, and are associated with increases in the length of stay and excessive hospital costs. Based on the data from the ENVIN-UCI study, the rates and aetiology of the main nosocomial infections have been described, and include ventilator-associated pneumonia, urinary tract infection, and both primary and catheter related bloodstream infections, as well as the incidence of multidrug-resistant bacteria. A literature review on the impact of different nosocomial infections in critically ill patients is also presented. Infection control programs such as zero bacteraemia and pneumonia have been also analysed, and show a significant decrease in NI rates in ICUs.

  2. Care of central venous catheters in Intensive Care Unit

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    Thomai Kollia

    2015-04-01

    Full Text Available Introduction: Central venous catheters (CVC are part of daily clinical practice, regarding treatment of critically ill patients in the Intensive Care Unit (ICU. Infections associated with CVC, are a serious cause of morbidity and mortality, thus making as a demanding need the adoption of clinical protocols for the care in ICU. Aim: The aim of this review was to explore the nursing care to prevent CVC’s infections in ICU. Method and material: The methodology followed included reviews and research studies. The studies were carried out during the period 2000-2014 and were drawn from foreign electronic databases (Pubmed, Medline, Cochrane and Greek (Iatrotek, on the nursing care of CVC, in the ICU to prevent infections. Results: The literature review showed that the right choice of dressings on the point of entry, the antiseptic treatment solution, the time for replacement infusion sets, the flushing of central venous catheter, the hand disinfection and finally the training of nursing staff, are the key points to prevent CVC’s infections in ICU. Conclusions: Education and compliance of nurses regarding the instructions of CVC's care, are the gold standard in the prevention of infections.

  3. An interprofessional service-learning course: uniting students across educational levels and promoting patient-centered care.

    Science.gov (United States)

    Dacey, Marie; Murphy, Judy I; Anderson, Delia Castro; McCloskey, William W

    2010-12-01

    Recognizing the importance of interprofessional education, we developed a pilot interprofessional education course at our institution that included a total of 10 nursing, BS health psychology, premedical, and pharmacy students. Course goals were for students to: 1) learn about, practice, and enhance their skills as members of an interprofessional team, and 2) create and deliver a community-based service-learning program to help prevent or slow the progression of cardiovascular disease in older adults. Teaching methods included lecture, role-play, case studies, peer editing, oral and poster presentation, and discussion. Interprofessional student teams created and delivered two different health promotion programs at an older adult care facility. Despite barriers such as scheduling conflicts and various educational experiences, this course enabled students to gain greater respect for the contributions of other professions and made them more patient centered. In addition, inter-professional student teams positively influenced the health attitudes and behaviors of the older adults whom they encountered.

  4. Predictors of mortality of patients with acute respiratory failure secondary to chronic obstructive pulmonary disease admitted to an intensive care unit: A one year study

    Directory of Open Access Journals (Sweden)

    Banga Amit

    2004-11-01

    Full Text Available Abstract Background Patients with acute exacerbation of chronic obstructive pulmonary disease (COPD commonly require hospitalization and admission to intensive care unit (ICU. It is useful to identify patients at the time of admission who are likely to have poor outcome. This study was carried out to define the predictors of mortality in patients with acute exacerbation of COPD and to device a scoring system using the baseline physiological variables for prognosticating these patients. Methods Eighty-two patients with acute respiratory failure secondary to COPD admitted to medical ICU over a one-year period were included. Clinical and demographic profile at the time of admission to ICU including APACHE II score and Glasgow coma scale were recorded at the time of admission to ICU. In addition, acid base disorders, renal functions, liver functions and serum albumin, were recorded at the time of presentation. Primary outcome measure was hospital mortality. Results Invasive ventilation was required in 69 patients (84.1%. Fifty-two patients survived to hospital discharge (63.4%. APACHE II score at the time of admission to ICU {odds ratio (95 % CI: 1.32 (1.138–1.532; p Conclusion APACHE II score at admission and SA levels with in 24 hrs after admission are independent predictors of mortality for patients with COPD admitted to ICU. The equation derived from these two parameters is useful for predicting outcome of these patients.

  5. Neurologic Complications in the Intensive Care Unit.

    Science.gov (United States)

    Rubinos, Clio; Ruland, Sean

    2016-06-01

    Complications involving the central and peripheral nervous system are frequently encountered in critically ill patients. All components of the neuraxis can be involved including the brain, spinal cord, peripheral nerves, neuromuscular junction, and muscles. Neurologic complications adversely impact outcome and length of stay. These complications can be related to underlying critical illness, pre-existing comorbid conditions, and commonly used and life-saving procedures and medications. Familiarity with the myriad neurologic complications that occur in the intensive care unit can facilitate their timely recognition and treatment. Additionally, awareness of treatment-related neurologic complications may inform decision-making, mitigate risk, and improve outcomes.

  6. Applying the Integrated Practice Unit Concept to a Modified Virtual Ward Model of Care for Patients at Highest Risk of Readmission: A Randomized Controlled Trial

    Science.gov (United States)

    Ng, Matthew Joo Ming; Balasubramaniam, Kanchana; Towle, Rachel Marie

    2017-01-01

    Background Emerging evidence from the virtual ward care model showed that multidisciplinary case management are inadequate to reduce readmissions or death for high risk patients. There is consensus that interventions should encompass both pre-hospital discharge and post-discharge transitional care to be effective. Integrated practice units (IPU) had been proposed as an approach of restructuring the organization and work processes of multidisciplinary teams to achieve value in healthcare. Our primary objective is to evaluate if the novel application of the IPU concept to organize a modified virtual ward model incorporating pre-hospital discharge transitional care can reduce readmissions of patients at highest risk for readmission. Methods We conducted an open label, assessor blinded randomized controlled trial on patients with one or more unscheduled readmissions in the prior 90 days and LACE score ≥ 10. 840 patients were randomized in 1:1 ratio and blocks of 6 to the intervention program (n = 420) or control (n = 420). Allocation concealment was effected via an off-site telephone service maintained by a hospital administrator. Intervention patients received discharge planning, medication reconciliation, coaching on self-management of chronic diseases using standardized action plans and an individualized care plan complete with written discharge instructions, appointments schedule, medication changes and the contact information of the outpatient VW nurse before discharge. At discharge, care is handed over to the outpatient VW team. Patients were closely monitored in the VW for three months that included a telephone review within 72 hours of discharge, home assessment, regular telephone reviews to identify early complications and early review clinics for patients who destabilize. The VW meet daily to discuss new patients and review care plans for patients. Control patients received standard hospital care that included a standardized patient copy of the hospital

  7. Perspectives of cardiac care unit nursing staff about developing hospice services in iran for terminally ill cardiovascular patients: A qualitative study

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    Saber Azami-Aghdash

    2015-01-01

    Full Text Available Introduction: The present study was conducted aiming to determine the points of view of cardiac care units′ nursing staff about designing and providing Hospice services in Iran for cardiovascular patients in the final stages of life. Materials and Methods: In this qualitative study, the perspectives of 16 Cardiac Care Unit (CCU nurses selected purposefully among hospitals of Tabriz-Iran University of Medical Sciences were investigated using semi-structured interviews and were analyzed in content analysis method. Results: 33 themes were finally extracted. Some nurses were for and some were against designing and providing Hospice services in Iran. The main reasons identified for supporting this plan included: Possibility of designing and providing these services consistent with high ethical values of Iranian society; approval of authorities due to increasing the load of chronic diseases and aged population; need of families due to the problems in taking care of patients and life concerns; better pain relief and respectful death; decrease of costs as a result of lower usage of diagnostic-therapeutic services, less use of expensive facilities and drugs, and better usage of hospital beds. Conclusion: Growing load of chronic diseases has made the need for Hospice as a necessary issue in Iran. In order to provide these services, studying the viewpoints of health service providers is inevitable. Therefore using and applying the results of this study in planning and policy making about designing and providing these services in Iran for cardiovascular patients in their final stages of lives could be helpful.

  8. Families' experiences of intensive care unit quality of care

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene; Gerritsen, Rik T; Koopmans, Matty;

    2015-01-01

    PURPOSE: The purpose of the study is to adapt and provide preliminary validation for questionnaires evaluating families' experiences of quality of care for critically ill patients in the intensive care unit (ICU). MATERIALS AND METHODS: This study took place in 2 European ICUs. Based on literature...... and qualitative interviews, we adapted 2 previously validated North American questionnaires: "Family Satisfaction with the ICU" and "Quality of Dying and Death." Family members were asked to assess relevance and understandability of each question. Validation also included test-retest reliability and construct...... validity. RESULTS: A total of 110 family members participated. Response rate was 87%. For all questions, a median of 97% (94%-99%) was assessed as relevant, and a median of 98% (97%-100%), as understandable. Median ceiling effect was 41% (30%-47%). There was a median of 0% missing data (0%-1%). Test...

  9. Sleep in the intensive care unit.

    Science.gov (United States)

    Pisani, Margaret A; Friese, Randall S; Gehlbach, Brian K; Schwab, Richard J; Weinhouse, Gerald L; Jones, Shirley F

    2015-04-01

    Sleep is an important physiologic process, and lack of sleep is associated with a host of adverse outcomes. Basic and clinical research has documented the important role circadian rhythm plays in biologic function. Critical illness is a time of extreme vulnerability for patients, and the important role sleep may play in recovery for intensive care unit (ICU) patients is just beginning to be explored. This concise clinical review focuses on the current state of research examining sleep in critical illness. We discuss sleep and circadian rhythm abnormalities that occur in ICU patients and the challenges to measuring alterations in circadian rhythm in critical illness and review methods to measure sleep in the ICU, including polysomnography, actigraphy, and questionnaires. We discuss data on the impact of potentially modifiable disruptors to patient sleep, such as noise, light, and patient care activities, and report on potential methods to improve sleep in the setting of critical illness. Finally, we review the latest literature on sleep disturbances that persist or develop after critical illness.

  10. A Technical Evaluation of Wireless Connectivity from Patient Monitors to an Anesthesia Information Management System During Intensive Care Unit Surgery.

    Science.gov (United States)

    Simpao, Allan F; Galvez, Jorge A; England, W Randall; Wartman, Elicia C; Scott, James H; Hamid, Michael M; Rehman, Mohamed A; Epstein, Richard H

    2016-02-01

    Surgical procedures performed at the bedside in the neonatal intensive care unit (NICU) at The Children's Hospital of Philadelphia were documented using paper anesthesia records in contrast to the operating rooms, where an anesthesia information management system (AIMS) was used for all cases. This was largely because of logistical problems related to connecting cables between the bedside monitors and our portable AIMS workstations. We implemented an AIMS for documentation in the NICU using wireless adapters to transmit data from bedside monitoring equipment to a portable AIMS workstation. Testing of the wireless AIMS during simulation in the presence of an electrosurgical generator showed no evidence of interference with data transmission. Thirty NICU surgical procedures were documented via the wireless AIMS. Two wireless cases exhibited brief periods of data loss; one case had an extended data gap because of adapter power failure. In comparison, in a control group of 30 surgical cases in which wired connections were used, there were no data gaps. The wireless AIMS provided a simple, unobtrusive, portable alternative to paper records for documenting anesthesia records during NICU bedside procedures.

  11. WellStar Paulding Hospital intensive care unit case study: achieving a research-based, patient-centered design using a collaborative process.

    Science.gov (United States)

    Burns, Georgeann B; Hogue, Vicky

    2014-01-01

    This article describes the processes and tools used by WellStar Paulding Hospital to plan and design a new intensive care unit (ICU) as part of a 108-bed replacement hospital on a new site. Seeking to create a culture of safety centered around patient care, quality, and efficiency, the team used multiple external resources to increase their effectiveness as participants in the design process and to ensure that the new ICU achieves the functional performance goals identified at the beginning of planning and design. Specific focus on evidence-based design was assisted through participation in the Center for Health Design's Pebble Project process as well as the Joint Commission International Safe Health Design Learning Academy Pilot Program.

  12. Profile of patients undergoing treatment for tuberculosis in a health unit with a Family Health Care Team

    Directory of Open Access Journals (Sweden)

    Cássia Kirsch Lanes

    2011-04-01

    Full Text Available Introduction: Brasil is 14th amongst the 20 countries with 80% of tuberculosis cases (TB in the world, with annual incidence of 46 new cases/100,000 inhabitants. The Health Unit of Divina Providencia Hospital, of SSC/ GHC, is a reference for TB treatment in an area of about 6,000 inhabitants. It’s expected about 6 new cases a year in the population covered by the hospital, considered a historic series and incidence in Porto Alegre, which currently is of 100/100,000. Objective: To describe the profile of TB carriers from USDP, with data on incidence, type of TB, serology for HIV, age, sex and start of treatment. Methods: Review of the registered cases in the USDP archives and review of the patient charts. Results: Between February 2007 and February 2008, 14 new cases of TB were registered in USDP. The ages were among 13 to 67 years, 8 men and 6 women. The average age of men was 38.6 years old and of women was 35.6 years old. Five were HIV positive and one person refused to do the HIV exam. Ten cases were exclusively of pulmonary TB and four cases of extra-pulmonary TB. The 14 cases were treated with E1 (RHZ. Out of the patients treated, 6 were discharged by cure (42%, 1 from abandonment (7% and 1 death (7%, and 6 were still undergoing treatment by the end of the data collection (46.6%. Conclusion: the high incidence of TB, more than double than expected, in the USDP territory, indicates that these ratios need to be reviewed and compared to other Health Units that act in the same manner. The gathering of new cases through the search of respiratory symptomatics, as well as the vigilance of cases in treatment, is allowing for good detection and cure ratios, with good assent to treatment.

  13. Prevention of Critical Care Complications in the Coronary Intensive Care Unit: Protocols, Bundles, and Insights From Intensive Care Studies.

    Science.gov (United States)

    van Diepen, Sean; Sligl, Wendy I; Washam, Jeffrey B; Gilchrist, Ian C; Arora, Rakesh C; Katz, Jason N

    2017-01-01

    Over the past half century, coronary care units have expanded from specialized ischemia arrhythmia monitoring units into intensive care units (ICUs) for acutely ill and medically complex patients with a primary cardiac diagnosis. Patients admitted to contemporary coronary intensive care units (CICUs) are at risk for common and preventable critical care complications, yet many CICUs have not adopted standard-of-care prevention protocols and practices from general ICUs. In this article, we (1) review evidence-based interventions and care bundles that reduce the incidence of ventilator-associated pneumonia, excess sedation during mechanical ventilation, central line infections, stress ulcers, malnutrition, delirium, and medication errors and (2) recommend pragmatic adaptations for common conditions in critically ill patients with cardiac disease, and (3) provide example order sets and practical CICU protocol implementation strategies.

  14. Emergence and characterization of tigecycline resistance in multidrug-resistant Klebsiella pneumoniae isolates from blood samples of patients in intensive care units in northern China.

    Science.gov (United States)

    Xu, Hui; Zhou, Yiheng; Zhai, Xingyue; Du, Zemin; Wu, Hao; Han, Yujia; Huo, Chunxiu; Chen, Yang

    2016-08-01

    Serious infections in intensive care unit patients caused by multidrug-resistant (MDR) Klebsiella pneumoniae represent a major threat worldwide owing to increased mortality and limited treatment options. With the application of tigecycline for MDR pathogens, tigecycline-non-susceptible K. pneumoniae isolates have recently emerged in China. To identify the susceptibility profile of MDR K. pneumoniae to tigecycline and evaluate the molecular characterization of tigecycline resistance, 214 MDR K. pneumoniae isolates were collected from blood samples of patients in intensive care units. MICs and clonal relatedness were determined by standard broth microdilution and multilocus sequence typing, respectively. Expression levels of efflux pumps and their global regulators were examined using real-time PCR. Mutations of local repressor were identified by PCR and sequencing. Our results show that the tigecycline resistance rate of 214 MDR K. pneumoniae isolates was 6.07 %. ST11 was the predominant clone type of tigecycline-non-susceptible K. pneumoniae isolates. Expression of efflux pump AcrB and global regulator RamA correlated with tigecycline MICs (AcrB: x2=8.91, P=0.03; RamA: x2=13.91, P<0.01), and mean expression levels of AcrB for the MICs ≥4 mg l-1 were significantly higher than MICs ≤2 mg l-1 (t=2.48, P=0.029). In addition, one tigecycline-resistant isolate harboured a deletion mutation in the ramR gene. These data indicated a linear correlative trend for overexpression of the AcrB and the tigecycline MICs resulting from the upregulation of RamA. The emergence of molecular type ST11 of MDR K. pneumoniae isolates should be monitored to identify factors that contribute to tigecycline resistance in intensive care units.

  15. Análise de estressores para o paciente em Unidade de Terapia Intensiva Analysis of stressors for the patient in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Almir Galvão Vieira Bitencourt

    2007-03-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O ambiente hospitalar, especialmente o de uma Unidade de Terapia Intensiva (UTI, devido à complexidade do atendimento prestado, bem como a estrutura física, o barulho, os equipamentos e a movimentação das pessoas, é tido como gerador de estresse para os pacientes. O objetivo deste estudo foi identificar e estratificar os estressores para pacientes internados em UTI, na perspectiva do próprio paciente, familiares e profissionais de saúde. MÉTODO: Estudo de corte transversal realizado entre junho e novembro de 2004, na UTI geral de hospital privado. A amostra foi composta por três grupos: pacientes (G1, familiares (G2 e um membro da equipe da UTI responsável pelo atendimento do paciente incluído (G3. Para identificação e estratificação dos fatores estressantes, utilizou-se a Escala de Estressores em UTI (Intensive Care Unit Environmental Stressor Scale - ICUESS. Para cada paciente e participante, foi calculado um escore total de estresse (ETE pela soma de todas as respostas da escala. RESULTADOS: Foram incluídos 30 pacientes e participantes em cada grupo. A média de idade foi de: 57,30 ± 17,61 anos para o G1; 41,43 ± 12,19 anos para o G2; e 40,82 ± 20,20 anos para o G3. A média do ETS foi: 62,63 ± 14,01 para os pacientes; 91,10 ± 30,91 para os familiares; e 99,30 ± 21,60 para os profissionais. A média do ETS dos pacientes foi estatisticamente inferior à encontrada nos familiares e nos profissionais de saúde (p BACKGROUND AND OBJECTIVES: The hospital environment, especially in Intensive Care Units (ICU, due to the complexity of the assistance, as well as the physical structure, the noise, the equipments and people's movement, is considered as stress generator for the patients. The aim of this study was to identify and stratify the stressful factors for patients at an ICU, in the perspective of the own patient, relatives and health care professionals. METHODS: A cross-sectional study was carried

  16. Metallo-β-lactamase-producing clinical isolates of Acinetobacter species and Pseudomonas aeruginosa from intensive care unit patients of a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Irfan S

    2008-01-01

    Full Text Available Prompt detection of metallo-β-lactamase (MBL producing isolates is necessary to prevent their dissemination. Frequency of MBLs producing strains among multidrug resistant (MDR Acinetobacter species and Pseudomonas aeruginosa was evaluated in critical care patients using imipenem-EDTA disk method. One hundred MDR Acinetobacter spp. and 42 Pseudomonas aeruginosa were checked for MBL production, from January to June 2001. MBL was produced by 96.6 % of imipenem-resistant Acinetobacter isolates, whereas 100% imipenem-resistant Pseudomonas aeroginosa isolates were MBL producers. Carbapenem resistance in MDR Acinetobacter spp. and Pseudomonas aeruginosa isolates in this study was due to MBLs. This calls for strict infection control measures to prevent further dissemination.

  17. [Jargon of the neonatal intensive care unit].

