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https://www.readbyqxmd.com/read/29677007/near-continuous-glucose-monitoring-makes-glycemic-control-safer-in-icu-patients
#1
Jean-Charles Preiser, Olivier Lheureux, Aurelie Thooft, Serge Brimioulle, Jacques Goldstein, Jean-Louis Vincent
OBJECTIVES: Tight glycemic control using intermittent blood glucose measurements is associated with a risk of hypoglycemia. Glucose concentrations can now be measured near continuously (every 5-15 min). We assessed the quality and safety of glycemic control guided by a near-continuous glucose monitoring system in ICU patients. DESIGN: Prospective, cluster-randomized, crossover study. SETTING: Thirty-five-bed medico-surgical department of intensive care with four separate ICUs...
April 19, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29676777/do-not-resuscitate-orders-in-older-adults-during-hospitalization-a-propensity-score-matched-analysis
#2
Karishma Patel, Liron Sinvani, Vidhi Patel, Andrzej Kozikowski, Christopher Smilios, Meredith Akerman, Kinga Kiszko, Sutapa Maiti, Negin Hajizadeh, Gisele Wolf-Klein, Renee Pekmezaris
OBJECTIVES: To explore the effect of the presence and timing of a do-not-resuscitate (DNR) order on short-term clinical outcomes, including mortality. DESIGN: Retrospective cohort study with propensity score matching to enable direct comparison of DNR and no-DNR groups. SETTING: Large, academic tertiary-care center. PARTICIPANTS: Hospitalized medical patients aged 65 and older. MEASUREMENTS: Primary outcome was in-hospital mortality...
April 20, 2018: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29669237/current-practice-of-diagnosis-and-management-of-acute-kidney-injury-in-intensive-care-unit-in-resource-limited-settings
#3
Nattachai Srisawat, Nattaya Sintawichai, Win Kulvichit, Nuttha Lumlertgul, Patita Sitticharoenchai, Nicha Thamrongsat, Sadudee Peerapornratana
PURPOSE: In a resource limited settings, there is sparse information about the management of acute kidney injury (AKI) based on systemic data collection. This survey aimed to described the current management of AKI in intensive care units (ICUs) across Thailand. MATERIALS AND METHODS: Questionnaires were distributed to 160 physicians involved in the intensive care between January and December 2014 across Thailand. Distribution was done through an online survey platform or telephone interview...
April 11, 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/29668211/a-payer-provider-partnership-for-integrated-care-of-patients-receiving-dialysis
#4
Justin Kindy, David Roer, Robert Wanovich, Stephen McMurray
OBJECTIVES: Patients with end-stage renal disease (ESRD) are clinically complex, requiring intensive and costly care. Coordinated care may improve outcomes and reduce costs. The objective of this study was to determine the impact of a payer-provider care partnership on key clinical and economic outcomes in enrolled patients with ESRD. STUDY DESIGN:  Retrospective observational study. METHODS: Data on patient demographics and clinical outcomes were abstracted from the electronic health records of the dialysis provider...
April 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29667378/alarming-results-of-nosocomial-infections-in-a-multicenter-program-of-surveillance-in-polish-intensive-care-units
#5
Michał Wałaszek, Anna Różańska, Małgorzata Bulanda, Jadwiga Wojkowska-Mach, Polish Society of Hospital Infections Team
INTRODUCTION: Nosocomial bloodstream infections (BSI) among patients in intensive care units (ICU) are the most common form of nosocomial infections and they are serious complications of the treatment process. The etiological factors of these infections and the proper antibiotic therapy can influence the effects of patient treatment. The aim of the study was to analyze the epidemiology, microbiology and antibiotic therapy of nosocomial BSI in Polish ICU patients. MATERIALS AND METHODS: The retrospective study covered patients hospitalized in seven ICUs for adults with a general profile, located in southern Poland...
