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Admission criteria in intensive care unit

Megan Barry, Truc M Le, Melissa C Gindville, Lori C Jordan
BACKGROUND: Pediatric stroke alerts or "code strokes" allow for rapid evaluation, imaging, and treatment of children presenting with stroke-like symptoms. In a previous study of emergency department-initiated pediatric stroke alerts, 24% of children had confirmed strokes. The purpose of this study was to characterize in-hospital pediatric stroke alerts. METHODS: Demographic and clinical information was obtained from a quality improvement database and medical records for children (zero to 20 years) at a single institution for whom a stroke alert was activated after hospital admission between April 2011 and December 2016...
August 10, 2018: Pediatric Neurology
Emma Macdonald-Laurs, Archana Koirala, Philip N Britton, William Rawlinson, Chee Chung Hiew, Jocelynne Mcrae, Russell C Dale, Cheryl Jones, Kristine Macartney, Brendan McMullan, Sekhar Pillai
PURPOSE: Neurological complications of influenza cause significant disease in children. Central nervous system inflammation, the presumed mechanism of influenza-associated encephalopathy, is difficult to detect. Characteristics of children presenting with severe neurological complications of influenza, and potential biomarkers of influenza-associated encephalopathy are described. METHODS: A multi-center, retrospective case-series of children with influenza and neurological complications during 2017 was performed...
September 28, 2018: European Journal of Paediatric Neurology: EJPN
Sharon R Lewis, Michael W Pritchard, Oliver J Schofield-Robinson, David Jw Evans, Phil Alderson, Andrew F Smith
BACKGROUND: During intensive care unit (ICU) admission, patients and their carers experience physical and psychological stressors that may result in psychological conditions including anxiety, depression, and post-traumatic stress disorder (PTSD). Improving communication between healthcare professionals, patients, and their carers may alleviate these disorders. Communication may include information or educational interventions, in different formats, aiming to improve knowledge of the prognosis, treatment, or anticipated challenges after ICU discharge...
October 13, 2018: Cochrane Database of Systematic Reviews
Xiaoming Wang, Zhou Yuan, Qihong Chen, Jiangquan Yu, Ruiqiang Zheng
OBJECTIVE: To compare the effect of 0.9% NaCl solution, Ringer solution, and acetate sodium potassium magnesium calcium glucose solution (ASPMCG solution) on internal environment in patients with septic shock receiving early fluid resuscitation. METHODS: A prospective randomized controlled trial was conducted. From June 2016 to January 2018, a total of 280 patients with septic shock admitted to intensive care unit (ICU) of Northern Jiangsu People's Hospital were enrolled...
September 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Fang Fang, Xiaohan Hu, Xiaomei Dai, Sanfeng Wang, Zhenjiang Bai, Jiao Chen, Jian Pan, Xiaozhong Li, Jian Wang, Yanhong Li
BACKGROUND: Research on acute kidney injury (AKI) has focused on identifying early biomarkers. However, whether AKI could be diagnosed in the absence of the classic signs of clinical AKI and whether the condition of subclinical AKI, identified by damage or functional biomarkers in the absence of oliguria or increased serum creatinine (sCr) levels, is clinically significant remains to be elucidated in critically ill children. The aims of the study were to investigate the associations between urinary cystatin C (uCysC) levels and AKI and mortality and to determine whether uCysC-positive subclinical AKI is associated with adverse outcomes in critically ill neonates and children...
October 10, 2018: Critical Care: the Official Journal of the Critical Care Forum
Eva Rydahl, Lena Eriksen, Mette Juhl
OBJECTIVE: The objective of this review was to identify, assess and synthesize the best available evidence on the effects of induction prior to post-term on the mother and fetus. Maternal and fetal outcomes after routine labor induction in low-risk pregnancies at 41+0 to 41+6 gestational weeks (prior to post-term) were compared to routine labor induction at 42+0 to 42+6 gestational weeks (post-term). INTRODUCTION: Induction of labor when a pregnancy exceeds 14 days past the estimated due date has long been used as an intervention to prevent adverse fetal and maternal outcomes...
October 5, 2018: JBI Database of Systematic Reviews and Implementation Reports
Molly Wong Vega, Stacey Beer, Marisa Juarez, Poyyapakkam R Srivaths
BACKGROUND: Underrecognition of pediatric malnutrition may affect nutrition interventions and outcomes. Pediatric malnutrition uses more specific etiology-based criteria but lacks clarity in implementation guidelines. Study goals were to identify malnutrition and risk among hospitalized patients, characterize malnutrition risk factors, and assess reliability of criteria against outcome measures. MATERIALS AND METHODS: All children 44 weeks postmenstrual age-18 years, admitted for 48 hours during a 16-day period, were included (n = 528)...
