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https://www.readbyqxmd.com/read/28224111/attributable-cost-of-a-nosocomial-infection-in-the-intensive-care-unit-a-prospective-cohort-study
#1
Binila Chacko, Kurien Thomas, Thambu David, Hema Paul, Lakshmanan Jeyaseelan, John Victor Peter
AIM: To study the impact of hospital-acquired infections (HAIs) on cost and outcome from intensive care units (ICU) in India. METHODS: Adult patients (> 18 years) admitted over 1-year, to a 24-bed medical critical care unit in India, were enrolled prospectively. Treatment cost and outcome data were collected. This cost data was merged with HAI data collected prospectively by the Hospital Infection Control Committee. Only infections occurring during ICU stay were included...
February 4, 2017: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28222984/index-complications-predict-secondary-complications-after-infrainguinal-lower-extremity-bypass-for-critical-limb-ischemia
#2
Matthew R Peacock, Nishant K Shah, Alik Farber, Su Yeon Lee, Jeffrey A Kalish, Denis Rybin, Gheorghe Doros, Jeffrey J Siracuse
OBJECTIVE: Patients undergoing lower extremity bypass (LEB) are at high risk of perioperative complications that can lead to a cascade of secondary complications. Our goal was to understand the association of index complications with secondary complications after LEB. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2005 to 2012 was used to analyze secondary complications after five index complications after LEB: deep/organ space surgical site infection, urinary tract infection (UTI), myocardial infarction (MI), pneumonia, and acute renal failure (ARF)...
February 17, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28212478/-risk-factors-related-with-ventilator-associated-pneumonia-in-a-neonatal-intensive-care-therapy
#3
Juan Pablo Romo-Gamboa, Bertha Alicia Sandoval-Pérez, Ana Bertha Rodríguez-López, Marco Antonio Torres-González, Juan Carlos Barrera-de León
BACKGROUND: Ventilator-associated pneumonia (VAP) represents the second cause of nosocomial infections and it is associated with greater morbility, duration of mechanical ventilation (MV), and hospital stay. The objective was to determine factors related with VAP in neonates. METHODS: Analytical transversal study including newborns admitted already intubated with at least 48 hours of MV or who were intubated in Neonatal Therapy. VAP was defined according to the criteria of the Centers for Disease Control and Prevention: "those patients submitted to MV during at least 48 hours"...
2017: Revista Médica del Instituto Mexicano del Seguro Social
https://www.readbyqxmd.com/read/28209304/prognostic-value-of-the-nutritional-risk-index-in-heart-transplant-recipients
#4
Eduardo Barge-Caballero, Fernando García-López, Raquel Marzoa-Rivas, Gonzalo Barge-Caballero, David Couto-Mallón, María J Paniagua-Martín, Miguel Solla-Buceta, Carlos Velasco-Sierra, Francisco Pita-Gutiérrez, José M Herrera-Noreña, José J Cuenca-Castillo, José Manuel Vázquez-Rodríguez, María G Crespo-Leiro
INTRODUCTION AND OBJECTIVES: To study the prognostic impact of preoperative nutritional status, as assessed through the nutritional risk index (NRI), on postoperative outcomes after heart transplantation (HT). METHODS: We conducted a retrospective, single-center study of 574 patients who underwent HT from 1991 to 2014. Preoperative NRI was calculated as 1.519 × serum albumin (g/L) + 41.7 × (body weight [kg] / ideal body weight [kg]). The association between preoperative NRI and postoperative outcomes was analyzed by means of multivariable logistic regression and multivariable Cox regression...
February 10, 2017: Revista Española de Cardiología
https://www.readbyqxmd.com/read/28209037/-lung-function-influenced-the-prognosis-of-cardiac-surgery-in-patients-with-chronic-obstructive-pulmonary-disease
#5
C T Wu, J H Zhao, D Wei, Y X Shi, G F Zhu
Objective: To investigate the value of lung function for the prognosis of cardiac surgery in patients with chronic obstructive pulmonary disease(COPD). Methods: A retrospective analysis was conducted on the hospitalized patients with coronary heart disease or valvular heart disease in Beijing Anzhen hospital during Janury 2013 to December 2015. The relationship between lung function and extubation time, time of staying in ICU, second time tracheal incubation, tracheotomy and mortality rate were analyzed. Results: There were 355 patients without surgery in a total 1 729 of patients, of which 65 (18...