2018: Przegla̧d Epidemiologiczny
https://www.readbyqxmd.com/read/29667097/an-elevated-respiratory-quotient-predicts-complications-after-cardiac-surgery-under-extracorporeal-circulation-an-observational-pilot-study
#6
J Piot, A Hébrard, M Durand, J F Payen, P Albaladejo
Following cardiac surgery, hyperlactatemia due to anaerobic metabolism is associated with an increase in both morbidity and mortality. We previously found that an elevated respiratory quotient (RQ) predicts anaerobic metabolism. In the present study we aimed to demonstrate that it is also associated with poor outcome following cardiac surgery. This single institution, prospective, observational study includes all those patients that were consecutively admitted to the intensive care unit (ICU) after cardiac surgery with cardiopulmonary bypass, that had also been monitored using pulmonary artery catheter...
April 17, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29666098/a-misplaced-peripherally-inserted-central-catheter-presenting-as-contralateral-pleural-effusion
#7
Jogender Kumar, Sudeep K C, Kanya Mukhopadhyay, Somosri Ray
A preterm neonate born at 27 weeks, with a birth weight of 555 g, was on continuous positive airway pressure (CPAP) for apnoea of prematurity and initially received total parenteral nutrition (TPN) through the umbilical venous catheter. Peripherally inserted central catheter (PICC) was inserted in the left basilica vein on day 8 to continue TPN. The baby developed respiratory distress with persistent hypoxia after TPN was initiated through the PICC line. The baby required mechanical ventilation due to worsening of respiratory distress, and chest X-ray, as well as ultrasound conducted 12 hours, postinfusion of TPN revealed right-sided pleural effusion...
April 17, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29661929/arginase-1-expression-in-myeloid-cells-regulates-s-aureus-planktonic-but-not-biofilm-infection
#8
Kelsey J Yamada, Cortney E Heim, Amy L Aldrich, Casey M Gries, Anna G Staudacher, Tammy Kielian
S. aureus is a leading cause of device-associated biofilm infections, which represent a serious health care concern based on their chronicity and antibiotic resistance. We previously reported that S. aureus biofilms preferentially recruit myeloid-derived suppressor cells (MDSCs), which promote monocyte and macrophage anti-inflammatory properties. This is associated with increased myeloid arginase-1 (Arg-1) expression, which has been linked to anti-inflammatory and pro-fibrotic activity that are observed during S...
April 16, 2018: Infection and Immunity
https://www.readbyqxmd.com/read/29659468/routine-versus-clinically-indicated-short-peripheral-catheter-replacement-an-evidence-based-practice-project
#9
Catherine Stevens, Kerry A Milner, Jennifer Trudeau
Despite current, high-quality, level 1 evidence that supports clinically indicated short peripheral catheter (SPC) replacement, the current practice in the health care system studied was to change SPCs routinely every 96 hours. A before-and-after design was used to evaluate the impact of SPC replacement when clinically indicated. Following the practice change, there were no SPC-related infections, monthly phlebitis rates ranged from 1.9% to 3.5%, and SPC use decreased by 14.2%, resulting in estimated cost savings of $2100 and 70 hours of nursing time saved...
May 2018: Journal of Infusion Nursing: the Official Publication of the Infusion Nurses Society
https://www.readbyqxmd.com/read/29659467/a-standard-push-pull-protocol-for-waste-free-sampling-in-the-pediatric-intensive-care-unit
#10
Clare McBride, Suzan Miller-Hoover, James A Proudfoot
Blood sampling is a major source of blood loss in the pediatric intensive care unit (PICU). Blood-sparing sampling techniques such as the push-pull method can significantly reduce sampling-related blood loss and protect patients from anemia and blood transfusions. The push-pull method is supported by research evidence for central venous catheter (CVC) sampling, but research protocols differ and not all CVCs and laboratory tests have been studied. A standard push-pull protocol for the PICU was developed, implemented, and evaluated in this evidence-based practice project...
May 2018: Journal of Infusion Nursing: the Official Publication of the Infusion Nurses Society
https://www.readbyqxmd.com/read/29659463/maintaining-short-peripheral-catheter-patency-a-comparison-of-saline-lock-versus-continuous-infusion-in-the-acute-care-setting
#11
Sheila Serr Roszell, Holly Barlowe Rabinovich, Cheryl A Smith-Miller
Sparse evidence exists about how short peripheral catheter (SPC) duration is affected by the presence of a saline lock versus continually infusing fluids. Often the choice to lock an SPC with saline is based on provider preference, rather than available evidence or patient-centered factors. This study compared the duration of 85 SPCs: locked with saline versus continuously running fluids. A secondary analysis considered the influence of a number of intermittent medications and flushes. Although the saline-locked group had a slightly longer duration time, it was not statistically significant...
