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Journal of Intensive Care Medicine

Ohoud Almalki, Alexander R Levine, Elizabeth Turner, Kelly Newman, Marc DeMoya, Jarone Lee, Edward A Bittner, Hsin Lin
PURPOSE: The goal of this study was to investigate barriers to timely antibiotic administration in septic surgical intensive care unit (SICU) patients and examine the impact of a multidisciplinary bundle on the time from prescription to antibiotic administration. METHODS: This was a pre- and postintervention study that consisted of 3 phases: (1) preintervention phase, retrospective evaluation of data, (2) intervention implementation, and (3) a postintervention phase...
September 2017: Journal of Intensive Care Medicine
Brian T Wessman, Carrie Sona, Marilyn Schallom
BACKGROUND: Poor communication among health-care providers is cited as the most common cause of sentinel events involving patients. Patient care in the critical care setting is incredibly complex. A consistent care plan is necessary between day/night shift teams and among bedside intensive care unit (ICU) nurses, consultants, and physicians. Our goal was to create a novel, easily accessible communication device to improve ICU patient care. METHODS: This communication improvement project was done at an academic tertiary surgical/trauma/mixed 36-bed ICU with an average of 214 admissions per month...
September 2017: Journal of Intensive Care Medicine
Riad Abou Zahr, Edward Vincent S Faustino, Thomas Carpenter, Paul Kirshbom, E Kevin Hall, John T Fahey, Sarah B Kandil
Deficiency in 25-hydroxyvitamin D (25OHD) is associated with increased morbidity and mortality in the critically ill. Children who underwent surgery for congenital heart disease under cardiopulmonary bypass (CPB) are typically deficient in 25OHD. It is unclear whether this deficiency is due to CPB. We hypothesized that CPB reduces the levels of 25OHD in children with congenital heart disease. We conducted a prospective observational study on children aged 2 months to 17 years who underwent CPB. Serum was collected at 3 time points: immediately before, immediately after surgery, and 24 hours after surgery...
September 2017: Journal of Intensive Care Medicine
Samih Raad, Rachel Elliott, Evan Dickerson, Babar Khan, Khalil Diab
OBJECTIVE: In our academic intensive care unit (ICU), there is excess ordering of routine laboratory tests. This is partially due to a lack of transparency of laboratory-processing costs and to the admission order plans that favor daily laboratory test orders. We hypothesized that a program that involves physician and staff education and alters the current ICU order sets will lead to a sustained decrease in routine laboratory test ordering. DESIGN: Prospective cohort study...
September 2017: Journal of Intensive Care Medicine
Jessica L Elefritz, Karri A Bauer, Christian Jones, Julie E Mangino, Kyle Porter, Claire V Murphy
INTRODUCTION: Emergence of multidrug-resistant (MDR) gram-negative (GN) pathogens and lack of novel antibiotics have increased the use of colistin, despite unknown optimal dosing. This study aimed to evaluate the safety and efficacy of a colistin loading dose, high-dose (LDHD) maintenance regimen in patients with MDR-GN pneumonia. METHODS: A retrospective cohort analysis was performed comparing critically ill patients with MDR-GN pneumonia pre- and postimplementation of a colistin LDHD guideline with a primary outcome of clinical cure...
September 2017: Journal of Intensive Care Medicine
Christine A Motzkus, Roger Luckmann
PURPOSE: Sepsis treatment protocols emphasize source control with empiric antibiotics and fluid resuscitation. Previous reviews have examined the impact of infection site and specific pathogens on mortality from sepsis; however, no recent review has addressed the infection site. This review focuses on the impact of infection site on hospital mortality among patients with sepsis. METHODS: The PubMed database was searched for articles from 2001 to 2014. Studies were eligible if they included (1) one or more statistical models with hospital mortality as the outcome and considered infection site for inclusion in the model and (2) adult patients with sepsis, severe sepsis, or septic shock...
September 2017: Journal of Intensive Care Medicine
Sangeeta Manerikar, Seetharaman Hariharan
OBJECTIVES: The prognosticating ability of one-time recorded Acute Physiology and Chronic Health Evaluation (APACHE) IV score was compared with serially recorded Mortality Prediction Model (MPM) II scores. DESIGN AND METHODS: A prospective observational study was conducted for a period of 6 months. Acute Physiology and Chronic Health Evaluation IV score was recorded during the first day on intensive care unit (ICU) admission. Mortality Prediction Model II was recorded on admission, 24, 48, and 72 hours...