October 7, 2018: Nutrition in Clinical Practice
Keshav Goyal, Amarjyoti Hazarika, Ankur Khandelwal, Navdeep Sokhal, Ashish Bindra, Niraj Kumar, Shweta Kedia, Girija P Rath
Introduction and Aims: Recognizing and treating nonneurological complications occurring in traumatic brain injury (TBI) patients during intensive care unit (ICU) stay are challenging. The aim is to estimate various nonneurological complications in TBI patients. The secondary aim is to see the effect of these complications on ICU stay, disability, and mortality. Materials and Methods: This was a prospective observational study at the neuro-ICU of a Level-I trauma center...
September 2018: Indian Journal of Critical Care Medicine
Koen S Simons, Eva Verweij, Paul M C Lemmens, Sam Jelfs, Munhum Park, Peter E Spronk, Johannes P C Sonneveld, Hilde-Marieken Feijen, Marijke S van der Steen, Armin G Kohlrausch, Mark van den Boogaard, Cornelis P C de Jager
BACKGROUND: High noise levels in the intensive care unit (ICU) are a well-known problem. Little is known about the effect of noise on sleep quality in ICU patients. The study aim is to determine the effect of noise on subjective sleep quality. METHODS: This was a multicenter observational study in six Dutch ICUs. Noise recording equipment was installed in 2-4 rooms per ICU. Adult patients were eligible for the study 48 h after ICU admission and were followed up to maximum of five nights in the ICU...
October 5, 2018: Critical Care: the Official Journal of the Critical Care Forum
Alexander Meyer, Dina Zverinski, Boris Pfahringer, Jörg Kempfert, Titus Kuehne, Simon H Sündermann, Christof Stamm, Thomas Hofmann, Volkmar Falk, Carsten Eickhoff
BACKGROUND: The large amount of clinical signals in intensive care units can easily overwhelm health-care personnel and can lead to treatment delays, suboptimal care, or clinical errors. The aim of this study was to apply deep machine learning methods to predict severe complications during critical care in real time after cardiothoracic surgery. METHODS: We used deep learning methods (recurrent neural networks) to predict several severe complications (mortality, renal failure with a need for renal replacement therapy, and postoperative bleeding leading to operative revision) in post cardiosurgical care in real time...
September 28, 2018: Lancet Respiratory Medicine
Mehtap Pehlivanlar-Kucuk, Ahmet O Kucuk, Cagatay E Ozturk, Mehmet C Er, Fatma Ulger
BACKGROUND: Uric acid is synthesized from xanthine via xanthine oxidase as an end-product of purine metabolism. Uric acid is a major non-enzymatic antioxidant in the blood, and it exerts a protective action on vitamin C. There are a limited number of ICU studies related to uric acid, which is a valuable prognostic biomarker. This study aimed to evaluate the utility of uric acid as a biomarker in predicting the outcomes of critically ill patients. METHODS: This prospective, multi-centered cohort study included 128 patients from two different intensive care units who met the study inclusion criteria between May 2017 and October 2017...
September 1, 2018: Clinical Laboratory
J Moya Sánchez, M Royo-Villanova Reparaz, A Andreu Ruiz, T Ros Argente Del Castillo, S Sánchez Cámara, J H de Gea García, E Andreu Soler, D Pérez Martínez, M P Olmo Sánchez, C Llamas Lázaro, R H Reyes Marlés, R Jara Rubio
OBJECTIVE: To evaluate the feasibility of using the Sentinella® portable gamma-camera for the diagnosis of brain death (BD). DESIGN: A prospective, observational feasibility study was carried out. SETTING: Intensive Care Unit of a third level hospital. PATIENTS: Consecutive recording was made of the adults diagnosed with brain death based on clinical criteria following admission to the Intensive Care Unit in the period from January to December 2017...
September 27, 2018: Medicina Intensiva
Sanjit R Konda, Ariana Lott, Kenneth A Egol
Introduction: In response to increasing health-care costs, Centers for Medicare & Medicaid Services has initiated several programs to transition from a fee-for-service model to a value-based care model. One such voluntary program is Bundled Payments for Care Improvement Advanced (BPCI Advanced) which includes all hip and femur fractures that undergo operative fixation. The purpose of this study was to analyze the current cost and resource utilization of operatively fixed (nonarthroplasty) hip and femur fracture procedure bundle patients at a single level 1 trauma center within the framework of a risk stratification tool (Score for Trauma Triage in the Geriatric and Middle-Aged [STTGMA]) to identify areas of high utilization before our hospitals transition to bundle period...
