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Intubation critical care

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https://www.readbyqxmd.com/read/29329162/reorganizing-care-with-the-implementation-of-electronic-medical-records-a-time-motion-study-in-the-picu
#1
Nadia Roumeliotis, Geneviève Parisien, Sylvie Charette, Elizabeth Arpin, Fabrice Brunet, Philippe Jouvet
OBJECTIVES: To assess caregivers' patient care time before and after the implementation of a reorganization of care plan with electronic medical records. DESIGN: A prospective, observational, time-motion study. SETTING: A level 3 PICU. PARTICIPANTS: Nurses and orderlies caring for intubated patients during an 8-hour work shift before (2008-2009) and after (2016) implementation of reorganization of care in 2013. INTERVENTIONS: The reorganization plan included improved telecommunication for healthcare workers, increased tasks delegated to orderlies, and an ICU-specific electronic medical record (Intellispace Critical Care and Anesthesia information system, Philips Healthcare)...
January 11, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29325842/use-of-dexmedetomidine-in-cardiothoracic-and-vascular-anesthesia
#2
REVIEW
Lucía Gallego-Ligorit, Marc Vives, Jorge Vallés-Torres, T Alberto Sanjuán-Villarreal, Azucena Pajares, Mario Iglesias
Dexmedetomidine is a highly selective α2-adrenergic agonist with analgesic and sedative properties. In the United States, the Food and Drug Administration approved the use of the drug for short-lasting sedation (24 h) in intensive care units (ICUs) in patients undergoing mechanical ventilation and endotracheal intubation. In October 2008, the Food and Drug Administration extended use of the drug for the sedation of nonintubated patients before and during surgical and nonsurgical procedures. In the European Union, the European Medicine Agency approved the use of dexmedetomidine in September 2011 with a single recognized indication: ICU adult patients requiring mild sedation and awakening in response to verbal stimulus...
December 2, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29322820/reevaluation-of-the-critically-ill-patients-with-nonconvulsive-status-epilepticus-by-using-salzburg-consensus-criteria
#3
Ozlem Gungor Tuncer, Ebru Altindag, Sevda Ozel Yildiz, Mecbure Nalbantoglu, Mehmet Eren Acik, Sedef Tavukcu Ozkan, Betul Baykan
OBJECTIVE: We aimed to assess the usefulness of the Salzburg Consensus Criteria (SCC) for determining the prognosis of critically ill patients with nonconvulsive status epilepticus (NCSE). METHODS: We retrospectively reviewed consecutive patients with unconsciousness followed up in the intensive care unit (ICU). Three clinical neurophysiologists, one of them blinded to clinical and laboratory data, reevaluated all EEG data independently and determined NCSE according to SCC...
January 1, 2018: Clinical EEG and Neuroscience: Official Journal of the EEG and Clinical Neuroscience Society (ENCS)
https://www.readbyqxmd.com/read/29313312/influence-of-single-dose-antibiotic-prophylaxis-for-early-onset-pneumonia-in-high-risk-intubated-patients
#4
Timothy D Lewis, Kelly A Dehne, Kathryn Morbitzer, Denise H Rhoney, Casey Olm-Shipman, J Dedrick Jordan
BACKGROUND: Early-onset pneumonia (EOP) after endotracheal intubation is common among critically ill patients with a neurologic injury and is associated with worse clinical outcomes. METHODS: This retrospective cohort study observed outcomes pre- and post-implementation of an EOP prophylaxis protocol which involved the administration of a single dose of ceftriaxone 2 g around the time of intubation. The study included patients ≥ 18 years who were admitted to the University of North Carolina Medical Center (UNCMC) neuroscience intensive care unit (NSICU) between April 1, 2014, and October 26, 2016, and intubated for ≥ 72 h...