    Science.gov (United States)

    Carbajal, R; Lenclen, R; Paupe, A; Blanc, P; Hoenn, E; Couderc, S

    2001-01-01

    Jargon, the specialized vocabulary and idioms, is frequently used by people of the same work or profession. The neonatal intensive care unit (NICU) makes no exception to this. As a matter of fact, NICU is one place where jargon is constantly developing in parallel with the evolution of techniques and treatments. The use of jargon within the NICU is very practical for those who work in these units. However, this jargon is frequently used by neonatologists in medical reports or other kinds of communication with unspecialized physicians. Even if part of the specialized vocabulary can be decoded by physicians not working in the NICU, they do not always know the exact place that these techniques or treatments have in the management of their patients. The aim of this article is to describe the most frequent jargon terms used in the French NICU and to give up-to-date information on the importance of the techniques or treatments that they describe.

  18. Antibiotic sensitivity pattern of gram negative bacilli isolated from the lower respiratory tract of ventilated patients in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Goel Nidhi

    2009-01-01

    Full Text Available Background: Lower respiratory tract infections (LRTIs are the most frequent infections among patients in Intensive care units (ICUs. Aims: To know the bacterial profile and determine the antibiotic susceptibility pattern of the lower respiratory tract isolates from patients admitted to the ICU. Settings and Design: Tertiary care hospital, retrospective study. Materials and Methods: Transtracheal or bronchial aspirates from 207 patients admitted to the ICU were cultured, identified, and antibiotic sensitivity was performed by standard methods. Statistical Analysis Used: SPSS software was used for calculation of % R of 95% confidence interval (CI. Results: Of 207 specimens, 144 (69.5% were culture positive and 63 (30.4% showed no growth. From 144 culture positives, 161 isolates were recovered, of which 154 (95.6% were Gram negative bacilli (GNB. In 17 (11.0% patients, two isolates per specimen were recovered. The most common GNB in order of frequency were Pseudomonas aeruginosa (35%, Acinetobacter baumannii (23.6%, and Klebsiella pneumoniae (13.6%. A very high rate of resistance (80-100% was observed among predominant GNB to ciprofloxacin, ceftazidime, co-trimoxazole, and amoxycillin/clavulanic acid combination. Least resistance was noted to meropenem and doxycycline. Conclusion: Nonfermenters are the most common etiological agents of LRTIs in ICU. There is an alarmingly high rate of resistance to cephalosporin and β-lactam-β-lactamase inhibitor group of drugs. Meropenem was found to be the most sensitive drug against all GNB. Acinetobacter and Klebsiella spp. showed good sensitivity to doxycycline.

  19. Development of a daily mortality probability prediction model from Intensive Care Unit patients using a discrete-time event history analysis.

    Science.gov (United States)

    Huang, Ying Che; Chang, Kuang Yi; Lin, Shih Pin; Chen, Kung; Chan, Kwok Hon; Chang, Polun

    2013-08-01

    As studies have pointed out, severity scores are imperfect at predicting individual clinical chance of survival. The clinical condition and pathophysiological status of these patients in the Intensive Care Unit might differ from or be more complicated than most predictive models account for. In addition, as the pathophysiological status changes over time, the likelihood of survival day by day will vary. Actually, it would decrease over time and a single prediction value cannot address this truth. Clearly, alternative models and refinements are warranted. In this study, we used discrete-time-event models with the changes of clinical variables, including blood cell counts, to predict daily probability of mortality in individual patients from day 3 to day 28 post Intensive Care Unit admission. Both models we built exhibited good discrimination in the training (overall area under ROC curve: 0.80 and 0.79, respectively) and validation cohorts (overall area under ROC curve: 0.78 and 0.76, respectively) to predict daily ICU mortality. The paper describes the methodology, the development process and the content of the models, and discusses the possibility of them to serve as the foundation of a new bedside advisory or alarm system.

  20. VENTILATOR ASSOCIATED PNEUMONIA IN INTENSIVE CARE UNIT

    Directory of Open Access Journals (Sweden)

    Syed Ali

    2015-12-01

    Full Text Available BACKGROUND Knowledge of the incidence of ventilator-associated pneumonia (VAP and its associated risk factors is imperative for the development and use of more effective preventive measures. METHODOLOGY We conducted a prospective cohort study over a period of 12 months to determine the incidence and the risk factors for development of VAP in critically ill adult patients admitted in intensive care units (ICUs in Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, we included 150 patients, on mechanical ventilation for more than 48 hours. VAP was diagnosed according to the current diagnostic criteria. RESULTS The study cohort comprised of 150 patients of various cases of cerebrovascular accident, poisoning, neurological disorders, sepsis and others. VAP was diagnosed when a score of ≥6 was obtained in the clinical pulmonary infection scoring system having six variables and a maximum score of 12. The mean age of the patients was 40 years. Of the 150 patients, 28 patients developed VAP during the ICU stay. The incidence of VAP in our study was 18.8%. The risk factor in our study was decrease in the PaO2/FiO2 ratio, duration of mechanical ventilation, impaired consciousness, tracheostomy, re-intubation, emergency intubation, nasogastric tube, emergency intubation and intravenous sedatives were found to be the specific risk factors for early onset VAP, while tracheostomy and re-intubation were the independent predictors of late-onset VAP, The most predominant organisms in our study was Pseudomonas (39.2%. CONCLUSIONS Knowledge of these risk factors may be useful in implementing simple and effective preventive measures. Precaution during emergency intubation, minimizing the occurrence of reintubation, avoidance of tracheostomy as far as possible, and minimization of sedation. The ICU clinicians should be aware of the risk factors for VAP, which could prove useful in identifying patients at high risk for VAP, and modifying patient care to

  1. NOSOCOMIAL ACINETOBACTER INFECTIONS IN INTENSIVE CARE UNIT

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    Nwadike V. Ugochukwu

    2013-01-01

    Full Text Available Acinetobacter plays an important role in the infection of patients admitted to hospitals. Acinetobacter are free living gram-negative coccobacilli that emerge as significant nosocomial pathogens in the hospital setting and are responsible for intermittent outbreaks in the Intensive Care Unit. The aim of this study was to determine the prevalence of Acinetobacter in patients admitted into the Intensive Care Unit and determine their role in infections in the ICU. A total of one hundred patients were recruited for the study, catheter specimen urine, tracheal aspirate and blood culture were collected aseptically from the patients. The specimens were cultured on blood and MacConkey and the organisms identified using Microbact 12E (0xoid. The Plasmid analysis was done using the TENS miniprep method. Fourteen (14% of the 100 patients recruited into the study, developed Acinetobacter infection. Acinetobacter spp constituted 9% of the total number of isolates. Twelve (86% of the isolates were recovered from tracheal aspirate, 1(7% from urine and 1(7% from blood. All of the isolates harbor plasmids of varying molecular sizes. Ten of the fourteen Acinetobacter were isolated at about the same period of time in the ICU with 6(42.7% having plasmid size in the 23.1kb band and all showed similar pattern revealing that the isolates exhibit some relatedness. The clonal nature of the isolates suggest that strict infection control practices must be adopted in ICU, also an antibiotic policy must be developed for the ICU to prevent abuse of antibiotics that may lead to selection of resistant bacteria.

  2. Does eosinophilic COPD exacerbation have a better patient outcome than non-eosinophilic in the intensive care unit?

    Science.gov (United States)

    Saltürk, Cüneyt; Karakurt, Zuhal; Adiguzel, Nalan; Kargin, Feyza; Sari, Rabia; Celik, M Emin; Takir, Huriye Berk; Tuncay, Eylem; Sogukpinar, Ozlem; Ciftaslan, Nezihe; Mocin, Ozlem; Gungor, Gokay; Oztas, Selahattin

    2015-01-01

    Background COPD exacerbations requiring intensive care unit (ICU) admission have a major impact on morbidity and mortality. Only 10%–25% of COPD exacerbations are eosinophilic. Aim To assess whether eosinophilic COPD exacerbations have better outcomes than non-eosinophilic COPD exacerbations in the ICU. Methods This retrospective observational cohort study was conducted in a thoracic, surgery-level III respiratory ICU of a tertiary teaching hospital for chest diseases from 2013 to 2014. Subjects previously diagnosed with COPD and who were admitted to the ICU with acute respiratory failure were included. Data were collected electronically from the hospital database. Subjects’ characteristics, complete blood count parameters, neutrophil to lymphocyte ratio (NLR), delta NLR (admission minus discharge), C-reactive protein (CRP) on admission to and discharge from ICU, length of ICU stay, and mortality were recorded. COPD subjects were grouped according to eosinophil levels (>2% or ≤2%) (group 1, eosinophilic; group 2, non-eosinophilic). These groups were compared with the recorded data. Results Over the study period, 647 eligible COPD subjects were enrolled (62 [40.3% female] in group 1 and 585 [33.5% female] in group 2). Group 2 had significantly higher C-reactive protein, neutrophils, NLR, delta NLR, and hemoglobin, but a lower lymphocyte, monocyte, and platelet count than group 1, on admission to and discharge from the ICU. Median (interquartile range) length of ICU stay and mortality in the ICU in groups 1 and 2 were 4 days (2–7 days) vs 6 days (3–9 days) (P2%. NLR and peripheral eosinophilia may be helpful indicators for steroid and antibiotic management. PMID:26392758

  3. Nosocomial Infections in Neonatal Intensive Care Units

    OpenAIRE

    2013-01-01

    Neonates, especially prematures, requiring care in Intensive Care Unit are a highly vulnerable population group at increased risk for nosocomial infections. In recent decades become one of the leading causes of morbidity and mortality in the Neonatal Intensive Care Unit. Aim: Highlighting the severity of nosocomial infections for hospitalized infants and the imprinting of risk factors that affects their development. Material-Methods: Searched for studies published in international scientific ...

  4. Cuidando da família de pacientes em situação de terminalidade internados na unidade de terapia intensiva Caring for the families of terminally ill patients in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Márcio Soares

    2007-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O cuidado dos familiares é uma das partes mais importantes do cuidado global dos pacientes internados nas unidades de terapia intensiva (UTI. No contexto de um paciente terminal ou no qual as perspectivas de recuperação são muito improváveis, esta face do cuidado assume uma importância ainda maior, pois na maioria das vezes o paciente não estará desperto, e será preciso lidar e cuidar dos seus familiares. Os familiares têm necessidades específicas e apresentam freqüências elevadas de estresse, distúrbios do humor e ansiedade durante o acompanhamento da internação na UTI, e que muitas vezes persistem após a morte do seu ente querido. CONTEÚDO: Foram selecionados artigos sobre o cuidado de familiares de pacientes em situação de terminalidade na UTI publicados nos últimos 20 anos na PubMed. CONCLUSÕES: A literatura recente está repleta de evidências de que estratégias voltadas para os familiares como a melhoria da comunicação, da prevenção de conflitos e do conforto espiritual, para citar algumas, resultam em maiores satisfação e percepção da qualidade da assistência prestada ao paciente na UTI.BACKGROUND AND OBJECTIVES: Caring for the families is one of the major tasks of the global care of patients admitted to the intensive care unit (ICU. In the context of a terminally ill patient or a patient in whom the recovery from the acute illness is unlikely, dealing with and caring for their family members becomes even more important as the patient will not be awake in most of situations. Family members have specific needs and present with high incidence of symptoms of stress, depression, anxiety and related disorders during the ICU of their beloved one, which can even persist late after the patient's death. CONTENTS: Review of selected studies on the care of family members of patients at the end-of-life admitted to the ICU published at the PubMed database during the last 20 years. CONCLUSIONS

  5. DIAGNOSTIC EFFICACY OF CARDIAC TROPONIN-T IN ACUTE MYOCARDIAL INFARCTION PATIENTS ADMITTED IN INTENSIVE CARDIAC CARE UNIT

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    Tapan

    2016-03-01

    Full Text Available INTRODUCTION Myocardial infarction is a common and severe manifestation of ischaemic heart disease (IHD. Acute myocardial infarction (AMI is the result of death of heart muscle cells following either from a prolonged or severe ischaemia. The World Health Organisation emphasises IHD as our "Modern Epidemic" and AMI as common cause of sudden death. AIM The present study has been undertaken with the aim to assess the role of cardiac Troponin-T in early diagnosis of AMI and to evaluate its positive roles over CK-MB and LDH enzyme assays. The study also aims to find out the role of cardiac Troponin-T test, where ECG changes are nondiagnostic and inconclusive for AMI. MATERIAL & METHOD One hundred cases of provisionally diagnosed AMI, who were admitted during June 2012 to July 2015 in ICC Unit of TMC & Dr. BRAM Teaching Hospital, formed the subjects for the study. Those patients reported 2 to 10 hours after onset of chest pain were included in this study. Patients reported beyond 10 hours after onset of chest pain of AMI cases and patients having chest pain of non-AMI causes are excluded from the study. The provisional diagnosis of AMI was done on the basis of the history, chest pain, clinical findings and ECG changes. Trop-T test (Troponin-T sensitive rapid test by Muller Bardoff, et al, 1991 as well as CK-MB (creatine kinase-MB isoenzymeassays were performed immediately for each and every patient. Trop-T test was repeated in some selective cases where the early changes were insignificant and the results were compared with those of CK-MB, at different period of the disease onset. RESULTS The rapid cardiac Troponin-T test (CTn-T has 100% specificity for AMI whereas CK-MB and LDH have specificities of 80% and 60% respectively. The CTn-T has diagnostic efficiency of 92% for AMI but ECG has only 69% sensitivity and 80% specificity. The overall diagnostic efficacy of cardiac Troponin-T is higher than that of CK-MB, LDH and ECG (94% versus 92%, 91 % and 72

  6. “The Patient is Dying, Please Call the Chaplain”: The Activities of Chaplains in One Medical Center’s Intensive Care Units

    Science.gov (United States)

    Choi, Philip J.; Curlin, Farr A.; Cox, Christopher E.

    2015-01-01

    Context Patients and families commonly experience spiritual stress during an intensive care unit (ICU) admission. While a majority of patients report that they want spiritual support, little is known about how these issues are addressed by hospital chaplains. Objectives To describe the prevalence, timing, and nature of hospital chaplain encounters in ICUs. Methods This was a retrospective cross-sectional study of adult ICUs at an academic medical center. Measures included: days from ICU admission to initial chaplain visit, days from chaplain visit to ICU death or discharge, hospital and ICU length of stay, severity of illness at ICU admission and chaplain visit, and chart documentation of chaplain communication with the ICU team. Results Of a total of 4169 ICU admissions over six months, 248 (5.9%) patients were seen by chaplains. Of the 246 patients who died in an ICU, 197 (80%) were seen by a chaplain. There was a median of two days from ICU admission to chaplain encounter and a median of one day from chaplain encounter to ICU discharge or death. Chaplains communicated with nurses after 141 encounters (56.9%), but with physicians after only 14 encounters (5.6%); there was no documented communication in 55 encounters (22%). Conclusion In the ICUs at this tertiary medical center, chaplain visits are uncommon and generally occur just before death among ICU patients. Communication between chaplains and physicians is rare. Chaplaincy service is primarily reserved for dying patients and their family members rather than providing proactive spiritual support. These observations highlight the need to better understand challenges and barriers to optimal chaplain involvement in ICU patient care. PMID:26025278

  7. Candidemia in the intensive care unit: analysis of direct treatment costs and clinical outcome in patients treated with echinocandins or fluconazole.

    Science.gov (United States)

    Heimann, S M; Cornely, O A; Wisplinghoff, H; Kochanek, M; Stippel, D; Padosch, S A; Langebartels, G; Reuter, H; Reiner, M; Vierzig, A; Seifert, H; Vehreschild, M J G T; Glossmann, J; Franke, B; Vehreschild, J J

    2015-02-01

    Direct treatment costs caused by candidemia in German intensive care unit (ICU) patients are currently unknown. We analyzed treatment costs and the impact of antifungal drug choice. Comprehensive data of patients who had at least one episode of candidemia while staying in the ICU between 01/2005 and 12/2010 were documented in a database using the technology of the Cologne Cohort of Neutropenic Patients (CoCoNut). A detailed analysis of all disease-associated treatment costs was performed. Patients treated with echinocandins (i.e., anidulafungin, caspofungin, micafungin) or fluconazole were analyzed separately and compared. Forty-one and 64 patients received echinocandins and fluconazole, respectively. The mean Acute Physiology and Chronic Health Evaluation (APACHE) IV score was 114 (95 % confidence interval [CI]: 106-122) vs. 95 (95 % CI: 90-101, p = fluconazole groups, the mean costs per patient of ICU treatment were 20,338 (95 % CI: 12,893-27,883) vs. 11,932 (95 % CI: 8,016-15,849, p = 0.110), and the total direct treatment costs per patient were 37,995 (95 % CI: 26,614-49,376) vs. 22,305 (95 % CI: 16,817-27,793, p = 0.012), resulting in daily costs per patient of 1,158 (95 % CI: 1,036-1,280) vs. 927 (95 % CI: 828-1,026, p = 0.001). Our health economic analysis shows the high treatment costs of patients with candidemia in the ICU. Sicker patients had a prolonged hospitalization and were more likely to receive echinocandins, leading to higher treatment costs. Outcomes were comparable to those achieved in less sick patients with fluconazole.

  8. Nursing management and organizational ethics in the intensive care unit.

    Science.gov (United States)

    Wlody, Ginger Schafer

    2007-02-01

    This article describes organizational ethics issues involved in nursing management of an intensive care unit. The intensive care team and medical center management have the dual responsibility to create an ethical environment in which to provide optimum patient care. Addressing organizational ethics is key to creating that ethical environment in the intensive care unit. During the past 15-20 yrs, increasing costs in health care, competitive markets, the effect of high technology, and global business changes have set the stage for business and healthcare organizational conflicts that affect the ethical environment. Studies show that critical care nurses experience moral distress and are affected by the ethical climate of both the intensive care unit and the larger organization. Thus, nursing moral distress may result in problems related to recruitment and retention of staff. Other issues with organizational ethics ramifications that may occur in the intensive care unit include patient safety issues (including those related to disruptive behavior), intensive care unit leadership style, research ethics, allocation of resources, triage, and other economic issues. Current organizational ethics conflicts are discussed, a professional practice model is described, and multidisciplinary recommendations are put forth.

  9. [The specificities of care in cognitive-behavior units].

    Science.gov (United States)

    2015-01-01

    Special units have been created within rehabilitation units to provide care to patients with productive behavior disorders, associated with Alzheimer's disease or other forms of dementia. They must respect organizational and architectural constraints and develop multiple partnerships. Based on an assessment and their expertise in behavior disorders, the multidisciplinary team draws up and implements a personalized care program comprising non pharmacological approaches, the benefit of which can usually be seen in the abatement of the disorders. Thorough preparation of the patient's return home or admission to a nursing home enables knowledge concerning the patient's specific situation to be passed on to other caregivers and the patient's family.

  10. Caring for Latino patients.

    Science.gov (United States)

    Juckett, Gregory

    2013-01-01

    Latinos comprise nearly 16 percent of the U.S. population, and this proportion is anticipated to increase to 30 percent by 2050. Latinos are a diverse ethnic group that includes many different cultures, races, and nationalities. Barriers to care have resulted in striking disparities in quality of health care for these patients. These barriers include language, lack of insurance, different cultural beliefs, and in some cases, illegal immigration status, mistrust, and illiteracy. The National Standards for Culturally and Linguistically Appropriate Services address these concerns with recommendations for culturally competent care, language services, and organizational support. Latinos have disproportionately higher rates of obesity and diabetes mellitus. Other health problems include stress, neurocysticercosis, and tuberculosis. It is important to explore the use of alternative therapies and belief in traditional folk illnesses, recognizing that health beliefs are dependent on education, socioeconomic status, and degree of acculturation. Many-but not all-folk and herbal treatments can be safely accommodated with conventional therapy. Physicians must be sensitive to Latino cultural values of simpatia (kindness), personalismo (relationship), respeto (respect), and modestia (modesty). The LEARN technique can facilitate cross-cultural interviews. Some cultural barriers may be overcome by using the "teach back" technique to ensure that directions are correctly understood and by creating a welcoming health care environment for Latino patients.