February 12, 2017: Chinese Journal of Tuberculosis and Respiratory Diseases
https://www.readbyqxmd.com/read/28208930/precautionary-measures-for-successful-open-heart-surgery-in-g6pd-deficient-patient-a-case-report
#6
Rupesh Kumar
Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is among the most common enzymatic disorders of red blood cells. Cardiac surgeries on this group of individuals are associated with an additional risk in terms of impaired oxygenation, prolonged ventilation and increased risk of haemolysis. These patients have a very low threshold for haemolysis due to oxidative stress. Many commonly used drugs also predispose the individual for haemolysis when they are subjected to surgery. Here we present a known case of G6PD deficient patient with symptoms of breathlessness for the last nine years who was taken for surgery with pre-planned precautionary measures to avoid unnecessary haemolysis...
December 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28207437/lack-of-association-between-preoperative-statin-use-and-respiratory-and-neurologic-complications-after-cardiac-surgery
#7
Ryu Komatsu, Huseyin Oguz Yilmaz, Jing You, C Allen Bashour, Shobana Rajan, Edward G Soltesz, Daniel I Sessler, Alparslan Turan
BACKGROUND: Statins may reduce the risk of pulmonary and neurologic complications after cardiac surgery. METHODS: The authors acquired data for adults who had coronary artery bypass graft, valve surgery, or combined procedures. The authors matched patients who took statins preoperatively to patients who did not. First, the authors assessed the association between preoperative statin use and the primary outcomes of prolonged ventilation (more than 24 h), pneumonia (positive cultures of sputum, transtracheal fluid, bronchial washings, and/or clinical findings consistent with the diagnosis of pneumonia), and in-hospital all-cause mortality, using logistic regressions...
February 16, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28203417/clinical-factors-associated-with-weaning-failure-in-patients-requiring-prolonged-mechanical-ventilation
#8
Hong-Joon Shin, Jin-Sun Chang, Seong Ahn, Tae-Ok Kim, Cheol-Kyu Park, Jung-Hwan Lim, In-Jae Oh, Yu-Il Kim, Sung-Chul Lim, Young-Chul Kim, Yong-Soo Kwon
BACKGROUND: For patients requiring prolonged mechanical ventilation (PMV), weaning is difficult and mortality is very high. PMV has been defined recently, by consensus, as constituting ≥21 consecutive days of mechanical ventilation (MV) for ≥6 hours per day. This study aimed to evaluate the clinical factors predicting weaning failure in patients undergoing PMV in medical intensive care unit (ICU). METHODS: We retrospectively reviewed the clinical and laboratory characteristics of 127 patients who received MV for more than 21 days in the medical ICU at Chonnam National University Hospital in South Korea between January 2005 and December 2014...
January 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28197046/outcome-of-noncardiac-surgical-patients-admitted-to-a-multidisciplinary-intensive-care-unit
#9
Pradeep Kumar, M K Renuka, M S Kalaiselvan, A S Arunkumar
CONTEXT: Surgical procedures carry significant morbidity and mortality depending on the type of surgery and patients. There is a dearth of evidence from India on the outcome of surgical patients admitted to an Intensive Care Unit (ICU). AIMS: We aimed to describe the incidence and risk factors of postoperative complications and mortality in noncardiac surgical patients admitted to the ICU. SETTINGS AND DESIGN: This was a prospective observational study on all perioperative patients admitted to a multidisciplinary ICU for 18 months...
