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Journal of Intensive Care Medicine

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https://www.readbyqxmd.com/read/27568477/futility-disputes-a-review-of-the-literature-and-proposed-model-for-dispute-navigation-through-trust-building
#1
Brian D Leland, Alexia M Torke, Lucia D Wocial, Paul R Helft
Futility disputes in the intensive care unit setting have received significant attention in the literature over the past several years. Although the idea of improving communication in an attempt to resolve these challenging situations has been regularly discussed, the concept and role of trust building as the means by which communication improves and disputes are best navigated is largely absent. We take this opportunity to review the current literature on futility disputes and argue the important role of broken trust in these encounters, highlighting current evidence establishing the necessity and utility of trust in both medical decision-making and effective communication...
October 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27440134/thiamine-levels-during-intensive-insulin-therapy-in-critically-ill-patients
#2
Wouter van Snippenburg, Mariet G J Reijnders, Jose G M Hofhuis, Rien de Vos, Stephan Kamphuis, Peter E Spronk
INTRODUCTION: Thiamine is an essential cofactor in carbohydrate metabolism, and deficiency can therefore cause various organ dysfunctions. Little is known about the prevalence and possible worsening of thiamine deficiency in critically ill patients. In this study, we investigated the prevalence of thiamine deficiency at admission to the intensive care unit (ICU) and hypothesized that intensive insulin therapy, aimed at regulating glucose levels, increases thiamine utilization and therefore might cause or worsen deficiency in patients with limited thiamine stores...
October 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27435907/thiocyanate-accumulation-in-critically-ill-patients-receiving-nitroprusside-infusions
#3
Amanda A Morris, Robert L Page, Laura J Baumgartner, Scott W Mueller, Robert MacLaren, Douglas N Fish, Tyree H Kiser
PURPOSE: This study evaluated thiocyanate concentrations and factors associated with thiocyanate accumulation in intensive care unit patients receiving nitroprusside with and without sodium thiosulfate coadministration. MATERIALS AND METHODS: This retrospective study evaluated critically ill adults who received nitroprusside infusions and had at least one thiocyanate concentration. Patients with thiocyanate accumulation (concentrations ≥30 µg/mL) were compared to patients without accumulation...
October 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27402394/the-association-of-age-with-short-term-and-long-term-mortality-in-adults-admitted-to-the-intensive-care-unit
#4
Raghu R Seethala, Kevin Blackney, Peter Hou, Haytham M A Kaafarani, Daniel Dante Yeh, Imoigele Aisiku, Christopher Tainter, Marc deMoya, David King, Jarone Lee
BACKGROUND: Based on the current literature, it is unclear whether advanced age itself leads to higher mortality in critically ill patients or whether it is due to the greater number of comorbidities in the elderly patients. We hypothesized that increasing age would increase the odds of short-term and long-term mortality after adjusting for baseline comorbidities in intensive care unit (ICU) patients. METHODS: We performed a retrospective cohort study of 57 160 adults admitted to any ICU over 5 years at 2 academic tertiary care centers...
October 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27377392/tolerability-of-enteral-nutrition-in-mechanically-ventilated-patients-with-septic-shock-who-require-vasopressors
#5
Cristian Merchan, Diana Altshuler, Caitlin Aberle, John Papadopoulos, David Schwartz
PURPOSE: Enteral nutrition (EN) is often held in patients receiving vasopressor support for septic shock. The rationale for this practice is to avoid mesenteric ischemia. The objective of this study is to evaluate the tolerability of EN in patients with septic shock who require vasopressor support and determine factors associated with tolerance of EN. MATERIALS AND METHODS: This was a single-center retrospective review of adult patients admitted to the intensive care unit with a diagnosis of septic shock and an order for EN...
October 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/26902255/multidrug-resistance-acinetobacter-bacteremia-secondary-to-ventilator-associated-pneumonia-risk-factors-and-outcome
#6
Evgeni Brotfain, Abraham Borer, Leonid Koyfman, Lisa Saidel-Odes, Amit Frenkel, Shaun E Gruenbaum, Vsevolod Rosenzweig, Alexander Zlotnik, Moti Klein
PURPOSE: Acinetobacter baumannii is a multidrug resistant (MDR), gram-negative bacterium commonly implicated in ventilator-associated pneumonia (VAP) in critically ill patients. Patients in the intensive care unit (ICU) with VAP often subsequently develop A baumannii bacteremia, which may significantly worsen outcomes. MATERIALS AND METHODS: In this study, we retrospectively reviewed the clinical and laboratory records of 129 ICU patients spanning 6 years with MDR A baumannii VAP; 46 (35%) of these patients had concomitant MDR A baumannii bacteremia...
October 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/26893318/trends-in-extracorporeal-membrane-oxygenation-for-the-treatment-of-acute-respiratory-distress-syndrome-in-the-united-states
#7
Barret Rush, Katie Wiskar, Landon Berger, Donald Griesdale
OBJECTIVES: Our aim was to describe patient characteristics and trends in the use of extracorporeal membrane oxygenation (ECMO) for the treatment of acute respiratory distress syndrome (ARDS) in the United States from 2006 to 2011. METHODS: We used the Nationwide Inpatient Sample to isolate all patients aged 18 years who had a discharge International Classification of Diseases, Ninth Revision diagnosis of ARDS, with and without procedure codes for ECMO, between 2006 and 2011...