  11. The effects of selective decontamination in Dutch Intensive Care Units

    NARCIS (Netherlands)

    Oostdijk, E.A.N.

    2013-01-01

    Infections are an important complication in the treatment of critical ill patients in Intensive Care Units (ICUs) and are associated with increased mortality, morbidity and health care costs. Selective Decontamination of the Digestive Tract (SDD) and Selective Oropharyngeal Decontamination (SOD) are

  12. Associations of Adverse Clinical Course and Ingested Substances among Patients with Deliberate Drug Poisoning: A Cohort Study from an Intensive Care Unit in Japan

    Science.gov (United States)

    Ichikura, Kanako; Takeuchi, Takashi

    2016-01-01

    Objectives Some patients with deliberate drug poisoning subsequently have an adverse clinical course. The present study aimed to examine whether the type of drugs ingested and psychiatric diagnoses were related to an adverse clinical course. Methods We conducted a cohort study of patients with deliberate drug poisoning admitted to the intensive care unit of a university hospital located in Tokyo, Japan, between September 2006 and June 2013. Intensive care unit (ICU) stay of ≥4 days was used as a primary outcome measure, while the incidence of aspiration pneumonitis was used as a secondary outcome measure. Ingested substances and psychiatric diagnoses were used as explanatory variables. Results Of the 676 patients with deliberate drug poisoning, 88% had a history of psychiatric treatment and 82% had ingested psychotropic drugs. Chlorpromazine-promethazine-phenobarbital combination drug (Vegetamin®) ranked fifth among the most frequently ingested substances in cases of deliberate drug poisoning and had the highest incidence of prolonged ICU stay (20%) and aspiration pneumonitis (29%). The top three major classes consisted of benzodiazepines (79%), new-generation antidepressants (25%), and barbiturates/non-barbiturates (23%). Barbiturate overdose was independently associated with increased odds of both prolonged ICU stay (8% vs. 17%; odds ratio [OR], 2.97; 95% confidence interval [CI], 1.60–5.55) and aspiration pneumonitis (8% vs. 24%; OR, 3.83; 95% CI, 2.18–6.79) relative to those associated with overdose of only other sedative-hypnotics (i.e., benzodiazepines). Conclusion These results suggest that judicious prescribing of barbiturates by psychiatrists could reduce the risk of an adverse clinical course when a patient attempts an overdose. PMID:27560966

  13. Admission of hematopoietic cell transplantation patients to the intensive care unit at the Pontificia Universidad Católica de Chile Hospital.

    Science.gov (United States)

    Escobar, Karen; Rojas, Patricio; Ernst, Daniel; Bertin, Pablo; Nervi, Bruno; Jara, Veronica; Garcia, Maria Jose; Ocqueteau, Mauricio; Sarmiento, Mauricio; Ramirez, Pablo

    2015-01-01

    Patients undergoing hematopoietic cell transplantation (HCT) can have complications that require management in the intensive care unit (ICU). We conducted a retrospective study of patients undergoing HCT between 2007 and 2011 with admission to the ICU. We analyzed 97 patients, with an average age of 37 (range, 15 to 68). The main indications for HCT were hematologic malignancies (84%, n = 82). Ninety percent (n = 87) received myeloablative conditioning. Thirty-one percent were admitted (autologous transplant recipients 15%, allogeneic transplant recipients 34%, and umbilical cord blood [UCB] transplant recipients 48%) with an average length of stay of 19 days (range, 1 to 73 days). The average time between transplantation and transfer was 15 days. The main causes of admission were acute respiratory failure (63%) and septic shock (20%). ICU mortality was 20% for autologous transplantations and 64% for allogeneic transplantations (adult donor and UCB combined). On average, patients died 108 days after the transplantation (range, 4 to 320 days). One-year overall survival, comparing patients entering the ICU with those never admitted, was 16% versus 82% (P < .0001) for allogeneic transplantations (adult donor and UCB combined) and 80% versus 89% (P = not significant) for autologous transplantations. Acute graft-versus-host disease was significantly associated with death in ICU after UCB HCT. ICU support is satisfactory in about one half of patients admitted, characterized by a short and medium term prognosis not as unfavorable as has been previously reported.

  14. From stroke unit care to stroke care unit

    NARCIS (Netherlands)

    De Keyser, J; Sulter, G.

    1999-01-01

    In some stroke units continuous monitoring of blood pressure, electrocardiogram, body temperature, and oxygen saturation has become an integral part of the management of acute stroke. In addition, regular measurements of blood glucose are performed. Stroke units equipped with such monitoring facilit

  15. Assessment of risk factors related to healthcare-associated methicillin-resistant Staphylococcus aureus infection at patient admission to an intensive care unit in Japan

    Directory of Open Access Journals (Sweden)

    Ogura Hiroshi

    2011-11-01

    Full Text Available Abstract Background Healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA infection in intensive care unit (ICU patients prolongs ICU stay and causes high mortality. Predicting HA-MRSA infection on admission can strengthen precautions against MRSA transmission. This study aimed to clarify the risk factors for HA-MRSA infection in an ICU from data obtained within 24 hours of patient ICU admission. Methods We prospectively studied HA-MRSA infection in 474 consecutive patients admitted for more than 2 days to our medical, surgical, and trauma ICU in a tertiary referral hospital in Japan. Data obtained from patients within 24 hours of ICU admission on 11 prognostic variables possibly related to outcome were evaluated to predict infection risk in the early phase of ICU stay. Stepwise multivariate logistic regression analysis was used to identify independent risk factors for HA-MRSA infection. Results Thirty patients (6.3% had MRSA infection, and 444 patients (93.7% were infection-free. Intubation, existence of open wound, treatment with antibiotics, and steroid administration, all occurring within 24 hours of ICU admission, were detected as independent prognostic indicators. Patients with intubation or open wound comprised 96.7% of MRSA-infected patients but only 57.4% of all patients admitted. Conclusions Four prognostic variables were found to be risk factors for HA-MRSA infection in ICU: intubation, open wound, treatment with antibiotics, and steroid administration, all occurring within 24 hours of ICU admission. Preemptive infection control in patients with these risk factors might effectively decrease HA-MRSA infection.

  16. Comparison of patient-ventilator asynchrony during pressure support ventilation and proportional assist ventilation modes in surgical Intensive Care Unit: A randomized crossover study

    Directory of Open Access Journals (Sweden)

    Parshotam Lal Gautam

    2016-01-01

    Full Text Available Background: The patient-ventilator asynchrony is almost observed in all modes of ventilation, and this asynchrony affects lung mechanics adversely resulting in deleterious outcome. Innovations and advances in ventilator technology have been trying to overcome this problem by designing newer modes of ventilation. Pressure support ventilation (PSV is a commonly used flow-cycled mode where a constant pressure is delivered by ventilator. Proportional assist ventilation (PAV is a new dynamic inspiratory pressure assistance and is supposed to be better than PSV for synchrony and tolerance, but reports are still controversial. Moreover, most of these studies are conducted in chronic obstructive pulmonary disease patients with respiratory failure; the results of these studies may not be applicable to surgical patients. Thus, we proposed to do compare these two modes in surgical Intensive Care Unit (ICU patients as a randomized crossover study. Aims: Comparison of patient-ventilator asynchrony between PSV and PAV plus (PAV+ in surgical patients while weaning. Subjects and Methods: After approval by the Hospital Ethics Committee, we enrolled twenty patients from surgical ICU of tertiary care institute. The patients were ventilated with pressure support mode (PSV and PAV+ for 12 h as a crossover from one mode to another after 6 h while weaning. Results: Average age and weight of patients were 41.80 ± 15.20 years (mean ± standard deviation [SD] and 66.50 ± 12.47 (mean ± SD kg, respectively. Comparing the asynchronies between the two modes, the mean number of total asynchronous recorded breaths in PSV was 7.05 ± 0.83 and 4.35 ± 5.62, respectively, during sleep and awake state, while the same were 6.75 ± 112.24 and 10.85 ± 11.33 in PAV+. Conclusion: Both PSV and PAV+ modes of ventilation performed similarly for patient-ventilator synchrony in surgical patients. In surgical patients with acute respiratory failure, dynamic inspiratory pressure

  17. A review of documented oral care practices in an intensive care unit.

    Science.gov (United States)

    Goss, Linda K; Coty, Mary-Beth; Myers, John A

    2011-05-01

    Oral care is recognized as an essential component of care for critically ill patients and nursing documentation provides evidence of this process. This study examined the practice and frequency of oral care among mechanically ventilated and nonventilated patients. A retrospective record review was conducted of patients admitted to an intensive care unit (ICU) between July 1, 2007 and December 31, 2007. Data were analyzed using bivariate and multivariate analyses to determine the variables related to patients receiving oral care. Frequency of oral care documentation was found to be performed, on average, every 3.17 to 3.51 hr with a range of 1 to 8 hr suggesting inconsistencies in nursing practice. This study found that although oral care is a Center for Disease Control and Prevention (CDC) recommendation for the prevention of hospital-associated infections like ventilator-associated pneumonia (VAP), indication of documentation of the specifics are lacking in the patients' medical record.

  18. [Stress, coping, and general health of nurses working at a care unit for patients with AIDS and hematologic diseases].

    Science.gov (United States)

    Britto, Eliane da Silva; Carvalho, Ana Maria Pimenta

    2003-12-01

    Based on Lazarus and Folkman's theory about stress and coping, this research aimed at answering questions related to how nurses, who work in two specialized units of a general hospital, evaluate their working environment, their health and how they manage with stressing situations. In the unit of infectious diseases, the nurses' evaluation of their working environment did not surpass the limits of what is considered as acceptable. In the unit of hematological alterations, the results showed higher stress levels. In both units, the evaluation of their health was considered as satisfactory and the coping strategies were similar.

  19. Effect of acupressure with valerian oil 2.5% on the quality and quantity of sleep in patients with acute coronary syndrome in a cardiac intensive care unit.

    Science.gov (United States)

    Bagheri-Nesami, Masoumeh; Gorji, Mohammad Ali Heidari; Rezaie, Somayeh; Pouresmail, Zahra; Cherati, Jamshid Yazdani

    2015-10-01

    The purpose of this three-group double-blind clinical trial study was to investigate the effect of acupressure ( zhǐ yā) with valerian ( xié cǎo) oil 2.5% on the quality and quantity of sleep in patients with acute coronary syndrome (ACS) in a coronary intensive care unit (CCU). This study was conducted on 90 patients with ACS in Mazandaran Heart Center (Sari, Iran) during 2013. The patients were randomly assigned to one of three groups. Patients in the acupressure with valerian oil 2.5% group (i.e., valerian acupressure group) received bilateral acupoint ( xué wèi) massage with two drops of valerian oil for 2 minutes for three nights; including every point this treatment lasted in total 18 minutes. Patients in the acupressure group received massage at the same points with the same technique but without valerian oil. Patients in the control group received massage at points that were 1-1.5 cm from the main points using the same technique and for the same length of time. The quality and quantity of the patients' sleep was measured by the St. Mary's Hospital Sleep Questionnaire (SMHSQ). After the intervention, there was a significant difference between sleep quality and sleep quantity in the patients in the valerian acupressure group and the acupressure group, compared to the control group (p Gushing Spring ( yǒng quán) acupoints can have therapeutic effects and may improve the quality and quantity of sleep in patients with ACS. Using these techniques in combination with herbal medicines such valerian oil can have a greater impact on improving sleep and reducing waking during the night.

  20. Family experience survey in the surgical intensive care unit.

    Science.gov (United States)

    Twohig, Bridget; Manasia, Anthony; Bassily-Marcus, Adel; Oropello, John; Gayton, Matthew; Gaffney, Christine; Kohli-Seth, Roopa

    2015-11-01

    The experience of critical care is stressful for both patients and their families. This is especially true when patients are not able to make their own care decisions. This article details the creation of a Family Experience Survey in a surgical intensive care unit (SICU) to capture and improve overall experience. Kolcaba's "Enhanced Comfort Theory" provided the theoretical basis for question formation, specifically in regards to the four aspects of comfort: "physical," "psycho-spiritual," "sociocultural" and "environmental." Survey results were analyzed in real-time to identify and implement interventions needed for issues raised. Overall, there was a high level of satisfaction reported especially with quality of care provided to patients, communication and availability of nurses and doctors, explanations from staff, inclusion in decision making, the needs of patients being met, quality of care provided to patients and cleanliness of the unit. It was noted that 'N/A' was indicated for cultural needs and spiritual needs, a chaplain now rounds on all patients daily to ensure these services are more consistently offered. In addition, protocols for doctor communication with families, palliative care consults, daily bleach cleaning of high touch areas in patient rooms and nurse-led progressive mobility have been implemented. Enhanced comfort theory enabled the opportunity to identify and provide a more 'broad' approach to care for patients and families.

  1. [Oral communication between colleagues in geriatric care units].

    Science.gov (United States)

    Maury-Zing, Céline

    2014-01-01

    Transmitting information orally between colleagues in gerontology care units. While the only certified method of transmitting nursing information is in writing, the oral tradition remains firmly rooted in the practice of health care providers. Professionals caring for elderly patients need to exchange information--whether it be considered important or trivial-, anywhere and at any time. In this article, professionals describe how they were able to identify which configurations of players and teams enable information to flow and benefit the care of elderly patients.

  2. ICU病人镇静治疗的护理对策%Nursing strategy of sedative therapy to intensive care units patients

    Institute of Scientific and Technical Information of China (English)

    罗杨; 洪蝶玫; 黄嘉佳

    2009-01-01

    To explore the nursing strategy of sedative therapy to intensive care units (ICU) patients. The clinical nursing of 197 ICU patients treated with midazolam or propofol were retrospectively summarized and analyzed, whose Sedation Scale scores were 1. After the treatment all indexes of 197 patients in respiration and circulation systerm were obviously improved. 197 patients had more compliance to the treatment and without unexpected extubation, endotracheal tube falling off and the comphcations such as bad memory and dyssemnia. The synthesis measures such as closely observing pafient's condition, enhancing clinical monitoring, promptly modulating the doses of sedatives and dealing with drug adverse reaction, carefully completing the whole mental nursing were the key points of ensuring safe sedative treating and less complications to ICU patients.%探讨ICU病人应用镇静治疗的护理对策.对2006年9月至2007年9月197例Ramsay评分标准1分的ICU病人应用咪唑安定或丙泊酚镇静治疗的临床护理行回顾性总结和分析.197例病人应用镇静治疗后呼吸和循环系统各项指标明显改善,病人能更好地配合治疗,无意外拔管和导管脱落,无不良记忆及睡眠障碍等并发症发生.严密观察病情、加强临床监护、及时调整镇静药物的剂量和处理药物不良反应、细致做好全程心理护理等综合措施,是保证ICU病人镇静治疗安全、减少并发症发生的关键.

  3. Importance of re-calibration time on pulse contour analysis agreement with thermodilution measurements of cardiac output: a retrospective analysis of intensive care unit patients.

    Science.gov (United States)

    Scully, Christopher G; Gomatam, Shanti; Forrest, Shawn; Strauss, David G

    2016-10-01

    We assessed the effect of re-calibration time on cardiac output estimation and trending performance in a retrospective analysis of an intensive care unit patient population using error grid analyses. Paired thermodilution and arterial blood pressure waveform measurements (N = 2141) from 222 patient records were extracted from the Multiparameter Intelligent Monitoring in Intensive Care II database. Pulse contour analysis was performed by implementing a previously reported algorithm at calibration times of 1, 2, 8 and 24 h. Cardiac output estimation agreement was assessed using Bland-Altman and error grid analyses. Trending was assessed by concordance and a 4-Quadrant error grid analysis. Error between pulse contour and thermodilution increased with longer calibration times. Limits of agreement were -1.85 to 1.66 L/min for 1 h maximum calibration time compared to -2.70 to 2.41 L/min for 24 h. Error grid analysis resulted in 74.2 % of points bounded by 20 % error limits of thermodilution measurements for 1 h calibration time compared to 65 % for 24 h. 4-Quadrant error grid analysis showed analysis method and thermodilution showed poor agreement to monitor changes in cardiac output.

  4. Pharmacokinetic/pharmacodynamic profiling of imipenem in patients admitted to an intensive care unit in India: A nonrandomized, cross-sectional, analytical, open-labeled study

    Directory of Open Access Journals (Sweden)

    B Abhilash

    2015-01-01

    Full Text Available Background and Aim: Widespread use of imipenem in intensive care units (ICUs in India has led to the development of numerous carbapenemase-producing strains of pathogens. The altered pathophysiological state in critically ill patients could lead to subtherapeutic antibiotic levels. Hence, the aim of this study was to investigate the variability in the pharmacokinetic and pharmacodynamic profile of imipenem in critically ill patients admitted to an ICU in India. Materials and Methods: Plasma concentration of imipenem was determined in critically ill patients using high performance liquid chromatography, at different time points, by grouping them according to their locus of infection. The elimination half-life (t΍ and volume of distribution (V d values were also computed. The patients with imipenem trough concentration values below the minimum inhibitory concentration (MIC and 5 times the MIC for the isolated pathogen were determined. Results: The difference in the plasma imipenem concentration between the gastrointestinal and the nongastrointestinal groups was significant at 2 h (P = 0.015 following drug dosing; while the difference was significant between the skin/cellulitis and nonskin/cellulitus groups at 2 h (P = 0.008, after drug dosing. The imipenem levels were above the MIC and 5 times the MIC for the isolated organism in 96.67% and 50% of the patients, respectively. Conclusions: The pharmacokinetic profile of imipenem does not vary according to the locus of an infection in critically ill patients. Imipenem, 3 g/day intermittent dosing, maintains a plasma concentration which is adequate to treat most infections encountered in patients admitted to an ICU. However, a change in the dosing regimen is suggested for patients infected with organisms having MIC values above 4 mg/L.

  5. Fatores prognósticos em pacientes idosos admitidos em unidade de terapia intensiva Prognostic factors in elderly patients admitted in the intensive care unit

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    Francine de Cristo Stein

    2009-08-01

    Full Text Available OBJETIVOS: Atualmente o envelhecimento populacional é proeminente fenômeno mundial. Então, a avaliação do prognóstico em pacientes idosos é necessária, sendo assim o objetivo deste estudo foi identificar fatores de risco em população de pacientes idosos admitidos em unidade de terapia intensiva. MÉTODOS: Foi realizado estudo prospectivo, em unidade de terapia intensiva geral de um hospital terciário, durante 5 meses. Pacientes com idade maior ou igual a 65 anos que permaneceram na unidade de terapia intensiva por tempo maior ou igual a 24 horas foram incluídos, pacientes moribundos e aqueles readmitidos na unidade de terapia intensiva durante mesma internação hospitalar foram excluídos. RESULTADOS: Foram envolvidos no estudo 199 pacientes com média de idade de 75,4± 6,8 anos, 58,8% do sexo feminino. A mortalidade hospitalar foi 57,3%. A média do APACHE II, SOFA, MODS e KATZ índice (avaliação de atividades diárias foram respectivamente 20,0±5,8, 6,8±3,9, 2,4±1,9 e 5,3±1,6. A maioria dos pacientes estava no pós-operatório 59,3%, sendo que 41,6% estavam em uso de ventilação mecânica invasiva. Foi determinante independente de maior mortalidade através de análise de regressão: a idade avançada (76,9±6,7 anos óbito versus 73,3±6,5 anos alta; p=Currently, aging of the population is a widespread global phenomenon. Therefore, the assessment of prognosis in elderly patients is needed. This study aims to identify risk factors in a population of elderly patients admitted in the intensive care unit METHODS: A prospective study in the intensive care unit of a general tertiary hospital was carried out for five months. Patients with 65 years or more of age, who stayed in the intensive care unit for 24 hours or more were included and those at the-end-of-life, patients readmitted to intensive care unit during the same hospital stay were excluded. RESULTS: In this study 199 patients were involved, with a mean age of 75.4±6

  6. Incidence of and risk factors for infection or colonization of vancomycin-resistant enterococci in patients in the intensive care unit.