January 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28194277/risk-factors-and-prognosis-of-pain-events-during-mechanical-ventilation-a-retrospective-study
#10
Ayahiro Yamashita, Masaki Yamasaki, Hiroki Matsuyama, Fumimasa Amaya
BACKGROUND: Pain assessment is highly recommended in patients receiving mechanical ventilation. However, pain intensity and its impact on outcomes in these patients remain obscure. We collected the results of routine pain assessments, utilizing the behavioral pain scale (BPS), from 151 patients receiving mechanical ventilation. Risk factors associated with a pain event, defined as BPS of >5, and its impact on patient outcomes were investigated. METHODS: A total of 151 consecutive adult patients receiving mechanical ventilation for more than 24 h in a single 10-bed ICU were enrolled in this study...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28190434/intensive-care-unit-acquired-weakness
#11
J Horn, G Hermans
When critically ill, a severe weakness of the limbs and respiratory muscles often develops with a prolonged stay in the intensive care unit (ICU), a condition vaguely termed intensive care unit-acquired weakness (ICUAW). Many of these patients have serious nerve and muscle injury. This syndrome is most often seen in surviving critically ill patients with sepsis or extensive inflammatory response which results in increased duration of mechanical ventilation and hospital length of stay. Patients with ICUAW often do not fully recover and the disability will seriously impact on their quality of life...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28187795/management-of-the-comatose-patient
#12
E F M Wijdicks
Coma has many causes but there are a few urgent ones in clinical practice. Management must start with establishing the cause and an attempt to reverse or attenuate some of the damage. This may include early neurosurgical intervention, efforts to reduce brain tissue shift and raised intracranial pressure, correction of markedly abnormal laboratory abnormalities, and administration of available antidotes. Supporting the patient's vital signs, susceptible to major fluctuations in a changing situation, remains the most crucial aspect of management...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28183545/total-intravenous-anesthesia-without-muscle-relaxant-in-a-parturient-with-amyotrophic-lateral-sclerosis-undergoing-cesarean-section-a-case-report
#13
Wei Xiao, Lei Zhao, Fengying Wang, Hong Sun, Tianlong Wang, Guoguang Zhao
Cases of amyotrophic lateral sclerosis with pregnancy are quite rare. The aim of this case report is to present the successful use of total intravenous anesthesia without muscle relaxant for cesarean section in a parturient with amyotrophic lateral sclerosis at 35 weeks' gestation. The parturient presented with impaired neuromuscular function. Titrated general anesthesia with short-acting anesthetics was applied. During the procedure, no muscle relaxant was used. This strategy helped avoid prolonged ventilation and prevent maternal respiratory complications...
February 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28178046/acute-respiratory-distress-syndrome-in-pregnant-women
#14
Barret Rush, Pawel Martinka, Brett Kilb, Robert C McDermid, John H Boyd, Leo Anthony Celi
OBJECTIVE: To estimate the rate of acute respiratory distress syndrome (ARDS) in pregnant patients as well as to investigate clinical conditions associated with mortality. METHODS: We used the Nationwide Inpatient Sample from 2006 to 2012 to identify a cohort of pregnant patients who underwent mechanical ventilation for ARDS. A multivariate model predicting in-hospital mortality was created. RESULTS: A total of 55,208,382 hospitalizations from the 2006-2012 Nationwide Inpatient Samples were analyzed...
March 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28167225/no-child-left-behind-liver-transplantation-in-critically-ill-children
#15
Abbas Rana, Michael Kueht, Moreshwar Desai, Fong Lam, Tamir Miloh, Jennifer Moffett, N Thao N Galvan, Ronald Cotton, Christine O'Mahony, John Goss
BACKGROUND: Advances in critical care prolong survival in children with liver failure, allowing more critically ill children to undergo orthotopic liver transplantation (OLT). In order to justify the use of a scarce donor resource and avoid futile transplants, we sought to determine survival in children who undergo OLT while receiving pre-OLT critical care. STUDY DESIGN: We analyzed 13,723 pediatric OLTs using the United Network for Organ Sharing (UNOS) database from 1987 to 2015, including 6,746 recipients in the Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease (MELD/PELD) era (2002 to 2015)...