October 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27352613/impact-of-a-multidisciplinary-bundle-on-time-to-antibiotic-administration-in-septic-sicu-patients
#8
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
https://www.readbyqxmd.com/read/27271750/a-novel-icu-hand-over-tool-the-glass-door-of-the-patient-room
#9
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
https://www.readbyqxmd.com/read/27251108/vitamin-d-status-after-cardiopulmonary-bypass-in-children-with-congenital-heart-disease
#10
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
https://www.readbyqxmd.com/read/27251106/reduction-of-laboratory-utilization-in-the-intensive-care-unit
#11
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
https://www.readbyqxmd.com/read/27139010/efficacy-and-safety-of-a-colistin-loading-dose-high-dose-maintenance-regimen-in-critically-ill-patients-with-multidrug-resistant-gram-negative-pneumonia
#12
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
https://www.readbyqxmd.com/read/26880006/does-infection-site-matter-a-systematic-review-of-infection-site-mortality-in-sepsis
#13
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
https://www.readbyqxmd.com/read/26768423/do-serially-recorded-prognostic-scores-predict-outcome-better-than-one-time-recorded-score-on-admission-a-prospective-study-in-adult-intensive-care-patients
#14
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
https://www.readbyqxmd.com/read/27530511/noninvasive-ventilation-in-the-critically-ill-patient-with-obesity-hypoventilation-syndrome-a-review
#15
Telma C A Sequeira, Ahmed S BaHammam, Antonio M Esquinas
Obesity is a global epidemic that adversely affects respiratory physiology. Sleep-disordered breathing and obesity hypoventilation syndrome (OHS) are among the most common pulmonary complications related to obesity class III. Patients with OHS may present with acute hypercapnic respiratory failure (AHRF) that necessitates immediate noninvasive ventilation (NIV) or invasive ventilation and intensive care unit (ICU) monitoring. The OHS is underrecognized as a cause of AHRF. The management of mechanical ventilation in obese ICU patients is one of the most challenging problems facing respirologists, intensivists, and anesthesiologists...
August 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27509917/extracorporeal-support-for-chronic-obstructive-pulmonary-disease-a-bright-future
#16
John M Trahanas, William R Lynch, Robert H Bartlett
In the past the only option for the treatment of respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease (aeCOPD) was invasive mechanical ventilation. In recent decades, the potential for extracorporeal carbon dioxide (CO2) removal has been realized. We review the various types of extracorporeal CO2 removal, outline the optimal use of these therapies for aeCOPD, and make suggestions for future controlled trials. We also describe the advantages and requirements for an ideal long-term ambulatory CO2 removal system for palliation of COPD...
August 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27189952/comparative-effectiveness-of-second-vasoactive-agents-in-septic-shock-refractory-to-norepinephrine
#17
H Bryant Nguyen, Samantha Lu, Isabella Possagnoli, Phillip Stokes
OBJECTIVE: We aim to identify the appropriate vasoactive agent in patients with septic shock who are refractory to optimal doses of norepinephrine. METHODS: In this retrospective observational cohort study over a 4-year period, patients who received norepinephrine within 24 hours of ICU admission and a second agent within 48 hours were enrolled. RESULTS: Among 2640 patients screened, 234 patients were enrolled, aged 60.8 ± 17.8 years, Acute Physiology and Chronic Health Evaluation IV 98...
August 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/26721638/analysis-of-unplanned-postoperative-admissions-to-the-intensive-care-unit
#18
Timothy D Quinn, Rodney A Gabriel, Richard P Dutton, Richard D Urman
PURPOSE: To investigate factors associated with unplanned postoperative admissions to the intensive care unit (ICU). METHODS: Data from the National Anesthesia Clinical Outcomes Registry (NACOR) were analyzed. We performed univariate and multivariate logistic regression to identify patient- and surgery-specific characteristics associated with unplanned postoperative ICU admission. We also recorded the prevalence of Current Procedural Terminology (CPT) and International Classification of Diseases, ninth revision ( ICD-9) billing codes and outcomes for unplanned postoperative ICU admissions...
August 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28612677/an-unusual-complication-with-the-administration-of-a-volatile-anesthetic-agent-for-status-asthmaticus-in-the-pediatric-intensive-care-unit-case-report-and-review-of-the-literature
#19
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
https://www.readbyqxmd.com/read/28359216/revisiting-ultrasound-guided-subclavian-axillary-vein-cannulations-importance-of-pleural-avoidance-with-rib-trajectory
#20
Mourad H Senussi, Phani C Kantamneni, Ali Omranian, Mani Latifi, Tarik Hanane, Eduardo Mireles-Cabodevila, Neal F Chaisson, Abhijit Duggal, Ajit Moghekar
The Centers for Disease Control and Prevention guidelines for the prevention of catheter-related bloodstream infections suggest using "a subclavian site, rather than an internal jugular or a femoral site, in adult patients." This recommendation is based on evidence of lower rates of thrombosis and catheter-related bloodstream infections in patients with subclavian central venous catheters (CVCs) compared to femoral or internal jugular sites. However, preference toward a subclavian approach to CVC insertion is hindered by increased risk of mechanical complications, especially pneumothorax, when compared to other sites...
July 2017: Journal of Intensive Care Medicine
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