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    Sung-Ching Pan

    Full Text Available The prevalence of vancomycin-resistant enterococci (VRE colonization or infection in the hospital setting has increased globally. Many previous studies had analysed the risk factors for acquiring VRE, based on cross-sectional studies or prevalent cases. However, the actual incidence of and risk factors for VRE remain unclear. The present study was conducted in order to clarify the incidence of and risk factors for VRE in the intensive care unit (ICU. From 1(st April 2008 to 31(st March 2009, all patients admitted to a surgical ICU (SICU were put on active surveillance for VRE. The surveillance cultures, obtained by rectal swab, were taken on admission, weekly while staying in the SICU, and on discharge from the SICU. A total of 871 patients were screened. Among them, 34 were found to carry VRE before their admission to the SICU, and 47 acquired VRE during their stay in the SICU, five of whom developed VRE infections. The incidence of newly acquired VRE during ICU stay was 21.9 per 1000 patient-days (95% confidence interval [CI], 16.4-29.1. Using multivariate analysis by logistic regression, we found that the length of ICU stay was an independent risk factor for new acquisition of VRE. In contrast, patients with prior exposure to first-generation cephalosporin were significantly less likely to acquire VRE. Strategies to reduce the duration of ICU stay and prudent usage of broad-spectrum antibiotics are the keys to controlling VRE transmission.

  7. Intelligent monitoring system for intensive care units.

    Science.gov (United States)

    Nouira, Kaouther; Trabelsi, Abdelwahed

    2012-08-01

    We address in the present paper a medical monitoring system designed as a multi-agent based approach. Our system includes mainly numerous agents that act as correlated multi-agent sub-systems at the three layers of the whole monitoring infrastructure, to avoid non informative alarms and send effective alarms at time. The intelligence in the proposed monitoring system is provided by the use of time series technology. In fact, the capability of continuous learning of time series from the physiological variables allows the design of a system that monitors patients in real-time. Such system is a contrast to the classical threshold-based monitoring system actually present in the Intensive Care Units (ICUs) which causes a huge number of irrelevant alarms.

  8. Is there a role of palliative care in the neonatal intensive care unit in India?

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    Manjiri P Dighe

    2011-01-01

    Full Text Available Recent advances in medical care have improved the survival of newborn babies born with various problems. Despite this death in the neonatal intensive care unit (NICU is an inevitable reality. For babies who are not going to "get better," the health care team still has a duty to alleviate the physical suffering of the baby and to support the family. Palliative care is a multidisciplinary approach to relieve the physical, psycho social, and spiritual suffering of patients and their families. Palliative care provision in the Indian NICU settings is almost nonexistent at present. In this paper we attempt to "build a case" for palliative care in the Indian NICU setting.

  9. Glucocorticoid therapy for hypotension in the cardiac intensive care unit

    NARCIS (Netherlands)

    Millar, K. J.; Thiagarajan, R. R.; Laussen, P. C.

    2007-01-01

    In recent years, it has been our practice to treat persistent hypotension in the cardiac intensive care unit with glucocorticoids. We undertook a retrospective review in an attempt to identify predictors of a hemodynamic response to steroids and of survival in these patients. Patients who had receiv

  10. Transfusional profile in different types of intensive care units

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    Ilusca Cardoso de Paula

    2014-06-01

    Full Text Available Background and objectives: anemia is a common clinical finding in intensive care units. The red blood cell transfusion is the main form of treatment, despite the associated risks. Thus, we proposed to evaluate the profile of transfusional patients in different intensive care units. Methods: prospective analysis of patients admitted in the intensive care units of a tertiary university hospital with an indication for transfusion of packed red blood cells. Demographic profile and transfusional profile were collected, a univariate analysis was done, and the results were considered significant at p = 0.05. Results: 408 transfusions were analyzed in 71 patients. The mean hemoglobin concentration on admission was 9.7 ± 2.3 g/dL and the pre-transfusional concentration was 6.9 ± 1.1 g/dL. The main indications for transfusion were hemoglobin concentration (49% and active bleeding (32%. The median number of units transfused per episode was 2 (1-2 and the median storage time was 14 (7-21 days. The number of patients transfused with hemoglobin levels greater than 7 g/dL and the number of bags transfused per episode were significantly different among intensive care units. Patients who received three or more transfusions had longer mechanical ventilation time and intensive care unit stay and higher mortality after 60 days. There was an association of mortality with disease severity but not with transfusional characteristics. Conclusions: the practice of blood products transfusion was partially in agreement with the guidelines recommended, although there are differences in behavior between the different profiles of intensive care units. Transfused patients evolved with unfavorable outcomes. Despite the scarcity of blood in blood banks, the mean storage time of the bags was high.

  11. Parameters influencing in-hospital mortality in patients hospitalized in intensive cardiac care unit: is there an influence of anemia and iron deficiency?

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    Uscinska, Ewa; Sobkowicz, Bozena; Sawicki, Robert; Kiluk, Izabela; Baranicz, Malgorzata; Stepek, Tomasz; Dabrowska, Milena; Szmitkowski, Maciej; Musial, Wlodzimierz J; Tycinska, Agnieszka M

    2015-04-01

    We investigated the incidence and prognostic value of anemia as well as of the iron status in non-selected patients admitted to an intensive cardiac care unit (ICCU). 392 patients (mean age 70 ± 13.8 years, 43% women), 168 with acute coronary syndromes (ACS), 122 with acute decompensated heart failure, and 102 with other acute cardiac disorders were consecutively, prospectively assessed. The biomarkers of iron status-serum iron concentration (SIC), total iron binding capacity (TIBC), and transferrin saturation (TSAT) together with standard clinical, biochemical and echocardiographic variables-were analyzed. In-hospital mortality was 3.8% (15 patients). The prevalences of anemia (according to WHO criteria), and iron deficiency (ID) were 64 and 63%, respectively. The level of biomarkers of iron status, but not anemia, was lower in patients who died (p < 0.05). Anemia was less frequent in patients with ACS as compared to the remaining ICCU population (p = 0.019). The analysis by logistic regression indicated the highest risk of death for age [odds ratio (OD) 1.38, 95% CI 1.27-1.55], SIC (OR 0.85, 95% CI 0.78-0.94), TIBC (OR 0.95, 95% CI 0.91-0.98), left ventricle ejection fraction (OR 0.85, 95% CI 0.77-0.93), as well as hospitalization for non-ACS (OR 0.25, 95% CI 0.14-0.46), (p < 0.05). The risk of death during hospitalization tended to increase with decreasing levels of TIBC (p = 0.49), as well as with the absence of ACS (p = 0.54). The incidence of anemia and ID in heterogeneous ICCU patients is high. Parameters of the iron status, but not anemia per se, independently influence in-hospital mortality. The prevalence of anemia is higher in non-ACS patients, and tends to worsen the prognosis.

  12. Teamwork in the Neonatal Intensive Care Unit

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    Barbosa, Vanessa Maziero

    2013-01-01

    Medical and technological advances in neonatology have prompted the initiation and expansion of developmentally supportive services for newborns and have incorporated rehabilitation professionals into the neonatal intensive care unit (NICU) multidisciplinary team. Availability of therapists specialized in the care of neonates, the roles of…

  13. Obesity in the intensive care unit: risks and complications.

    Science.gov (United States)

    Selim, Bernardo J; Ramar, Kannan; Surani, Salim

    2016-08-01

    The steady growing prevalence of critically ill obese patients is posing diagnostic and management challenges across medical and surgical intensive care units. The impact of obesity in the critically ill patients may vary by type of critical illness, obesity severity (obesity distribution) and obesity-associated co-morbidities. Based on pathophysiological changes associated with obesity, predominately in pulmonary reserve and cardiac function, critically ill obese patients may be at higher risk for acute cardiovascular, pulmonary and renal complications in comparison to non-obese patients. Obesity also represents a dilemma in the management of other critical care areas such as invasive mechanical ventilation, mechanical ventilation liberation, hemodynamic monitoring and pharmacokinetics dose adjustments. However, despite higher morbidity associated with obesity in the intensive care unit (ICU), a paradoxical lower ICU mortality ("obesity paradox") is demonstrated in comparison to non-obese ICU patients. This review article will focus on the unique pathophysiology, challenges in management, and outcomes associated with obesity in the ICU.

  14. Novel Predictors of Sepsis Outperform the American Burn Association Sepsis Criteria in the Burn Intensive Care Unit Patient

    Science.gov (United States)

    2013-01-01

    Albrecht MC, Albrecht MA, Griffith ME, et al. Impact of Acinetobacter infection on the mortality of burn patients. J Am Coll Surg 2006;203:546–50. 18...31 Sepsis is a significant problem for burn patients. It is a systemic infection that overwhelms the body’s immune system, triggering an... Infection has been demonstrated to precede multiple organ failure syndrome in 83% of burn patients, and reported mortality in this population

  15. Perceived versus Observed Patient Safety Measures in a Critical Care Unit from a Teaching Hospital in Southern Colombia

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    Jorge Hernan Montenegro

    2016-01-01

    Full Text Available Introduction. Patient safety is an important topic. The purpose of this study is to evaluate the perceived versus observed patient safety measures (PSM in critically ill patients in a teaching hospital in Latin America. Materials and Methods. The level of perceived patient safety was evaluated with the patient safety hospital survey. Three months later, a qualitative study was conducted, including video recording of procedures, graded according to adherence to PSM. Levels of adherence were scored during patient mobilization (PM, placement of central catheters (PCC, other invasive procedures (OIP, infection control (IC, and endotracheal intubation (ETI. Results. The perceived adherence of PSM in the prestudy survey was considered fair by 89.1% of the ICU staff. After the survey, 829 ICU procedures were video-recorded. Mean observed adherence for fair patient safety measures was 20.8%. Perceived adherence was higher than the real patient safety protocol measures observed in the videos. Conclusion. Perception of PSM was higher than observed in the management of critically ill patients in a teaching hospital in southern Colombia.

  16. Evaluation of risk factors in acute myocardial infarction patients admitted to the coronary care unit, Tripoli Medical Centre, Libya.

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    Abduelkarem, A R; El-Shareif, H J; Sharif, S I

    2012-04-01

    The aim of this study was to provide an overview of the risk factors for acute myocardial infarction in patients attending Tripoli Medical Centre, Libya. Records were reviewed for 622 patients with a mean age of 58.3 (SD 12.9) years. Diabetes mellitus (48.2%), hypertension (35.7%) and smoking (50.6%) were among the risk factors reported. There were 110 patients (17.7%) who died during hospitalization, mainly suffering cardiogenic shock (48.0%). The rate of use of thrombolytic therapy was low in patients who were female (40.4% versus 58.4% for males), older age (31.6% for those > 85 years versus 63.3% for patients < 55 years), diabetics (45.3% versus 62.0% for non-diabetic patients) and hypertensives (47.3% versus 57.8% for non-hypertensive patients). Prevention strategies should be implemented in order to improve the long-term prognosis and decrease overall morbidity and mortality from coronary artery disease in Libyan patients.

  17. Short-term and long-term mortality in very elderly patients admitted to an intensive care unit

    NARCIS (Netherlands)

    de Rooij, S. E.; Govers, A.; Korevaar, J C; Abu-Hanna, A; Levi, M; de Jonge, E

    2006-01-01

    OBJECTIVE: To report short-term and long-term mortality of very elderly ICU patients and to determine independent risk factors for short-term and long-term mortality DESIGN AND SETTING: Retrospective cohort study in the medical/surgical ICU of a tertiary university teaching hospital. PATIENTS: 578 c

  18. Barriers to cancer pain management in danish and lithuanian patients treated in pain and palliative care units

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Samsanaviciene, Jurgita; Liubarskiene, Zita

    2014-01-01

    The prevalence of cancer-related pain is high despite available guidelines for the effective assessment and management of that pain. Barriers to the use of opioid analgesics partially cause undertreatment of cancer pain. The aim of this study was to compare pain management outcomes and patient......-related barriers to cancer pain management in patient samples from Denmark and Lithuania. Thirty-three Danish and 30 Lithuanian patients responded to, respectively, Danish and Lithuanian versions of the Brief Pain Inventory pain scale, the Barriers Questionnaire II, the Hospital Anxiety and Depression Scale......, the Specific Questionnaire On Pain Communication, and the Medication Adherence Report Scale. Emotional distress and patient attitudes toward opioid analgesics in cancer patient samples from both countries explained pain management outcomes in the multivariate regression models. Pain relief and pain medication...

  19. Performance and burnout in intensive care units

    NARCIS (Netherlands)

    Keijsers, GJ; Schaufeli, WB; LeBlanc, P; Zwerts, C; Miranda, DR

    1995-01-01

    The relationship between three different performance measures and burnout was explored in 20 Dutch Intensive Care Units (ICUs). Burnout (i.e. emotional exhaustion and depersonalization) proved to be significantly related to nurses' perceptions of performance as well as to objectively assessed unit p

  20. Should β-lactam antibiotics be administered by continuous infusion in critically ill patients? A survey of Australia and New Zealand intensive care unit doctors and pharmacists.

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    Cotta, Menino O; Dulhunty, Joel M; Roberts, Jason A; Myburgh, John; Lipman, Jeffrey

    2016-06-01

    Although there is a biological precedent for administration of β-lactam antibiotics by continuous or extended infusion, there is no definitive evidence of a survival benefit compared with intermittent administration. The aim of this study was to explore clinician uncertainty with regard to the administration of β-lactam antibiotics by continuous infusion. Doctors and pharmacists in Australian and New Zealand intensive care units (ICUs) were surveyed to investigate current β-lactam antibiotic administration practices as well as the degree of uncertainty regarding the benefit of continuous infusion of two commonly used broad-spectrum β-lactams, namely meropenem and piperacillin/tazobactam (TZP). There were 111 respondents to the survey. Intermittent infusion was reported as standard practice for meropenem (73.9%) and TZP (82.0%). A greater proportion of pharmacists compared with doctors believed continuous infusion to be more effective than intermittent administration (85.4% vs. 34.3%, respectively; P infusion resulted in better patient outcomes (65.9% and 74.6%, respectively; P = 0.85). Overall, 91.0% of respondents were prepared to enrol eligible patients into a definitive randomised controlled trial on β-lactam antibiotic administration. In conclusion, there is equipoise among clinicians working in Australian and New Zealand ICUs as to whether administration by continuous infusion offers a survival benefit in critically ill patients.

  1. The Predictivity of Neutrophil Gelatinase Associated Lipocaline in the Development of Radiocontrast-Induced Nephropathy in the Intensive Care Unit Patients

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    Funda TÜRKMEN

    2013-05-01

    Full Text Available OBJECTIVE: The aim of this study is to investigate the predictive value of neutrophil gelatinase associated lipocaline (NGAL levels in the development of radiocontrast-induced nephropathy (rin in intensive care unit patients. MATERIAL and METHODS: Forty patients (female: male was 23:17 with a mean age of 73.7± 9.7 yrs (range= 60-94 yrs were included in the study. Lopromide 623mg/dl (ultravist 300 (iv was administered at a dose of 1.5 ml/kg. NGAL measurements were performed with the ELISA method on serum samples (cut-off >25 ng/ml. RESULTS: Eight patients were diagnosed as RIN. Five of these had 20% or more increases in NGAL levels. Cases who developed RIN had a statistically significant and direct correlation between the increases in NGAL and serum creatinine levels (p= 0.02. When the means of NGAL levels were compared before and six hours after the procedure, there was a significant increase after the procedure (p0.05. CONCLUSION: When compared to creatinine, plasma NGAL levels help to establish the diagnosis of RIN at a much earlier stage.

  2. Parenteral nutrition in the intensive care unit.

    Science.gov (United States)

    Jeejeebhoy, Khursheed N

    2012-11-01

    Patients in the intensive care unit (ICU) are unable to nourish themselves orally. In addition, critical illness increases nutrient requirements as well as alters metabolism. Typically, ICU patients rapidly become malnourished unless they are provided with involuntary feeding either through a tube inserted into the GI tract, called enteral nutrition (EN), or directly into the bloodstream, called parenteral nutrition (PN). Between the 1960s and the 1980s, PN was the modality of choice and the premise was that if some is good, more is better, which led to overfeeding regimens called hyperalimentation. Later, the dangers of overfeeding, hyperglycemia, fatty liver, and increased sepsis associated with PN became recognized. In contrast, EN was not associated with these risks and it gradually became the modality of choice in the ICU. However, ICU patients in whom the gastrointestinal tract was nonfunctional (i.e., gut failure) required PN to avoid malnutrition. In addition, EN was shown, on average, to not meet nutrient requirements, and underfeeding was recognized to increase complications because of malnutrition. Hence, the balanced perspective has been reached of using EN when possible but avoiding underfeeding by supplementing with PN when required. This new role for PN is currently being debated and studied. In addition, the relative merits and needs for protein, carbohydrates, lipids, and micronutrients are areas of study.

  3. The study of hospital bavage solution and calorie and protein in take. For patients needs from the special care unit at Imam Khomeini hospital, Sari, Iran during 2005

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    Sh. Ala

    2008-01-01

    Full Text Available AbstractBackground and Purpose: Malnutrition is a major problem within intensive care units (ICU affecting the outcome of patients. In Imam Khomeini Hospital, patients were fed with gavage solutions prepared in the kitchen of hospitals, however, its' nutritional value has not been studied at present time. The aim of this study was to analyze the gavage solution and to compare the calculated nutritional demand with the provided values.Materials and Methods: The amount of carbohydrate, lipid and protein of gavage solution has been determined with Leen ion, Gerber and Kejeldal methods, respectively. In this study, 30 patients with at least 5 days in the ICU were included. Daily metabolic needs were calculated with Harris-Benedict equation and then, calculated calorie and protein values were compared with the provided values.Results: The carbohydrate, lipid, protein and energy contents of gavage solutions were 0.035 ±0.002 g/ml, 0.0225±0.017 g/ml, 0.012 ± 0.002 g/ml, and 0.39 ± 0.164 Kcal/ml. The calorie and protein provided by the hospital solution, in comparison to the standard enteral solutions, were 32.5% and 16% respectively. Total energy expenditure (TEE at the time of admission to ICU was 2302 ± 633 Kcal/ per day. During week 1, 2, and 3, TEE was 2301±634, 2283 ± 661 and 2228 ± 790 respectively. Maximum provided energy was 600 ± 632 Kcal/ per day. Maximum protein was provided in week 3 and equal to 22.9% of patient’s needs.Conclusion: The gavage solution provided by hospitals can not meet the calorie and protein needs of patients. It is necessary to prepare solutions with enough contents of carbohydrate, lipid and protein or to provide them with standard enteral nutritional solutions.Key words: Gavage, Intensive care unit, Malnutrition, Calorie, ProteinJ Mazand Univ Med Sci 2008; 18(64: 81-85 (Persian

  4. Influence of renal function on the pharmacokinetics of piperacillin/tazobactam in intensive care unit patients during continuous venovenous hemofiltration.