January 8, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29305711/early-management-of-retained-hemothorax-in-blunt-head-and-chest-trauma
#5
Fong-Dee Huang, Wen-Bin Yeh, Sheng-Shih Chen, Yuan-Yuarn Liu, I-Yin Lu, Yi-Pin Chou, Tzu-Chin Wu
BACKGROUND: Major blunt chest injury usually leads to the development of retained hemothorax and pneumothorax, and needs further intervention. However, since blunt chest injury may be combined with blunt head injury that typically requires patient observation for 3-4 days, other critical surgical interventions may be delayed. The purpose of this study is to analyze the outcomes of head injury patients who received early, versus delayed thoracic surgeries. MATERIALS AND METHODS: From May 2005 to February 2012, 61 patients with major blunt injuries to the chest and head were prospectively enrolled...
January 5, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29298792/lemierre-s-syndrome-a-pain-in-the-neck-with-far-reaching-consequences
#6
Thomas James Stubington, Paul James
Lemierre's syndrome is a potentially life-threatening consequence of oropharyngeal and ear infections and often results in critical care admission and even intubation. Due to the multisystem manifestation, multiple teams may initially be involved in the care, some of which may be unfamiliar with the features and usual clinical course. This report describes a case in a 36-year-old woman with the classic features of internal jugular vein thrombosis and septic emboli to the lungs secondary to an oropharyngeal infection...
January 3, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29289914/incidence-outcomes-and-outcome-prediction-of-unplanned-extubation-in-critically-ill-children-an-11year-experience
#7
R Al-Abdwani, C B Williams, C Dunn, J Macartney, K Wollny, H Frndova, N Chin, D Stephens, C S Parshuram
PURPOSE: Unplanned extubation represents loss of control in the ICU, is associated with harm and is used as a measure of quality of care. We evaluated the rates and consequences of unplanned extubation. MATERIALS AND METHODS: Eligible patients were intubated, <18years, and in ICU. Patient, care-related and environmental characteristics were compared in patients who did and did not receive positive pressure ventilation in the 24h after events. Rates are expressed per 100 intubation-days...
December 24, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29287880/revisits-after-pediatric-tracheotomy-airway-concerns-result-in-returns
#8
Sophie Shay, Nina L Shapiro, Neil Bhattacharyya
OBJECTIVES: Children undergoing tracheotomy represent a medically vulnerable patient population, and understanding the reasons for revisiting the hospital setting following tracheotomy is critical for improving the quality of care for these patients. This study aims to investigate the incidence and characteristics of revisits following pediatric tracheotomy. METHODS: Cross-sectional, population-based study using state databases. The State Inpatient Databases and State Emergency Department Databases for California, Florida, Iowa and New York 2010-11 were linked and examined for cases of pediatric tracheotomy (patients < 18...
January 2018: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/29262440/who-is-safe-to-extubate-in-the-neuroscience-intensive-care-unit
#9
Julian Bösel
Patients admitted to the neuroscience intensive care unit (NICU) may have respiratory compromise from either central or peripheral neurological pathology, and may hence require intubation and mechanical ventilation for very diverse reasons. Liberation from invasive ventilation, that is, extubation, at the earliest possible time is a widely accepted principle in intensive care. For this, classic extubation criteria have been established in the general critical care setting, mainly targeting pulmonary function and cooperativeness of the patient...
December 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29233755/postoperative-fasting-after-general-anaesthesia-a-survey-of-french-anaesthesiology-practices
#10
Sylvain Le Pape, Matthieu Boisson, Thibault Loupec, FabienVigneau, Bertrand Debaene, Denis Frasca
BACKGROUND: Preoperative fasting is well-codified worldwide. In contrast, the literature on the postoperative fasting (POF) is scarce leading to potentially wide discrepancies among anaesthesiology practices. This survey assessed French POF practices. METHODS: From March 2013 to January 2014, a survey was conducted among anaesthesiologists, members of the French Society of Anaesthesiology and Critical Care. The POF durations of either fluid or solid food intake was assessed according to airway management procedures (endotracheal intubation [EI] or laryngeal mask [LMA]) and age of the patients (adult or paediatric)...