September 2017: Journal of Intensive Care Medicine
Brittany Shutes, W Joshua Frazier, Joseph D Tobias
In severe cases of status asthmaticus, when conventional therapies fail, volatile anesthetic agents remain a therapeutic option. When delivered outside of the operating room setting, specialized delivery techniques are needed to ensure the safe and effective use of volatile anesthetic agents. We present a 16-year-old adolescent with status asthmaticus who required the therapeutic administration of the volatile anesthetic agent, sevoflurane, in the pediatric intensive care unit (PICU). Although initially effective in reducing bronchospasm, progressive hypercarbia developed due to defective functioning of the carbon dioxide absorber of the anesthesia machine...
July 2017: Journal of Intensive Care Medicine
Seok In Lee, So Young Lee, Chang Hyu Choi, Kook Yang Park, Chul-Hyun Park
Acute myocardial infarction (AMI) can progress to cardiogenic shock and mechanical complications. When extracorporeal membrane oxygenation (ECMO) is applied to a patient with AMI with cardiogenic shock and mechanical complications, left ventricular (LV) decompression is an important recovery factor because LV dilation increases myocardial wall stress and oxygen consumption. The authors present the case of a 72-year-old man with AMI and LV dilation who developed cardiogenic shock and papillary muscle rupture and who was treated successfully by ECMO with a left atrial venting...
July 2017: Journal of Intensive Care Medicine
Justin K Lui, Gisela I Banauch
Bedside goal-directed ultrasound is a powerful tool for rapid differential diagnosis and monitoring of cardiopulmonary disease in the critically ill patient population. The bedside intensivist is in a unique position to integrate ultrasound findings with the overall clinical situation. Medically critically ill patients who require urgent bedside diagnostic assessment fall into 2 categories: (1) acute respiratory failure and (2) hemodynamic derangements. The first portion of this review outlines the diagnostic role of bedside ultrasound in the medically critically ill patient population for the diagnosis and treatment of acute respiratory failure, acute respiratory distress, and severe hypoxemia...
July 2017: Journal of Intensive Care Medicine
Asad E Patanwala, Jennifer R Martin, Brian L Erstad
OBJECTIVE: To evaluate the evidence for the use of intravenous ketamine for analgosedation in the intensive care unit. METHODS: MEDLINE and EMBASE were queried from inception until July 2015. Search terms used included ketamine, intensive care, and critical care. The search retrieved 584 articles to be screened for inclusion. The intent was to include randomized controlled studies using sustained intravenous infusions (>24 hours) of ketamine in the critically ill patients...
July 2017: Journal of Intensive Care Medicine
Ryan W R Guilbault, Marcus Andreas Ohlsson, Anna M Afonso, Mark H Ebell
OBJECTIVE: To prospectively validate a previously developed classification and regression tree (CART) model that predicts the likelihood of a good outcome among patients undergoing inpatient cardiopulmonary resuscitation. DESIGN: Prospective validation of a clinical decision rule. SETTING: Skåne University Hospital in Malmo, Sweden. PATIENTS: All adult patients (N = 287) experiencing in-hospital cardiopulmonary arrest and undergoing cardiopulmonary resuscitation between 2007 and 2010...
June 2017: Journal of Intensive Care Medicine
Filippo Sanfilippo, Sven Asmussen, Dirk M Maybauer, Cristina Santonocito, John F Fraser, Gabor Erdoes, Marc O Maybauer
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) offers therapeutic options in refractory respiratory and/or cardiac failure. Systemic anticoagulation with heparin is routinely administered. However, in patients with heparin-induced thrombocytopenia or heparin resistance, the direct thrombin inhibitor bivalirudin is a valid option and has been increasingly used for ECMO anticoagulation. We aimed at evaluating its safety and its optimal dosing for ECMO. METHODS: Systematic web-based literature search of PubMed and EMBASE performed via National Health Service Library Evidence and manually, updated until January 30, 2016...