May 2018: Journal of Infusion Nursing: the Official Publication of the Infusion Nurses Society
https://www.readbyqxmd.com/read/29658218/-burden-of-healthcare-associated-infections-in-outpatient-care
#12
Walter Zingg, Aliki Metsini, Qiao Fu, Diana Neves, Didier Pittet
There is little evidence on healthcare-associated infections in outpatient care. The Swiss Federal Office for Public Health commissioned a systematic review to estimate the incidence of healthcare-associated infections in non-institutional settings. A total of 126 papers were eligible for data abstraction. The identified reports and studies were heterogeneous and generally of low quality. The main outcomes were surgical site infections, central venous catheter-related bloodstream infections, and urinary tract infections...
April 11, 2018: Revue Médicale Suisse
https://www.readbyqxmd.com/read/29658216/-prevention-of-urinary-tract-infection-in-the-elderly-what-s-new-in-long-term-care-facilities
#13
Sonia Lajoso, Marie Immaculée Nahimana Tessemo, Eve Rubli Truchard, Amel Rodondi, Christiane Petignat
Urinary tract infections are common in the elderly. They are a frequent reason for antibiotic prescription in nursing homes and hospitals. Doctors are confronted daily to the challenge that it is to diagnose urinary tract infections in older patients. The incidence of asymptomatic bacteriuria and the presence of unspecific symptoms and signs in this population transform guidelines for prevention and treatment into some kind of a battle. In this article we will : 1) make a reminder of the particular features of urinary tract infection in the elderly person ; 2) present the recommendations made by the experts and 3) emphasize the prevention of catheter-related urinary tract infection...
April 11, 2018: Revue Médicale Suisse
https://www.readbyqxmd.com/read/29657872/therapeutic-plasma-exchange-for-refractory-sle-a-comparison-of-outcomes-between-different-sub-phenotypes
#14
Aynur Soyuöz, Ömer Karadağ, Tülay Karaağaç, Levent Kılıç, Şule Apraş Bilgen, Osman İlhami Özcebe
Objective: Therapeutic plasma exchange (TPE) offers an alternative therapeutic modality for patients with systemic lupus erythematosus (SLE) and primary antiphospholipid syndrome (APS). However, there is conflicting evidence regarding its efficacy in different sub-phenotypes. This study aimed to investigate the main clinical characteristics and outcomes of patients with different phenotypes of SLE and APS treated with TPE at a tertiary care center. Methods: The database of the Blood and Apheresis Unit between 2001 and 2013 was screened for patients with SLE and primary APS...
March 2018: European Journal of Rheumatology
https://www.readbyqxmd.com/read/29657370/delirium-in-the-intensive-care-unit-incidence-risk-factors-and-impact-on-outcome
#15
Nejla Tilouche, Mohamed Fekih Hassen, Habiba Ben Sik Ali, Oussamma Jaoued, Rim Gharbi, S Souheil El Atrous
Background: The incidence and risk factors for delirium vary among studies. Objective: We aimed to determine the incidence, risk factors, and impact on outcome of delirium in a medical Intensive Care Unit (ICU) in Tunisia using a prospective observational study. Patients: All consecutive patients admitted to the ICU between May 2012 and April 2013 were included if they were aged more than 18 years and had an ICU stay of more than 24 h. Patients who had a cardiac arrest or have a history of dementia or psychosis were excluded...