December 9, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29210925/frequency-of-desaturation-and-association-with-hemodynamic-adverse-events-during-tracheal-intubations-in-picus
#11
Simon Li, Ting-Chang Hsieh, Kyle J Rehder, Sholeen Nett, Pradip Kamat, Natalie Napolitano, David A Turner, Michelle Adu-Darko, J Dean Jarvis, Conrad Krawiec, Ashley T Derbyshire, Keith Meyer, John S Giuliano, Joana Tala, Keiko Tarquinio, Michael D Ruppe, Ronald C Sanders, Matthew Pinto, Joy D Howell, Margaret M Parker, Gabrielle Nuthall, Michael Shepherd, Guillaume Emeriaud, Yuki Nagai, Osamu Saito, Jan Hau Lee, Dennis W Simon, Alberto Orioles, Karen Walson, Paula Vanderford, Asha Shenoi, Anthony Lee, Geoffrey L Bird, Michael Miksa, Ana Lia Graciano, Jesse Bain, Peter W Skippen, Lee A Polikoff, Vinay Nadkarni, Akira Nishisaki
OBJECTIVES: Oxygen desaturation during tracheal intubation is known to be associated with adverse ICU outcomes in critically ill children. We aimed to determine the occurrence and severity of desaturation during tracheal intubations and the association with adverse hemodynamic tracheal intubation-associated events. DESIGN: Retrospective cohort study as a part of the National Emergency Airway Registry for Children Network's quality improvement project from January 2012 to December 2014...
November 28, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29210033/strategies-for-the-prevention-of-airway-complications-a-narrative-review
#12
REVIEW
T M Cook
Despite being infrequent, complications of airway management remain an important contributor to morbidity and mortality during anaesthesia and care of the critically ill. Developments in the last three decades have made anaesthesia safer, and this has been mirrored in the equipment and techniques available for airway management. Modern technology including novel oxygenation modalities, widespread availability of capnography, second-generation supraglottic airway devices and videolaryngoscopy provide the tools to make airway management safer still...
January 2018: Anaesthesia
https://www.readbyqxmd.com/read/29209509/realtime-ultrasound-guided-percutaneous-tracheostomy-in-emergency-setting-the-glass-ceiling-has-been-broken
#13
Parli Raghavan Ravi, M N Vijai, Sachin Shouche
Background: In recent years ultrasound guided percutaneous tracheostomy (USPCT) has become a routine practice in critical care units. Its safety and superiority over conventional percutaneous tracheostomy and bronchoscopic guided PCT is proven to be non-inferior in elective cases. However its role in emergency percutaneous tracheostomy has never been studied, since percutaneous tracheostomy itself remains an enigma in accessing emergency airway. There is no report of use of ultrasound guided percutaneous tracheostomy in emergency setting so far in the literature...
2017: Disaster and Military Medicine
https://www.readbyqxmd.com/read/29202739/the-lung-microbiome-in-patients-with-pneumocystosis
#14
J Kehrmann, B Veckollari, D Schmidt, O Schildgen, V Schildgen, N Wagner, M Zeschnigk, L Klein-Hitpass, O Witzke, J Buer, J Steinmann
BACKROUND: Pneumocystis jirovecii pneumonia (PCP) is an opportunistic fungal infection that is associated with a high morbidity and mortality in immunocompromised individuals. In this study, we analysed the microbiome of the lower respiratory tract from critically ill intensive care unit patients with and without pneumocystosis. METHODS: Broncho-alveolar fluids from 65 intubated and mechanically ventilated intensive care unit patients (34 PCP+ and 31 PCP- patients) were collected...
December 4, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/29202258/the-spice-iii-study-protocol-and-analysis-plan-a-randomised-trial-of-early-goaldirected-sedation-compared-with-standard-care-in-mechanically-ventilated-patients
#15
RANDOMIZED CONTROLLED TRIAL
Yahya Shehabi, Andrew B Forbes, Yaseen Arabi, Frances Bass, Rinaldo Bellomo, Suhaini Kadiman, Belinda D Howe, Colin McArthur, Michael C Reade, Ian Seppelt, Jukka Takala, Steve Webb, Matthew P Wise
BACKGROUND: Sedation strategy in critically ill patients who are mechanically ventilated is influenced by patient-related factors, choice of sedative agent and the intensity or depth of sedation prescribed. The impact of sedation strategy on outcome, in particular when delivered early after initiation of mechanical ventilation, is uncertain. OBJECTIVES: To present the protocol and analysis plan of a large randomised clinical trial investigating the effect of a sedation strategy, in critically ill patients who are mechanically ventilated, based on a protocol targeting light sedation using dexmedetomidine as the primary sedative, termed "early goal-directed sedation", compared with usual practice...