    Science.gov (United States)

    Arzuaga, Alazne; Maynar, Javier; Gascón, Alicia R; Isla, Arantxazu; Corral, Esther; Fonseca, Fernando; Sánchez-Izquierdo, José Angel; Rello, Jordi; Canut, Andrés; Pedraz, José Luis

    2005-02-01

    The pharmacokinetics of piperacillin/tazobactam (4 g/0.5 g every 6 or 8 hours, by 20-minute intravenous infusion) were studied in 14 patients with acute renal failure who underwent continuous venovenous hemofiltration with AN69 membranes. Patients were grouped according to severity (CL(CR) 50 mL/min). A noncompartmental analysis was performed. The sieving coefficient (0.78 +/- 0.28) was similar to the unbound fraction (0.65 +/- 0.24) for tazobactam, but it was significantly different (0.34 +/- 0.25) from the unbound fraction (0.78 +/- 0.14) for piperacillin. Extracorporeal clearance was 37.0% +/- 28.8%, 12.7% +/- 12.6%, and 2.8% +/- 3.2% for piperacillin in each group and 62.5% +/- 44.9%, 35.4% +/- 17.0%, and 13.1% +/- 8.0% for tazobactam. No patients presented tazobactam accumulation. In patients with CL(CR) MIC90 values were 100% for a panel of 19 pathogens, but in those with CL(CR) > 50 mL/min, t(%)ss >MIC90 indexes were 55.5% and 16.6% for pathogens with MIC90 values of 32 and 64. The extracorporeal clearance of piperacillin/tazobactam is clinically significant in patients with CL(CR) > 50 mL/min, in which the risk of underdosing and clinical failure is important and extra doses are required.

  5. [Evaluation of the welcoming strategies in the Intensive Care Unit].

    Science.gov (United States)

    Maestri, Eleine; do Nascimento, Eliane Regina Pereira; Bertoncello, Kátia Cilene Godinho; de Jesus Martins, Josiane

    2012-02-01

    This qualitative study was performed at the adult Intensive Care Unit (ICU) of a public hospital in Southern Brazil with the objective to evaluate the implemented welcoming strategies. Participants included 13 patients and 23 relatives. Data collection was performed from July to October 2008, utilizing semi-structured interviews. All interviews were recorded. Data analysis was performed using the Collective Subject Discourse. The collected information yielded two discourses: the family recognized the welcoming strategies and the patients found the ICU team to be considerate. By including the family as a client of nursing care, relatives felt safe and confident. Results show that by committing to the responsibility of making changes in heath care practices, nurses experience a novel outlook towards ICU care, focused on human beings and associating the welcoming to the health care model that promotes the objectivity of care.

  6. Effectiveness, safety, and standard of service delivery: A patient-based survey at a pancha karma therapy unit in a secondary care Ayurvedic hospital

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    Sanjeev Rastogi

    2011-01-01

    Full Text Available Pancha karma is a modality of treatments commonly used in Ayurvedic hospitals. It has elaborate textual reference of its usage in various clinical conditions forming the basis of its extensive use in Ayurvedic clinical practice. Unfortunately, despite its unquestionable popularity and usage among Ayurvedic physicians and patients, it has not been evaluated rigorously on scientific parameters to identify its effectiveness, safety, and procedural standards. Considering the patient′s opinion as an important determinant in this perspective, this study aims at identifying the patient′s (actual recipients of pancha karma therapy perception toward the effectiveness, safety, and standard of service delivery concerning pancha karma through a structured survey at a pre-identified pancha karma therapy unit in a secondary care Ayurvedic hospital. Majority of the survey respondents considered these therapies as safe and effective (88%. Ninety-four percent respondents have expressed their satisfaction to the standard of services provided to them at the pancha karma unit of the hospital concerned.

  7. The clinical and economic value of the dipeptide alanyl-glutamine in total parenteral nutrition of critically ill patients treated in intensive care units in Italy

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    Maurizio Muscaritoli

    2009-06-01

    Full Text Available Introduction: the supplementation of alanyl-glutamine dipeptide in critically ill patients necessitating total parenteral nutrition (TPN improves clinical outcomes, reducing mortality, infection rate, and shortening ICU hospital lengths of stay (LOS, as compared to standard TPN regimens. Here we present a pharmacoeconomic evaluation of alanyl-glutamine dipeptide in critically ill patients admitted to Italian Intensive Care Units (ICUs. Methods: a Discrete Event Simulation model that incorporates outcomes rates from 200 Italian ICUs for over 60,000 patients, alanyl-glutamine dipeptide efficacy data synthesized by means of a Bayesian Random-Effects meta-analysis, and national cost data has been developed to evaluated the alternatives from the point of view of the hospital. Simulated clinical outcomes are death and infection rates in ICU, death rate in general ward, and hospital LOSs. One-way and probabilistic sensitivity analyses are performed by varying all uncertain parameter values in a plausible range. Results: alanyl-glutamine dipeptide results more effective and less costly than standard TPN: reduced mortality rate (23.55% ± 15.2% vs 34.50% ± 2.06%, infection rate (15.91% ± 3.95% vs 18.97% ± 3.94%, and hospital LOS (25.47 ± 0.26 vs 26.00 ± 0.27 days come at a lower total cost per patient (23,922 ± 3,249 vs 24,145 ± 3,361 Euro. Treatment cost is completely offset by savings on ICU and antibiotic costs. The cost/effectiveness acceptability curve indicates an estimated 78% probability of alanyl-glutamine dipeptide resulting dominant and a 90% probability of resulting cost/effective for a willingness to pay up to 1,500 Euro for one patient death avoided. Conclusions: alanyl-glutamine dipeptide is expected to improve clinical outcomes and to do so with a concurrent saving for the hospital.

  8. Characterization and sensitivity to antibiotics of bacteria isolated from the lower respiratory tract of ventilated patients hospitalized in intensive care units

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    Manuel Medell

    2012-02-01

    Full Text Available OBJECTIVE: This observational study described the characterization of bacteria isolated from the lower respiratory tract of ventilated patients hospitalized in intensive care units. The demonstration of isolated microorganism resistance to antibiotics and a time-trend analysis of infection comparing a 48-month period were also other objectives. METHOD: Semi-quantitative assays of 1254 samples taken from 741 ventilated patients were performed, while pathogens were identified using the Enterotube II assay and VITEK 2 Compact equipment. Bacterial resistance to antibiotics was assessed by the Kirby-Bauer disc diffusion method and time-trend analysis of infection was based on data recorded by hospital microbiology laboratories. RESULTS: The most prevalent isolated bacteria from the patient's lower respiratory tract were with Gram-negative bacteria (67.8% mostly represented by: Acinetobacter spp. (25.2%, Pseudomonas spp. (18.3% and Klebsiellas spp. (9.4%. Acinetobacter spp. showed moderate high to very high resistance to ceftriaxone (CRO, gentamicin (CN, amikacin (AK, meropenem (MRP, aztreonam (ATM and piperacillin/tazobactam (TZP. Some isolates of Acinetobacter spp. resistant to colistin (CS were identified in this patient population. Pseudomonas spp. and Klebsiella spp. were very highly resistant to ampicillin/sublactam (AMS and with moderate or low resistance to CRO, ATM, MRP, AK, CN and TZP. A decrease in the Pseudomonas spp. prevalence rate was observed, whereas an increase in Acinetobacter spp. and Klebsiella spp. prevalence rates were observed in a 48-month period. CONCLUSION: This research corroborated that these nosocomial infections are a relevant medical problem in our context. The most prevalent bacterial infections in the lower respiratory tract of ventilated patients were by Acinetobacter spp., Pseudomonas spp. and Klebsiella spp. The panel of antibiotics used as preventive therapy was not the solution of infections and probably induced

  9. The ability of two scoring systems to predict in-hospital mortality of patients with moderate and severe traumatic brain injuries in a Moroccan intensive care unit

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    Hicham Nejmi

    2014-01-01

    Full Text Available Aim of Study: We aim to assess and to compare the predicting power for in-hospital mortality (IHM of the Acute Physiology and Chronic Health Evaluation-II (APACHE-II and the Simplified Acute Physiology Score-II (SAPS-II for traumatic brain injury (TBI. Patients and Methods: This retrospective cohort study was conducted during a period of 2 years and 9 months in a Moroccan intensive care unit. Data were collected during the first 24 h of each admission. The clinical and laboratory parameters were analyzed and used as per each scoring system to calculate the scores. Univariate and multivariate analyses through regression logistic models were performed, to predict IHM after moderate and severe TBIs. Areas under the receiver operating characteristic curves (AUROC, specificities and sensitivities were determined and also compared. Results: A total of 225 patients were enrolled. The observed IHM was 51.5%. The univariate analysis showed that the initial Glasgow coma scale (GCS was lower in nonsurviving patients (mean GCS = 6 than the survivors (mean GCS = 9 with a statistically significant difference (P = 0.0024. The APACHE-II and the SAPS-II of the nonsurviving patients were higher than those of the survivors (respectively 20.4 ± 6.8 and 31.2 ± 13.6 for nonsurvivors vs. 15.7 ± 5.4 and 22.7 ± 10.3 for survivors with a statistically significant difference (P = 0.0032 for APACHE-II and P = 0.0045 for SAPS-II. Multivariate analysis: APACHE-II was superior for predicting IHM (AUROC = 0.92. Conclusion: The APACHE-II is an interesting tool to predict IHM of head injury patients. This is particularly relevant in Morocco, where TBI is a greater public health problem than in many other countries.

  10. Serum 1H-NMR metabolomic fingerprints of acute-on-chronic liver failure in intensive care unit patients with alcoholic cirrhosis.

    Directory of Open Access Journals (Sweden)

    Roland Amathieu

    Full Text Available INTRODUCTION: Acute-on-chronic liver failure is characterized by acute deterioration of liver function in patients with compensated or decompensated, but stable, cirrhosis. However, there is no accurate definition of acute-on-chronic liver failure and physicians often use this term to describe different clinical entities. Metabolomics investigates metabolic changes in biological systems and identifies the biomarkers or metabolic profiles. Our study assessed the metabolomic profile of serum using proton nuclear magnetic resonance ((1H-NMR spectroscopy to identify metabolic changes related to acute-on-chronic liver failure. PATIENTS: Ninety-three patients with compensated or decompensated cirrhosis (CLF group but stable liver function and 30 patients with cirrhosis and hospitalized for the management of an acute event who may be responsible of acute-on-chronic liver failure (ACLF group, were fully analyzed. Blood samples were drawn at admission, and sera were separated and stored at -80°C until (1H-NMR spectral analysis. Using orthogonal projection to latent-structure discriminant analyses, various metabolites contribute to the complete separation between these both groups. RESULTS: The predictability of the model was 0.73 (Q(2 Y and the explained variance was 0.63 (R(2 Y. The main metabolites that had increased signals related to acute-on-chronic liver failure were lactate, pyruvate, ketone bodies, glutamine, phenylalanine, tyrosine, and creatinine. High-density lipids were lower in the ALCF group than in CLF group. CONCLUSION: A serum metabolite fingerprint for acute-on-chronic liver failure, obtained with (1H-NMR, was identified. Metabolomic profiling may aid clinical evaluation of patients with cirrhosis admitted into intensive care units with acute-on-chronic liver failure, and provide new insights into the metabolic processes involved in acute impairment of hepatic function.

  11. Bispectral index monitoring in the management of sedation in an intensive care unit patient with locked-in syndrome.

    Science.gov (United States)

    Quraishi, Sadeq A; Blosser, Sandralee A; Cherry, Robert A

    2011-11-01

    Locked-in syndrome is an extremely rare neurological state caused by injury of the ventral pons. The syndrome is characterized by quadriplegia and anarthria with concomitant preservation of cortical function. When a reversible underlying pathological abnormality is identified and managed aggressively, meaningful recovery is possible. Because patients retain consciousness throughout their illness, a dependable method for titrating sedation may improve their quality of life. The case presented suggests that bispectral index monitoring may be a cost-effective and reliable method for managing sedation in patients with locked-in syndrome.

  12. A Brief Cognitive-Behavioral Psycho-Education (B-CBE Program for Managing Stress and Anxiety of Main Family Caregivers of Patients in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Vico Chung Lim Chiang

    2016-09-01

    Full Text Available Having a loved one in the intensive care unit (ICU is a stressful event, which may cause a high level of anxiety to the family members. This could threaten their wellbeing and ability to support the patients in, or after discharge from, the ICU. To investigate the outcomes of a brief cognitive-behavioral psycho-education program (B-CBE to manage stress and anxiety of the main family caregivers (MFCs, a pragmatic quasi-experimental study involving 45 participants (treatment group: 24; control group: 21 was conducted in an ICU. The Depression and Anxiety Stress Scale and the Critical Care Family Need Inventory were used to evaluate the primary outcomes on stress and anxiety, and satisfaction with family needs. The treatment group reported significantly better improvement in the information satisfaction score compared to the control group (p < 0.05; η2 = 0.09. Overall main effects were observed on the stress (p < 0.01; η2 = 0.20, anxiety (p < 0.01; η2 = 0.18, depression (p < 0.05; η2 = 0.13, support satisfaction (p < 0.05; η2 = 0.13, and comfort satisfaction (p < 0.05; η2 = 0.11 scores. The experience of this study suggest that MFCs are in great need of additional support like B-CBE to manage their stress and anxiety. Given the brevity of B-CBE, it is practical for critical care nurses to deliver and MFCs to take within the industrious context of an ICU. More studies are needed to investigate these types of brief psychological interventions.

  13. Base deficit-based predictive modeling of outcome in trauma patients admitted to intensive care units in dutch trauma centers

    NARCIS (Netherlands)

    Kroezen, Frank; Bijlsma, Taco S.; Liem, Mike S. L.; Meeuwis, J. Dik; Leenen, Luke P. H.

    2007-01-01

    Background: Worldwide, the base deficit is available as an objective indicator of acid base status. We used the base deficit as a measure of physiologic derangement in a Trauma and Injury Severity Score (TRISS)-like model as a predictor for outcome in trauma patients. Methods: We prospectively recor

  14. Comparative Study of Plasma Endotoxin with Procalcitonin Levels in Diagnosis of Bacteremia in Intensive Care Unit Patients

    Directory of Open Access Journals (Sweden)

    Tao Wang

    2016-01-01

    Conclusions: Plasma endotoxin was more related to GN than to Gram-positive bacteremia, and that endotoxin level was species dependent, but PCT level remained relatively more stable within the GN bacteria caused bacteremia. Both GN and positive bacteria caused bacteremia in the ICU patients in different regions of China. And PCT is a more valuable biomarker than endotoxin in the diagnosis of bacteremia.

  15. Searching for predictors of surgical complications in critically ill surgery patients in the intensive care unit: a review

    NARCIS (Netherlands)

    Meyer, Z.C.; Schreinemakers, J.M.J.; Waal, R.A. de; Laan, L. van der

    2015-01-01

    We reviewed the use of the levels of C-reactive protein, lactate and procalcitonin and/or the Sequential Organ Failure Assessment score to determine their diagnostic accuracy for predicting surgical complications in critically ill general post-surgery patients. Included were all studies published in

  16. Burnout in the intensive care unit professionals

    Science.gov (United States)

    Chuang, Chien-Huai; Tseng, Pei-Chi; Lin, Chun-Yu; Lin, Kuan-Han; Chen, Yen-Yuan

    2016-01-01

    Abstract Background: Burnout has been described as a prolonged response to chronic emotional and interpersonal stress on the job that is often the result of a period of expending excessive effort at work while having too little recovery time. Healthcare workers who work in a stressful medical environment, especially in an intensive care unit (ICU), may be particularly susceptible to burnout. In healthcare workers, burnout may affect their well-being and the quality of professional care they provide and can, therefore, be detrimental to patient safety. The objectives of this study were: to determine the prevalence of burnout in the ICU setting; and to identify factors associated with burnout in ICU professionals. Methods: The original articles for observational studies were retrieved from PubMed, MEDLINE, and Web of Science in June 2016 using the following MeSH terms: “burnout” and “intensive care unit”. Articles that were published in English between January 1996 and June 2016 were eligible for inclusion. Two reviewers evaluated the abstracts identified using our search criteria prior to full text review. To be included in the final analysis, studies were required to have employed an observational study design and examined the associations between any risk factors and burnout in the ICU setting. Results: Overall, 203 full text articles were identified in the electronic databases after the exclusion of duplicate articles. After the initial review, 25 studies fulfilled the inclusion criteria. The prevalence of burnout in ICU professionals in the included studies ranged from 6% to 47%. The following factors were reported to be associated with burnout: age, sex, marital status, personality traits, work experience in an ICU, work environment, workload and shift work, ethical issues, and end-of-life decision-making. Conclusions: The impact of the identified factors on burnout remains poorly understood. Nevertheless, this review presents important information

  17. Dysrhythmias Induced by Streptokinase Infusion in Patients with Acute Myocardial Infarction Admitted to Cardiac Care Units in the Northwest of Iran

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    Parizad Razieh

    2014-01-01

    Full Text Available Objective: Currently, the most common cause of death in the world is cardiovascular disease, particularly myocardial infarction. Myocardial infarction is caused by reducing or cutting off the blood supply to the heart muscle due to obstruction caused by the presence of plaque or thrombus. The first step for the treatment of acute myocardial infarction is using thrombolytic drugs. By the analysis of plaque and removing the blockage, the blood flows to the affected area again. The most important thrombolytic agent is streptokinase; however, in addition to its therapeutic effect it also has some complications and by identifying them mortality and disability can be prevented. The present study aimed to investigate the most common arrhythmia after infusion of streptokinase in patients with acute myocardial infarction (AMI. Materials and Methods: This research was a descriptive study. The study population included patients admitted to the cardiac care unit of Shahid Madani Hospital, Tabriz, Iran, with a diagnosis of AMI from September 2012 until March 2014. Data were collected by using a checklist and the findings of the study were analyzed by SPSS software. Results: Of the 116 hospitalized patients, 78 (67.5% were male and 37 (32.5% were female, and the largest percentage of infected patients was in the age group of 60-70 years [n = 38 (33%]. Regarding cardiac risk factors, 57 (49% of patients were hyperlipidemic, 36 (31% were diabetic, 34 (30% had high blood pressure, 25 (21% were smokers, and 21 (18% had a positive family history of cardiac problems. Patients who were admitted with a diagnosis of AMI, in 53 (46% cases had streptokinase injection, and in 86 (74% complications had occurred during drug injection; 87 (75% patients had dysrhythmia and 29 (25% had bleeding. Common dysrhythmia was premature ventricular contraction (PVC with 90 (78.2% cases. Moreover, 53 (46% patients had slow ventricular tachycardia (VT, 18 (16% had premature atrial

  18. ACUTE UNDIFFERENTIATED FEVER IN INTENSIVE CARE UNITS

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    Srikanth Ram Mohan

    2014-03-01

    Full Text Available Acute undifferentiated fever (AUF is common in tropical regions of the developing world, its specific etiology is often unknown. It’s common causes include malaria, dengue fever, enteric fever, leptospirosis, rickettsial infection. AUF is defined as fever without any localised source of infection, of 14 days or less in duration. The objective of the study was to focus on identifying the causes of AUF in patients admitted to Intensive care units & to determine importance of clinical examination in identifying the cause. It was a prospective study done in our Medical college Hospital at Kolar, Karnataka between 1-11-2010 to 30-11-2011. Cases presenting to hospital aged >18 years with complaints of Fever & admitted in Intensive care units were included in study. A total of 558 cases were enrolled. The clinical findings were noted and subsequent Investigations required were asked for. The study compromised of approximately equal number of Male & Female patients & age varied from 18 – 100 years. There was a clear seasonal variation – More no of cases were admitted between April & November. Majority presented with Fever of Short duration (1-3 days. Certain well defined syndromes were identified like:  Fever with Thrombocytopenia – the most common of all the syndromes.  Fever with Myalgia & Arthralgia,  Fever with Hepatorenal dysfunction,  Fever with Encephalopathy,  Fever with Pulmonary - Renal dysfunction and  Fever with Multiorgan dysfunction (MODS. Out of 558 cases AUF was noted in 339 cases (60.86%. An etiological diagnosis could be made for 218 cases (39.06%. Leptospirosis was the commonest cause with 72 cases (12.9%. The no of cases with Dengue were 48(8.6%, Malaria –25 (4.4%, Viral fever –35 (6.2%, Mixed infections – 12 (2.1%, Pulmonary Tuberculosis -25 ( 4.4% and one case of Rickettsial Infection. MODS was the most common presentation in AUF patients, seen in 108 cases (31.8% and 40 cases expired. A study of AUF

  19. Long-Term Impact of Acute, Critical Illness and Admission to an Intensive Care Unit. Perspectives of Patients and Partners

    DEFF Research Database (Denmark)

    Ågård, Anne Sophie

    2013-01-01

    and their partners and from public registers. The ICU survivors struggled for independence, and their main concerns were to recover physical strength, regain functional capacity, and resume domestic roles. Recovery evolved in three phases from initially feeling their way, to getting a grip, and later maintaining......-based programs. Also, they had frequent out-patient hospital visits. The spouses played an active and vital role throughout recovery. To promote progress in the patient’s recovery while simultaneously keeping the couples’ practical and social lives together, the spouses progres-sively shifted their role from......-term trajectories of ICU survivors and the concrete challenges facing the patients and their partners after ICU discharge, particularly as seen from their own perspectives. In this longitudinal grounded theory study, data were collected from dyad and focus group interviews with 18 previously healthy ICU survivors...