June 2017: Journal of Intensive Care Medicine
Joshua D Lenchus, Michelle Biehl, Jorge Cabrera, Alice Gallo de Moraes, Cameron Dezfulian
Venous thromboembolism (VTE), encompassing pulmonary embolism (PE) and deep venous thrombosis (DVT), is a major cause of morbidity and mortality of particular relevance for intensivists and hospitalists. Acute VTE is usually managed with parenteral unfractionated heparin or low-molecular-weight heparin, followed by an oral vitamin K antagonist. Data are lacking for optimal treatment of less common occurrences, such as upper extremity DVT, and for approaches such as thrombolysis for PE associated with early signs of hemodynamic compromise or inferior vena cava filters when anticoagulation is contraindicated...
June 2017: Journal of Intensive Care Medicine
Mabrouk Bahloul, Najeh Baccouch, Kamilia Chtara, Mouna Turki, Olfa Turki, Chokri Ben Hamida, Hedi Chelly, Fatma Ayedi, Anis Chaari, Mounir Bouaziz
BACKGROUND: We aimed to investigate whether serum cholinesterase (SChE) activity can be helpful for the diagnosis of septic shock and to evaluate its usefulness in comparison with procalcitonin (PCT) and C-reactive protein (CRP). METHODS: A prospective single-blinded study conducted in an intensive care unit of university hospital. Patients were classified as having cardiogenic shock, septic shock, or hemorrhagic shock. We also included a control group without neither hemodynamic instability nor sepsis...
June 2017: Journal of Intensive Care Medicine
Nidhi Maley, Achamyeleh Gebremariam, Folafoluwa Odetola, Kanakadurga Singer
BACKGROUND: Sepsis induces inflammation in response to infection and is a major cause of mortality and hospitalization in children. Obesity induces chronic inflammation leading to many clinical manifestations. Our understanding of the impact of obesity on diseases, such as infection and sepsis, is limited. The objective of this study was to evaluate the association of obesity with organ dysfunction, mortality, duration, and charges during among US children hospitalized with infection...
June 2017: Journal of Intensive Care Medicine
Roberto Santa Cruz, Lic Veronica Alvarez, Roberto Heredia, Fernando Villarejo
BACKGROUND: Mortality in acute lung injury (ALI) remains high, with outcome data arising mostly from multicenter studies. We undertook this investigation to determine hospital mortality in patients with ALI in a single center. METHODS: We studied patients admitted between 2005 and 2012 with ALI and acute respiratory distress syndrome (ARDS) according to the American European Consensus Conference (AECC) criteria and recorded clinical variables. Thereafter, patients were classified as subgroups according to the AECC and Berlin definition in order to compare the clinical characteristics and outcomes...
June 2017: Journal of Intensive Care Medicine
Mohammed A Al-Biltagi, Ahmed Ahmed Abd ElBasset Abo-Elezz, Khaled Talaat Abu-Ela, Ghada Abudelmomen Suliman, Tamer Gomaa Hassan Sultan
OBJECTIVE: The objective of this study was to evaluate the prognostic significance of soluble intercellular adhesion molecule 1 (sICAM-1) measurement in plasma for the prediction of outcome of acute lung injury (ALI) in children that may allow early recognition of critical cases. METHODS: The study was performed as a prospective, controlled cohort study involving 40 children with ALI and 30 healthy children. The plasma level of sICAM-1 was measured at days 1 and 3 of development of ALI for the patient group and measured only once for the control group...
June 2017: Journal of Intensive Care Medicine
Daniel Jimenez, James Antaki, Nader Kamangar
BACKGROUND: Spontaneous pneumothorax (SP) is uncommon and can present as a primary disease process or as a result of underlying lung pathology. Several parenchymal lung diseases, such as malignancy, are known to cause SP. One such malignancy, angiosarcoma, has a high propensity to metastasize to the lung and present as cavitary and cystic lesions. CASE: We present a case of a 76-year-old male diagnosed with angiosarcoma of the scalp that was found to have extensive cystic pulmonary metastatic lesions...
May 2017: Journal of Intensive Care Medicine
Jonathan Baird-Gunning, Tom Lea-Henry, Lotte C G Hoegberg, Sophie Gosselin, Darren M Roberts
Lithium is a commonly prescribed treatment for bipolar affective disorder. However, treatment is complicated by lithium's narrow therapeutic index and the influence of kidney function, both of which increase the risk of toxicity. Therefore, careful attention to dosing, monitoring, and titration is required. The cause of lithium poisoning influences treatment and 3 patterns are described: acute, acute-on-chronic, and chronic. Chronic poisoning is the most common etiology, is usually unintentional, and results from lithium intake exceeding elimination...
May 2017: Journal of Intensive Care Medicine
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