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Icu admission criteria

Ryne Jenkins, Nicholas A Morris, Bryce Haac, Richard Van Besien, Deborah M Stein, Wan-Tsu Chang, Gary Schwartzbauer, Gunjan Parikh, Neeraj Badjatia
BACKGROUND: Data regarding who will require tracheostomy are lacking which may limit investigations into therapeutic effects of early tracheostomy. METHODS: We performed an observational study of adult traumatic brain injury (TBI) patients requiring intensive care unit (ICU) admission for ≥ 72 h and mechanical ventilation for ≥ 24 h between January 2014 and December 2014 at a level 1 trauma center. Patients who had life-sustaining measures withdrawn were excluded...
October 17, 2018: Neurocritical Care
Laura Fuchs Bahlis, Luciano Passamani Diogo, Ricardo de Souza Kuchenbecker, Sandra Costa Fuchs
OBJECTIVE: To describe the patient profile, mortality rates, the accuracy of prognostic scores, and mortality-associated factors in patients with community-acquired pneumonia (CAP) in a general hospital in Brazil. METHODS: This was a cohort study involving patients with a clinical and laboratory diagnosis of CAP and requiring admission to a public hospital in the interior of Brazil between March 2014 and April 2015. We performed multivariate analysis using a Poisson regression model with robust variance to identify factors associated with in-hospital mortality...
July 2018: Jornal Brasileiro de Pneumologia: Publicaça̋o Oficial da Sociedade Brasileira de Pneumologia e Tisilogia
Indah K Murni, Trevor Duke, Andrew J Daley, Sharon Kinney, Yati Soenarto
BACKGROUND: Nosocomial bloodstream infection (BSI) is associated with high mortality rates. Evaluating factors to predict mortality is important for prevention and improving clinical outcomes. AIM: To evaluate the clinical predictors of mortality in paediatric nosocomial bloodstream infection. METHODS: A prospective cohort study was conducted from 1 December 2010 until 28 February 2013 in a teaching hospital in Yogyakarta, Indonesia. All patients admitted consecutively to the paediatric ICU (PICU) and paediatric wards after > 48 h of hospitalisation were eligible...
October 17, 2018: Paediatrics and International Child Health
Christopher Melinosky, Shiming Yang, Peter Hu, HsiaoChi Li, Catriona H T Miller, Imad Khan, Colin Mackenzie, Wan-Tsu Chang, Gunjan Parikh, Deborah Stein, Neeraj Badjatia
Background: In the acute resuscitation period after traumatic brain injury (TBI), one of the goals is to identify those at risk for secondary neurological decline (ND), represented by a constellation of clinical signs that can be identified as objective events related to secondary brain injury and independently impact outcome. We investigated whether continuous vital sign variability and waveform analysis of the electrocardiogram (ECG) or photoplethysmogram (PPG) within the first hour of resuscitation may enhance the ability to predict ND in the initial 48 hours after traumatic brain injury (TBI)...
2018: Frontiers in Neurology
Mitchell Cameron, Kathleen M McDermott, Lewis Campbell
OBJECTIVE: It is common practice for hospitals to use a trauma team activation criteria (TTAC) to identify patients at risk of major trauma and to activate a multidisciplinary team to receive such patients on arrival to the ED. The aims of this study are to describe the frequency of individual criteria and the ability of one currently used system to predict major trauma, and to estimate the effect of simplified criteria on the prediction. DESIGN AND SETTING: A retrospective observational study of the entire cohort of adult patients who a) received trauma team activation or b) were included in the trauma registry of Royal Darwin Hospital in 2015...
October 5, 2018: Injury
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
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
Jonathan R Studnek, E Brooke Lerner, Manish I Shah, Lorin R Browne, David C Brousseau, Jeremy T Cushman, Peter S Dayan, Patrick C Drayna, Amy L Drendel, Matthew P Gray, Christopher A Kahn, Michael T Meyer, Manish N Shah, Rachel M Stanley
BACKGROUND: Emergency Medical Services (EMS) providers must be able to identify the most appropriate destination facility when treating children with potentially severe medical illnesses. Currently, no validated tool exists to assist EMS providers in identifying children who need transport to a hospital with higher-level pediatric care. In order for such a tool to be developed, a criterion standard needs to be defined that identifies children who received higher-level pediatric medical care...
October 3, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency 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
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
Verena Rass, Max Gaasch, Mario Kofler, Alois Josef Schiefecker, Bogdan-Andrei Ianosi, Paul Rhomberg, Ronny Beer, Bettina Pfausler, Elke R Gizewski, Claudius Thomé, Erich Schmutzhard, Raimund Helbok
OBJECTIVES: Subarachnoid hemorrhage is a life-threatening disease associated with high mortality and morbidity. A substantial number of patients develop systemic inflammatory response syndrome. We aimed to identify risk factors for systemic inflammatory response syndrome development and to evaluate the role of systemic inflammatory response syndrome on patients'outcome. DESIGN: Retrospective observational cohort study of prospectively collected data. SETTING: Neurocritical care unit at a tertiary academic medical center...
September 24, 2018: Critical Care Medicine
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
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
Manohar Bairy, Faith H W See, Ru Sin Lim
BACKGROUND: Estimating the glomerular filtration rate (eGFR) when the creatinine (Cr) is rapidly changing, as in acute kidney injury (AKI), has been a challenge. The Kinetic Estimated Glomerular Filtration Rate (KeGFR) formula by S. Chen estimates the GFR in the acute state by factoring the time interval between rising Cr values and the volume of distribution (VD). It provides the clinician with an eGFR value for each non-steady state Cr value. We applied the KeGFR formula to detect AKI in an adult non-ICU inpatient setting...
September 19, 2018: Nephron
Rachel Gray, Joaquin Cagliani, Leo I Amodu, Peter Nauka, Benjamin Villacres, Tabia Santos, Alex Castenada, Joanna Fishbein, Nibras Ahmed, Gene Coppa, Horacio L Rodriguez Rilo
BACKGROUND/AIMS: No single classification system has so far effectively predicted the severity for Acute Pancreatitis (AP). This study compares the effectiveness of classification systems: Original Atlanta (OAC), Revised Atlanta (RAC), Determinant based classification (DBC), PANC 3, Harmless AP Score (HAPS), Japanese Severity Score (JSS), Symptoms Nutrition Necrosis Antibiotics and Pain (SNNAP), and Beside Index of Severity for AP (BISAP) in predicting outcomes in AP. METHODS: Scores for BISAP, Panc 3, HAPS, SNNAP, OAC, RAC, and DBC were calculated for 221 adult patients hospitalized for AP...
September 18, 2018: Digestion
S Javed Zaidi, Lorene Schweig, Dhaval Patel, Alexander Javois, Javeed Akhter
INTRODUCTION: Hemoptysis in children is an uncommon presenting symptom but can be life-threatening if massive. Cardiac catheterization and coil embolization of aorto-pulmonary collateral vessels (APCs) is uncommon in pediatric hemoptysis patients without congenital heart disease. METHODS: We present a series of seven infants (≤12 months of age) with hemoptysis, all of whom underwent cardiac catheterization to look for and intervene upon APCs, if found. Only those patients who underwent both bronchoscopy as well as cardiac catheterization from January 1995 to January 2015 were included in this retrospective review...
September 18, 2018: Pediatric Pulmonology
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