  20. Clinical study of midazolam sequential with dexmedetomidine for agitated patients undergoing weaning to implement light sedation in intensive care unit

    Institute of Scientific and Technical Information of China (English)

    Xing Lu; Jun Li; Tong Li; Jie Zhang; Zhi-Bo Li; Xin-Jing Gao; Lei Xu

    2016-01-01

    Purpose:To evaluate midazolam sequential with dexmedetomidine for agitated patients undergoing weaning to implement light sedation in ICU.Methods:This randomized,prospective study was conducted in Tianjin Third Central Hospital,China.Using a sealed-envelope method,the patients were randomly divided into 2 groups (40 patients per group).Each patient of group A received an initial loading dose of midazolam at 0.3-3 mg/kg·h 24 h before extubation,followed by an infusion of dexmedetomidine at a rate of 0.2-1 μg/kg·h until extubation.Each patient of group B received midazolam at a dose of 0.3-3 mg/kg·h until extubation.The dose of sedation was regulated according to RASS sedative scores maintaining in the range of-2-1.All patients were continuously monitored for 60 min after extubation.During the course,heart rate (HR),mean artery pressure (MAP),extubation time,adverse reactions,ICU stay,and hospital stay were observed and recorded continuously at the following time points:24 h before extubation (T1),12 h before extubation (T2),extubation (T3),30 min after extubation (T4),60 min after extubation (T5).Results:Both groups reached the goal of sedation needed for ICU patients.Dexmedetomidine was associated with a significant increase in extubation quality compared with midazolam,reflected in the prevalence of delirium after extubation (20% (8/40) vs 45% (18/40)),respectively (p =0.017).There were no clinically significant decreases in HR and MAP after infusing dexmedetomidine or midazolam.In the group A,HR was not significantly increased after extubation;however,in the group B,HR was significantly increased compared with the preextubation values (p < 0.05).HR was significantly higher in the group B compared with the group A at 30 and 60 main after extubation (both,p < 0.05).Compared with preextubation values,MAP was significantly increased at extubation in the group B (p < 0.05) and MAP was significantly higher at T3,T4,T5 in the group B than group A (p < 0

  1. The Cardiovascular Intensive Care Unit-An Evolving Model for Health Care Delivery.

    Science.gov (United States)

    Loughran, John; Puthawala, Tauqir; Sutton, Brad S; Brown, Lorrel E; Pronovost, Peter J; DeFilippis, Andrew P

    2017-02-01

    Prior to the advent of the coronary care unit (CCU), patients having an acute myocardial infarction (AMI) were managed on the general medicine wards with reported mortality rates of greater than 30%. The first CCUs are believed to be responsible for reducing mortality attributed to AMI by as much as 40%. This drastic improvement can be attributed to both advances in medical technology and in the process of health care delivery. Evolving considerably since the 1960s, the CCU is now more appropriately labeled as a cardiac intensive care unit (CICU) and represents a comprehensive system designed for the care of patients with an array of advanced cardiovascular disease, an entity that reaches far beyond its early association with AMI. Grouping of patients by diagnosis to a common physical space, dedicated teams of health care providers, as well as the development and implementation of evidence-based treatment algorithms have resulted in the delivery of safer, more efficient care, and most importantly better patient outcomes. The CICU serves as a platform for an integrated, team-based patient care delivery system that addresses a broad spectrum of patient needs. Lessons learned from this model can be broadly applied to address the urgent need to improve outcomes and efficiency in a variety of health care settings.

  2. Invasive candidiasis in pediatric intensive care units.

    Science.gov (United States)

    Singhi, Sunit; Deep, Akash

    2009-10-01

    Candidemia and disseminated candidiasis are major causes of morbidity and mortality in hospitalized patients especially in the intensive care units (ICU). The incidence of invasive candidasis is on a steady rise because of increasing use of multiple antibiotics and invasive procedures carried out in the ICUs. Worldwide there is a shifting trend from C. albicans towards non albicans species, with an associated increase in mortality and antifungal resistance. In the ICU a predisposed host in one who is on broad spectrum antibiotics, parenteral nutrition, and central venous catheters. There are no pathognomonic signs or symptoms. The clinical clues are: unexplained fever or signs of severe sepsis or septic shock while on antibiotics, multiple, non-tender, nodular erythematous cutaneous lesions. The spectrum of infection with candida species range from superficial candidiasis of the skin and mucosa to more serious life threatening infections. Treatment of candidiasis involves removal of the most likely source of infection and drug therapy to speed up the clearance of infection. Amphotericin B remains the initial drug of first choice in hemodynamically unstable critically ill children in the wake of increasing resistance to azoles. Evaluation of newer antifungal agents and precise role of prophylactic therapy in ICU patients is needed.

  3. Probiotics in the intensive care unit.

    Science.gov (United States)

    Morrow, Lee E; Gogineni, Vijaya; Malesker, Mark A

    2012-04-01

    Probiotics are living microorganisms that, when ingested in adequate amounts, provide benefits to the host. The benefits include either a shortened duration of infections or decreased susceptibility to pathogens. Proposed mechanisms of beneficial effects include improving gastrointestinal barrier function, modification of the gut flora by inducing host cell antimicrobial peptides and/or local release of probiotic antimicrobial factors, competition for epithelial adherence, and immunomodulation. With increasing intensive care unit (ICU) antibacterial resistance rates and fewer new antibiotics in the research pipeline, focus has been shifted to non-antibiotic approaches for the prevention and treatment of nosocomial infections. Probiotics offer promise to ICU patients for the prevention of antibiotic-associated diarrhea, Clostridium difficile infections, multiple organ dysfunction syndrome, and ventilator-associated pneumonia. Our current understanding of probiotics is confounded by inconsistency in probiotic strains studied, optimal dosages, study durations, and suboptimal sample sizes. Although probiotics are generally safe in the critically ill, adverse event monitoring must be rigorous in these vulnerable patients. Delineation of clinical differences of various effective probiotic strains, their mechanisms of action, and optimal dosing regimens will better establish the role of probiotics in various disorders. However, probiotic research will likely be hindered in the future given a recent ruling by the U.S. Food and Drug Administration.

  4. Noninvasive near-infrared blood glucose monitoring using a calibration model built by a numerical simulation method: Trial application to patients in an intensive care unit.

    Science.gov (United States)

    Maruo, Katsuhiko; Oota, Tomohiro; Tsurugi, Mitsuhiro; Nakagawa, Takehiro; Arimoto, Hidenobu; Hayakawa, Mineji; Tamura, Mamoru; Ozaki, Yukihiro; Yamada, Yukio

    2006-12-01

    We have applied a new methodology for noninvasive continuous blood glucose monitoring, proposed in our previous paper, to patients in ICU (intensive care unit), where strict controls of blood glucose levels are required. The new methodology can build calibration models essentially from numerical simulation, while the conventional methodology requires pre-experiments such as sugar tolerance tests, which are impossible to perform on ICU patients in most cases. The in vivo experiments in this study consisted of two stages, the first stage conducted on healthy subjects as preliminary experiments, and the second stage on ICU patients. The prediction performance of the first stage was obtained as a correlation coefficient (r) of 0.71 and standard error of prediction (SEP) of 28.7 mg/dL. Of the 323 total data, 71.5% were in the A zone, 28.5% were in the B zone, and none were in the C, D, and E zones for the Clarke error-grid analysis. The prediction performance of the second stage was obtained as an r of 0.97 and SEP of 27.2 mg/dL. Of the 304 total data, 80.3% were in the A zone, 19.7% were in the B zone, and none were in the C, D, and E zones. These prediction results suggest that the new methodology has the potential to realize a noninvasive blood glucose monitoring system using near-infrared spectroscopy (NIRS) in ICUs. Although the total performance of the present monitoring system has not yet reached a satisfactory level as a stand-alone system, it can be developed as a complementary system to the conventional one used in ICUs for routine blood glucose management, which checks the blood glucose levels of patients every few hours.

  5. Effect of graded early mobilization versus routine physiotherapy on the length of intensive care unit stay in mechanically ventilated patients: A randomized controlled study

    Directory of Open Access Journals (Sweden)

    Priyakshi Bezbaruah

    2012-01-01

    Full Text Available Background: Early mobilization is an important component of physiotherapy used to prevent and decrease pulmonary and immobilization complications, which are the major goals of physiotherapy in the intensive care unit (ICU. Prolonged bed rest and hospitalization leads to deconditioning and weakness which can further increase the length of the ICU stay. This study was conducted to find an answer to whether early mobilization is as effective as or better than routine physiotherapy in reducing the length of ICU stay in mechanically ventilated patients. Study Design: Randomized controlled study. Study Setting: Medical ICU, Father Muller Medical College Hospital. Mangalore, Karnataka, India. Aim: To detect the effectiveness of graded early mobilization and routine physiotherapy and to compare these techniques with respect to the length of ICU stay in mechanically ventilated patients. Materials and Methods: Fifteen subjects of both gender who were on mechanical ventilators fulfilling the inclusion criteria were randomly assigned to two groups, group 1 (graded early mobilization, n = 8 and Group 2 (routine physiotherapy, n = 7 by using the randomization plan from the website www.randomization.com. All the vitals of the subjects were noted as they were made to perform particular maneuvers depending on the group they belonged to. Participants recruited into the early mobilization group were mobilized as soon as their vitals were stable and were able to participate in the therapy. The patients who underwent routine physiotherapy were mobilized once they were extubated. At the time of discharge from the ICU, days of weaning, days first out of bed, and length of ICU stay were noted. Results: A significant difference was observed between early mobilization and routine physiotherapy groups with respect to the length of ICU stay. Conclusion: Early mobilization showed better outcome compared to routine physiotherapy in reducing the length of ICU stay in

  6. Analysis of Patients with Delirium in Intensive Care Unit%ICU谵妄患者病因分析以及处理

    Institute of Scientific and Technical Information of China (English)

    薛晓艳; 朱继红

    2011-01-01

    分析急诊ICU患者出现谵妄症状的原因以及处理对策.分析总结我院急诊ICU 3年间所有患者的资料,发现20.2%的患者出现谵妄症状,原因为:(1)疾病相关;(2)药物相关;(3)监护环境等多种因素作用结果.经过调整治疗方案、加强心理护理后,需要镇静药物的仅为谵妄患者的19.7%.因此寻找谵妄原因很重要,治疗重点在于去除谵妄原因以及相关促发因素.%Analyze the causes of patients with delirium and their management in ICU. Review the document of patient with delirium in Emergency Intensive Care Unit of Beijing university people's hospital; analyze the causes of delirium, management and outcome of the patients. The rate of delirium of our patients was 20. 2%. Their causes were diseases related, medications related, or environment and other risks co-related. After adjust therapy and psychological nursing, the rate of sedation was 19. 7%. So identifying the etiology of delirium is the most important thing in the management of delirium in ICU. Both prevention and treatment should focus on the minimization and/or elimination of predisposing and precipitating factors.

  7. Heavy metal in the intensive care unit: a review of current literature on trace element supplementation in critically ill patients.

    Science.gov (United States)

    Rech, Megan; To, Long; Tovbin, Alina; Smoot, Thomas; Mlynarek, Mark

    2014-02-01

    Trace elements are essential for many physiologic processes. In recent years, supplementation has been studied for a variety of indications, including glycemic control, wound healing, antioxidant effect, and anemia. Critical illness, especially states such as burns, traumas, and septic shock, is associated with inflammatory and oxidative stress, immune dysfunction, and malnutrition. In these patients, enteral and parenteral nutrition or pharmaceutical supplementation is used to provide essential macronutrients, including trace elements. The purpose of this review is to describe trace element supplementation, including iron, copper, chromium, manganese, selenium, and zinc, and highlight their mechanism, pharmacology, outcome data, and adverse effects.

  8. Impact of critically ill patients in regards to the boarding time from the emergency department to the intensive care unit

    Directory of Open Access Journals (Sweden)

    George Fildissis

    2011-07-01

    Full Text Available Objective: To determine the association between ED overcrowding and outcomes for critically ill patients Design and Setting: We included medical and surgical pts that all of them were intubated promptly to ED of 2 general hospitals of Athens GR, for 12 months. Pts survived > 24hours were divided into 2 groups: ED boarding 61 yrs, female gender and direct admission to ICU were associated with lower hospital survival (odds ratio 0.815; 95% 0.612-0.976. Conclusions: Boarding time of critically ill from ED to ICUs is very important because it is strongly related to the hospital LOS and mortality rate.

  9. Intensive care unit nurses' opinions about euthanasia.

    Science.gov (United States)

    Kumaş, Gülşah; Oztunç, Gürsel; Nazan Alparslan, Z

    2007-09-01

    This study was conducted to gain opinions about euthanasia from nurses who work in intensive care units. The research was planned as a descriptive study and conducted with 186 nurses who worked in intensive care units in a university hospital, a public hospital, and a private not-for-profit hospital in Adana, Turkey, and who agreed to complete a questionnaire. Euthanasia is not legal in Turkey. One third (33.9%) of the nurses supported the legalization of euthanasia, whereas 39.8% did not. In some specific circumstances, 44.1% of the nurses thought that euthanasia was being practiced in our country. The most significant finding was that these Turkish intensive care unit nurses did not overwhelmingly support the legalization of euthanasia. Those who did support it were inclined to agree with passive rather than active euthanasia (P = 0.011).

  10. Competence of nurses in the intensive cardiac care unit

    OpenAIRE

    Nobahar, Monir

    2016-01-01

    Introduction Competence of nurses is a complex combination of knowledge, function, skills, attitudes, and values. Delivering care for patients in the Intensive Cardiac Care Unit (ICCU) requires nurses’ competences. This study aimed to explain nurses’ competence in the ICCU. Methods This was a qualitative study in which purposive sampling with maximum variation was used. Data were collected through semi-structured interviews with 23 participants during 2012–2013. Interviews were recorded, tran...

  11. Transtorno de estresse pós-traumático em pacientes de unidade de terapia intensiva Post-traumatic stress disorder in intensive care unit patients

    Directory of Open Access Journals (Sweden)

    Andrea Vannini Santesso Caiuby

    2010-03-01

    Full Text Available O transtorno de estresse pós-traumático tem sido descrito em pacientes após tratamento em unidade de terapia intensiva. O objetivo foi revisar estudos sobre os aspectos psicológicos e as intervenções terapêuticas destes pacientes após internação em unidade de terapia intensiva. Trinta e oito artigos foram incluídos. A prevalência de transtorno de estresse pós-traumático variou de 17% a 30% e a incidência de 14% a 24%. Os fatores de risco foram: história prévia de ansiedade, depressão ou pânico, ter memórias traumáticas ilusórias (memórias derivadas de formações psíquicas como sonho e delirium, tempo de ventilação mecânica, experiências estressantes, crenças e comportamentos de característica depressiva. Doses altas de opióides, sintomas na retirada da sedação ou analgesia e o uso de lorazepam foram relacionados ao aumento de delirium e de memória ilusória. A sintomatologia do transtorno pode ser reduzida com a administração de hidrocortisona, com a interrupção diária da sedação e não foram encontrados estudos de efetividade de intervenção psicológica.Post-traumatic stress disorder has been detected in patients after treatment in intensive care unit. The main goal of this study is to review the psychological aspects and therapeutic interventions on those patients after their treatment on intensive care unit. Thirty eight articles have been included. The prevalence of post-traumatic stress disorder has varied from 17% up to 30% and the incidence from 14% to 24%. The risk factors were: previous anxiety historic, depression or panic, having delusional traumatic memories (derived from psychic formations as dreams and delirium, belief effects, depressive behavior, stressing experiences and mechanical ventilation. High doses of opiates, symptoms caused by sedation or analgesia reduction and the use of lorazepam were related with the increase of delirium and delusional memory. The disorder sintomatology

  12. COMPARATIVE EVALUATION OF CENTRAL VENOUS VERSUS ARTERIAL BLOOD SAMPLE FOR REPETITIVE MEASUREMENTS IN CRITICALLY ILL PATIENTS ADMITTED IN INTENSIVE CARE UNIT

    Directory of Open Access Journals (Sweden)

    Rukhsana

    2015-08-01

    Full Text Available OBJECTIVES: The purpose of present study was to evaluate the reliability of central venous blood gas monitoring as an alternative to arterial blood gas monitoring and to assess that the central venous catheter is convenient and reliable source of blood for repetitive measurement of pH bicarbonate and PCO2 in critically ill patients admitted in surgical intensive care unit (SICU. METHODS: We took one hundred patients who required ABG analysis between 20 - 60 years of age. The cases were divided in four groups which constituted major admissions in SICU in one year. Out of one hundred patients for the study there were 19 Poisoning patients, 15 Trauma patients, 40 Major abdominal surgery patients, 26 Hypovolemic shock patients and others. Central Venous blood drawn within 5 min of an ABG measurement and the samples analyzed immediately on automated ABG analyzer were compared. RESULTS: Bland Altman plots demonstrated a high degree of agreement between the two corresponding sets of measurements of arterial and venous blood with coefficient of correlation 0.979 for pH. The coefficient of correlation was highly positive i.e. 0.926 for PCO 2 and 0.955 for HCO 3 - which is statistically significant. There was also positive correlation for saturation between arterial and venous blood i.e. 0.57 with clinically acceptable difference and is statistically significant. The difference in pO 2 measurements was however higher with correlation coefficient of 0.259 although the arterial saturation and finger oximetry reveals a good degree of agreement with clinically acceptable bias. CONCLUSION: Venous blood gas (VBG analysis clearly does not replace ABG analysis in determining exact pO 2 status and arterial puncture may still be required for invasive arterial BP monitoring. With positive correlation and regression plots obtained, venous samples can be used as an alternative to arterial samples depending on the significant positive correlation values obtained for

  13. The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: Intensive care benefit for the elderly

    DEFF Research Database (Denmark)

    Sprung, Charles L; Artigas, Antonio; Kesecioglu, Jozef

    2012-01-01

    RATIONALE:: Life and death triage decisions are made daily by intensive care unit physicians. Admission to an intensive care unit is denied when intensive care unit resources are constrained, especially for the elderly. OBJECTIVE:: To determine the effect of intensive care unit triage decisions...... for intensive care unit admission. INTERVENTIONS:: Admission or rejection to intensive care unit. MEASUREMENTS AND MAIN RESULTS:: Demographic, clinical, hospital, physiologic variables, and 28-day mortality were obtained on consecutive patients. There were 8,472 triages in 6,796 patients, 5,602 (82%) were...... on mortality and intensive care unit benefit, specifically for elderly patients. DESIGN:: Prospective, observational study of triage decisions from September 2003 until March 2005. SETTING:: Eleven intensive care units in seven European countries. PATIENTS:: All patients >18 yrs with an explicit request...