2018: Geriatric Orthopaedic Surgery & Rehabilitation
Despoina Tzira, Anargyroula Prezerakou, Ioannis Papadatos, Artemis Vintila, Anastasia Bartzeliotou, Filia Apostolakou, Ioannis Papassotiriou, Vassiliki Papaevangelou
Objective: Measurement of salivary biomarkers can provide important information regarding hypothalamic-pituitary-adrenal axis activity both under normal conditions as well as in response to psychological or physical stress. Our aim was to correlate salivary stress markers, such as cortisol, α-amylase and immunoglobulin A, with the Pediatric Risk Index Score of Mortality, underlying disease (pathologic, trauma and postoperative), need for mechanical ventilation/sedation and time lag between onset of illness and admission in children admitted in the pediatric intensive care unit...
2018: SAGE Open Medicine
Murray M Pollack, Richard Holubkov, Robert A Berg, Christopher J L Newth, Kathleen L Meert, Rick E Harrison, Joseph Carcillo, Heidi Dalton, David L Wessel, J Michael Dean
BACKGROUND: Early identification of children at risk for cardiac arrest would allow for skill training associated with improved outcomes and provides a prevention opportunity. OBJECTIVE: Develop and assess a predictive model for cardiopulmonary arrest using data available in the first 4 h. METHODS: Data from PICU patients from 8 institutions included descriptive, severity of illness, cardiac arrest, and outcomes. RESULTS: Of the 10074 patients, 120 satisfying inclusion criteria sustained a cardiac arrest and 67 (55...
September 25, 2018: Resuscitation
Valentina D'Ambrosio, Flaminia Vena, Claudia Marchetti, Daniele Di Mascio, Seila Perrone, Chiara Boccherini, Antonio Pizzuti, Pierluigi Benedetti Panici, Antonella Giancotti
INTRODUCTION: Fetal femur length below the expected value has been described as a marker of aneuploidy, skeletal dysplasia, intrauterine-growth-restriction (IUGR) and small-for-gestational age (SGA) neonate. The aim of this systematic review and meta-analysis was to evaluate the strength of association between isolated short femur length and IUGR or SGA, and perinatal adverse outcomes. MATERIAL AND METHODS: PubMed, EMBASE, Medline were searched from the inception of each database to May 2018...
September 25, 2018: Acta Obstetricia et Gynecologica Scandinavica
Jincy Immanuel, David Simmons
Blood glucose monitoring is fundamental for hyperglycemia management during pregnancy, but are the devices up to the job? Studies assessing the accuracy of 10 commercially available glucose meters during pregnancy showed that although >98-99% of the meter values were in the acceptable zones of the error grid for the majority of the meters, the meter performance varied, with the majority showing positive bias and a few showing minimal negative bias. The mean difference between meter and laboratory plasma values varied between -0...
October 2018: Diabetes Care
Won Uk Koh, Ha-Jung Kim, Hee-Sun Park, Min-Jeong Jang, Young-Jin Ro, Jun-Gol Song
BACKGROUND: The strategy for bilateral total knee arthroplasty (TKA) depends on the timing of surgery for each knee. The purpose of this study was to determine whether the type of surgical strategy for bilateral TKA (staggered, staged, or simultaneous) influences the incidence of acute kidney injury (AKI) and related complications. METHODS: Enrolled patients from a single tertiary teaching hospital were divided into 3 groups according to the surgical strategy for bilateral TKA: staggered (≤7 days between the first and second procedure; n = 368), staged (8 days to 1 year between the first and second procedure; n = 265), or simultaneous (n = 820)...
September 19, 2018: Journal of Bone and Joint Surgery. American Volume
Jean-Damien Ricard, Fadia Dib, Marina Esposito-Farese, Jonathan Messika, Christophe Girault
INTRODUCTION: This study protocol describes a trial designed to investigate whether high-flow heated and humidified nasal oxygen (HFHO) therapy in patients with hypercapnic acute respiratory failure (ARF) reduces the need of non-invasive ventilation (NIV). METHODS AND ANALYSIS: This is an open-label, superiority, international, parallel-group, multicentre randomised controlled two-arm trial, with an internal feasibility pilot phase. 242 patients with hypercapnic ARF requiring NIV admitted to an intensive care unit, an intermediate care or a respiratory care unit will be randomised in a 1:1 ratio to receive HFHO or standard oxygen in between NIV sessions...
September 19, 2018: BMJ Open
Omid Mehrpour, Ayob Akbari, Firoozeh Jahani, Alireza Amirabadizadeh, Elaheh Allahyari, Borhan Mansouri, Patrick C Ng
BACKGROUND: Acute poisoning is a common chief complaint leading to emergency department visits and hospital admissions in developing countries such as Iran. Data describing the epidemiology of different poisonings, characteristics of the clinical presentations, and the predictors of outcome are lacking. Such data can help develop more efficient preventative and management strategies to decrease morbidity and mortality related to these poisonings. This manuscript describes the epidemiology of acute poisoning among patients admitted to the intensive care unit (ICU) in Birjand, Iran...
September 19, 2018: BMC Emergency Medicine
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