February 3, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28163425/elective-nasal-continuous-positive-airway-pressure-to-support-respiration-after-prolonged-ventilation-in-infants-after-congenital-cardiac-surgery
#16
Hemang Gandhi, Amit Mishra, Rajesh Thosani, Himanshu Acharya, Ritesh Shah, Jigar Surti, Alpesh Sarvaia
BACKGROUND: We sought to compare the effectiveness of oxygen (O2) treatment administered by an O2 mask and nasal continuous positive airway pressure (NCPAP) in infants after congenital cardiac surgery. METHODS: In this retrospective observational study, 54 infants undergoing corrective cardiac surgery were enrolled. According to the anesthesiologist's preference, the patients ventilated for more than 48 h were either put on NCPAP or O2 mask immediately after extubation...
January 2017: Annals of Pediatric Cardiology
https://www.readbyqxmd.com/read/28158885/breaking-bad-delirium-methamphetamine-and-boric-acid-toxicity-with-hallucinations-and-pseudosepsis
#17
Kayla Johnson, Joanna L Stollings, E Wesley Ely
OBJECTIVES: A 30-year-old patient presented with hallucinations and profound shock. He was initially misdiagnosed as having severe sepsis; once ingestions were considered, he was diagnosed as potentially having arsenic toxicity. SUMMARY: The clinical story reveals many instructional lessons that could aid in the evaluation and management of future patients. This man presented with large amounts of blue crystals around his nose and lips from inhaling and eating boric acid (an ant poison) so he could, as he put it, kill the ants "pouring into my mouth and nose and up into my brain...
February 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28157809/withdrawal-assessment-tool-1-monitoring-in-picu-a-multicenter-study-on-iatrogenic-withdrawal-syndrome
#18
Angela Amigoni, Maria Cristina Mondardini, Ilaria Vittadello, Federico Zaglia, Emanuele Rossetti, Francesca Vitale, Stefania Ferrario, Fabio Savron, Giancarlo Coffaro, Luca Brugnaro, Roberta Amato, Andrea Wolfler, Linda S Franck
OBJECTIVES: Withdrawal syndrome is an adverse reaction of analgesic and sedative therapy, with a reported occurrence rate between 17% and 57% in critically ill children. Although some factors related to the development of withdrawal syndrome have been identified, there is weak evidence for the effectiveness of preventive and therapeutic strategies. The main aim of this study was to evaluate the frequency of withdrawal syndrome in Italian PICUs, using a validated instrument. We also analyzed differences in patient characteristics, analgesic and sedative treatment, and patients' outcome between patients with and without withdrawal syndrome...
February 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28157394/how-well-prepared-are-medical-and-nursing-students-to-identify-common-hazards-in-the-icu
#19
Alison S Clay, Saumil M Chudgar, Kathleen M Turner, Jacqueline Vaughn, Nancy W Knudsen, Jeanne M Farnan, Vineet M Arora, Margory A Molloy
RATIONALE: Care in the hospital is hazardous. Harm in the hospital may prolong hospitalization, increase suffering, result in death, and increase costs of care. While the interprofessional team is critical to eliminating hazards that may result in adverse events to patients, professional students' formal education may not prepare students adequately for this role. OBJECTIVES: To determine if medical and nursing students can identify hazards of hospitalization that could result in harm to patients and to detect differences between professions in the types of hazards identified...
February 3, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28153504/effect-of-omega-3-polyunsaturated-fatty-acids-derived-from-fish-oil-in-major-burn-patients-a-prospective-randomized-controlled-pilot-trial
#20
Serrana Tihista, Estrella Echavarría
BACKGROUND & AIMS: The burn patient is the clearest example of prolonged inflammatory response. Various nutrients, particularly omega-3 polyunsaturated fatty acids (ω-3 PUFAs), have been demonstrated as attenuating the inflammatory response, and reduce infectious complications. In absence of definitive evidence in major burns the study aimed at investigating the effect particularly on infectious complications of enteral nutrition enriched with ω-3 PUFAs. METHOD: Prospectively randomized controlled trial...
January 16, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
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