  14. Caracterização das infecções relacionadas à assistência à saúde em uma Unidade de Terapia Intensiva | Description of Infections Related to Health Care (IRAS of patients in an Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Francisco Gilberto Fernandes Pereira

    2016-02-01

    Full Text Available Objetivo: Analisar as Infecções Relacionadas à Assistência à Saúde (IRAS de pacientes em Unidade de Terapia Intensiva. Método: Estudo epidemiológico, retrospectivo, realizado em Hospital Universitário de Fortaleza, no período entre 2008 a 2011. Os dados foram coletados por formulário, organizados em tabelas e analisados por meio da estatística descritiva. Resultados: Houve média equilibrada em relação ao sexo e média de idade de 58,3 anos. O tempo de internação e diagnóstico da infecção foi de 21,2 e 11,7 dias, respectivamente. O cateter venoso central foi realizado em 89,3% dos pacientes. A topografia mais incidente foi a respiratória em 48,1%, e a Pseudomonas aeruginosa foi o principal patógeno encontrado em 18,3%. Os antimicrobianos mais utilizados foram os glicopeptídeos, representados pela Vancomicina e Teicoplanina. O desfecho clínico mais frequente foi o óbito em 65,4%. Conclusão: As IRAS no ambiente da terapia intensiva acometem um grande percentual de pacientes, sendo necessário a implementação de estratégias que visem reduzir as estatísticas e promover um ambiente hospitalar seguro. ================================================ Objective: to analyze Infections Related to Health Care (IRAS of patients in an Intensive Care Unit. Method: epidemiological retrospective study conducted at the University Hospital of Fortaleza, between 2008 and 2011. Data were collected, organized in tables, and analyzed using descriptive statistics. Results: equal number of female and male patients; average age of 58.3 years; average length of hospitalization and of diagnosis of infection of 21.2 and 11.7 days, respectively; central venous catheter performed in 89.3% of patients; most frequent topography: respiratory in 48.1% of patients; main identified pathogen: pseudomonas aeruginosa in 18.3% of patients; most used antimicrobials: glycopeptides, represented by vancomycin and teicoplanin; and, most frequent clinical

  15. The Use of Modafinil in the Intensive Care Unit.

    Science.gov (United States)

    Gajewski, Michal; Weinhouse, Gerald

    2016-02-01

    As patients recover from their critical illness, the focus of intensive care unit (ICU) care becomes rehabilitation. Fatigue, excessive daytime somnolence (EDS), and depression can delay their recovery and potentially worsen outcomes. Psychostimulants, particularly modafinil (Provigil), have been shown to alleviate some of these symptoms in various patient populations, and as clinical trials are underway exploring this novel use of the drug, we present a case series of 3 patients in our institution's Thoracic Surgery Intensive Care Unit. Our 3 patients were chosen as a result of their fatigue, EDS, and/or depression, which prolonged their ICU stay and precluded them from participating in physical therapy, an integral component of the rehabilitative process. The patients were given 200 mg of modafinil each morning to increase patient wakefulness, encourage their participation, and enable a more restful sleep during the night. Although the drug was undoubtedly not the sole reason why our patients became more active, the temporal relationship between starting the drug and our patients' clinical improvement makes it likely that it contributed. Based on our observations with these patients, the known effects of modafinil, its safety profile, and the published experiences of others, we believe that modafinil has potential benefits when utilized in some critically ill patients and that the consequences of delayed patient recovery and a prolonged ICU stay may outweigh the risks of potential modafinil side effects.

  16. Social determinants and maternal exposure to intimate partner violence of obstetric patients with severe maternal morbidity in the intensive care unit: a systematic review protocol

    Science.gov (United States)

    Ayala Quintanilla, Beatriz Paulina; Taft, Angela; McDonald, Susan; Pollock, Wendy; Roque Henriquez, Joel Christian

    2016-01-01

    Introduction Maternal mortality is a potentially preventable public health issue. Maternal morbidity is increasingly of interest to aid the reduction of maternal mortality. Obstetric patients admitted to the intensive care unit (ICU) are an important part of the global burden of maternal morbidity. Social determinants influence health outcomes of pregnant women. Additionally, intimate partner violence has a great negative impact on women's health and pregnancy outcome. However, little is known about the contextual and social aspects of obstetric patients treated in the ICU. This study aimed to conduct a systematic review of the social determinants and exposure to intimate partner violence of obstetric patients admitted to an ICU. Methods and analysis A systematic search will be conducted in MEDLINE, CINAHL, ProQuest, LILACS and SciELO from 2000 to 2016. Studies published in English and Spanish will be identified in relation to data reporting on social determinants of health and/or exposure to intimate partner violence of obstetric women, treated in the ICU during pregnancy, childbirth or within 42 days of the end of pregnancy. Two reviewers will independently screen for study eligibility and data extraction. Risk of bias and assessment of the quality of the included studies will be performed by using the Critical Appraisal Skills Programme (CASP) checklist. Data will be analysed and summarised using a narrative description of the available evidence across studies. This systematic review protocol will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. Ethics and dissemination Since this systematic review will be based on published studies, ethical approval is not required. Findings will be presented at La Trobe University, in Conferences and Congresses, and published in a peer-reviewed journal. Trial registration number CRD42016037492. PMID:27895065

  17. Sleep in the Intensive Care Unit measured by polysomnography

    DEFF Research Database (Denmark)

    Andersen, J H; Boesen, Hans Christian Toft; Olsen, Karsten Skovgaard

    2013-01-01

    Sleep deprivation has deleterious effects on most organ systems. Patients in the Intensive care unit (ICU) report sleep deprivation as the second worst experience during their stay only superseded by pain. The aim of the review is to provide the clinician with knowledge of the optimal sleep...

  18. [Benefits of aromatherapy in dementia special care units].

    Science.gov (United States)

    Bilien, Corinne; Depas, Nathalie; Delaporte, Ghislaine; Baptiste, Nathalie

    2016-01-01

    Aromatherapy is classed as a non-pharmacological treatment, recognised as a therapy for certain disorders. This practice was the subject of a study in a special care unit for patients with dementia. The objective was to demonstrate the benefit of aromatherapy diffusion on major behavioural disorders.

  19. Human-centered environment design in intensive care unit

    NARCIS (Netherlands)

    Li, Y.; Albayrak, A.; Goossens, R.H.M.; Xiao, D.; Jakimowicz, J.J.

    2013-01-01

    Because of high risk and instability of the patients in Intensive care unit(ICU), the design of ICU is very difficult. ICU design, auxiliary building design, lighting design, noise control and other aspects can also enhance its management. In this paper, we compare ICU design in China and Holland ba

  20. Anaesthesia for procedures in the intensive care unit.

    Science.gov (United States)

    Chollet-Rivier, M; Chioléro, R L

    2001-08-01

    Taking in charge severely ill patients in the intensive care environment to manage complex procedures is a performance requiring highly specific knowledge. Close collaboration between anaesthetists and intensive care specialists is likely to improve the safety and quality of medical care. Three forms of anaesthetic care should be considered in clinical practice: sedation and analgesia; monitored anaesthetic care; and general anaesthesia or conduction block anaesthesia. Even in the field of sedation and analgesia, the anaesthesiologist can offer expertise on new anaesthetic techniques like: the most recent concepts of balanced anaesthesia in terms of pharmacokinetics and dynamics, favouring the use of short-acting agents and of sedative-opioid combinations. New modes of administration and monitoring intravenous anaesthesia have been developed, with potential application in the intensive care unit. These include the use of target-controlled administration of intravenous drugs, and of electroencephalographic signals to monitor the level of sedation.

  1. Analysis on blood stream infections in patients in surgical intensive care unit%SICU 患者血流感染危险因素分析

    Institute of Scientific and Technical Information of China (English)

    李楠; 任军红; 李双玲; 王东信

    2015-01-01

    OBJECTIVE To investigate the risk factors and prognosis of blood stream infections in surgical critically ill patients and simultaneously analyze the sources ,distribution and characteristics of drug resistance of the patho‐gens so as to guide clinical practice in anti‐infection therapy , especially in empirical anti‐infection therapy . METHODS The clinical data of 59 patients confirmed to have infections in surgical intensive care unit between 2007 and 2013 were collected .The risk factors of blood stream infections ,source ,distribution and characteristics of drug resistance of the pathogens ,and prognosis of the patients were analyzeds .The software Windows SPSS17 .0 was used for statistical analysis .RESULTS A total of 96 strains of pathogens were isolated from the 59 patients with blood stream infections .Gram‐positive bacteria ,gram‐negative bacteria and fungi accounted for 30 .20% (29 strains) ,47 .92% (46 strains) ,21 .88% (21 strains) respectively .Multidrug‐resistant bacteria accounted for 45 .83% (44 strains) of all bacteria .Staphylococcus aureus had 100 .00% resistance to linezolid ,K lebsiella pneu‐moniae and Pseudomonas aeruginosa had 100 .00% resistance to ampicillin .CONCLUSION Patients with blood stream infections in surgical intensive care unit had various risk factors with a variety of pathogens from different sources .Their prognosis was very poor .Enhanced monitoring and effective anti‐infection strategy should be a‐dopted .%目的:了解外科重症监护病房(S IC U )患者血流感染的危险因素、病原菌来源及分布、耐药特点、患者预后,为临床抗感染治疗尤其是经验性抗感染治疗提供指导。方法收集2007-2013年SICU确诊为血流感染的59例患者临床资料,对其感染的危险因素、病原菌来源及分布、耐药性及预后进行描述性研究,采用 Window s SPSS17.0进行统计分析。结果59例血流感染患者共检出病原菌96

  2. Management of neutropenic patients in the intensive care unit (NEWBORNS EXCLUDED) recommendations from an expert panel from the French Intensive Care Society (SRLF) with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF).

    Science.gov (United States)

    Schnell, David; Azoulay, Elie; Benoit, Dominique; Clouzeau, Benjamin; Demaret, Pierre; Ducassou, Stéphane; Frange, Pierre; Lafaurie, Matthieu; Legrand, Matthieu; Meert, Anne-Pascale; Mokart, Djamel; Naudin, Jérôme; Pene, Frédéric; Rabbat, Antoine; Raffoux, Emmanuel; Ribaud, Patricia; Richard, Jean-Christophe; Vincent, François; Zahar, Jean-Ralph; Darmon, Michael

    2016-12-01

    Neutropenia is defined by either an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society in collaboration with the French Group for Pediatric Intensive Care Emergencies, the French Society of Anesthesia and Intensive Care, the French Society of Hematology, the French Society for Hospital Hygiene, and the French Infectious Diseases Society. Literature review and formulation of recommendations were performed using the Grading of Recommendations Assessment, Development and Evaluation system. Each recommendation was then evaluated and rated by each expert using a methodology derived from the RAND/UCLA Appropriateness Method. Six fields are covered by the provided recommendations: (1) ICU admission and prognosis, (2) protective isolation and prophylaxis, (3) management of acute respiratory failure, (4) organ failure and organ support, (5) antibiotic management and source control, and (6) hematological management. Most of the provided recommendations are obtained from low levels of evidence, however, suggesting a need for additional studies. Seven recommendations were, however, associated with high level of evidences and are related to protective isolation, diagnostic workup of acute respiratory failure, medical management, and timing surgery in patients with typhlitis.

  3. Persistence of clones of coagulase-negative staphylococci among premature neonates in neonatal intensive care units: two-center study of bacterial genotyping and patient risk factors

    NARCIS (Netherlands)

    C.L. Vermont (Clementien); N.G. Hartwig (Nico); A. Fleer; P. de Man (Peter); R. de Groot (Ronald); A.F. van Belkum (Alex); H.A. Verbrugh (Henri); J.N. van den Anker (John)

    1998-01-01

    textabstractFrom 1 January 1995 until 1 January 1996, we studied the molecular epidemiology of blood isolates of coagulase-negative staphylococci (CoNS) in the Neonatal Intensive Care Units (NICUs) of the Sophia Children's Hospital (SCH; Rotterdam, The Netherlands) and the Wilhelmi

  4. Mutual Agreement Between Providers in Intensive Care Medicine on Patient Care After Interdisciplinary Rounds

    NARCIS (Netherlands)

    Ten Have, Elsbeth Cornelia Maria; Nap, Raoul Ernesto

    2014-01-01

    Purpose: Insights regarding the results of interdisciplinary communication about patient care are limited. We explored the perceptions of intensivists, junior physicians, and nurses about patient care directly after the interdisciplinary rounds (IDRs) in the intensive care unit (ICU) to determine mu

  5. Burnout in the intensive care unit professionals

    Science.gov (United States)

    Guntupalli, Kalpalatha K.; Wachtel, Sherry; Mallampalli, Antara; Surani, Salim

    2014-01-01

    Background: Professional burnout has been widely explored in health care. We conducted this study in our hospital intensive care unit (ICU) in United States to explore the burnout among nurses and respiratory therapists (RT). Materials and Methods: A survey consisting of two parts was used to assess burnout. Part 1 addressed the demographic information and work hours. Part 2 addressed the Maslach Burnout Inventory-Human Service Survey. Results: The analysis included 213 total subjects; Nurses 151 (71%) and RT 62 (29%). On the emotional exhaustion (EE) scale, 54% scored “Moderate” to “High” and 40% scored “Moderate” to “High” on the depersonalization (DP) scale. Notably 40.6% scored “Low” on personal accomplishment (PA) scale. Conclusion: High level of EE, DP and lower PAs were seen among two groups of health care providers in the ICUs. PMID:24701063

  6. Burnout in the intensive care unit professionals

    Directory of Open Access Journals (Sweden)

    Kalpalatha K Guntupalli

    2014-01-01

    Full Text Available Background: Professional burnout has been widely explored in health care. We conducted this study in our hospital intensive care unit (ICU in United States to explore the burnout among nurses and respiratory therapists (RT. Materials and Methods: A survey consisting of two parts was used to assess burnout. Part 1 addressed the demographic information and work hours. Part 2 addressed the Maslach Burnout Inventory-Human Service Survey. Results: The analysis included 213 total subjects; Nurses 151 (71% and RT 62 (29%. On the emotional exhaustion (EE scale, 54% scored "Moderate" to "High" and 40% scored "Moderate" to "High" on the depersonalization (DP scale. Notably 40.6% scored "Low" on personal accomplishment (PA scale. Conclusion: High level of EE, DP and lower PAs were seen among two groups of health care providers in the ICUs.

  7. Emotional consequences of intensive care unit delirium and delusional memories after intensive care unit admission : A systematic review

    NARCIS (Netherlands)

    Nouwen, Marinus J.; Klijn, Francina A. M.; van den Broek, Brigitte T. A.; Slooter, Arjen J. C.

    2012-01-01

    Purpose: The aim of this study was to review literature exploring the emotional consequences of delirium and delusional memories in intensive care unit patients. Methods: A systematic review was performed using PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and PsychINFO.

  8. Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study

    NARCIS (Netherlands)

    Kett, D.H.; Azoulay, E.; Echeverria, P.M.; Vincent, J.L.; Pickkers, P.

    2011-01-01

    OBJECTIVES: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. DESIGN: A retrospective analysis of the Extended Prevalence of Infection in the I

  9. 138例急诊重症监护室中毒患者分析%The analysis of 138 severe poisoning patients in emergency intensive care unit

    Institute of Scientific and Technical Information of China (English)

    徐胜勇; 于学忠; 李毅; 王仲; 郭树彬; 朱华栋

    2012-01-01

    Objective To investigate the epidemiology and features of severe poisoning.Methods A retrospective analysis of patients with severe poisoning admitted into the emergency intensive care unit of Peking Union Medical College Hospital from February 2008 to March 2010 was made.Results A total of 138 patients consisting of 45 males and 93 females were enrolled.The average age was 39.2 years.Committed suicide with toxic agents was the major cause of poisoning (76.8% ),followed by alcoholism (8.7% ) and misuse of medicine (5.8%).Of them,96.4% patients were poisoned by swallowing poison agents,and 45.7% patients were treated with gastric lavage and 15.2% of patients with hemofiltration.Mortality was 3.62%.Conclusions Our study presents the current status of acute severe poisoning in the large general hospital.%目的 分析重症中毒病例的临床特点,为规范救治重症中毒患者提供参考数据.方法 回顾性分析2008年2月至2010年3月期间,北京协和医院急诊重症监护室收治的所有重症中毒患者的临床流行病学特点和救冶情况.结果 共138例患者,其中男性45例,女性93例;平均年龄39.2岁;自杀为第一位中毒原因(占76.8%),其次是饮酒(占8.7%)和乱服药(占5.8%);96.4%的患者为经口摄入毒物;45.7%的患者接受了洗胃治疗;15.2%的患者接受了血液净化治疗;病死率3.62%.结论 这些数据提供了大型综合性医院重症中毒患者的临床信息和当前救治情况.

  10. Sociodemographic and Geographic Predictors of Quality of Care in United States Patients With End-Stage Renal Disease Due to Lupus Nephritis

    Science.gov (United States)

    Plantinga, Laura C.; Drenkard, Cristina; Patzer, Rachel E.; Klein, Mitchel; Kramer, Michael R.; Pastan, Stephen; Lim, S. Sam; McClellan, William M.