December 2017: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/29199145/acetaminophen-induced-acute-liver-failure-is-more-common-and-more-severe-in-women
#16
Jessica B Rubin, Bilal Hameed, Michelle Gottfried, William M Lee, Monika Sarkar
BACKGROUND & AIMS: Acetaminophen overdose is the leading cause of acute liver injury (ALI) and acute liver failure (ALF) in the developed world. Sex differences in acetaminophen-induced hepatotoxicity have not been described. METHODS: We collected data from the Acute Liver Failure Study Group cohort, a national registry of 32 academic medical centers in North America of adults with ALI or ALF, including 1162 patients with acetaminophen-induced ALI (n=250) or acetaminophen-induced ALF (n=912) from January 2000 through September 2016...
November 30, 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/29194282/frequency-and-characterization-of-tracheal-intubation-adverse-events-in-pediatric-sepsis
#17
Sarah K Schmidt, Lina Brou, Sara J Deakyne, Rakesh D Mistry, Halden F Scott
OBJECTIVES: Intubation in critically ill pediatric patients is associated with approximately 20% rate of adverse events, but rates in the high-risk condition of sepsis are unknown. Our objectives were to describe the frequency and characteristics of tracheal intubation adverse events in pediatric sepsis. DESIGN: Retrospective cohort study of a sepsis registry. SETTING: Two tertiary care academic emergency departments and four affiliated urgent cares within a single children's hospital health system...
November 30, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29178953/video-laryngoscopy-does-not-improve-the-intubation-outcomes-in-emergency-and-critical-patients-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#18
Jia Jiang, Danxu Ma, Bo Li, Yun Yue, Fushan Xue
BACKGROUND: There is significant controversy regarding the influence of video laryngoscopy on the intubation outcomes in emergency and critical patients. This systematic review and meta-analysis was designed to determine whether video laryngoscopy could improve the intubation outcomes in emergency and critical patients. METHODS: We searched the Cochrane Central Register of Controlled Trials, PubMed, Embase, and Scopus databases from database inception until 15 February 2017...
November 24, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29166565/hospital-based-physicians-intubation-decisions-and-associated-mental-models-when-managing-a-critically-and-terminally-ill-older-patient
#19
Shannon Haliko, Julie Downs, Deepika Mohan, Robert Arnold, Amber E Barnato
BACKGROUND: Variation in the intensity of acute care treatment at the end of life is influenced more strongly by hospital and provider characteristics than patient preferences. OBJECTIVE: We sought to describe physicians' mental models (i.e., thought processes) when encountering a simulated critically and terminally ill older patient, and to compare those models based on whether their treatment plan was patient preference-concordant or preference-discordant. METHODS: Seventy-three hospital-based physicians from 3 academic medical centers engaged in a simulated patient encounter and completed a mental model interview while watching the video recording of their encounter...
November 1, 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/29166296/emergency-intubations-in-a-high-volume-pediatric-emergency-department
#20
Jen Heng Pek, Gene Yong-Kwang Ong
INTRODUCTION: Resuscitation of critically ill children can be chaotic, and emergency airway management is often fraught with difficulties. This study aimed to characterize the Singaporean landscape of tracheal intubation in a pediatric emergency unit, placing emphasis on safety outcomes, procedural process of care, and provider training. METHODS: A retrospective review of all cases presented to the KK Women's and Children's Hospital from January 2009 to December 2013 with intubation carried out within the pediatric emergency unit was done...
November 21, 2017: Pediatric Emergency Care
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