March 2018: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29655510/histopathological-validation-of-optical-coherence-tomography-findings-of-the-coronary-arteries
#16
REVIEW
Kenichi Fujii, Rika Kawakami, Seiichi Hirota
Optical coherence tomography (OCT), a catheter-based imaging modality for the visualization of coronary arteries, is widely used during percutaneous coronary intervention to improve the understanding of the anatomy of coronary artery stenosis and to elucidate the mechanisms of atherosclerosis. In this review, we provide a short description of the histopathological validations of OCT for visualizing atherosclerotic plaques and vascular healing response after drug-eluting stent (DES) implantation. Because OCT measures the intensity of light returning from within a tissue, tissue having a higher heterogeneity of optical index of refraction, such as microcalcification deposition and foam cell accumulation on the luminal surface, may exhibit stronger optical scattering that appears as a thin-cap fibroatheroma image...
April 11, 2018: Journal of Cardiology
https://www.readbyqxmd.com/read/29652390/integrated-catheter-for-simultaneous-radio-frequency-ablation-and-optoacoustic-monitoring-of-lesion-progression
#17
Johannes Rebling, Francisco Javier Oyaga Landa, Xosé Luís Deán-Ben, Alexandre Douplik, Daniel Razansky
Radio frequency (RF) catheter ablation is commonly used to eliminate dysfunctional cardiac tissue by heating via an alternating current. Clinical outcomes are highly dependent on careful anatomical guidance, electrophysiological mapping, and careful RF power titration during the procedure. Yet, current treatments rely mainly on the expertise of the surgeon to assess lesion formation, causing large variabilities in the success rate. We present an integrated catheter design suitable for simultaneous RF ablation and real-time optoacoustic monitoring of the forming lesion...
April 15, 2018: Optics Letters
https://www.readbyqxmd.com/read/29651905/the-intracavitary-electrocardiography-method-for-tip-location-of-jugular-internal-vein-access-device-in-infants-of-less-than-5-kg-a-pilot-study
#18
Rossella Mastroianni, Antonella Capasso, Gaetano Ausanio
PURPOSE: This is a prospective observational study conducted by neonatologists in neonatal intensive care unit from Sant'Anna and San Sebastiano Hospital, Caserta, Italy. The objective of the study is to verify the feasibility of intracavitary electrocardiography method for tip location of central venous access device in infants of less than 5 kg and evaluate the accuracy of the method in comparison with post-procedural echocardiographical verification of the tip position. PATIENTS AND METHODS: We enrolled 27 patients weighted between 0...
April 1, 2018: Journal of Vascular Access
https://www.readbyqxmd.com/read/29649830/healthcare-associated-infections-after-lower-urinary-tract-endoscopic-surgery-analysis-of-risk-factors-associated-microorganisms-and-patterns-of-antibiotic-resistance
#19
Raquel Sopeña-Sutil, José Medina-Polo, Juan Justo-Quintas, Javier Gil-Moradillo, Lucia Garcia-Gonzalez, Raúl Benítez-Sala, Manuel Alonso-Isa, Alba Lara-Isla, Angel Tejido-Sanchez
OBJECTIVES: To review the incidence of healthcare-associated infections/urinary tract infection (UTI), risk factors, microorganisms isolated and antibiotic resistances in patients who underwent lower urinary tract endoscopic surgery (LUTES) in a tertiary care hospital. METHODS: A prospective observational study was carried out including 1,498 patients who undergo LUTES. Patients with and without UTI after surgery were compared. We analysed infection incidence, risk factors, microorganisms isolated and antibiotic resistances...
April 12, 2018: Urologia Internationalis
https://www.readbyqxmd.com/read/29649820/accuracy-of-acid-base-diagnoses-using-the-central-venous-blood-gas-in-the-medical-intensive-care-unit
#20
Sarah J Schrauben, Dan Negoianu, Cristiana Costa, Raphael M Cohen, Stanley Goldfarb, Barry D Fuchs, Jeffrey S Berns
BACKGROUND: Acid-base disturbances are frequent in critically ill patients. Arterial blood gas (ABG) is the gold standard in the diagnosis of these disturbances, but it is invasive with potential hazards. For patients with a central venous catheter, venous blood gas (VBG) sampling may be an alternative, less-invasive diagnostic tool. However, the accuracy of a central VBG-based acid-base disorder diagnosis compared to an ABG is unknown. The primary objective of this study was to assess the accuracy of a central VBG-based acid-base disorder diagnosis compared to the "gold standard" ABG in critically ill patients...
April 12, 2018: Nephron
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