    2017-01-01

    Objective To describe end-stage renal disease (ESRD) quality of care (receipt of pre-ESRD nephrology care, access to kidney transplantation, and placement of permanent vascular access for dialysis) in US patients with ESRD due to lupus nephritis (LN-ESRD) and to examine whether quality measures differ by patient sociodemographic characteristics or US region. Methods National surveillance data on patients in the US in whom treatment for LN-ESRD was initiated between July 2005 and September 2011 (n = 6,594) were analyzed. Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (95% CIs) were determined for each quality measure, according to sociodemographic factors and US region. Results Overall, 71% of the patients received nephrology care prior to ESRD. Black and Hispanic patients were less likely than white patients to receive pre-ESRD care (OR 0.73 [95% CI 0.63–0.85] and OR 0.73 [95% CI 0.60–0.88], respectively) and to be placed on the kidney transplant waitlist within the first year after the start of ESRD (HR 0.78 [95% CI 0.68–0.91] and HR 0.82 [95% CI 0.68–0.98], respectively). Those with Medicaid (HR 0.51 [95% CI 0.44–0.58]) or no insurance (HR 0.36 [95% CI 0.29–0.44]) were less likely than those with private insurance to be placed on the waitlist. Only 24% had a permanent vascular access, and placement was even less likely among the uninsured (OR 0.62 [95% CI 0.49–0.79]). ESRD quality-of-care measures varied 2–3-fold across regions of the US, with patients in the Northeast and Northwest generally having higher probabilities of adequate care. Conclusion LN-ESRD patients have suboptimal ESRD care, particularly with regard to placement of dialysis vascular access. Minority race/ethnicity and lack of private insurance are associated with inadequate ESRD care. Further studies are warranted to examine multilevel barriers to, and develop targeted interventions to improve delivery of, care among patients with LN-ESRD. PMID:25692867

  11. Dificuldades vivenciadas pela equipe multiprofissional na unidade de terapia intensiva Dificultades vividas por el grupo de atención al paciente en la unidad de tratamiento intensivo Difficulties experienced by the patient care team at the intensive care unit

    Directory of Open Access Journals (Sweden)

    Maria Abadia Leite

    2005-04-01

    debe promover discusiones y reflexionar sobre los aspectos técnico-científicos y éticos de la atención, tanto a los pacientes en estado crítico como de la familia de los pacientes, ante una mejor calidad de la atención y de las relaciones interpersonales.This interpretative case study aimed to identify the difficulties experienced by the patient care team while working at the Intensive Care Unit. Data were collected through participant observation and semistructured interviews with doctors, nurses and nurse's aides. Two major categories emerged from the data analysis: Care delivery in intensive care - "it is difficult to deal with death and inform the patient's family" and care delivery in intensive care - "the lack of material resources and the difficulty to work in a team". The difficulties are related to the contact with family members, dealing with death and the lack of material resources, and particularly with the relation between team members. Therefore, teams need to promote opportunities and discussions to reflect on the technical, scientific and ethic aspects of care for critical patients as well as family members, with a view to better care quality and interpersonal relations.

  12. The Leapfrog initiative for intensive care unit physician staffing and its impact on intensive care unit performance: a narrative review.

    Science.gov (United States)

    Gasperino, James

    2011-10-01

    The field of critical care has changed markedly in recent years to accommodate a growing population of chronically critically ill patients. New administrative structures have evolved to include divisions, departments, and sections devoted exclusively to the practice of critical care medicine. On an individual level, the ability to manage complex multisystem critical illnesses and to introduce invasive monitoring devices defines the intensivist. On a systems level, critical care services managed by an intensivist-led multidisciplinary team are now recognized by their ability to efficiently utilize hospital resources and improve patient outcomes. Due to the numerous cost and quality issues related to the delivery of critical care medicine, intensive care unit physician staffing (IPS) has become a charged subject in recent years. Although the federal government has played a large role in regulating best practices by physicians, other third parties have entered the arena. Perhaps the most influential of these has been The Leapfrog Group, a consortium representing 130 employers and 65 Fortune 500 companies that purchase health care for their employees. This group has proposed specific regulatory guidelines for IPS that are purported to result in substantial cost containment and improved quality of care. This narrative review examines the impact of The Leapfrog Group's recommendations on critical care delivery in the United States.

  13. Reflecting on healthcare and self-care in the Intensive Care Unit: our story

    Directory of Open Access Journals (Sweden)

    Allan Peterkin

    2014-12-01

    Full Text Available Health care professionals working in Intensive Care Units (ICUs are exposed to high levels of stress-provoking stimuli. Some may unconsciously employ negative coping skill s which may contribute to burnout and negatively affect patient care. We chose to explore ways of facilitating and encouraging self-reflective practice in an effort to increase empathic traits and enhance communication. A narrative medicine series, which included six sessions that were focused on different narrative approaches, was organized for staff of an academic teaching hospital. Totally, 132 interdisciplinary ICU staff attended the sessions. They were generally open to exploring the selected approaches and discussing their reflections within the interdisciplinary environment. The narrative medicine series provided tools for health care professionals to enhance self-reflective skills utilizing a team-based learning approach. The anticipated outcomes were improved self-care, increased empathy and communication skills, enhanced team functioning, which all contribute to better patient care at the bedside.

  14. Perception of nurses regarding risk classification in emergency care units

    Directory of Open Access Journals (Sweden)

    Carmen Lúcia Mottin Duro

    2014-09-01

    Full Text Available This study aimed to assess nurses’ perception regarding the risk classification in emergency care units. It is a descriptive study that used a qualitative approach and that was conducted with 55 nurses from emergency care units in the south of Brazil. Data were collected between July and October, 2011, through open questions, answered in writing. The data collected were submitted to the thematic analysis technique. Results indicate that the risk classification contributes to the organization of the service flow provided to patients, intervening in severe cases and preventing sequelae. Difficulties were described, such as: inadequate physical installations, overcrowding, disagreement in the definition of priorities among doctors and nurses and lack of articulation between the emergency care network and basic health care. It is highlighted the need to improve the physical structure, the quantity of human resources and the implementation of public policies to overcome these challenges.

  15. Procalcitonin use in a pediatric intensive care unit.

    Science.gov (United States)

    Cies, Jeffrey J; Chopra, Arun

    2014-09-01

    We evaluated whether procalcitonin (PCT) might aid diagnosing serious bacterial infections in a general pediatric intensive care unit population. Two-hundred and one patients accounted for 332 PCT samples. A PCT ≥1.45 ng/mL had a positive predictive value of 30%, a negative predictive value of 93% and a sensitivity of 72% and a specificity of 75%. These data suggest PCT can assist in identifying patients without serious bacterial infections and limit antimicrobial use.

  16. Comparative genomics of an IncA/C multidrug resistance plasmid from Escherichia coli and Klebsiella isolates from intensive care unit patients and the utility of whole-genome sequencing in health care settings.

    Science.gov (United States)

    Hazen, Tracy H; Zhao, LiCheng; Boutin, Mallory A; Stancil, Angela; Robinson, Gwen; Harris, Anthony D; Rasko, David A; Johnson, J Kristie

    2014-08-01

    The IncA/C plasmids have been implicated for their role in the dissemination of β-lactamases, including gene variants that confer resistance to expanded-spectrum cephalosporins, which are often the treatment of last resort against multidrug-resistant, hospital-associated pathogens. A bla(FOX-5) gene was detected in 14 Escherichia coli and 16 Klebsiella isolates that were cultured from perianal swabs of patients admitted to an intensive care unit (ICU) of the University of Maryland Medical Center (UMMC) in Baltimore, MD, over a span of 3 years. Four of the FOX-encoding isolates were obtained from subsequent samples of patients that were initially negative for an AmpC β-lactamase upon admission to the ICU, suggesting that the AmpC β-lactamase-encoding plasmid was acquired while the patient was in the ICU. The genomes of five E. coli isolates and six Klebsiella isolates containing bla(FOX-5) were selected for sequencing based on their plasmid profiles. An ∼ 167-kb IncA/C plasmid encoding the FOX-5 β-lactamase, a CARB-2 β-lactamase, additional antimicrobial resistance genes, and heavy metal resistance genes was identified. Another FOX-5-encoding IncA/C plasmid that was nearly identical except for a variable region associated with the resistance genes was also identified. To our knowledge, these plasmids represent the first FOX-5-encoding plasmids sequenced. We used comparative genomics to describe the genetic diversity of a plasmid encoding a FOX-5 β-lactamase relative to the whole-genome diversity of 11 E. coli and Klebsiella isolates that carry this plasmid. Our findings demonstrate the utility of whole-genome sequencing for tracking of plasmid and antibiotic resistance gene distribution in health care settings.

  17. DALI: Defining Antibiotic Levels in Intensive care unit patients: a multi-centre point of prevalence study to determine whether contemporary antibiotic dosing for critically ill patients is therapeutic

    Directory of Open Access Journals (Sweden)

    Roberts Jason A

    2012-07-01

    Full Text Available Abstract Background The clinical effects of varying pharmacokinetic exposures of antibiotics (antibacterials and antifungals on outcome in infected critically ill patients are poorly described. A large-scale multi-centre study (DALI Study is currently underway describing the clinical outcomes of patients achieving pre-defined antibiotic exposures. This report describes the protocol. Methods DALI will recruit over 500 patients administered a wide range of either beta-lactam or glycopeptide antibiotics or triazole or echinocandin antifungals in a pharmacokinetic point-prevalence study. It is anticipated that over 60 European intensive care units (ICUs will participate. The primary aim will be to determine whether contemporary antibiotic dosing for critically ill patients achieves plasma concentrations associated with maximal activity. Secondary aims will compare antibiotic pharmacokinetic exposures with patient outcome and will describe the population pharmacokinetics of the antibiotics included. Various subgroup analyses will be conducted to determine patient groups that may be at risk of very low or very high concentrations of antibiotics. Discussion The DALI study should inform clinicians of the potential clinical advantages of achieving certain antibiotic pharmacokinetic exposures in infected critically ill patients.

  18. Prevention of nosocomial infections in the neonatal intensive care unit.

    Science.gov (United States)

    Adams-Chapman, Ira; Stoll, Barbara J

    2002-04-01

    Nosocomial infections are responsible for significant morbidity and late mortality among neonatal intensive care unit patients. The number of neonatal patients at risk for acquiring nosocomial infections is increasing because of the improved survival of very low birthweight infants and their need for invasive monitoring and supportive care. Effective strategies to prevent nosocomial infection must include continuous monitoring and surveillance of infection rates and distribution of pathogens; strategic nursery design and staffing; emphasis on handwashing compliance; minimizing central venous catheter use and contamination, and prudent use of antimicrobial agents. Educational programs and feedback to nursery personnel improve compliance with infection control programs.

  19. [Multicenter study on the treatment and outcome of patients admitted to intensive care units in Italy. Presentation of the research project and the study protocol. GiViTI (Gruppo Italiano per la Valutazione degli interventi in Terapia Intensiva)].

    Science.gov (United States)

    Apolone, G; Brazzi, L; Pesce, C

    1992-12-01

    Although Intensive Care Units (ICU) are present in most of the Italian Hospitals for acute patients, the heterogeneity of the patients case-mix and the large variation in structural, organizational and staffing arrangements have limited the feasibility and precision of evaluation studies aimed at assessing the quality of health care delivered and its impact on patients outcomes. To our knowledge there has been no nationwide study aimed at assessing the quality and effectiveness of the delivered care in samples of ICUs and patients that are representative of the source populations. To study the effects of variations in health care practices on the outcome of the patients admitted in ICU, we designed a multicentric observational study involving 120 ICUs within the country. The present study is the first part of a project involving a network of Intensive Care Units gathered under the name of GiViTI-Italian Group for the Evaluation of the Interventions in Intensive Care-that is representative of the national Italian reality in the field. The idea of a large collaborative group acting in the field of Intensive Care stands in line with several quality, effectiveness and resource utilization studies that are ongoing in other European countries and is also the result of a series of smaller-scale experiences carried out by other Italian groups eventually emboied in the GiViTI project. In the framework of the ongoing long term, multisite, and multidisciplinary project, the present study calls for the recruitment of all consecutive patients seen at the participant centers during a two months period.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. Impact of enhanced ventilator care bundle checklist on nursing documentation in an intensive care unit.

    Science.gov (United States)

    Malouf-Todaro, Nabia; Barker, James; Jupiter, Daniel; Tipton, Phyllis Hart; Peace, Jane

    2013-01-01

    Ventilator-associated pneumonia is a hospital-acquired infection that may develop in patients 48 hours after mechanical ventilation. The project goal was to determine whether a ventilator-associated pneumonia care bundle checklist embedded into an existing electronic health record would increase completeness of nursing documentation in an intensive care unit setting. With the embedded checklist, there were significant improvements in nursing documentation and a decreased incidence of ventilator-associated pneumonia.

  1. Factors associated with maternal death in an intensive care unit

    Science.gov (United States)

    Saintrain, Suzanne Vieira; de Oliveira, Juliana Gomes Ramalho; Saintrain, Maria Vieira de Lima; Bruno, Zenilda Vieira; Borges, Juliana Lima Nogueira; Daher, Elizabeth De Francesco; da Silva Jr, Geraldo Bezerra

    2016-01-01

    Objective To identify factors associated with maternal death in patients admitted to an intensive care unit. Methods A cross-sectional study was conducted in a maternal intensive care unit. All medical records of patients admitted from January 2012 to December 2014 were reviewed. Pregnant and puerperal women were included; those with diagnoses of hydatidiform mole, ectopic pregnancy, or anembryonic pregnancy were excluded, as were patients admitted for non-obstetrical reasons. Death and hospital discharge were the outcomes subjected to comparative analysis. Results A total of 373 patients aged 13 to 45 years were included. The causes for admission to the intensive care unit were hypertensive disorders of pregnancy, followed by heart disease, respiratory failure, and sepsis; complications included acute kidney injury (24.1%), hypotension (15.5%), bleeding (10.2%), and sepsis (6.7%). A total of 28 patients died (7.5%). Causes of death were hemorrhagic shock, multiple organ failure, respiratory failure, and sepsis. The independent risk factors associated with death were acute kidney injury (odds ratio [OR] = 6.77), hypotension (OR = 15.08), and respiratory failure (OR = 3.65). Conclusion The frequency of deaths was low. Acute kidney injury, hypotension, and respiratory insufficiency were independent risk factors for maternal death. PMID:28099637

  2. National Patient Care Database (NPCD)

    Data.gov (United States)

    Department of Veterans Affairs — The National Patient Care Database (NPCD), located at the Austin Information Technology Center, is part of the National Medical Information Systems (NMIS). The NPCD...

  3. Evaluation of adjusted central venous blood gases versus arterial blood gases of patients in post-operative paediatric cardiac surgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Naveen G Singh

    2015-01-01

    Full Text Available Background and Aims: Central venous catheters are in situ in most of the intensive care unit (ICU patients, which may be an alternative for determining acid-base status and can reduce complications from prolonged arterial cannulation. The aim of this study was to examine the reliability between adjusted central venous blood gas (aVBG and arterial blood gas (ABG samples for pH, partial pressure of carbon-di-oxide (pCO2, bicarbonate (HCO3−, base excess (BE and lactates in paediatric cardiac surgical ICU. Methods: We applied blood gas adjustment rule, that is aVBG pH = venous blood gas (VBG pH +0.05, aVBG CO2 = VBG pCO2 - 5 mm Hg from the prior studies. In this study, we validated this relationship with simultaneous arterial and central venous blood obtained from 30 patients with four blood sample pairs each in paediatric cardiac surgical ICU patients. Results: There was a strong correlation (R i.e., Pearson's correlation between ABG and aVBG for pH = 0.9544, pCO2 = 0.8738, lactate = 0.9741, HCO3− = 0.9650 and BE = 0.9778. Intraclass correlation co-efficients (ICCs for agreement improved after applying the adjustment rule to venous pH (0.7505 to 0.9454 and pCO2 (0.4354 to 0.741. Bland Altman showed bias (and limits of agreement for pH: 0.008 (−0.04 to + 0.057, pCO2: −3.52 (–9.68 to +2.65, lactate: −0.10 (−0.51 to +0.30, HCO3−: −2.3 (–5.11 to +0.50 and BE: −0.80 (−3.09 to +1.49. Conclusion: ABG and aVBG samples showed strong correlation, acceptable mean differences and improved agreement (high ICC after adjusting the VBG. Hence, it can be promising to use trend values of VBG instead of ABG in conjunction with a correction factor under stable haemodynamic conditions.

  4. Recovering activity and illusion: the nephrology day care unit.

    Science.gov (United States)

    Remón Rodríguez, C; Quirós Ganga, P L; González-Outón, J; del Castillo Gámez, R; García Herrera, A L; Sánchez Márquez, M G

    2011-01-01

    Day Care Units are an alternative to hospital care that improves more efficiency. The Nephrology, by its technical characteristics, would be benefit greatly from further development of this care modality. The objectives of this study are to present the process we have developed the Nephrology Day Care Unit in the Puerto Real University Hospital (Cádiz, Spain). For this project we followed the Deming Management Method of Quality improvement, selecting opportunities, analyzing causes, select interventions, implement and monitor results. The intervention plan includes the following points: 1) Define the place of the Day Care Unit in the organization of our Clinical Department of Nephrology, 2) Define the Manual of organization, 3) Define the structural and equipment resources, 4) Define the Catalogue of services and procedures, 5) Standards of Care Processes. Protocols and Clinical Pathways; and 6) Information and Registration System. In the first 8 months we have been performed nearly 2000 procedures, which corresponds to an average of about 10 procedures per day, and essentially related to Hemodialysis in critical or acute patients, the Interventional Nephrology, the Clinical Nephrology and Peritoneal Dialysis. The development of the Nephrology Day Care Units can help to increase our autonomy, our presence in Hospitals, recover the progressive loss of clinical activity (diagnostic and therapeutic skills) in the past to the benefit of other Specialties. It also contributes to: Promote and develop the Diagnostic and Interventional Nephrology; improve the clinical management of patients with Primary Health Level, promote the Health Education and Investigation, collaborate in the Resources Management, and finally, to make more attractive and exciting our Specialty, both for nephrologists to training specialists.

  5. Medical Assistant-based care management for high risk patients in small primary care practices

    DEFF Research Database (Denmark)

    Freund, Tobias; Peters-Klimm, Frank; Boyd, Cynthia M.

    2016-01-01

    Background: Patients with multiple chronic conditions are at high risk of potentially avoidable hospital admissions, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices. Objective.......77) and general health scores (EQ-5D +0.03, CI 0.00 to 0.05) improved significantly at 24 months of intervention. Intervention costs summed up to 10 United States dollars per patient per month. Limitations: Limitations included a small number of primary care practices and a low intensity of intervention......: To determine whether protocol-based care management delivered by medical assistants improves patient care in patients at high risk of future hospitalization in primary care. Design: Two-year cluster randomized clinical trial. Setting: 115 primary care practices in Germany. Patients: 2,076 patients with type 2...

  6. Economic analysis of the cost of Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Mazetas D.

    2014-04-01

    Full Text Available The cost of Intensive Care Units has the greatest impact on overall medical costs and the overall cost for the health of a country and an increasing number of studies from around the world presenting the quantification of these costs. Aim: Review of the Economic Analysis of the Cost of Intensive Care Units. Method: Search was made in the SCOPUS, MEDLINE and CINAHL databases using the key-words “Intensive Care Units (ICU”, “Cost”, “Cost Analysis”, “Health Care Costs”, “Health Resources”, “ICU resources”. The study was based on articles published in English from 2000 to 2011 investigating the Economic Analysis of the Cost of Intensive Care Units. Results: The cost of ICU is a significant percentage of gross domestic product in developed countries. Most cost analysis studies that relate to plans that include the study of staff costs, duration of stay in the ICU, the clinical situations of hospitalized patients, engineering support, medications and diagnostic tests costing scales and in relation to the diagnostic criteria. Conclusions: most studies conclude that the remuneration of staff, particularly nurses, in the ICU is the largest cost of ICU, while for the duration of stay in the ICU results are conflicting. The analysis on the cost-effectiveness of ICU can help to better apply these findings to the therapeutic context of ICU.

  7. INFARTO AGUDO DE MIOCARDIO EN PACIENTES JÓVENES INGRESADOS EN CUIDADOS INTENSIVOS / Acute myocardial infarction in young patients admitted to the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Ricardo Grau Ávalos

    2012-01-01

    factors, the most common topographic locations, treatment used, and to analyze mortality. Method: A descriptive, retrospective and longitudinal study was performe